The Diary of a Fat Woman

Roller coasters and low blood pressure

2010-06-03T11:56:00.002-04:00

Kings Dominion was fantastic!!!!! Even though there were a couple of rides I wouldn't try out of fat fear, for the most part I rode what I wanted and walked all day with no pain. I thoroughly enjoyed myself and outlasted most of the teenage girls I was with. I am grateful for that. I didn't realize how much I missed living until I soaked up the day on the drive home.

Here is a post I put out on OH about low blood pressure, been having some issues with it and wanted to post reasons, remedies on here so I won't lose it.

I have seen this come up over and over on this forum and I have just started experiencing this almost 18 months post op. I have had low blood pressure (90/70 range) since surgery but none of the side effects like dizziness and so forth. I have been doing some research and have found some of the more common reasons this happens to us.

Dehydration - this is a big one, anything less than 64 oz a day is not enough

Low iron levels or anemia - get your labs done

Low electrolytes - A G2 or powerade zero will fix this one

Lack of B12 - any of the B vitamins really

There was also low oxygen and thyroid problems, along with a lot of more serious reasons for low blood pressure but the above pretty much explain why after weight loss surgery, this happens.

For me, I thought, hey beats high blood pressure but this is not true...low blood pressure can still cause heart attack, stroke and kidney failure.

So along with fixing the above vitamin and water issues, here are some home remedies and recommendations I came across that might be helpful.

If the water and vitamin issues are not in check, avoid vigorous excercise as it can cause black outs

Breathing excercises and low impact excercise like swimming and biking are good for getting the blood pumping nicely

Fresh fruit, increased protein with fluids, vitamin c and vitamin b

Raw beetroot juice and epsom salt baths

The dizziness, halos around the eyes, tired are just too much for me and I don't like not feeling in control so I am going to work on this for sure.

That's it!

2010-05-27T12:41:00.002-04:00

I keep saying that's it...starting right now, no more grazing, no more snacking, no more junk food. I wake up, I have a protein shake, eggs for breakfast, some type of meat for lunch, maybe an afternoon cheese sick and by the time I get home the bottom falls out. I can't get a handle on snacking on stuff, even when I am choosing low carb, I am still taking in more calories and carbs than I need because I am eating every hour on the hour. I say I am going to the gym but I don't go. I cut out the G2, extra carbs, I cut out the creamer because of extra carbs. I am still stuck at 250-255. I think I have hit the mental part of this journey and I need to get a handle on it. I am taking my kids to Kings Dominion tomorrow and the weight limit for most rides is 250 lbs, 45 inch waist. That's me...I said I was going to do a liquid diet this week, see if I could drop a few pounds before the trip just to be safe because I didn't want to still be too fat for the rides. I could so do a liquid diet as I NEVER get hungry but my head hunger wins every time. I think I just love food, the texture, the taste but I also think I am totally self sabotaging because heck I don't deserve to be happy as former fat girl tells me all the time. I thought I had a handle on this but I obviously don't. Time to shift gears again. I think I am going to order the Beck diet solution book and workbook and start there. I can not let this defeat me.

One bite at a time

2010-04-16T15:31:00.004-04:00

So I have been really looking at what I am eating, counting everything trying to balance good eating skills with low carb so I can still lose weight. My sodium intake is out of control. I think on top of the vit D issues, I am retaining water from the sodium. But my blood pressure has been so low, my doc says eat salt, don't worry about your sodium. Ugghh! I am going to reduce it, if I begin having any low blood pressure incidents like dizziness, i will see my doctor. This is what I ate yesterday and my ending totals:

Morning: 16 oz cup of coffee w/ creamer
Breakfast: 2 scrambled eggs w/ cheese no added salt or pepper
Snack; 1 oz beef jerky, slice of cheese
Lunch:1/4 chicken quesadillia on low carb tortilla w/ spoonful salsa/sour cream
Snack: 1 oz beef jerky
Dinner: Inside of subway club, no bread
Dessert: 1/2 slice angel food cake, topped with 2 sliced strawberries and splenda
snack: spoonful peanut butter
Cals Fat Cholest Sodium Carbs Sugars Fiber Protein
1,055 49g 592mg 3,599mg 58g 42g 6g 90g

I feel like I ate a balanced diet, the beef jerky is definitely going to have to go, my carbs aren't great for losing phase but they aren't bad either. I think considering some of the things I have gone through with my eating, I think I made good choices and I am proud of that. This is a lifestyle change for me and I will figure it out, one day at a time, one bite at a time.

In a funk

2010-04-08T11:18:00.002-04:00

This sucks! I can not budge my weight loss. I thought my G2 and creamer was the problem so I cut it out. 80 oz water a day, gym, low carb and this is what the last month looks like:

2/24 263
3/3 257
3/11 265
3/17 259
3/24 259
3/31 257
4/7 261

So what happened after the scale yesterday morning.... I have been on a binge. I have been reading on the vitamin issues and came across some info that low Vit D causes sugar cravings and weight gain. Hmmm...could this be the problem?? It has got to be something. A month and only a 3 lb loss. I guess I shouldn't complain, better than gaining. Just in a funk..

Reevaluating

2010-03-24T13:12:00.002-04:00

So I kicked up the liquid intake to try to offset this dehydration thing. Still trying to figure out my labs. Looks like I am low on ferritin even though my other iron levels look good, Vit D (on my second round of 50,000 units a week) getting ready to add D3 as I understand this is better than just plain ole D.
So even with the increase in liquid, staying away from bad carbs and hitting the gym again, I am still stuck in the 250's. Up 5, down 5! What is the problem? So I decided to track everything that went in my mouth today. Well I see where the problem is!! My G2 and hazelnut creamer...Damn liquid calories! They have never phased my weight loss before but I think they are the culprit now. I said if I ever needed to adjust what I was doing, I will. Starting tomorrow I will drastically decrease my creamer in my coffee and totally give up my G2's for a bit. What? You didn't expect me to go cold turkey did you? I hate water but this is a must. I suspect to be able to report a huge loss next posting.

Vitamin issues and BUN creatinine

2010-03-15T09:41:00.004-04:00

Had my labs done back in November by my PCP and my Vitamin D and iron was low. She put me on 50,000 units once a week for 3 months. I changed my multi vitamin to a prenatal vitamin for the extra iron. Went back for my follow up on my labs last week. Vitamin D is still low, she put me back on 50,000 units for 3 more months. Iron was ok this go round, B12 was a little high. Reduced my 2500 mcg to every other day versus every day. I expected the ups and downs with the vitamins as I have read about them on OH. What I have never heard of was BUN (Blood urea nitrogen) creatinine levels. My BUN level and my creatinine levels were within normal range. My BUN creatinine ratio was 29. This scared me at first because I was told this tests your kidney function. But I have since learned that the jump is probably from an increase in protein and slight dehydration. I am not drinking 64 oz a day but I am getting in close to 60 oz, but that is with my coffee too, which the caffeine is not helping from what I am hearing. This is what labtestsonline had to say about BUN levels:
5. What is a BUN/Creatinine ratio?
Occasionally, a doctor will look at the ratio between a person’s BUN and blood creatinine to help them determine what is causing these concentrations to be higher than normal. The ratio of BUN to creatinine is usually between 10:1 and 20:1. An increased ratio may be due to a condition that causes a decrease in the flow of blood to the kidneys, such as congestive heart failure or dehydration. It may also be seen with increased protein, from gastrointestinal bleeding, or increased protein in the diet. The ratio may be decreased with liver disease (due to decrease in the formation of urea) and malnutrition.
This makes me even more thankful I got my VSG. I knew I would not be 100% compliant with RNY and the malabsorption scared me so I know if I had gone that route, my issues would be worse. The congestive heart failure aspect scares me because this puts me right in line with all my dad's illness' but I am going to remain positive that this is from lack of fluid and my body freaking out over losing a great amount of weight. I am increasing my fluid and trying to incorporate regular water into my diet besides drinking nothing but G2, juice and coffee. Gah! I hate water....sigh

Things I have learned after one year...

2010-01-22T08:51:00.002-05:00

Today is my one year anniversary of my surgery. I have lost 120 lbs total. I have lost and regained the same five pounds for 3 months now. Totally my fault. My head is trying to catch up with the weight loss, I have been making excuses for not eating right, money, time, stress. Whatever! They are horrible reasons to not use this gift I have been given. I have learned a few things along the way... I can eat way more now than I could in the beginning. Granted it is no where near pre op but more than a few months out of surgery. Before surgery I would go to McDonald's and order a filet of fish, a Big Mac meal w/ Large sweet tea and a double cheeseburger. Today when I go to McDonald's, I order the chicken nuggets happy meal, eat about 1/2 the fries and about 3 nuggets. Big difference. I have learned that I can eat a lot if I let myself graze. This is not a smart thing to do. I can get in just as many calories when I graze as I did pre op. Scary huh? Like yesterday...I am ashamed to post this but I just want you to know it is possible to consume as much food post op as pre op if you spread it out versus 3 meals and 2 snacks VSG portions... I had one egg and 4 pieces of bacon for breakfast. Ate about half the egg and 2 pieces of bacon...about 30 minutes later I was able to finish it. I started on a ziploc bag of cashews about 10;30am, munched on them off and on all day. Had a hershey bar in my desk, broke off a piece here and there, finished it off my end of day also. Lunch I had a chicken pot pie, could only eat about a third of it and about 30 minutes later, I took those last few bites and finished it off. While cooking dinner I had a bite of carrot cake. For dinner I had 1 hamburger patty, spoonful of mac and cheese and 8 french fries. I ate off that plate for an hour and got it all down! Later that night while watching tv, I had another bite of cake, 30 min later I had a 2 oz bowl of cereal, 30 min later I had a half a cookie. That is a LOT of food. Lesson from all this, once you are full, throw away the rest of the dang food or put it up for the next meal. In order to stay on track and keep on losing:
DO NOT NIBBLE ON THE SAME PLATE FOR MORE THAN 15 MINUTES.
DO NOT EAT BETWEEN DESIGNATED MEAL AND SNACK TIME
PROTEIN FIRST, VEGETABLE SECOND, CARBS LAST
DO NOT DRINK FOR AT LEAST 30 MINUTES AFTER YOU EAT
DRINK AT LEAST 64 OZ OF WATER EVERYDAY
DO SOME FORM OF EXCERCISE FOR AT LEAST 15 MINUTES A DAY

Those are pretty basic and simple. Staying on track and breaking old habits is hard as hell!
I am not where I am supposed to be but THANK GOD I am not where I used to be which is 381 lbs, size 30/32, unable to walk from my car to my office without being out of breath, unable to shop in Walmart unless I used a scooter. Today I can do all those things and more, I have not used a scooter since surgery, I weigh 255 lbs and in a size 22/24. I have a ways to go but I will get there.

Good Riddance 2009

2009-12-31T10:02:00.002-05:00

This year has been nothing but a rollar coaster to say the least. I had big hopes for 2009 being my surgery was in January, this was going to be a year of change, a good year. Change did come but it wasn't all good. The news calls this the year of death because so many celebrities died, well it was my year of death too. I came close to death after my surgery, lost my uncle in February, my grandmother in April, my father in July and two days before Christmas my cousin lost her husband. Most importantly I lost the former version of me, the death of the fat me. It has had many challenges and played some serious mind games with me. I have battled with eating the right foods and exercise. These past few weeks I have been eating like I did last christmas before I had surgery. Like I was never going to be able to eat those types of foods again...sord of a get it while you can attitude. I know this is not true. I dare not say 2010 is going to be a great year because well we saw what happened when I said that last year. I am planning on trying to learn to love myself. Try to figure out why I choose food as a comfort and prefer my fat as a protection shield. I have got to do something or I am going to sit here at 126 lbs lost and go no further. The strong side of me will not let that happen. I want to become a gym junkie, I want to run. 2010 will be the year of finding me. I came up with some resolutions, some weight related some not. They will not all happen in January but I posted them on a sticky and put them on my computer as a reminder so maybe I will accomplish them one by one. They are:

1. Join some walk a thons (Got some great information on American Heart Association and Kidney Foundation)
2. Give back to the community (I want to do meals on wheels and volunteer at the local women's shelter)
3. Run (I plan on walking to the end of my road, eventually jogging and just going a little further everyday)
4. Only have sweets and junk on birthdays and holidays, stick to the program
5. Take shooting lessons and get my gun permit (this is way out in left field for me but I have always wanted to do it)
6. Travel (no where big, just a couple of trips to somewhere)
7. Go to church more (I need to reconnect with God, I need him to complete this)
8. Live life, do something everyday, whether it is call someone on the phone, the gym, volunteer, clean, shop, go to visit a friend, something!
9. Make mommy and me dates (My girls are older, I need to set aside time for them so I don't lose our connections)

Big goals! I have NEVER had this many goals. It has always been lose weight, that is it. I am not getting any younger, i want to live. I wish you all the best New Year.

But how bad do you want it?

2009-12-03T12:56:00.002-05:00

Well you know when I don't blog regularly I am doing bad weight wise or there is something going on in my personal life. I guess it is a little of both but MOSTLY doing bad weight wise. I have asked myself several times over the past month, c'mon seriously? How bad do you want this? Why are you slacking? I have eaten junk and more junk. I have got to start working on the mental part of this whol journey because I am doing some serious self sabotaging to myself. I have lost 119 lbs, have gained and lost the same 5 lbs over the past 2 months. I should be down AT LEAST another 30 lbs by now!! I DO NOT want to stay at 260 lbs..I want to keep going. The diet is not hard, I truly do not EVER get hungry so why do I gravitate to the sugary sweets and chips and pizza? I think there are a couple of things going on.
#1: It is there and it is quick

#2: It tastes so darn good

#3: Hell, everyone else is eating it and it's not fair that I can't (Wow did that sound a 2 year old or what!)

#4: I hate the way my body is looking, I hate that I have to wear longer sleeves and longer shirts to cover up the excess skin. The left side of my stomach is still not shrinking along with my right so there is literally a hump (a ball of fat) and in the past when I am disgusted or mad at myself what do I do, EAT!

#5: I think I am scared of the attention. I am getting a lot of compliments and what are you doing and you are so skinny looking. I have always been the wallflower, no one noticed me. Now I find it makes me nervous and I still can't make eye contact, I just want to hurry up and get past them so I can hide just as I always did. I feel people looking at me now so I am even more self conscious of the excess skin so I think I am subconsciously trying to gain weight to go back to my safe place. Which is totally weird because I don't like how I felt before. I can shop now and walk and stand and not hurt like before.

The mental part of all this is definitely harder than I thought. I heard people say that but I really thought, if I could just lose weight everything will be perfect. Guess I lied to myself...now how do I fix it?

Other stuff going on, went to the doctor for my physical and blood work...vitamin D and iron were extremely low, thyroid levels out of whack a little. Up'd my vitamins and will make an appointment with the endocrinologist after christmas. She documented the excess skin issues and I told her my upper back pain has increased with this last 20 pounds I have lost. She said it was the excess skin pulling. Great!! Had another reality check early November...my mom had 3 blockages in her main artery and she has never been overweight or smoked. So heart problems are definitely in my genes between her and my dad...all the more reason to get this crap under control.

