Gastric Banding–Pre-Surgery Stuff

by Christine on April 11th, 2010

filed under Gastric Banding Surgery, General Information

This blog post is a continuation of the gastric-banding surgery post that I began yesterday. Please read from the original posting first and then read this one in order to view them in chronological order! This posting describes the pre-surgery testing and medifast period that I had to undergo prior to gastric banding surgery.
Pre-Surgery Stuff
Before I could do anything, I had to attend a mandatory informational meeting. This meeting was held at the hospital, and all it was was an informational “what is LapBand and Gastric Bypass, and which one should I pick” kind of meeting. I personally decided that lap band was a better option for me than gastric bypass only because I know someone that went through GP….and GP alters your diet for the rest of your life….as in, you cannot have sweets, sugar, alcohol, etc….EVER again. That’s DEFINITELY not something I want to consider. Lap Band limits the quantity of food and requires some dietary restrictions, but none as severe as the GP. Anyway, I digress.

Following the Informational Meeting, the Bariatric Center then called me for an appointment. This appointment involved a general physical. I had to get into one of those awful hospital gowns with my ass sticking out. The doctor asked me questions about cancer/diabetes, etc in my family history. He checked the size of my liver and listened to my lungs. He checked my blood pressure, looked into my eyes and mouth, etc. Nothing evasive or very uncomfortable. He told me after this meeting that I am an “excellent candidate” for lapband surgery.

He then walked me over to the surgery planner. She called me in a week with my surgery date already planned! My surgery date was February 28, 2009.

There are many pre-qualification doctor visits needed before my surgery, including a psychiatric evaluation, a meeting with the nutritionist, etc. I had about one month to make those visits.

Before surgery, you need to lose 10% of your body weight. This will reduce the size of your liver and make it easier for the doctors to find your stomach and wiggle their way into your insides. For me, 10% of my body weight was 20 pounds or so. In order to achieve this goal, I went on a Medifast Diet, which is essentially just a protein shake diet, for 6-8 weeks prior to the surgery. I started the medifast diet on January 1, 2009.

Psychological Visit
In order to qualify for the surgery, you need to pass a psycholigical exam. I believe the point of this exam is to determine that you aren’t suffering from depression (I mean, that you’re not well-adjusted and actually suffering, not being treated for it, etc.), to check for past suicide attempts and find out what the deal is with that, and to make sure that you have a good support system during surgery and the weight loss time. They want to make sure that you aren’t keeping your surgery a secret from your family and friends.

My appointment went amazingly fast. I was worried a little bit beforehand because I DO have a past suicide attempt and am currently being treated for depression. However, he felt confident that my meds are straightened out and that I’m secure and in-tact. (Which I am. I am not suicidal or anything like that.) There was a form to fill out about family medical history, which he looked over. Then he informed me that I’m an excellent candidate for surgery and he will recommend me to the doctor!

I had to pay a $30 copay for this psych appointment.

Pre-Hospital Testing #1
I had to go in to the hospital for a half day worth of testing. Now, the tests that they want you to take are really dependent on your physical condition and existing ailments and whatnot. For instance, my ex-boss who had the lapband surgery had tests for his gall bladder, which involved gall bladder surgery BEFORE lapband surgery. For me, the gall bladder wasn’t a problem at all, so they didn’t even test me for it. Before testing you couldn’t eat or drink anything after 10 p.m. the night before.

I showed up at the hospital and gave them all my insurance information. Then they got me into a gown (which, surprisingly, wasn’t as awful as I was expecting. Yes, the shirt was one of those open-backed dealies, but they also gave me loose pants to go with it AND a robe for over the gown.) First they called me in for some X-rays. Turn this way. Then turn that way. Snap snap snap. Less than 2 minutes and I was back out in the waiting room.

Then they called me in to do gastrointestinal testing. This involves drinking a barium “milkshake.” It comes in a milk bottle, like maybe 16 ounces of the stuff. And….it’s not as horrible tasting as I thought it would be, but it was still VILE!!! The woman laid me down on this metal bench with a big old contraption (another X-ray machine?) above it. It was pretty intimidating looking. So I’m laying on my tummy and they pour this drink into a plastic cup and give me a straw to drink through. She said, “I’m going to take some pictures of you while this stuff is going through your body. So follow my instructions and don’t move!” Then she goes into the other room and says, “Drink! Now breathe. Drink! Now breathe!” To be honest, the stuff was super gross so I was like Drink – gag – gasp for breath – drink – gag – gasp for breath. Tears were running down my face from the gagging. The lady was really nice though. She gave me a few minutes breather before she wanted to try the whole thing again. UGH.

I guess some people digest the stuff slower than others, so the barium liquid doesn’t make it all the way down into your tummy like it should, so with some patients they ask them to walk around to get the liquid moving, then bring them back and do another round of tests. I guess my body works pretty fast, so one shot was all that was needed. Fabulous!

Then they told me to get dressed and go to meet the repiratory people. I went to that person. She needed to take blood from me, but from an artery instead of a vein. It was still in my wrist, and it didn’t hurt very much. It felt like normal when you give blood. Just make sure you don’t wiggle and move too much. That was fast. Then she had me breathe into this contraption to see what my lung capacity is. All you do is blow as hard as you can, then HOLD your breathe (don’t breathe in) and you get dizzy and think you’ll pass out then, she says, “good!” and you get to gasp for a breath. I had no problems with that test, and it wasn’t hard or intrusive or anything. (I have to imagine that swimming would greatly enhance your ability to hold your breath for this test.)

After that I was done!

Medifast Diet
On January 2nd I started on the Medifast diet. Now, I went online and I saw that anyone can buy their products online. However, there are real FOOD items online, but my doctor only wanted me to do a shake diet. I’m not entirely sure why, but okay, that’s what the doctor wanted.

My Medifast diet was a little different than my boss’s was, so I have to imagine that they tailor this diet on a case-by-case basis. My boss had to do 5 shakes per day, with NO FOOD AT ALL during this period. He was on the diet for, oh, what, 4 or 5 weeks? During that time he lost 40 pounds. Of course, he was much heavier than me and had more weight to lose. He did very well following the shakes-only diet, although he expressed to me that he got really sick of the flavors.

If you decide to order these shakes (again, anyone can order them!) or embark on this diet, let me warn you — the strawberry shakes are truly putrid! I had a really hard time choking the stuff down. The vanilla is pretty bland and neither good nor bad, but you can add other flavors to it for a little variety. For instance, if you go to the grocery store and buy some extracts, you can make root beer flavored shakes or whatnot using the vanilla base flavor. I personally think the chocolate and the orange flavors were the best.

Like I said, my diet was different than my boss’s. Because I have less weight to lose (although I explained to the doc that I am weight-loss resistant) they gave me MORE time to lose weight but put me on a four-shake-a-day diet with one small meal per day in addition. The small meal should include some kind of lean meat (grilled chicken, fish, etc