Good stuff: Went on a cruise to the Bahamas November 6 with some family. This was to celebrate my 100 lbs loss. So many wow moments that skinny folk take for granted. Being able to walk down the aisle in the plane, buckling the seatbelt without an extender, walking from one side of town in Nassau to the other without needing a chair right away(normally I would just not go because I knew I couldn't walk it), feeling normal sized around all the people, not avoiding picture taking, wearing high heels to dinner and then walking around the cruise ship with no efforts, taking the elevator even though it was crowded instead of waiting for the next one(out of fear there was not enough room for me), carrying my luggage and walking the airports...just going on a trip like that! It was awesome!!

Unfamiliar territory

2009-10-02T10:28:00.002-04:00

So I joined a gym finally. My cousin owns it so he walked me through some weight machines for strength training to make sure I knew how to work them. I don't know that I would have gone in a regular gym anytime soon had I not known someone. I am supposed to be going at least 3 times a week. Doing the different strength training excercises and then cardio for at least 20 minutes. I find that when I go I feel so out of place. I feel like everyone is staring at me so I have a hard time doing the machines so I stick to the cardio area. I know I need to work my muscles in my arms, back and belly. I have got to figure out a way to overcome this because I am only hurting myself. I wish I could go early morning when there is no one there but sigh I must make a living. I have done the treadmill and increase my speed each time I go in and am amazed that I can walk for 20 minutes and then step foot on another machine. Sometimes I forget that I used to not be able to even do dishes without hunching over the sink. I tried the eliptical and found it to be fun. Fun? Did I actually say that? Although I can't do it for very long yet. I have done the bicycle also. I find that if I can get past the initial burn in my legs and feet instead of quitting that it eases up and doesn't hurt as bad, it becomes tolerable. So right now, I am fiddling with the machines for about 10 minutes and find that I venture to the cardio area. I generally do about 35-45 minutes on the different cardio machines depending on how far I push myself. My goal is to do a little more each time so I can get to the point of a good 2 hour work out.

I am finding that I can definitely eat more than when I first had surgery. My stomach is a finicky thing though. Like for example, when my monthly friend came along this past month that whole week, no matter what I ate, chicken or slider foods I could eat a lot more than normal and I seemed to want more. For breakfast that whole week, I was eating 1 whole scrambled egg with cheese and about 3 strips of bacon. Yesterday I got the usual egg and 3 bacon strips and could barely finish the egg and ate a piece of bacon and started on the second piece and knew if I took another bite I was going to be sick. Weird huh? This whole past week I have been craving carbs so I had a 3 oz bowl of mac and cheese and at it all...yesterday I thought I got tuna for lunch but it turned out to be tuna and pasta...anyways, took 2 bites of the pasta and was full. Within a minute I had the foamies, saliva filling my mouth, I went to the bathroom thinking I was going to be sick but it passed. I tell ya, you never know how your new stomach will take the food you are giving it. I am glad to know that part of the amount of food I was able to eat was just a passing thing though. I was beginning to worry a little.

Ramblings

2009-09-21T17:14:00.002-04:00

Well, down to 270. Haven't seen 270 since my youngest was around 2. I know that is still heavy but compared to 381, those are beautiful numbers to me. My hair seems to be coming in thicker so I think the worst is over as far as hair loss goes. I am looking forward to putting highlights back in it. Lots of sagging skin, pretty depressing sometimes but I try not to dwell on it. I keep saying I am going to start going to my PCP so that I can have some type of documentation on record about skin issues so if I need a panni (which I am 100% sure I am) I will have a better chance with insurance. My boobs, arms, belly and thighs look like a deflated balloon. I have heard so many different things from it will tighten up some over the next year to try this remedy, try this one. I'll try em, heck if I find something that works that would be fantastic. My sagging stomach is what makes me still feel like I am 381 lbs. When I sit down I see these thinner thighs under a mountain of flesh that spreads. I wear a spanx and it helps (some) with clothes on. I find myself looking at all these before and after pictures studying people's belly area. This is just one of the downsides to WLS but I still say the good outweighs the bad and I would do it again in a heartbeat.
I finally got to try a new recipe this weekend. I am finding I am getting bored with the same foods and steering off course with junk food. I got this recipe from SuzieQuizie on OH.com:

Chicken Eldorado1 lb cooked chicken breast chopped1 medium onion, chopped fine1/2 tsp granulated garlic3 tsp cilantro dried, or 1/4 cup fresh1 ½ tsp ground cumin16 ounce tomato sauce1/2 cup ripe olives sliced(optional)8 ounces sour cream (light was great)2 Tbsp olive oil1 cup cottage cheese ( lowfat is good)1 cup chopped fresh or canned green chiles7 oz bag tortilla chips crushed ( didn't use any in this but did crush about 4 baked tortilla chips over the top for a little crunch.Still very low carb and was really good. 8 ozs monterey Jack cheese shredded

In sautee pan, using the 2 Tbsp olive oil, add onion and sautee until translucent, add garlic, tomato sauce and olives.Cook over low heat about 2 minutes until nice and bubbly; add chicken, set aside.Combine sour cream, cottage cheese and chiles. Layer half the chips, meat mixture, sour cream mixture and Monterey Jack cheese in a greased 2 1/2 quart casserole. Repeat this layering a second time. Bake at 375 preheated oven for about 30 minutes till hot, and cheese is melted. Serves 6 to 8 Variations:Could add jalapenos, black beans, corn, or could even use salsa instead of the tomato sauce, just watch the sugar content in the sauce or salsa you use. Lots of possibilities for variations with this one. Ground pork, turkey, or beef instead of chicken would be great as well.

I replaced the clilantro and chiles with a can of rotel instead and just used regular canola oil instead of olive oil. It was really good, a little more runny than I would have liked, could have been my variations and I didn't put the tortilla chips in the casserole. I think next time I make it I am going to skip the cottage cheese, bake the chicken, tomato sauce, rotel and monterey jack cheese and then top it w/ sour cream after it cooks.

I found that I absolutely love the Kashi products. The Kashi go lean honey almond flax cereal tastes like Honey Smacks only the bites are harder. So good. Higher in carbs than I would like but it has 9 grams of protein and it is healthy, better than that bowl of Honey Smacks. Their happy trail cookies are so good also. Gives you that sweet cookie taste you are seeking without all the junk.

Still not sick of chicken, although my family is. Loving teriyaki salmon and baked tilapia. Never thought I would like baked fish!!

Wow! I actually lost 100 lbs

2009-09-08T12:04:00.002-04:00

Just like when I got under 300 and I didn't have the reaction I expected, same thing happened when I hit the 100 lb loss. Don't get me wrong I was excited and called a couple of friends but at the same time, it was eh whatever. I think my brain is just not where my body is. Almost as if, it doesn't believe it or can't process what is happening so it discounts it. I got back on board a week ago, protein first, walking a mile at work everyday and BAM, the weight just dropped. I dropped 9 lbs in a week. I got up for work one morning and couldn't wear 3 pairs of my pants. They were literally falling off. I pulled out some reserves I had in the closet. A size 22/24! Could not believe it! I felt so confident that day. I felt normal for the first time in a long time. Over the weekend, I tried on some of my other reserves and some were too big..26/28's. New shorts and pants with tags still on them. I bought some of those years ago thinking someday. I kind of chuckled to myself and said someday came and went...goodbye 26/28's forever! I went to Goodwill and Ross just to see if I could find a few pairs of pants and here is proof the brain is just not comprehending. I picked up a 22/24 , held it up and said there is no way I can get into that, hung it up and walked away. A few minutes later I said to myself, yes you can! Go get them damn pants and yes...they fit! :)

Losing my dad and 3 lbs before the 100 mark!

2009-08-20T13:31:00.002-04:00

In my last post my dad had come home from the hospital after a 6 month stay. He was home for 8 days and he passed. Needless to say this has put me on an emotional roller coaster. I am 3 lbs away from hitting 100 pounds lost and can't shake the emotional eating and smoking. I knew we didn't have that much time with him left given how weak and sick he was but I didn't expect the phone call that morning of July 23rd. My dad had become increasingly weak and my mom was having a difficult time getting him back and forth to dialysis every other day. I had stayed the weekend before and came by that Wednesday night to talk to my dad because the case worker was questioning my mom's ability to care for him. God, how I wish I hadn't had that conversation with my dad now....you know, you go through all the what if's in your head, what you should have said, what you did say, what you didn't say. I told him we needed him not to give up, to push because they were questioning mom and we were scared they were going to put him in a nursing home. He said "Don't say that" Did I push him to give up??? I will always wonder that and I have my moments where I feel overwhelming guilt for that. That wasn't my intention. He also didn't want me to leave and I told him I had to go to work the next day, that I loved him and I put my forehead to his and told him to trust God. That is the last correspondence I had with my dad until my daughter called me at 7:39 the next morning to say, "Mom hurry papa's gone!" I felt my world stop. The only good in all of this is that #1 My dad is no longer in pain and he is in heaven where there is only happy tears and no more suffering, #2 God answered every prayer we had asked over the past 6- 7 months. After my dad was in a coma for a few months, the doctors had no hope for him to really walk again because his feet had dropped, after the trache was placed, the doctors said he was too dependent on the ventilator and would probably always be on a feeding tube and never talk again. We asked God for a healing or to not let him die in this shape in a hospital, to bring him home. My dad walked, my dad talked, my dad ate food and my dad came home. My dad was also afraid to die, he was scared to leave us and he was afraid it was going to hurt. I promised my dad that when it was his time to go, he wouldn't be scared that God would come get him. He died peacefully in his sleep, no gasping for air, nothing, just peacefully. God helped me keep my promise to my dad, he wasn't scared. He was a true miracle and even through the pain God's grace showed. He was way too young to leave this world but his quality of life here on earth wasn't what he would want to live and I know he is better off where he is at now.

8/29/1948 - 7/23/2009

God saw him getting tired,
When a cure was not to be.
So He wrapped his arms around him,
and whispered, "Come to me".
A long battle and a fight he did give,
until God called him home for eternity to live

Though our hearts ache and miss him everyday
I could not wish him back
To suffer through that again.
For when I saw him sleeping that Thursday morn,
I could see he was at peace and free from pain evermore.
Now he is seeing his loved ones,
worshipping Jesus and cracking jokes,
perhaps tomorrow he'll find a fishing hole
and sip on an 8 pack of little Cokes.

Under 300!!!

2009-07-17T13:34:00.002-04:00

Haven't been posting as I should. My dad did not come home from the hospital as we thought. He had a heart attack during dialysis the day he was to come home. This set him back a few weeks ofcourse. My computer at home crashed, don't have the money to get one and we are banned from going to social networks at work so I have not been able to reach out to OH for support. My dad is my number 1 reason I chose to go forth with surgery...you would think watching him suffer for 6 months and dieing a slow agonizing death, I would have better motivation to eat right and not smoke. I have not been making good choices. I stalled at 300 a month ago. I blamed it on vacations, stress from my dad's illness, my mom needing me, stress from my teenager. But they are all mere excuses. I got back on the bandwagon Monday with slowly making better choices and BAM, down 5 lbs! Under 300 for the first time in 10 years. I thought I would be more emotional but nothing. I think I am in denial. I think my mind is determined to self sabotage. I need to do some soul searching and really work on this. I want my life to be different, but wanting and taking action are two different things. I have wanted it for over 10 years, I am just now taking action...small baby step action but action nontheless. I suppose it is all a work in progress. We all know that we didn't have surgery on our minds, just our stomach. Thank God I can not sabotage to the point I did pre surgery.
On a good note, my dad is home now. He came home Tuesday just 8 days shy of being exactly 6 months in a hospital. My mom was so thankful to be home as she stayed with him the entire time. Her faith is unwavering. She amazes me. He is not well by any means, just stable. i don't know how much longer we have with him. I was thinking last night about people always say "Life is short". You know it is such an overused phrase and it does not get the depth of thought and action on our part that is deserves. Life truly is short and it should be cherished.
I am still noticing the difference in clothes, had to buy new pants and some shirts. My bathing suit that I (GRRR) paid 100.00 for last summer is falling off of me. I am getting compliments (I am not used to that). The hair loss has pretty much stopped, I am still taking the collagen, biotin and other vitamins and using the shampoo. I am not noticing any changes with my skin issues. I know that will take some time. I miss all my OH friends!! I wish I was at a 100 lb loss versus just an 86 lbs loss but you know what, I am not where I want to be but Thank God I am not where I used to be. One day at a time, one foot in front of the other...I will get there!

First noticeable drop in size

2009-05-29T13:56:00.004-04:00

Because I started out so large, my 30/32 sized clothes were already busting at the seams so I knew it would take me longer to move down in size. In all actuality if they made a 34/36, I probably would have been wearing those instead. Well, this past weekend I decided to go through my clothes as my family was fussing that my clothes were falling off of me and it looked like I was wearing a tent. I didn't see it because I am so used to everything being so tight, it was nice that things weren't so snug for once. Anyways, moving forward...I went through my clothes and packed up some of my nicer work pants and shirts and bagged up 5 bags to go to goodwill. I found clothes that I wore back in the 80 's and 90's, what was I thinking holding onto this stuff?? I had a hard time at first, making piles of trash, give away, goodwill, maybe I can wear or will need one day..then I had to finally say, no you will not need any of it because we are not going back! I did keep a couple pairs of jeans that although were a little loose, I thought they are still wearable and I felt comfortable in them for once. Can't change everything all at once, I suppose. So my closet looks bare and I head out to find me just a few tops. At the store, my fat girl mentality kicked in and I automatically went for the biggest size, I decided to try on a 26/28 and said the whole time, it's not going to fit, it is going to be too small. Guess what, it fit and truth of the matter I really could have gone with a 22/24 but I am not comfortable in clingy clothes. What a good feeling! So that means I have at least dropped 3 sizes! The only issue I had was most of the shirts were either too short in the waist or the sleeves were cut up to the armpit. This infuriated me. If you are a larger woman, why would you want to show off your fat stomach or jiggly arms??? I want to cover those areas not expose them. I end up getting stuck with quarter inch sleeves most of the time. I tell ya, who makes fat people clothes anyway?

I am down 68 lbs and people are finally starting to notice. I am getting all the questions of how much, what are you doing. I feel guilty about not disclosing the WLS but I just don't want everyone at work to know and I am fearful that what if it doesn't work and I don't lose a bunch of weight and people start talking abut how it didn't work, I must be broke or something. I had a lady who is very open about her RNY ask what I was doing and I didn't lie, I said cutting back portions, low carb and exercising. Not a lie, right? Here was her follow up question...no pills? you didn't have gastric bypass? My response, no I didn't have gastric bypass (I didn't lie, thank god she didn't ask specifically WLS) and I am taking B12 and protein supplements in the morning, which is also not a lie. Is this wrong??

I am having to wear my spanx everyday now as the stomach issues are not getting better. I am not comfortable without the spanx because I am all jiggly. Price I have to pay, I guess. I am going to make an appointment with my PCP soon so I can start getting the stomach issues documented so when it comes time to submit for a pannilectomy, I will have my back up. I got my collagen pills and am using the nioxin shampoo and I got a hair cut, shoulder length. I am noticing improvements, I am not losing near as much hair, it seems, or maybe I am just not noticing it since it is shorter. Either way I am pleased as I am not pulling out gobs of hair at a time. So far, I recommend the collagen tablets.

My dad is coming home next week, after 5 months in the hospital so I feel like my life is somewhat becoming normal again. Maybe I can try some of those recipes I have been wanting to try.

The dreaded hair loss and skin issues

2009-05-05T12:12:00.004-04:00

I knew it would happen. I read about it so I should have been well prepared for the hair loss. But I wasn't! For the last 3 weeks, I am noticing more and more hair loss. I am pulling it out by the handful, my brush has these long strands of hair every time I brush my hair and my shower is clogging. I can feel my hair getting thinner and it was already thin to begin with. I know there is nothing I can do to stop the hair loss, just to improve hair growth. I have been taking 3000 mcg of biotin each day since I had surgery. I have done some research and have since added Nioxin shampoo and conditioner, Vitamin E and Collagen tablets. I have read about using prenatal vitamins on a short term basis. If these other methods do not work, i will be adding prenatal vitamins. I have an appointment with my hairdresser tomorrow. I am going to talk to her about a shorter cut. I had heard this helps also with hair growth as well as not noticing hair loss as much with the shorter hair. The long strands are a bit alarming. The collagen tablets I ordered are Neocell Laboratories Collagen Plus C Tablets - 120 Tablets type 1 and 3.
I also read the collagen tablets help with skin elasticity as well and I can use all the help I can get in that area since if I get any plastic surgery, it will most likely only be a pannilectomy (insurance covered). After the noticeable hair loss, I started examining my body in the mirror, looking for changes. I am noticing the right side of my overlapping stomach is shrinking whereas my left is not. Can you say "Panic" and boy I did. It sent me into a slight depression for about a week and all kinds of regrets surfaced. I thought I am going to look deformed!! Didn't help matters that a post shared a website about someone who needed plastics after WLS and the pictures were downright scary. I am not sure what is going on with my stomach but I do know that I lost most stomach muscles after my emergency C section and after careful examination of the fact that I can't reverse surgery and the even bigger fact of why would you want to because I feel so much better, I decided this too shall pass. Take your rain and find the rainbow in it all. That's all I can do. I haven't had any time to myself with my dad being sick, work and everyday life but I made a commitment to myself that I will start exercising somehow, someway to at least try to help tone some things; as well as getting in my protein and water. When I watch tv at night, during commercials, I will do arm exercises (punching motions) and leg lifts all while sitting in the recliner. Hey, it's a start! I am also doing Wii Fit and yesterday I got all 64 oz of water in for the first time since surgery. Yay me!!

A quarter of a doughnut

2009-04-21T14:16:00.003-04:00

That's all it took! Easter weekend, spent it at the hospital celebrating the arrival of my great nephew with family. Everyone wanted to go to Dunkin Donuts/Baskin Robbins. Off we go, I am planning on buying nothing, only taking a sip from my daughters fat free frozen yogurt smoothie. I am waiting on everyone and talk myself into having a bite of a boston creme donut, I purchase it, take a quarter of it and give the rest to my friend. I think I heard halos playing as I savored this dang donut! But could I control myself.Noooo...I leave with a mango fat free frozen yogurt smoothie of my own and a 6 pack of donut holes. I only drink about half of the smoothie and ate one donut hole. The rest went in the trash. I felt so guilty. I worked so hard and went through so much to sabotage myself. That was it! I was done....until Monday when the leftover Nutella was staring me in my face...and Tuesday when the kids easter candy was on the table, peanut butter easter egg..ain't nothin like em; and Thursday when all the Easter candy was on sale 75% off. Oh and over the weekend, a bite of my daughter's chips and french fries. Ok I have unleashed a monster! Got to get back on track. Sunday went well. I refuse to give in...Monday was good too, except TOM arrived. Oh could that be it? Is that the reason or did I self sabotage? Either way, I am back on track. Go to the grocery store with DD last night and she wants me to buy this Oreo pie..no I say..well ok, only if we buy the Hershey Pie instead. What? Did I really just say that? Yes..I did and I ate a piece! WTH is wrong with me?? I know better! So now a quarter of a donut, that one choice has sent me spiraling down a sugary carb filled slope all week. Moral of the story, Just say No. I have said No so many times since surgery and the head hunger passed. I survived and did not die because I chose not to have something. Surgery is not a cure all and it makes me even more angry than ever to hear someone say it's the easy way out. This is not easy. I still have to make a choice so...Back to the basics. I must brush myself off and try again. I CAN do this!

First 50 lbs!

2009-04-03T16:17:00.002-04:00

Went for my check up with my surgeon yesterday and I weighed 330lbs. That is 51 lbs down from my starting weight of 381. If I feel this good after just 50 lbs, I can not wait for the next 150 to come off. I can walk better, my legs aren't swollen and don't ache like they used to, I can breathe better, I don't get sleepy at my usual 2pm timeslot during the day, and I can wipe my rear without pulling a muscle!! I said at my last trip to Walmart before surgery that I would not ever use a scooter again and since surgery I have not had to use one. I need to get in a gym so I can try to start toning as I can feel my skin getting squishy. I just have not had time. My dad is still in the hospital and I have been running back and forth there in between work. I would not have been able to do that pre surgery, I would have fallen on my face from exhaustion and I am so thankful I can do for my mom and dad. I have not been making some of the best choices with all the running around but I am trying. I am eating more fish and trying to stay away from red meat as I am finding that doesn't agree with me too well unless it is ground hamburger. I cooked pot roast in the crockpot and it felt like it was stuck, I had to throw it up. I have not been able to do reheated meat, it seems too dry and I get that stuck feeling in my throat. I have all these recipes I have found that I want to try but haven't been to the grocery store in a month now other than essentials. My poor kids probably feel deprived. They told me last night that I needed to buy some new pants because mine was falling off and I was looking skinny. What a great feeling! I said I was going to do something to celebrate every 50 lbs, I think I am going to do a me day and go get a mani and pedi, haircut, eyebrows waxed and maybe a facial. Well I am off for now, got to run to the hospital...

Step 2

2009-03-20T12:20:00.002-04:00

Every week for the next 12 weeks, I would like to post a 12 step series. I plan to personally work through each of these twelve steps and I encourage you to do the same. What I write following each step is a window into my journey. I hope that through sharing our stories and working through the OA 12 step program together, we can overcome the addiction that is food. ~celticfaery~

2. Came to believe that a Power greater than ourselves could restore us to sanity.

I have come to say my peace about this step 4 times now. I have gathered my thoughts, hit reply and then left without commenting. Coming to terms with a higher power has always been a struggle for me. I believe in God (the father, the son and the holy spirit). I have cried out many times in my life, ignored him many times in my life and have seen him pull me out of some dark situations even when I didn't ask for his help, as well as him not answering when I desperately wanted his help. I guess the bottom line is that I never did and still don't fully trust...I don't listen to that voice inside my head when God is trying to speak to me or guide me...I always think I can fix this or I have a better way. Well look where "my way "got me. I have teeter tottered from being somewhat religious, to overboard religious, to rebellious against religion..all over the place. I have finally come to a point in my life where I don't believe in religion. I believe it is about your personal relationship with Jesus, your time with him, the bible,positive influences in your life and the choices you make. Like I said before all my choices got me to where I was pre-op. A miserable, super morbidly obese woman that was slowly dying and had not lived life in over 10 years. I was literally drowning in my fat. It wasn't that I didn't believe God could take away my food addiction..I knew he could but I didn't believe he would do it. I wasn't worthy. I had told myself for years that I didn't deserve happiness, that I didn't deserve to be loved because of a choice I had made 15 years prior (I won't disclose that choice in this public forum) and as long as I packed on the pounds and stayed fat no one would want me. I was punishing myself so even though I cried out to God to help me and why did he let me get fat and woe is me..I continually shut him out. I finally had a break through in that area and finally realized that God has forgiven me already, I need not ask for continuous forgiveness. I needed to forgive myself. I have been working on that for about a year and a half now. Surgery was the first step in showing me that I am worthy to have a good life. I am finally starting to truly love myself. After watching my dad slowly go from the strongest, able bodied happy go lucky man I know to a frail handicapped angry man over the past few years. God and my dad has shown me that if I don't correct my actions with food and smoking that I am going to be in my dad's shoes in the near future and I will be alone. My dad has said to me many times," I don't care how big you get I love you no matter what but I worry about your health and I don't want you to end up like me..unable to walk because of weight and neuropathy, unable to work because of diabetes and congestive heart failure and unable to breath because of emphysema." It has been a painstaking journey to watch my dad slowly die and the toll it has taken on my mother. I have had lots of conversations with God here recently as you can imagine trying to understand why my dad lays in a hospital on a ventilator. Sometimes we don''t always understand but that is where faith comes in and trusting your higher power and that there is a reason most of the time. Is it because he has unfinished business, is it a punishment for something he did in his lifetime..or was it to show me my future and save my life? I am not where I want to be but thank God I am not where I used to be....Me and God have a lot to sort out still.

Step 1

2009-03-13T08:42:00.001-04:00

Looking for new foods

2009-03-12T11:23:00.002-04:00

I am looking for new, healthy recipes. Tired of the same ole stuff. I know we are supposed to stick to mostly low carb and some of these recipes are a little higher in carbs than I'd like but I think #1 if it's a healthy choice and #2 if the carbs are good carbs it should be ok. Plus I think some of the recipes can be adjusted to lower the carbs and to our tastes. I know for a few that call for wheat flour, I might substitute the low carb baking mix/flour. I haven't tried any of them yet but wanted to go ahead and post so I didn't lose them. I will come back and edit them once I have adjusted things and tasted them. These are all Biggest Loser recipes...some of the nutritional information is listed at the beginning of the recipe and some at the end.

Fancy Fish Sticks
Jillian Michaels' own twist on a family favorite.
203 Calories, 4.5g Fat, 33.6g Protein, 223mg Sodium, .2g Fiber, 5.3g CarbohydratesYield: Serves 4

Ingredients
11⁄2 pounds grouper (haddock or cod work well, too)
cooking spray
1 Tbsp. fresh lime juice
1 Tbsp. fat-free mayonnaise
1⁄8 tsp. onion powder
1⁄8 tsp. freshly ground black pepper
1⁄2 cup fresh breadcrumbs
11⁄2 Tbsp. melted Smart Start
2 Tbsp. chopped fresh parsley

Instructions
Preheat oven to 425°F.
Place fish in an 11x7-inch baking dish coated with cooking spray.
Combine lime juice, mayonnaise, onion powder, and black pepper in a small bowl, and spread over fish.
Sprinkle with breadcrumbs; drizzle with Smart Start.
Bake for 20 minutes, or until fish flakes easily when tested with a fork.
Sprinkle with parsley and serve.

Rocco's Grilled Chicken Caesar Salad
Chef Rocco offers a healthier twist on this classic salad prepared by Heba.
291 Calories/ServingYield: Serves 4

Ingredients
Pam spray
4 large garlic cloves, 3 of them chopped
4 slices Ezekiel Bread
4 boneless skinless chicken breasts, about 1-1/3 pounds
Nu-Salt and freshly ground pepper to taste
1 cup fat-free sour cream
1 tablespoon Dijon mustard
juice and zest of 2 lemons
2 tablespoons grated pecorino-romano
1 large head romaine, cleaned and cut into bite-size pieces

Instructions
Preheat oven to 350
Place bread on a baking sheet and bake until golden brown and very crisp, about 8 minutes
Lightly bruise 1 whole garlic clove and rub it over the surface of each piece of bread
Cut bread into 1-inch cubes and set aside
Meanwhile, preheat a grill or grill pan over high heat
Season chicken breasts with Nu-Salt and pepper and spray lightly with Pam
Grill about 4 minutes per side, or until charred on the outside and just cooked through
Remove from grill and keep warm, Slice
Meanwhile, together the 3 chopped garlic cloves with the fat-free sour cream, Dijon mustard, lemon juice and zest and pecorino
Season with freshly ground black pepper and Nu-Salt
To serve, toss together the romaine with the sliced chicken, dressing and croutons
Adjust seasoning, if necessary
Although no actual salt is called for in this recipe, please add it as you see fit

Rocco's Whole Wheat Pizza
Enjoy a homemade pizza with significantly less fat and calories than the usual pie.
320 Calories, 7g Fat, 2g Saturated Fat, 5mg Cholesterol, 610mg Sodium, 53g Carbohydrates, 8g Fiber, 2g Sugar, 15g ProteinYield: Serves 8

Ingredients
1 tsp. molasses
1-1/2 cups warm water (about 110 degrees F)
1 Tbsp. active dry yeast
2 tsp. extra virgin olive oil
1 tsp. salt
3-1/2 cups whole wheat flour plus extra for rolling/kneading
2 cups Veggie Marinara Sauce
1/2 cup chopped fresh basil
4 oz. reduced fat mozzarella
1/4 cup grated Parmigiano-Reggiano

Instructions
In a large bowl, dissolve molasses in warm water. Sprinkle yeast over the top, and let stand for about 10 minutes, until foamy.
Stir the olive oil and salt into the yeast mixture, then mix in the whole wheat flour until dough starts to come together. Tip dough out onto a surface floured with the additional whole wheat flour, if necessary, and knead until all of the flour has been absorbed, and the ball of dough becomes smooth, about 5 minutes. Place dough in an oiled bowl, and turn to coat the surface. Cover loosely with a towel, and let stand in a warm place until doubled in size, about 1 hour.
When the dough is doubled, tip the dough out onto a lightly floured surface, and divide into 4 pieces. Form each into a tight ball. Let rise for about 45 minutes, until doubled.
Preheat the oven to 550 degrees F (220 degrees C) with pizza stone in oven. Roll a ball of dough with a rolling pin until it will not stretch any further. Then, drape it over both of your fists, and gently pull the edges outward, while rotating the crust. When the circle has reached the desired size, place on a pizza peel with cornmeal. Dock dough with a fork. Slide dough onto pizza stone in the oven and bake for 2-3 minutes.
Remove from oven and spread about 1/2 cup sauce on baked dough leaving a 1/2-1 inch border. Sprinkle sauce with basil. Mix cheeses together and sprinkle 1/4 of the mixture over the sauce. Slide pizza back onto the pizza stone in the oven and bake 4-5 more minutes, or until cheese is golden brown and bubbling and crust is brown and crispy. Repeat with remaining dough to 3 times to make 4 pizzas total. Allow to cool for about 2 minutes, cut into wedges with a pizza wheel and serve.

Southwestern Chicken PileUp
Nachos without the grease and guilt.
356 Calories, 38g Protein, 38g Carbohydrates, 6g Fat (1g saturated), 68mg Cholesterol, 8g Fiber, 489mg SodiumYield: Serves 1

Ingredients
1 tsp. salt-free Mexican or Southwest seasoning
1/4 tsp. garlic powder
1 small (1/4-pound) boneless, skinless chicken breast, trimmed of visible fat
1 whole-wheat pita (6 1/2" diameter)
2 Tbsp. hummus, preferably red-pepper flavor
2 Tbsp. no-salt-added canned black beans, drained
Several red onion strips
Several red bell pepper strips
2 Tbsp. chopped tomato
2 Tbsp. chopped fresh cilantro leaves
2 Tbsp. finely shredded Cabot 75% Light Cheddar Cheese
4 tsp. guacamole or fat-free sour cream (optional)

Instructions
Preheat the oven to 450°F. Preheat a grill to high heat.
Sprinkle the seasoning and garlic powder evenly over the chicken. Place the chicken on the grill rack. Reduce the heat to medium. (If it is not possible to reduce the heat, cook the chicken away from direct heat.) Grill for 3 to 5 minutes per side, or until no longer pink and the juices run clear. Transfer to a cutting board and let stand for 5 minutes. Chop the chicken into bite-sized pieces. Set aside.
Meanwhile, place the pita on the grill rack. Cook for 1 to 2 minutes per side, or until lightly toasted. Place the pita on a nonstick baking sheet. Spread evenly with the hummus. Top evenly in layers with the beans, the reserved chicken, onion, red pepper, tomato, cilantro, and cheese.
Bake for 6 to 8 minutes, or until the cheese is melted. Let stand for 5 minutes. Transfer to a serving plate. Slice into 4 wedges. Top each wedge with a teaspoon of guacamole or sour cream, if desired.

Winning Fried Chicken
Daniel from Biggest Loser 7 says this is "stinkin' awesome!"
173 Calories, 29g Protein, 9g Carbohydrates, 2g Fat, 66mg Cholesterol, 1g Fiber, 171mg SodiumYield: Serves 2

Ingredients
3 Tbsp. fat-free plain yogurt
4 large fresh basil leaves, chopped
1 tsp. chopped fresh oregano leaves
1 tsp. chopped fresh thyme leaves
1/4 tsp. garlic powder
pinch of salt
pinch of ground black pepper
4 Tbsp. Ian's Whole Wheat Panko Breadcrumbs, or finely crushed Wasa Light Rye Crispbread
2 small 1/4-pound boneless, skinless chicken breasts, trimmed of visible fat
Mustard or low-fat, low-sodium marinara sauce to taste (optional)

Instructions
Preheat the oven to 400 degrees F. Lightly mist a small nonstick baking sheet with olive oil spray.
In a medium shallow bowl, combine the yogurt, basil, oregano, thyme, garlic powder, salt and pepper. Stir to mix well.
Place 2 tablespoons of bread crumbs or crushed crispbread in another medium shallow bowl. Set next to the yogurt mixture. Dip one chicken breast into the yogurt mixture to coat. Transfer to the crumbs to coat evenly. Place on the prepared baking sheet. Add the remaining two tablespoons crumbs to the owl. Repeat the procedure with the second breast. Place on the baking sheet, not touching the other breast.
Bake for 10 minutes. Flip the chicken and bake for 8-10 minutes, or until no longer pink. Serve immediately with mustard or marinara sauce on the side, if desired.

Amanda's Cheesy Eggplant Lasagna
Total Time More than 1 Hour Preparation Time 1 hour Serving Size 6 Preparation Method Bake Preparation Method Broil Preparation Method Stove-Top Level of Difficulty Moderate

Ingredients
2 medium eggplant, peeled and cut into 1/4-inch-thick lengthwise slices
1 pinches of garlic salt, or to taste
1 package (1.25 lb) JENNIE-O TURKEY STORE® Lean Ground Turkey
1 package (8 ounces or more, to taste) sliced fresh mushrooms
1 clove garlic, minced
1 teaspoon Italian seasoning
2 cup low-fat marinara sauce
1 3/4 cup finely shredded low-fat or fat-free mozzarella cheese
From The Biggest Loser Cookbook

Directions
Preheat the broiler. Lightly mist a 13" x 9" glass baking dish with olive oil spray. Set aside.
Lightly mist the eggplant with olive oil spray. Place on a medium nonstick baking sheet. Sprinkle both sides with garlic salt. Broil 6" from the heat source for 3 to 5 minutes per side, or until tender and browned in spots.
Meanwhile, lightly mist a medium nonstick skillet with olive oil spray. Set over medium heat. Crumble the turkey into the pan. Cook, breaking into chunks with a wooden spoon for 3 to 5 minutes, or until lightly browned and no longer pink. Remove turkey. Lightly mist skillet with olive oil spray and add the mushrooms and garlic. Cook, stirring occasionally, for 8 to 10 minutes, or until there is no liquid remaining in the pan and the mushrooms are starting to brown.
Preheat the oven to 350°F.
Place half of the eggplant in a single layer in the bottom of the reserved baking dish. Top with half of the mushroom mixture, half of the cooked turkey, 1 tsp. Italian Seasoning, half of the marinara sauce, and half of the cheese. Repeat the layering with the remaining eggplant, mushrooms, turkey, seasoning, sauce, and cheese. Cover with aluminum foil.
Bake for 20 minutes. Remove the aluminum foil. Bake for 10 to 15 minutes, or until hot and the cheese is bubbly. Remove and let stand for 10 minutes. Cut it into 6 equal portions. Serve immediately.
This recipe is Biggest Loser Approved
4 servings
Calories: 305
Total Fat: 4 grams
Saturated Fat: 1 gram
Monounsaturated Fat - 1 gram
Sodium: 749mg
Cholesterol: 57 mg
Total Carbohydrate: 34 grams
Dietary Fiber: 9 grams
Sugars: 7 grams
Protein: 37 grams

Heather's Mexican Roll up
Total Time Under 15 minutes Preparation Time Under 15 minutes Serving Size 5 Preparation Method Stove-Top Level of Difficulty Easy

Ingredients
nonstick cooking spray
1 (1.25-pound) package JENNIE-O TURKEY STORE® Extra Lean Ground Turkey
5 (7 to 8-inch) whole wheat flour tortillas
5 tablespoons fat-free sour cream
2 cups shredded romaine lettuce
2 cups seeded, chopped tomato
1 cup salsa

From The Biggest Loser Cookbook
Directions
Place a nonstick skillet on medium-high heat until it is hot enough for a spritz of water to sizzle on it. With an oven mitt, briefly remove the pan from the heat to mist lightly with oil spray. Crumble the turkey into the pan. Cook, breaking into chunks with a wooden spoon 3 to 5 minutes or until lightly browned and no longer pink. Transfer to a plate. Cover to keep warm. Return the pan to medium heat. Place tortillas, one at a time, in the pan. Cook 30 seconds per side or until warm. Transfer to serving plate. Starting at one side of each tortilla, spread 1 tablespoon sour cream evenly over two-thirds of tortilla. Divide cooked turkey on top of sour cream. Top each tortilla with equal amounts of lettuce, tomato, and salsa. Sarting at filled side, roll up each tortilla. Serve immediately.
This recipe is Biggest Loser approved
Makes 5 servings
Per serving:
Calories: 234
Saturated Fat: less than 1 gram
Polyunsaturated Fat: trace
Mono Fat: trace
Sodium: 582mg
Total Fat: 4 grams
Cholesterol: 46 mg
Total Carbohydrate: 14 grams
Dietary Fiber: 4 grams
Protein: 34 grams

Spinach, Egg and Cheese Breakfast Wrap
Recipe from Biggest Loser Family Cookbook

Wraps are a quick and easy way to get plenty of nutrients any time of the day—if you fill them with smart choices. But be careful when choosing your tortilla. Many varieties are loaded with tons of sodium and don't taste any better than healthier versions.

Ingredients:Serves 1

1 (7 1/2-inch) low-carb, whole wheat or multigrain tortilla
Olive oil spray
3 egg whites
1 ounce (1/2 cup) Cabot's 75% Light Cheddar Cheese , finely shredded
1/4 cup fresh spinach leaves , stems removed

Place a small nonstick skillet over medium-high heat and add the tortilla (no need to add any fat). Heat the tortilla until just warm, about 30 seconds per side after the pan is heated.
Spray a small microwave-safe bowl with the olive oil spray and add the egg whites. Microwave on low for 30 seconds. Continue microwaving in 30-second intervals until the whites are just a bit runny on top. Stir with a fork, breaking the whites into large pieces. By the time you "scramble" and stir them, the residual heat should have cooked away the runniness. If they are still undercooked, cook in 10-second intervals until just done.
Place the warmed tortilla on a plate. Starting at the top, sprinkle the cheese in a 3-inch strip down the center to about 2 inches from the bottom. Top with half of the egg whites, the spinach leaves, then the remaining whites. Fold up the bottom so that the bare part is over the filling. Fold the sides into the center over the egg and serve.

Reprinted from: The Biggest Loser Family Cookbook by Chef Devin Alexander and the Biggest Loser Experts and Cast © 2009 by Universal Studios Licensing LLLP. The Biggest Loser™ and NBC Studios, Inc., and Reveille LLC. Permission granted by Rodale, Inc., Emmaus, PA 18098. Available wherever books are sold or directly from the publisher by calling (800) 848-4735.
Nutritional Information:214 calories, 27 g protein, 15 g carbohydrates, 5 g fat (2 g saturated), 10 mg cholesterol, 8 g fiber, 493 mg sodium (per serving)

Chicken Salad Dijon with Grapes and Apple
Recipe from Biggest Loser Family Cookbook

Dijon mustard lovers will love this twist on traditional chicken salad—and will also be shocked by the creaminess of the dressing, given that it has about one-third of the calories and one-fourth of the fat usually found in a similar-size serving. Serve over a bed of butter lettuce or fresh spinach or on sprouted grain or multigrain bread.

Ingredients:Serves 4

1 pound trimmed boneless, skinless chicken breasts
3 tsp. extra-virgin olive oil
Salt , to taste
Ground black pepper , to taste
3 Tbsp. fat-free plain yogurt
3 Tbsp. Dijon mustard
1/3 cup chopped celery
1/3 cup seedless grapes , each cut in half
1/3 cup chopped red apple
Preheat a grill to high heat.

Rub the chicken all over with 1 teaspoon of the olive oil and season with salt and pepper. Place on the grill and cook for 3 to 5 minutes per side, or until the chicken is no longer pink and juices run clear. Allow the chicken to cool, then cut it into bite-size cubes.
In a large glass or plastic mixing bowl, whisk together the remaining 2 teaspoons olive oil, the yogurt and mustard. Add the chicken, celery, grapes and apple. Gently toss well to combine. Season with salt and pepper and serve.

Reprinted from: The Biggest Loser Family Cookbook by Chef Devin Alexander and the Biggest Loser Experts and Cast © 2009 by Universal Studios Licensing LLLP. The Biggest Loser™ and NBC Studios, Inc., and Reveille LLC. Permission granted by Rodale, Inc., Emmaus, PA 18098. Available wherever books are sold or directly from the publisher by calling (800) 848-4735.
Nutritional Information:173 calories, 27 g protein, 4 g carbohydrates, 5 g fat (less than 1 g saturated), 66 mg cholesterol, trace fiber, 361 mg sodium (per serving)

Roasted Tilapia with Fire-Roasted Tomatoes and Olives
Recipe from Biggest Loser Family Cookbook

If you haven't seen them, fire-roasted tomatoes are newly emerging in popularity—you'll now find them with the other canned tomatoes in most major grocery stores. They're packed with flavor yet have no more fat or calories than traditional diced tomatoes.

Ingredients:Serves 4

2/3 cup canned fire-roasted diced tomatoes
12 small green olives with pimientos (sometimes called manzillas), cut into quarters
1 Tbsp. plus 1 tsp. minced onion
1 tsp. freshly crushed garlic or minced garlic
1 pound tilapia fillets
Olive oil in a sprayer (not store-bought spray that contains propellant)
Salt
Ground black pepper

Preheat the oven to 400°. In a medium bowl, combine the tomatoes (and their juice), olives, onion and garlic until mixed. Lightly mist the fillets on both sides with olive oil and season with salt and pepper. Place in a single layer in an 11" x 7" glass or ceramic baking dish or the equivalent. Top evenly with the tomato mixture. Roast until the fish flakes easily and is no longer translucent in the center, 10 to 12 minutes.

Reprinted from: The Biggest Loser Family Cookbook by Chef Devin Alexander and the Biggest Loser Experts and Cast © 2009 by Universal Studios Licensing LLLP. The Biggest Loser™ and NBC Studios, Inc., and Reveille LLC. Permission granted by Rodale, Inc., Emmaus, PA 18098. Available wherever books are sold or directly from the publisher by calling (800) 848-4735.
Nutritional Information:149 calories, 23 g protein, 4 g carbohydrates, 4 g fat (less than 1 g saturated), 57 mg cholesterol, trace fiber, 396 mg sodium (per serving)

Food Stages

2009-03-11T13:49:00.004-04:00

I am such a slacker these days with posting. So I wanted to post all the food stages and what I was eating and how much so here we go....

Clear Liquids for 7 days (I was on no food for 3 days post op because of my complications. I started clears on my 4th day in the hospital so this stage was a little longer for me, it was actually 10 days until I started full liquids)

I ate chicken, beef and vegetable broth - sugar free popsicles - water - no sugar added apple juice - crushed ice

I tried sugar free jello and crystal light in my water but could not stomach it. It was overwhelmingly sweet and made me nauseous.

It is so hard to get in all the fluids so don't sweat it when you can't. Just try to stay hydrated and get well. My meds counted as my liquids in according to my nurses so I counted them. I didn't really drink in between meals other than I constantly ate crushed ice and drank the water as the ice melted. Here is an example of the 1st few days of clears:

Day 1

Breakfast: 2 oz apple juice - 1 1/2 oz broth - 1 oz water

Meds: 1 oz every 4 hours (5 total for the day)

Lunch: 1 oz water- 1 oz apple juice - 2 oz broth

Liquids other than meals: 6 1/2 oz water - 1.5 oz sf popsicle

Dinner: 1/2 oz broth- 3 oz oj (wasn't supp to have that but it was on my tray and it was good!)

Total for the day : 25 oz.

Day 2

Breakfast: 2 1/2 oz broth - 2 oz water

meds: 1 oz every 4 hours (5 total for the day)

Lunch: 2 oz broth ; 1 bite sugar free jello

Liquids other than meals: 2 oz - (2) 1.5 sf popsicle

Dinner: 3 oz broth

Total for the day: 19.5 oz

Day 3

Breakfast: 1/2 oz water - 1 oz broth

Meds: 1 oz every 4 hours (5 total for the day)

Lunch: 1 oz water - 2 oz broth

Liquids other than meals: 1.5 oz sf popsicle - 4 oz

Dinner: ZERO

Total for the day: 11 (I was sick and nauseated this day)

Full liquids for 7 days

I ate cream of chicken soup - strained cream of mushroom soup - tomato soup - instant mashed potatoes (sometimes with melted cheese and sour cream) - sugar free pudding - protein shakes/drinks and ofcourse anything I ate on clears. I didn't get too creative in this stage. I did try some strained broccoli and cheese soup, it was ok. Cream of chicken was my favorite and off brands were not as good as Campbell's. I found during this stage I started getting my appetite back and noticed I was hungry like every 2 hours. I was still home recooping, so I ate, napped, ate and napped. I was getting in an average of 30-40 grams of protein and around 32 oz of waterby sipping in between meals. I didn't keep up with my calories, fat or carbs. My order of concern was protein, water and feeling better.

Example Day 1
8:30am - 3 oz cream of chicken soup; 1 oz pain med
10:30am - chewable vitamins
11:00am - 2 oz cream of chicken soup
2:00pm - 4 oz protein shake
3:00pm - 1 oz pain med ; chewable vitamins
4:30pm - 2 oz cream of mushroom soup
7:30pm - 4 oz protein shake; 1 oz pain med
9:15pm - sugar free popsicle

Example Day 2
9:30am - 4 oz decaf coffee with atkins vanilla shake; 1 oz pain med
10:30am - chewable vitamins
12:00pm - 3 oz cream of mushroom soup
2:00pm - 2 bites sugar free jello (this is when I discovered I just didn't have a taste for this anymore, it was too sweet and made me nauseaous for a while)
5:00 pm - 3 oz tomato soup
6:00pm - chewable vitamins
7:30pm - 3 oz cream of chicken soup

Example Day 3
7:30am - 2 oz cream of mushroom soup
9:00am - 3 oz tomato soup
10:00am - chewable vitamins
11:00am - 10oz Isopure Grape Frost clear liquid protein (I worked on this all day, I poured it in ice and sipped in place of my water)
12:30pm - 3 1/2 oz cream of chicken
2:15pm - 1/2 snack cup of chocolate sugar free pudding
4:15pm - 3 oz cream of chicken soup
5:00pm - chewable vitamins
6:15pm - 4 oz protein shake
8:00pm - 1 oz brocolli and cheese soup
8:45pm - 2 oz instant potatoes

Pureed/Mushies for 14 days

It was recommended to blend foods so it would be pureed but I never did that. I just chewed extremely well until it was mush before I swallowed. To each his own but this worked for me. I ate anything that was chunky yet soft, that I thought I could chew well and wouldn't have issues with. I still ate some cream of chicken soup, lots of Wendy's chili, corn beef hash, instant potatoes, I found some great recipes on eggface's blog. She is the WLS queen!! I was managing 40-60 grams of protein a day and about 32-48 oz water. My cousin makes this awesome baked mixed beans. I made it up during this stage with a few modifications. It was good comfort food and had to help up my protein (i never did find out the protein per serving) but here is the recipe:

Pre heat oven to 425
Fry and Drain:
1 1/2 lbs hamburger or ground turkey
1 small onion *
1 green bell pepper *
1 red bell pepper *
Combine with:
1- bag Oscar Myer bacon bits
1 cup brown sugar * (you can use brown sugar splenda)
1 - 2 cups ketchup
1 TBSP. mustard
2 - cans Bush's baked beans original
1 - can Great Northern Beans (I use 2 cans)
1 - can Kidney Beans
2 - cans Butter Beans * (I use 2 cans)
Bake at 425 for 45 min. or simmer on the stove or crockpot. I skip the whole oven thing

Example day 1

Breakfast - 4 oz italian bake http://theworldaccordingtoeggface.blogspot.com/2007/08/pureed-foods.html

Snack - 1/2 snack cup sugar free pudding

Lunch - 4 oz chili

Snack - chewable vitamins ; 4 oz protein shake

Dinner - 4 oz italian bake

Snack - sugar free popsicle

Example day 2

Breakfast - 2 oz corn beef hash

Lunch - 4 oz italian bake

Snack - chewable vitamins ; 1 oz corn beef hash

Dinner: 4 oz baked mix beans

Snack - 2 oz cream of chicken soup

Soft foods for 14 days

I stopped measuring and counting altogether in this stage. For the most part I still used my 4 oz bowls to guide myself but I mostly listened to my stomach and ate slow to know when I couldn't tolerate any more food. I didn't have this surgery to diet. I don't want to spend the rest of my life measuring, weighing, counting calories, fat grams and carbs. This is my plan and if I need to adjust it because my weight loss stops then I will. I eat what I want until I am full and then I enter it into dailyplate.com usually just to make sure I am getting in my protein but I only do this during the work week. I ate things like eggs, oatmeal, anything from previous stages, ground hamburger, chicken salad, tuna salad, egg salad. I was averaging 50-65 grams of protein a day and 32-48 oz water in this stage. Water is the toughest for me. My doctor recommended 100% juice to up my water intake and ofcourse count protein supplements.

Example Day 1
Breakfast - 1 scrambled egg with cheese
Snack - string cheese ; few bites chicken salad
Lunch - chicken salad
Snack - protein shake
Dinner - italian bake w/ ground hamburger
Snack - slice of cheddar cheese

Example day 2
Breakfast - 1/2 packet oatmeal (low sugar maple and brown sugar)
Snack - string cheese
Lunch - instant potatoes with sour cream and cheese
Snack - protein shake
Dinner - chicken salad

Regular diet (protein - vegetables - good carbs in that order)

The exception to that rule is I still can't eat popcorn, nuts, raw vegetables, until I am 6 months out. I am to stay away from all bad carbs like pasta, rice, sugar filled junk, chips etc. indefinately or at least until I have reached goal and in maintenance mode. At almost 2 1/2 months out, I have eaten a few cashews here and there, a bite of macaroni and cheese and even a chip or two -Don't judge me lol) I have found these soy crisps that have 9 grams of protein and cure my chip cravings. There is a lot of alternatives out there, you just have to look and plan ahead. When I don't plan is when I make poor choices. I am getting approximately 48-56 oz water a day and depending on what I eat 60-90 grams of protein. I watch dailyplate.com and try to stay within 30-40 fat grams and 20-40 carbs. I will adjust when I stop losing.

Example day 1
breakfast - scrambled egg with cheese ; 2 strips bacon
snack - string cheese
lunch - baked chicken ; bite or two of green beans
snack - finish chicken from lunch
dinner - honey bbq salmon ; few bites cabbage, one bite mashed potatoes
snack - scoop of breyers low carb butter pecan ice cream

Example day 2
breakfast - 2 turkey sausage links ; 1/2 packet oatmeal
snack - 8 oz 100 % orange juice
lunch - small ceasar salad with grilled chicken (If I buy salads at fast food places, I usually take a little bit of it and my daughter eats the rest)
snack - cheese
dinner - baked pork chop ; few bites cauliflower/brocolli mix
snack - protein shake ; spoonful of peanut butter

A quicky

2009-02-24T12:47:00.002-05:00

Wanted to drop in and give a quick update since I have not posted in almost a month! Things are just starting to settle down in my life so I can hopefully get back in a routine. I went back to work last Wednesday, a week after I was supposed to. My surgeon released me on the 11th to go back to work but my dad went in for surgery (tracheotomy) the next day so I stayed with my mom at the hospital and then on Friday, the 13th, my uncle passed away of a massive heart attack. The good news is my dad is getting better and we are hopeful they can wean him off the trach and I have lost 30 lbs. I am off the oxygen except at night when I sleep and that will go away once I get my C -Pap machine. I had horrible acid reflux the 1st 2 weeks and asked the doctor for some meds but it has since seemed to have subsided and I am not having any issues but I will keep the meds just in case. My incisions have healed nicely and I am losing my boobs!!! LOL My biggest struggle right now is getting that water and those vitamins in. The doctor told me to drink some 100% juices to help maintain water intake but I don't want the extra calories but the oj is soooo good. So I allow myself one 8-12 oz of oj a day. Besides I figure the Vitamin C is good for me. Chewable vitamins yuck! I got the bariatric mixed berry fusion. I am supposed to take 4 a day but I find that it takes forever to suck and chew one up and then it feels like it is expanding in my stomach like an alka seltzer. My doc says I can start swallowing pills now but I am a little scared so I have yet to buy them. Besides it is going to be more expensive to do the pills versus the chewable ones but I am willing to pay for the convenience of downing those pills with some water instead of chewing for 30 minutes 4 x a day. I am on a soft diet now and am eating about 3-4 oz every 3-4 hours. Thank God, there has been nothing that I have eaten that didn't agree with me and I have gotten sick only once, and that was totally my fault. I was at my aunt's house after the funeral and was working on eating some chicken. Rule of thumb is chew chew chew chew, nice and slow so it goes down easy...well too many people were talking to me and I was standing up, before I realized what I was doing I was taking normal size bites and swallowing. I ate too much too fast and it was now sitting in my throat. I had to excuse myself to the bathroom. I tried to swallow it down but the saliva kept coming up (I guess this is what they call foamies) so finally after about 10 minutes I gave in and threw it up. I felt better within a few minutes.
I was measuring everything out perfectly but now I am starting to be able to guage when I am full. I never thought so little amount of food would satisfy me but it does and I finish about the same time as everyone else because they are scarfing down their food and I am eating slow. Ok, well it is back to work I must go. I will post again ASAP. Thanks for reading!

Pouring rain but I see the rainbow in the horizon

2009-01-31T10:00:00.002-05:00

So I found my 3rd and 4th shoe to drop since my last post. Monday the 19th, they put my dad in the hospital to relieve some fluid from his lungs so he can breathe. He has emphysema, diabetes, neuropathy and congestive heart failure. So a hospital trip is not all that unusual for a man with his illness' however it was 3 days prior to my surgery and I was concerned. I was thinking of post poning but my mom cried and asked me not to because I had fought so hard and I needed the surgery so I didn't end up in my dad's shoes 25 years from now. So I kept my surgery day even though I really wanted my mom's help, I knew I would be ok on my own and with what assistance I could get from my sister in law and kids, besides from everything I have read there was a pretty quick turn around after surgery.
Surgery day was scheduled for Jan 22 at 12 noon. My daughter and I meet up with my sister in law and we go in, put on the gown, get hooked up to the IV and now we wait. Get a phone call that my doctor was running late, surgery is post poned to 1:00. We wait some more. I had not had anything to eat since 9 pm the night before (and even then it was clear liquids) so I was starting to really feel hungry about 12:30 and feeling a little anxious and agitated. They wheel me back and once the mask went over my face, I don't remember anything else until I wake up in recovery. So some of my time frames will be from what I have been told by others. So I came out of surgery about 4:30, they got me a room and sent my family to my room to wait for me. I remember the nurse telling me to take deep breaths and I can hear her talking on the phone saying things like . Blood pressure dropping, oxygen levels are 75, draining 150 cc's in 10 minutes. All I know is I am saying I am in pain, please give me something! My family says at 8:00 they become concerned because I haven't been wheeled up yet so they go to inquire and a few minutes later a nurse rushes them down stairs to sign some papers for me to have a second surgery because I am bleeding internally and my vitals are crashing. I thought for sure I was going to die. All I remember is Ashley holding my hand and me not wanting to let go, the man saying we have to go before she flat lines and telling Karen I was scared to please pray. Oh, the pain was horrific. When they moved me from the bed to the table I just hollered and moaned and groaned, it was awful. So I get out of 2nd surgery and come to find out, one of the original port sites where they went in nicked a blood vessel on its way out and it began to hemorrhage. I was placed in an ICU room about 1:00am. I had to receive 8 pints of blood over the next several days in ICU and was moved to a regular room on Sunday afternoon, January 25. I should have been home by now! They did my first leak test I think sometime on Friday and I remember the pain of moving from the bed to the table was again awful and the chalky barium swallow made me sick. I threw up. They tried another leak test Saturday morning. I survived this one but not without the pain and naseua, just no throwing up. So now I get to start eating clear liquids. Spent the next several days in a regular room and came home on Thursday Jan 29, one week from my surgery date. I was sent home with oxygen because they felt I might still have some fluid built up around my lungs and once I start moving around, it will relieve it self plus I lost so much blood they think I just might need a little bit of time to rebuild my red blood cell count, iron and oxygen stamina. I tell you, being tied to this oxygen machine is torture. I hope I never ever pick up another cigarette again in my life and if I think about it I hope God has etched this memory in my brain so it remains fresh and I remember that a cigarette is not worth exchanging it for an oxygen machine later in life.
My dad is still in the hospital and is having his ups and downs. I managed to get up there yesterday to see him and mom. Mom and I sat in the sanctuary together and talked for a little bit and cried a little bit after such an overwhelming week.
Each day it gets better. Right now my biggest struggle is getting in my fluids everyday. I will be posting example menus in another post but I never thought I would say I had a hard time getting 20 oz in a day and that is food and water combined. I am supposed to be getting in at least 32 oz of fluid and at least 30 grams of protein a day. It ain't happening! I am going to GNC tomorrow to try to get some supplements to help me out with the protein part so I can concentrate on fluids so I can start getting my max in. This will surely aid in recovery. So it is still raining in my neck of the woods but the clouds are rolling out and I see a rainbow in the horizon.

Waiting for the other shoe to drop

2009-01-18T09:36:00.000-05:00

I have always said everything happens in 3's to me. If something slightly goes awry, 2 other things generally fall into place; usually within a week or two of each other. Even deaths in our family usually happen in 3's. Granted and thankfully it is not always 3 of our closest relatives, it might be a distant 5th cousin I have never met but you get my drift. So this weekend is supposed to be a relaxing weekend before surgery, I was going to get my house in order, go shopping, pack but this is how it has gone so far as I sit here Sunday morning exhausted and none of the above has gotten done.
It ALWAYS rains (whether it is a slight drizzle or a pour down) during my parade, Ok maybe not always but 99% of the time. I always say if it wasn't for bad luck, I wouldn't have any at all.. Friday was my birthday, things are going pretty good and after dinner my 18 yo decides she wants to go out..I advise, you don't need to drive your car, it needs a new thermostat, you're gonna blow the motor. Oh no mom such and such said it wasn't that it's fine....1 hour later...mom i am broke down and the police are making me tow the car, I need you to bring me money for the tow. Grrrrrrrr!! Now mind you my van was already acting up but was going to work on getting it fixed when I got my taxes back. But now I have to get my van fixed sooner b/c she can't drive my van while I am in the hospital with it messed up like it is and then on top of recovering from surgery, I have to figure out what to do with her car. So I did what any normal self sabotager, food addict would do, I came home and ate some no no food. And Sat. morning I woke up with the sniffles (wonder if that hand anything to do with standing in the 20 degree weather with a BROKE DOWN CAR) I thought nooo I can't get a cold..I am having surgery next week! Tow guy wanted 200.00 to tow it to our home 35 miles away and 85.00 to tow it to my sister in law's 6 miles away so split second decision..tow it 6 miles and I'll pay the 85.00. There's #1...So Sat morning I head over to my brother's because he used to be a mechanic but hasn't done it professionally because of his back but was nice enough to try to help me because he knows I don't have the money to pay for labor. We go get parts for what we think is the problem, he works on my van all day. In the meantime, I rent a dolly from UHaul to get my daughter's car back to my parents place so we can figure out what to do with it..that was another 45.00. (PS for another 70.00 I could have saved myself the aggravation and had the guy tow it there to begin with) I drop my oldest off at work and go to pick the car up...no one is home. I read the instructions but it appears to be greek to me LOL Luckily someone came home and was able to help me get the car on the dolly. I drive my mom's van back to her house, pick up my van and youngest daughter as well as my brother's dog b/c my youngest was crying that it was going to freeze to death and how could I be so cruel...Deep Breath. Take her home, discover his dog and my dog don't get along so my dog rides with me to pick my oldest up from work at 9pm. Could I use a cigarette right about now? I prevailed although I could have smoken a pack in about 30 minutes! Here comes #2 (unless you see a number 2 that I missed, maybe the milkshake and the dog or the theater incident is number 2?? I'll get to that in a minute).....on the way home, my brother calls (he has his kids this weekend) Sis, I need you to come over, I am coughing up blood and mom is taking me to the emergency room and I need someone to sit with the kids AND someone to pick Gabby up from the movies at 11:30. I thought Lord, I have done given the man pneumonia from being in the cold all day. I knew he didn't feel good b/c he told me that morning but he insisted he was fine enough to work on the van. Besides my brother is a bit of an exaggerator so we never really know when to take him seriously, you know the boy who cried wolf...that's him. So I get home to drop off my dog and pick up his dog, since I am going over there anyway and as we are trying to leave...my dog gets loose and his dog won't get in the van and my daughter spills milkshake all over her. Drama queen she is, she starts crying (she does that when she gets really flustered and things aren't going smoothly). Get the dogs where they need to be and we are on our way. When we go to pick Gabby up from the movies there are like 50 police cars..come to find out there was a shooting, someone got tazered, there was a fight. Just added to my craziness. I get in touch with my sister in law and she decides to come get the kids...my brother gets home and she arrives at the same time. By the way, he had an upper respiratory infection and the doctor gave him antibiotics. I swear I am not lieing! This all really happened. LOL So where's the other shoe, my three? Did I miss it? Or is it yet to come....

My new birthday

2009-01-16T10:56:00.000-05:00

Wow! Surgery date is scheduled for Jan 22nd, just a week away! I have been so nervous and scared and excited all rolled into one. I went for my last consult appt with my surgeon on the 13th to go over last minute questions I had and what I needed to prepare for surgery(listed at the bottom of this post). The scales say I had lost 6 lbs doing the low carb and he was very pleased that I remained smoke free. Today is day 9 by the way :) I told him I was trusting him and he assured me everything was going to be fine. I went ahead and bought my chewable vitamins from the dr. office because it had everything I needed (multi, calcium, b12 and biotin) in one vitamin and it was only 26.00 for a month supply.
I went yesterday for my pre-op registration at Rex Hospital. It was pretty painless, went through the paperwork, insurance, did some bloodwork, talked to the anesthesiologist and got weighed. Their scale said I had only lost 4 lbs but I am going to stick with 6! Everyone was super nice. The registration lady said something to me that took me aback for a second but then I got it. I have been so nervous and questioning my decision and of course the what if I died on the operating table, right. Well the lady was asking her questions and asked my religion (denomination) I replied non- denominational, she kept typing , then she stopped looked at me and said "you know, there is a spirit of peace about you and that can only come from one place" (as she points up) and she goes back to typing.
I feel that was God's way of telling me it's ok, you made the right decision, I led you here and I am with you. I think it's all gonna be okay.

Questions for my surgeon and his answers
*Every surgeon has different views so answers vary from surgeon to surgeon

What kind of blood clot prevention does the hospital do? What can I do?
A: surgical hose, feet pumps and lots of walking
What kind of tubes will I have in me when I wake up? (catheter, ventilator, drain, ng tube)
A: possibly catheter and drain
What size bougie?
A: 34
Can I take my meds day of surgery?
A: yes
How long will I be in the hospital?
A: 1-2 days
What has to happen before I can go home?
A: Have to be able to walk, pee, drink and pass a leak test
How soon after I wake up can I have ice chips?
A: Once you pass the leak test that evening after surgery or the next morning
Is there anything that would make you switch from laproscopic to open surgery?
A: If he was unable to complete surgery due to unable to maneuver via lap
Is there anything that would make you switch surgery types?
A: Not without your consent
What kind of things should I be alarmed over enough to contact you after I get home?
A: High fever, severe pain, extreme nausea, unable to eat, drink, passing out, vomiting
Will you prescribe me pain meds, nausea meds and/or gas pain meds prior or when I am released?
A: Cross that bridge before your release
Do all my meds have to be liquid or chewable after surgery? How long before I can start taking pill form again?
A: For about a month or two
Pre-op diet?
A: Low carb 2 weeks prior, clear liquids day before surgery
Post-op diet?
A: Clear liquids, week one - Full liquids, week two - Pureed/mushies, week 3
What kind of protein do you recommend?
A: As long as it is between 50-75 a day, I don't care

Things I am buying to have at home after surgery

Multivitamin
Calcium Citrate
B12 Sublingual
(Bought the Bariatric fusion chewable that has all vitamins plus biotin in it)
Chicken and beef broth
Small dishes/spoons
Liquid tylenol and anit nausea medicine
Gas X strips
Water bottles
Measuring cups
Food Scale
unflavored protein
Isopure protein punch
Magic Bullet (I am buying the Hamilton 18 piece set that compares to Magic Bullet at 25.00 less)
Carnation Instant Breakfast - sugar free
Atkins shakes
Sugar free popsicles and jello

Taking to hospital

Robe
Slippers
2 sets of pj's and underwear
small fan
pillow
phone and charger
laptop
chapstick
sugar free peppermints

A letter to myself

2009-01-15T12:39:00.002-05:00

Dear Evolving Teresa

I just feel the need to remind you of a few things for when you are having a rough day after surgery and you are feeling a little down and perhaps having some regrets. You knew going into this that it was not going to be a breeze. There are certain sacrifices you have to make in order to be healthy and live a full life and one of them is food. I know this has been your best friend for 20 plus years but trust me, it really is the enemy. Remember overeating and all the bad carbs, and junk food is the reason you escalated into the person who can't put on her own shoes and socks without almost passing out. A simple task like washing dishes hurts your back. Like today for instance, after doing low carb for 2 weeks and actually feeling better than you have in a long time and the upcoming surgery, you decided a cheat day was in order...so you eat some bad carbs and you feel like crap. Food is your fuel, not your friend. Eat to live not live to eat. Also, remember the suffering you have watched your dad go through with the breathing problems and diabetes. Don't think it can't happen to you, it is in your blood line. Here is a list of things fat Teresa does/needs/can't do because of overeating:

Never enjoys the party because you are constantly looking for a place to sit down because your back is in piercing pain or because you feel uncomfortable in your own skin and also because you are not sure if the lawn chair the party giver has provided will hold up so you sit very tense and uneasy~ Never enjoys amusement parks because you can't fit on the rides and your back and feet ache from walking ~ Can't enjoy shopping because you have resulted to using a scooter and you are embarrassed by it and you can only shop at limited stores because you do rely on a scooter so you can only go to Walmart or Target~ Fat Clothes are expensive and they never fit right, they are either too tight in the stomach and too lose on the legs or just don't fit at all~ You can't wipe your rear end without becoming a contortionist and even then it's sometimes not enough ~ Avoiding cameras or when a picture does get taken of you, realizing your head and body make up for 2 of someone else ~ Your house is in a constant disarray because you can't clean it, you can't get on your knees or stand for more than 5 minutes without being in pain ~ You don't like having company or want your daughter's friends over because you are embarrassed of your house and yourself ~ Your youngest daughter doesn't want to walk next to you because she is embarrassed ~ Your oldest daughter is going to end up in jail from getting in a fight if one more person stares at you lol j/k but she is very overprotective and that is not fair that she has to be for that reason ~ Not able to walk into a restaurant without scoping it out first to make sure they have tables to accommodate a fat person ~ Walking into any room (friends house, work meeting, doctors office) and have the overwhelming sick feeling and stomach in knots for fear you might not be able to fit in that chair ~ Having the arms at the nail salon pop open over and over because your fat keeps bumping them so you end up holding onto them and not really enjoying your pedicure ~ Getting out of breath from walking from the office to the parking lot ~ Sweating while shopping even in the winter ~

You want to set a good example for your daughters. You do not want them to hurt and suffer the way you have physically and mentally. There are hundreds more I could list and I might come back to add to it as I think of them but for now that is enough. You deserve to feel beautiful.

Something else that you need to know, remain humble and don't forget who you are and where you came from. I know you will change some and that's ok. I want you to have more confidence and maybe speak your mind a little more so you don't get walked all over but don't get so overconfident that you over speak and hurt people's feelings, especially your daughters. Remember what it was like when people said things to you about your weight so DON'T DO IT TO THEM. NEVER make them feel that you of all people do not accept them for who they are. Don't forget who your friends are and don't get so busy with your new life that you forget to stop and talk to the ones who have always been there for you. Don't stop loving people in general, don't become judgmental of people's size, looks, circumstance...stop and lend an ear or helping hand; you were once them! Last but not least, DO NOT SETTLE for the first guy that comes along. With losing weight WILL come new found attention from men and you have not had that in a while so don't let it go to your head. Remain true to yourself and your girls (remember you are setting an example for them). Remember what your expectations are, he needs to love you for you, respect you and your views, be financially stable, intelligent, be accepting of your children. Meet his family and pay attention to how he treats his mama and sisters. Remember everything you have tried to teach your girls. And no hoochie mama clothes....ok maybe once you reach goal one night you can go out with the girls and act a little unlady like but don't make a habit of it. That is not who you are! You have class and style yet down to earth, carry yourself that way. Most of all be beautiful, you deserve all the happiness you have missed out on because of this prison of fat. Just don't lose who you are in the midst of losing weight.

Take care of yourself, take your vitamins religiously, exercise and make good food choices. Yes stop and smell the roses once in a while and have that bite of pie or pizza, just don't make that your food on a daily basis.

Sincerely

The former Teresa

Taking my life back

2009-01-09T15:16:00.000-05:00

So day 5 of low carb and you know what I noticed yesterday that my steering wheel didn't rub up against my stomach. I was like hey! That's a start. It is amazing the things skinny folks take for granted. I bet they never think about their stomach touching the steering wheel. I can't wait for all the other little victories to start happening. Today is day 3 of no diet coke, water only and today is.. drum roll please.......Day two of no cigarettes!!! I am really wanting a cigarette today though. I went and found me some quotes to remind myself that I am in control, not the junk food or the cigarettes. Here's my quotes:

I am the master of my fate; I am the captain of my soul.
William Ernest Henley

Knowing is not enough; we must apply. Willing is not enough; we must do!
Johann von Goethe

Fear not that life shall come to an end but rather fear that it never began.
John Henry Cardinal

What you do today determines where you'll be tomorrow.

A journey of a thousand miles begins with a single step.

I really like the first one and the last one.
I didn't think I had it in me to give up the cigarettes but I guess it is all mind over matter. I told myself that I only had to quit for 30 days, just til surgery. Oh yeah! I forgot to mention...THEY OVERTURNED THE DENIAL AND APPROVED ME FOR MY VSG SURGERY!!!!! WOOT WOOT! OH YEAH! LOL I called my daughter on Wed and was like did I get a letter and she was reading blah blah blah and then I heard: The external review board approved your request for benefits. I said whoa! Read that again....and as she did I just felt the lump in my throat and wanted to ball. I think I shed a tear or two but I was at work so I tried to compose myself. I just didn't think it was going to happen for me. Nothing ever goes my way so that night Jan 7 at 9pm I smoked my last cigarette. Miss pack and a half a day put them down, that's how bad I want this. I am tired of just existing, I am taking my life back.

Procrastination, Making changes and Hope

2009-01-05T15:03:00.000-05:00

Well it is a new year and 2009 has to be better than 2008. Between almost losing my dad, my brother and sister in law going through a sepearation, the gaining of 80 lbs to my body just shutting down and being tired all the time to the insurance denials for my VSG. But I have a good feeling about 2009.

I started low carb dieting today, making changes. I know if I get this surgery approved, I have to drop some weight prior to surgery for my liver's sake and I should have done this a long time ago. That is where the procrastination comes in. Same with smoking! I just got flustered with each denial and gave up in a sense. Same as I always do..self sabotage. Went back to eating all the wrong foods and smoking like a freight chain. I had my "last suppers" this weekend. All the fast food, sweet tea, carbs, chocolate and junk I wanted. I got water today instead of my diet coke and it has taken me all day to get through 16 oz when by this time I have had 2 diet cokes or a 32 oz sweet tea. Ugh! I hate water! But I will learn to love it!! LOL I have 5 packs of cigarettes left so I will start my zyban again tonight and try to slowly ween myself off again by not smoking in the car or the house so maybe when I put them down again this time, it won't be so hard. Caffeine will be the next to go. I am changing my coffee over to half and half..same with my beloved hazelnut creamer..I will be converting to sugar free by doing half full creamer and half sugar free until I can tolerate the sugar free. I have to change my mindset that I am not giving up all my comfort foods but instead making a change for a healthier lifestyle. I am a true food addict and chain smoker so this is not going to be easy. Then again I guess if it was I would not need a tool like the VSG to help me. I would have already done it on my own.
My hope comes from the meeting with the 2nd level appeal board on Dec 30th. I was told before the meeting that BCBS and myself would each state our case to a general surgeon. He or She was the deciding factor. They would hear us out and decide whether or not BCBS had to pay for my surgery. I asked ahead of time would it be a bariatric surgeon and the ins. lady said they could not guarantee the general surgeons specialty, it could be brain surgery for all she knows; that they just go down a list. So when we met, the general surgeon introduced himself as Dr. B, general surgeon, specializing in bariatric surgery for 12 years. In my head I was saying cha ching! Yes.. Yes! Thank you God Yes! So we go through the ordeal and to make a long story short, the ins. folks kept referencing gastroplasty and banding and being unsuccessful and this is the reason for denial and it being not medically necessary. Dr. B said you do realize gastroplasty and gastrectomy are TWO different procedures. There were crickets in the room, then some shuffling of some paper and stumbling over some words. I stated my case, Dr. B asked me about my sleep apnea and then I was dismissed. I was told I would receive a letter within 7 calendar days. I have great hope that this time it will be approved. How could it not?

Shot down again

2008-12-02T18:31:00.000-05:00

Well BCBS didn't care for my appeal as I received my 2nd denial letter on Nov. 21st stating that there was not enough evidence to support the sleeve as being non investigational , therefore it is considered non-medically necessary and the denial will be upheld. Uggghhh!!! So what did I do? Went to bed, sulked, ate a whole bunch, then got mad at myself becuase that is why I am fat to begin with. Decided to do nothing for a few days, then I got busy on my 2nd level appeal letter and some more documentation. I planned on mailing it that Wed. before Thanksgiving but I forgot so I mailed it yesterday. It is posted below along with the research links. Keep your fingers crossed!
Speaking of Thanksgiving, it is my favorite time of the year because after spending time with family, my sister in law and I sit up all night going through papers and head out about 3am to go Black Friday shopping. I absolutely love doing this! But this year I was afraid because of the back pain I had been experiencing and I had every reason to be afraid come that morning. My back and feet ached so bad. At one point, I had to go sit in the van, I was so angry at myself and the fat and the Graves Disease for being this way. It was all so clear once again of why I need this surgery.

2nd level appeal letter

To Whom It May Concern:

This letter comes in response to my recent denial dated November 21, 2008 for Weight Loss Surgery (WLS). I am writing this letter to implore that you reverse the decision not to approve Vertical Sleeve Gastrectomy (VSG) surgery on the basis it is considered investigational, therefore not medically necessary. In this letter I will explain why VSG is the best surgery for me and dispute BCBSNC’s assessment that VSG is investigational by asking you to review my Level 1 Appeal packet documentation as well as offering additional facts to dispute this claim. I am confident that you will reverse denial upon reviewing this additional information.

It has been established that WLS is medically necessary per my doctors, surgeon and BCBSNC’s medical policy (Attached in Level 1 Appeal packet) and I am grateful WLS is an option for me. I am even more appreciative of the fact that there is more than one WLS to choose from to accommodate a person’s medical and psychological needs. I have spent years researching different types of WLS; the side effects, lifestyle changes, the risks, the pros and the cons. I have read story after story of Gastric Bypass (RNY) and Lap Band being the perfect surgery for one individual, but not the next. I have read how one person’s body adapts to the changes from RNY or Lap band and the next person is continually sick from throwing up, dehydration, diarrhea, malnutrition, band slippage, band erosion; as well as suffering embarrassing moments in public by an abrupt exit because they ate too fast or ate the wrong food and had to make it to a restroom quick.
This is one of the many reasons I feel VSG is the best option for me and my lifestyle. It is the one WLS available that offers the most normalcy post op. There is no re-routing of my intestines so there is less malnutrition risk and complications; the stomach stays in tact, it remains a fully functioning stomach so there is minimum chance of dumping and complications. If you take a look at the attached surgery comparison chart you will see that VSG is the optimum choice. I do realize it is still a tool and as with all other WLS, I have to do my part in order to succeed. As I stated in my initial appeal letter, I am a morbidly obese female weighing 379 lbs with a BMI of 61 with mostly obese related co-morbidities that will improve or go away completely with weight loss. This surgery will open the door for a new life for me. I will no longer feel like a kid being punished sitting at their bedroom window watching the other kids play outside.

Partial Gastrectomies have been done on patients suffering from stomach cancer and peptic ulcers for well over 100 years so we know a patient can live successfully with part of the stomach removed. The first gastrectomy was performed by Theodor Billroth in 1881 on a patient with antral carcinoma. The procedure itself has been of course modified and improved over the years just as the original Vertical Gastroplasty of the 1970’s and 1980’s has made the pathway for the significantly improved Vertical Sleeve Gastrectomy. VSG was first performed in 1993 by Dr. Jamieson in England and has since been refined and improved into the VSG we know today by Dr. Gagner in 2001. The VSG has been performed for 15 years and as we know it today for the last 7 years. This is a far cry from an investigational surgery. The results from the studies submitted in my initial appeal packet speak for themselves as well as the people I correspond with on a daily basis on Obesityhelp.com forum ( http://www.obesityhelp.com/forums/vsg/ ) that are real life examples of the success of the VSG with weight loss in excess of 100 lbs with no major complications post op. Laparoscopic Associates of San Francisco has a two year study that can be viewed at www.facs.org/education/gs2004/gs33lee.pdf as a slideshow. I am confident the information provided is significant enough to disprove VSG as an investigational surgery. More insurance companies including BCBS Carefirst and Federal BCBS are adapting VSG in with their policies; this is further clarification this surgery is no longer considered investigational.

Please take a closer look at my initial Appeal Packet as well as the additional documentation attached. I am excited to begin a new life with the surgery that will most benefit me. I look forward to hearing from you soon with good news of a reversal of the initial denial. Thank you for your time.

Sincerely,

Research links:

http://www.obesityhelp.com/forums/vsg/cmsID,8874/mode,content/a,cms/

http://www.lapsf.com/vertical-gastrectomy-weight-loss-surgery.php

Old Medic's advice from OH

2008-11-11T14:39:00.000-05:00

Old Medic posted this and i thought it was very informative so I am posting it so I can come back and read it when I have surgery....

Post Date: 11/11/08 10:00 am There have been a number of notes lately along the lines of: I am so tired; I haven't lost a lot of weight; I can't drink much at a time; I'm losing so slowly; etc. These are mostly from newly sleeved patients, most of them within two weeks of their surgery.You are undergoing MAJOR SURGERY. This is a shock to your body, and you will be tired and listless at first. Your energy level will not be very high (there are exceptions, but they are rare). It may well take 3-6 weeks for you to get all of your stamina back. That is normal.Immediately after your surgery, your new stomach is swollen. You will not be able to drink much at all. It is not at all uncommon for people to be able to drink 1/2 an ounce or so, and they are full. This will change, so don't worry about it.You will likely NOT lose much in the first week or two. This is also normal, and don't get all freaked out about it. They pump you full of IV fluids, and you will lose that first.Gas - They fill your belly with CO2 during surgery. This gas remains inside you, until it is absorbed through your intestines and can escape from the body. This means burping and passing gas will happen, no matter what. You will feel bloated, and think you are the Goodyear Blimp! Not to worry, this too will pass.You will only be able to eat tiny amounts at first. That is also very, very normal. Over time, you will be able to eat more, but don't be in a rush.Weighing yourself - This can become a problem. My program recommends weighing yourself once a week, beginning two weeks after surgery. No more often than that. Your body will do its own thing, and if you try weighing yourself daily, you will drive yourself crazy. Weigh yourself on the same day of the week, and preferably in the morning before eating.What size is my new stomach? Frankly, what difference does it make what size it is? If it works for you, then it is the right size. Trust that your surgeon knows what he/she is doing (or why did you let them cut on you in the first place).DO NOT COMPARE YOURSELF TO ANYONE ELSE. Everyone loses at their own pace. On the whole, men lose faster than women. But there are so many factors involved, you will drive yourself nuts if you get into the "She's losing faster than me, what am I doing wrong" syndrome. IF you follow your program, you will lose weight. It may be faster, or slower than others, but so what?This is a tool for you. It is NOT a miracle, it is just a tool to help you lose the weight you couldn't keep off any other way. If you follow the program, everything will work out. If you know that you will regularly cheat, eat all the wrong stuff, etc., then you probably shouldn't have the surgery in the first place.QUESTIONS - QUESTIONS - QUESTIONS So many are afraid to adsk their doctors questions. Remember, the ONLY stupid question is the one you do not ask.Your doctor is YOUR EMPLOYEE. You hired them to do this work for you. Therefore, you are entitled to ask any, and all, questions that may come to mind. If they don't want to answer, or appear to be offended/upset by your questions, or make you feel stupid for asking, THEN GET ANOTHER DOCTOR!Any doctor that will not willingly answer any and all of your questions should be avoided. It is YOUR body, and you have the complete and total right to know everything you want to know about what hw/she is proposing to do to it.Lots of people are intimidated by physicians. Well, remember, their bodily functions are the same as yours, they get dressed the same way as you do, and I have yet to see any of them capable of walking on water.

Deny Deny Deny!

2008-11-10T19:38:00.000-05:00

So I was offically denied by my insurance company BCBSNC Oct. 31. My surgeon's office called me to let me know, they consider it investigational, did I want to schedule a different surgery? Uh no! I will appeal. Didn't surprise me they denied but still disappointed. So I hit the boards on OH seeking appeal advice. Put my research together and wrote a kick ass letter, if I do say so myself. The format of the letter came from vsgfaq.com but then i put my own information and thoughts in. I have the letter and research links at the bottom of this blog.
I was slightly perturbed with the ins. coordinator at my surgeon's office because I had asked her on the phone if Dr. Enochs could write a letter for me to go with my appeal. Her response was no because there is nothing medical to substantiate the sleeve over RNY. I told her that in the consult he recommended the sleeve so couldnt he just say that and give his reasons why it shouldn't be investigational...I will ask was her response. So I wrote a nice email explaining I understand Dr. Enochs can not medically give a reason for the sleeve over RNY, being I am a candidate for all surgeries but could he just document in his professional opinion why the sleeve shouldn't be considered investigational. Her response, no again..nothing medical.blah blah. Grrr! Did I not make my point? Did I not pay you a 400.00 consult fee? Are you not going to make killer money off this surgery? You can't write a 5 minute letter to fight for your patient? Really? If I had money lieing around to pay another consult fee to another surgeon, I would because that ticked me off. She made me feel like I was being pushed toward RNY because it was an easier route for THEM and I should just happily go through the production line. I am sorry, this is my body. THEY don't have to live with the choice I make. I know there are plenty of people that RNY and lapband have worked great for them. I am happy for them but the risks and possible complications are not for me. Don't get me wrong, I think Dr. Enochs is a competent surgeon and I like his bedside manner and feel confident he can perform this surgery but his staff make me feel like I am a burden. I was going to wait and submit my appeal after my Nov 18th appt so I could talk to Dr. Enochs personally and try to get my point across in person since maybe my message was garbled by a 3rd party but decided to go ahead and submit. I feel confident in my letter and research alone at this point. I will cross that bridge if I have to do a 2nd appeal.
They have 30 days to respond to my appeal. We shall see if my letter dazzles them. Hopefully my next post will say Approved!!

Here is the letter:

Name
Address

November 7, 2008

Blue Cross Blue Shield of North Carolina
Member Rights and Appeals Department – Level 1 Appeal
Address

To Whom It May Concern:
I’m hereby requesting a reversal of the initial denial for the bariatric procedure known as the Vertical Sleeve Gastrectomy/Gastric Sleeve (VSG-CPT code 43843) by Blue Cross Blue Shield of NC (BCBSNC). This request is made due to BCBSNC’s assessment that the VSG is experimental/investigational as well as preference of surgery choice VSG being considered investigational is at best, misguided, and at worst, a knowing endangerment of my health that could have risk management consequences if I have to have another procedure and there is an adverse outcome. I agree with the experts and my surgeon; that the Vertical Sleeve Gastrectomy (VSG) or Gastric Sleeve (GS) surgery is the safest and best weight loss route for me. I’m confident that after reviewing the attached documentation the committee will agree and grant approval for the VSG.
My doctors consider weight loss surgery as ‘medically necessary’ and I have met all the requirements to establish medical necessity per BCBSNC medical policy (attachment 1). I am a 36 year super morbidly obese female with mostly obesity related co-morbidities that will improve or go away entirely with WLS. My current weight is 381 lbs with a BMI of 61 and have been 300 plus for more than ten years. My co-morbidities are sleep apnea, GERD, edema onset, hiatal hernia, difficulty breathing, trouble sleeping, joint pain and back pain, I can not walk or stand for more than 10 minutes; the excess weight causes tremendous pressure on my back, legs and joints. This has caused me to not be able to fully function in daily activities, enjoy life or exercise presenting a more sedentary lifestyle just waiting for additional co-morbidities to set in. Not only am I at a health risk for heart disease, diabetes, heart attack, stroke, hypertension because of my weight alone, these co-morbidities are all in my blood line, which puts me at a greater health risk. My father and mother both have type II diabetes. My father also has hypertension, neuropathy, has had heart bypass surgery as well as numerous strokes. I am volume eater, portion control and continuous hunger are my issues which is why I strongly believe VSG is the perfect WLS choice for my life without having to re-route my intestines, subject myself to increased dumping and possible higher risk of complications, malabsortption issues and possible future side effects that many RNY patients have seen that include malnutrition, bowel obstruction, hernia, depression,
gastritis, increased GERD plus many more minor and major complications including death. This was seen in study after study during my research.

Given the VSG’s track record it is the best option when compared to other bariatric choices, such as the Gastric bypass (RNY) or Lapband. The VSG procedure has been used successfully for weight loss since 1976 as demonstrated by medical studies (attachment 2) with out the many side affects or complications associated with the RNY or the LabBand. While any surgery carries risks, and I’m well aware of these, this surgery is not riskier than other procedures; in fact statistics show that it is safer. Documented studies show that it will generate between 60 to 80% of Excess Body Weight Loss (EBWL) in 6 to 12 months, many patients have achieved 90 to 100% EBWL during the same time periods with weight loss of 100lbs. to 200lbs. The complication rate of the RNY is 6.5%, and it’s considered the “Gold Standard”, compared to the complication rate of 1.5% for the VSG in the last 10 years and with similar or better weight loss results. See many examples of attached supporting documentation (attachment 3) that shows VSG is less invasive with the same results as RNY and/or Lapband. I have also read many encouraging stories from real people on Obesityhelp.com VSG forum who are 1-4 years out and have no regrets from having chosen this surgery and have had great success in losing 100-200 lbs as well as many documented stories on other Obesityhelp.com forums of RNY and lap band patients having revisions to VSG and DS (Duodenal Switch) because of complications or lack of weight loss and sometimes weight regain. The DS has been around for many years and is approved by BCBSNC in patients with a BMI>50; the VSG is simply the first portion of this surgery minus the malabsorptive portion of the surgery, which can be completed if necessary but why subject your body to malabsorption issues and further complications if a restrictive procedure will accomplish the same goal. The VSG has been proven to perform well as a stand alone procedure.
After reviewing BCBSNC Medical Policies in regard to Bariatric Surgery I would like to point out two items.
First, “When Surgery for Morbid Obesity is not covered”, (page 6, attachment 1) quote:
2. When the procedure is considered investigational, including but not limited to f. Sleeve gastrectomy, either as the sole procedure or as one step in a staged procedure
How long does a procedure have to be studied before it is no longer considered investigational? The LapBand gained approval for general use in less than 5 years, it is an approved procedure under our plan .There are a number of studies available dating back to 2001 and 2002 that lasted at least 3 years, I have enclosed several (attachment 3) Just these examples alone that I could find show that studies have been performed longer than 3 years for VSG. One study measuring Anemia on patients having this surgery dates back to 1976, only back then the procedure was called Gastric Exclusion (attachment 3).
Second: Surgery types (page 2, attachment 1) quote:
6. Sleeve gastrectomy (no specific CPT code). A "sleeve" gastrectomy is an alternative approach to gastrectomy that can be performed on its own, or in combination with malabsorptive procedures (most commonly biliopancreatic diversion with duodenal switch). In this procedure, the greater curvature of the stomach is resected from the angle of His to the distal antrum, resulting in a stomach remnant shaped like a tube or "sleeve". The pyloric sphincter is preserved, resulting in a more physiologic transit of food from the stomach to the duodenum, and avoiding the "dumping syndrome" (overly rapid transport of food through stomach into intestines) that is seen with distal gastrectomy. This procedure is relatively simple to perform, and can be done by the open or laparoscopic technique. Some surgeons have proposed this as the first in a two-stage procedure for very high-risk patients. Weight loss following sleeve gastrectomy may improve a patient’s overall medical status, and thus reduce the risk of a subsequent more extensive malabsorptive procedure, such as biliopancreatic diversion.
I’m in complete agreement of this statement. BCBSNC’s own medical policy makes positive affirmation of the VSG surgery, which further solidifies my choice in surgery.

I believe that our plan should adapt this surgery as a covered service not only for its many health related advantages but also because it is a cost effective choice compared to ALL other surgeries that are considered “proven”. A vast number of medical experts on the issue of bariatric surgeries are in agreement that the VSG is quickly gaining acceptance when compared to the RNY and will become the surgery of choice for weight loss, Among them Dr John R. Romanelli, MD FACS in his article Laparoscopic Sleeve Gastrectomy: The newest front in the battle against Obesity, published in WLS Lifestyles, fall of 06. His name can be “Googled”. While the Peer Review Committee has not yet considered this surgery for review, it is acclaimed by experts in the bariatric field and my surgeon, as safe, effective, with less complication, side affects and a viable option for weight loss. Additionally other BCBS policies (attachment 4) including Federal BCBS and Carefirst BCBS are adapting the surgery as medically necessary and I have read instances from other Obesityhelp.com forum members where BCBS insurance companies, including Anthem BCBS are overturning their initial denial of the VSG once supporting documentation was received supporting it being non-investigational. I hope BCBSNC follows the example of fellow BCBS policies.
I was pleased and encouraged to find that my health plan covers bariatric surgery and although this procedure is considered investigational by some, there is a body of undisputable evidence showing it to be sound, safe and successful in achieving it’s goal and probably superior to other weight loss surgery options, with many less side affects and complications; but most importantly, the best procedure for my current medical conditions and future wellbeing.
I trust that the attached information will provide additional information that will make possible a reversal of the initial denial. Attached you will find the documents relating to my appeal for consideration of the VSG for medically necessary weight loss surgery as a covered service under the Bariatric Surgery benefits of our health plan. I encourage this committee to please review the documented experts opinion and recommendations on bariatric surgery and approve this procedure.
Enclosed:
· BCBSNC Medical Policy
· Seven significant studies and stories supporting and documenting Vertical Sleeve Gastrectomy (including misc. documentation and articles)
· BCBSNC denial letter
· BCBS Carefirst Medical Policy/FEP BCBS Medical Policy
· BCBSNC Appeal Form

Thank you for your expedited consideration in this matter as I await a reversal of the initial denial.
Sincerely,

Rearch links:
Misc.
http://www.lapsf.com/weight-loss-surgeries.html

http://www.fepblue.org/benefitplans/2008-sbp/SBP2008Brochure_English.pdf

http://notesnet.carefirst.com/ecommerce/medicalpolicy.nsf/vwwebtablex/b573f47a27838f028525746a00470014?

Attachment 2
The first is a study that was done from 1976 to 1982 to check on vitamin levels and nutrition of "Gastric Exclusion for treatment of Obesity", I was searching under one of the alternative names for VSG and this one came up. I hope it is correct. I could not tell because it did not mention the VSG or RNY. Thanks Mercy Q
http://www.pubmedcentral.nih.gov/articlere...i?artid=1250639

Attachment 3
The next one was done between 2/01 and 5/02 with patient's over 50 yrs old. Thanks Mercy Q
http://www.ssat.com/cgi-bin/abstracts/06dd...T_DDW06_272.cgi

http://www.springerlink.com/content/ur18177j45164773/

http://www.asbs.org/Newsite07/resources/sleeve_statement.pdf

http://www.contemporarysurgery.com/inside.asp?ArtID=6014

http://www.palmbeachpost.com/accent/content/accent/epaper/2007/06/24/a1d_GASTRIC_SLEEVE_0624.html

http://www.medicalnewstoday.com/articles/69889.php

Can I get some cheese with this whine....

2008-10-22T10:14:00.000-04:00

Feeling frustrated last couple of days. I am mad at myself that I didn't just have RNY 5 years ago and yet I am thankful that I have found the new WLS's I didn't know about like DS and VSG. I really want to have the sleeve but after going through all the paperwork, seminars, testing and money, I just now start really looking at my insurance policy. (Much thaanks to all the OH folks for all the advice, especially about researching before you choose a surgeon or surgery...wish I had known that before) My insurance policy lists all the surgeries...RNY, DS, VSG, LAP, BPD, GB..then it lists all six requirements of eligibility and gives CPT codes for surgery...flip to the next page...lap is not covered for BMI's over 50, oh and we don't cover sleeve gastrectomy AT ALL annnd, no 2 part surgery requests will be approved. Hmmmm sounds like RNY is all that is left!! Why should the insurance company get to decide??? If my surgeon, myself , PCP and enocrine dr. all think VSG is a good way for me to go then that is how it should be. So I blew the smoking thing out of the water...Bought a pack, smoked them....bought another pack. I just don't understand. My surgeon's office is submitting for VSG anyway, we shall see but my hopes are not very high!! I need to win the lottery so I can self pay and decide what is best for me not the insurance company. My advice to anyone looking into WLS for the first time...Spend months researching WLS options, lurk and ask questions on all forums on OH (obesityhelp.com), know your policy inside and out, choose a surgery, choose a surgeon and then JUMP!! Then again, maybe my subconscious knew I would back out if I didn't get my way so I invested all the time and money so I would do something, whether I wanted RNY or not. Nahhh, that's not it!

The Smoking Caterpillar

2008-10-19T08:44:00.000-04:00

That was what my dreams were about last night...the smoking caterpillar from Alice in Wonderland. Whoooo Arree Youuuu? I had several other weird dreams...all involved smoking ofcourse. I am attempting to quit. Yes I am such a pessimistic, I said attempting! Part of me really does want to quit..I don't like the hold I feel it has over me. I would rather be able to smoke for enjoyment but I am a true addict so I smoke like a freight chain, like a crack addict who hadn't had a fix in a while. But the other part of me...oh how I miss that first drag in the morning after sipping my coffee. I hate how it smells though...it embarasses me that people complain that their stuff smells like smoke when they leave my house. Wow, that is a great memory to leave behind...My niece saying ..oh smell my blanket, it smells like Aunt Teresa's house....smoke!!! NOOO, you want her to say it smells like baked cookies or my perfume or ANYTHING but smoke. I did pretty good last night with the smoking thing... I slept most of yesterday, I have tried to stay away from triggers like talking on the phone or the internet or driving. I decided not to shower this weekend..I know gross but if I shower I WILL go to the store and buy a pack!! I have to do laundry today so I will try to stay busy...worse case scenario, I just go back to bed. Tomorrow will be tougher because I have to go back to work. Uggghhhh. The caterpillar did turn into a butterfly and left his smokes behind eventually. That is the first and foremost reason I am quitting....to have this surgery so I can release myself from this cocoon of fat and become my own butterfly.

Quote:
Advice from a Caterpillar
The Caterpillar and Alice looked at each other for some time in silence: at last the Caterpillar took the hookah out of its mouth, and addressed her in a languid, sleepy voice.'Who are you?' said the Caterpillar.
This was not an encouraging opening for a conversation. Alice replied, rather shyly, 'I - I hardly know, sir, just at present - at least I know who I was when I got up this morning, but I think I must have been changed several times since then.
''What do you mean by that?' said the Caterpillar sternly. 'Explain yourself!''
I can't explain myself, I'm afraid, sir' said Alice, 'because I'm not myself, you see.
''I don't see,' said the Caterpillar.'I'm afraid I can't put it more clearly,' Alice replied very politely, 'for I can't understand it myself to begin with; and being so many different sizes in a day is very confusing.
''It isn't,' said the Caterpillar.'
Well, perhaps you haven't found it so yet,' said Alice; 'but when you have to turn into a chrysalis - you will some day, you know - and then after that into a butterfly, I should think you'll feel it a little queer, won't you?
''Not a bit,' said the Caterpillar.
'Well, perhaps your feelings may be different,' said Alice; 'all I know is, it would feel very queer to me.
''You!' said the Caterpillar contemptuously. 'Who are you?'

The Nut, The Surgeon and the Shrink

2008-10-18T08:32:00.000-04:00

So I had the last of my pre op testing and consultation this week. I met with the nutritionist Monday. I expected a lot of talk about diets and food choices but she was more interested in talking about the surgery itself and why I was doing it, I thought I was at the phychiatrist. Lasted about 30 minutes, it was painless and my inurance didn't pay for it so out of pocket I paid 55.00. At least it wasn't hundreds.
I had my consultation Tuesday. I have heard so many good things about Dr. Enochs, I was excited and nervous. My mom and daughter went with me so we can all have as much information as possible. The receptionist took my 400.00 consult fee...ouch! and a 30.00 co pay. This surprised me because I thought the point of the consult fee was to cover their costs in case you ended up not having surgery and got no money from the insurance company, which is why I didn't mind paying the consult fee but if I had to pay a co pay, that means they billed my insurance too. So they do get paid. I guess I should have asked but I was just so excited to have come this far in the process. I guess in the end, it really is all about money. My appointment was at 3:00, we arrived at 2:45, we were finally called back at 3:45, then sat in the room until 4:45..2 hours! I was irritated! I kept saying I hope they are having an off day because I would hate for them to be the top bariatric office in our area and this is how they operate. The nurse came in to take blood pressure and stuff and ask me what surgery I was looking at and I said possibly lap band or...and she jumped in to say "Your insurance won't cover lap because your BMI is too high" What??? What if that was the ONLY surgery I was willing to have? That would have been a good thing to tell me BEFORE I paid 400.00!! I said or the sleeve...she said oh they might do that but usually they only cover RNY. Well I don't want RNY. Why does it matter, it is my body! This just infuriates me. WLS is a choice I feel for lower BMI's but I think oncve you surpass 50, WLS is a necessity and it bewilders me how the insurance companies can look at it any other way. So Dr. Enochs came in and he was warm and friendly, made me feel very comfortable. He wasn't rushed even though he had to be somewhere by 6:00 and we were pushing 5:30. He skimmed over my chart and said he would recommend the sleeve for me as a surgeon because I don't really have many co-morbidies..I am somewhat healthy for a fat person! I do have a slight hernia and slight acid reflux and a fatty liver. The hurdle will be the insurance company. I know if they deny it, I will appeal...beyond that..I might push for lap band. I don't know what I will do. Try on my own once again I suppose. I didn't get to ask him all my questions, since most of them were surgery related I decided to wait until I was definately going to have surgery, plus he had to be somewhere so I thought I would be nice and not hold him up even though I had to wait for 2 hours but whatever, I am not bitter. LOL Really I'm not. I was a little irritated that day but Dr. Enochs was so nice, I got over it pretty quickly.
I met with the psychiatrist yesterday and she was super nice as well. I might have to meet up with her again. She specializes in bariatrics so I might need her down the road. I had to do a questionaire that asked questions like do I binge, do I closet eat, make myself throw up. Then we talked about the different surgeries and she said she has a lot of patients that are disappointed in their bands because they can cheat it and a lot of RNY's losing hair because they are not following the rules so she emphasized the importance of protein and eating right, lifestyle change. I know all these things but I think it really hit me for the first time in her office. I have just been so excited about what could be. She also helped me confirm my thoughts about not telling anyone at work. She said she has a patient that did tell everyone at work and they are not losing weight and people keep asking why isn't it working or can you get a refund. I don't want to face that pressure. I won't be lieing if they ask how I have lost weight and I say I watch my portions and excercise. A lot of people have surgery or get on medications to help cure a medical problem and end up losing weight. She asked if I was scared and if I thought about the changes I was going to have to make and I said I know the changes but I really don't feel I have a choice, it is kind of like if I had stomach cancer and they had to remove the cancerous stomach. It's a have to for me so "just jump" and figure out the rest later. She wanted to make sure I wasn't obsessed with being skinny...what did I want to weigh? I don't really care what I weigh...I just want to be healthy, to feel good, to be able to walk without hurting, to be able to really clean my house without relying on others, to be able to go places and have fun with my children, go on vacations and not stay in the hotel room or sit on a bench while everyone else around me is living. I want to live!

First Steps

2008-10-05T07:47:00.000-04:00

So in order to have surgery, you have to jump through some hoops with paperwork and testing. Ofcourse I attended an informational seminar back in May and filled out all the paperwork for the surgeon. I procrastinated for a couple of months on submitting verification of coverage to my insurance company...not sure why other than being scared of change. But I submitted it late August and then set up appointments. I saw my PCP first and talked about surgery, she was all for it. I came back in on 9-22 to do the EKG and bloodwork...piece of cake, I was in and out in 30 minutes. I went on 9-24 to do an ultrasound of my gall bladder..easy, a chest xray..easy, and a barium swallow...not so easy but not horrendous either. First they had me stand on this platform that was connected to a table in upright position against my back with an xray machine in front of me. I had to swallow these crystals that looked like pop rocks and I immediately had an overwhelming feeling to burp but I was told not to. Then I had to drink barium, this thick white chalky stuff, I had to gulp it while they took pics of it going down. Had to stop once, felt like I was going to spew! Then the table laid back...I had to literally roll around on the table to coat the barium on my stomach and lay in all kinds of positionsso they could take pictures and then drink some more barium and take more pictures. Talk about awkard! The next week, I felt a lot of gas and bloatiness, burped alot, had constapation, then diarhea, then constipation again. A co-worker gave me a nexium the following Wednesday and wheww..relief! Wish I had thought of that sooner!!! I scheduled my nutritionist and psychologist appointments and my consultation with my surgeon is October 14th. From there hopefully I can have surgery pretty quick since all should be done. I just have to quit smoking. My PCP prescribed me zyban..seemed to work the first day, last 2 days I couldn't get enough cigarettes but I made a quit date of Oct 20th...the plan is to put them down. I have had weird dreams last couple of nights on this med...real weird, like twisted stuff. I dreamnt I had a brain tumor, that I kicked my daughter out of the house and that someone broke in my house and we were fighting with knives. I told ya..weird!

Not promised tomorrow...Thank you God for today

2008-09-27T20:44:00.000-04:00

Have you ever been scared to death to move forward, yet scared to death to stay where you are? That's how I have felt for 10 years. Scared to leave my comfort zone and move onto a different life and make changes yet scared to stay in my comfort zone because it is miserable and will only lead to an untimely death carrying around all this extra weight. I thought I might had met my untimely death today...I had chest pains like I have never had before and then I threw my guts up. It scared me..bad! I thought I was having a heart attack. My daughter even wanted to call 911. It finally eased off and I have felt fine since so I am hoping it was something I ate yet still kinda scares me because if it was something I ate...shouldn't I still be sick? What if it was a minor heart attack and the massive one is lurking around the corner! So today my thoughts have been reflective...What if I had died? Who would take care of my kids? I don't want people to say, "It's a shame she died but no wonder she had a heart attack, look how fat she was" How would my parents pay for my funeral? Not to mention, the pall bearers mumbling under their breath at how heavy the casket is. I would miss out on my children's weddings, my nieces weddings, my grandchildren! All the trips we are supposed to take after our kids are grown. I would never meet the man of my dreams. I have too much left to do. I am thankful to be alive and I am angry at how much time I have wasted. Why have I waited so long...what exactly am I scared of? Even if this surgery doesn't happen...it is time for a change. I have to make a change. It is a matter of life and death at this point. I am playing Russian Roulette and my luck is not very good.

Covering the basics

2008-09-26T20:21:00.000-04:00

I have a lot of ground to cover in this first blog. As I said in my About me, I have been overweight most of my life. I started putting on weight at age 11 and it just escalated through the years. I have done all the fad diets and tried Phen -Fen, and with each success I put on more weight than I lost when I would go back to eating normal. I became a closet eater and food was my best friend. I was always known as the easy going , happy go lucky "friend" of the group. All the guys went for my friends so you can imagine what that did for my self-esteem.
I first heard of weight loss surgery (WLS) back in 1998, I saw an infomercial for Fobi Pouch which was only done in California. I was so desperate, I was willing to travel to Cali. I went through the whole process and insurance denied it. I went through a major depression and packed on about 70 lbs. During this time, I lost my job, my girls were becoming teenagers, my ex husband passed away and I pretty much became a hermit because I was scared to go anywhere out of fear of not being able to fit in a booth, or movie theater seat or people staring at me. At this point, I had escalated up to about 300 lbs. In 2002 I had no choice but to get back in the world because I had to make a living and provide for my girls so I forced myself to function. I landed a good job with the state in 2003 and started looking into WLS again. This time I went to a Duke seminar and Lap-Band was now an option but my insurance only covered Gastric Bypass. This surgery scared me to death so I passed besides my weight wasn't a physical hinderance at this time just an appearance issue. I teeter tottered between 300-330 up until 2007 when I was diagnosed with hyperthyroidism and Graves disease. Now most people with this disease lose weight because their metabolism is on overdrive but I maintained my weight, lucky me I was in the 2% that weight loss was not a side effect.... but with the meds, my doctor told me I would most likely put on some weight and I did! Over the next year I packed on 50lbs...I am now at a womping 378, and it is a physical issue now. My knees hurt, my back hurts, I can't breathe, walk, do household chores. I am miserable! So once again I check into WLS and my insurance says "Yes" with the proper paperwork, they would most likely cover the Lap Band. Woo hoo! This go round is so different for me because it's not about getting the guy or looking good, all those are nice but I want to be healthy. I want to ride rides with my kids at amusement parks and walk and play and laugh. I have missed out on the past 10 years of their lives and mine! So I embark on this journey to find the skinny woman trapped inside.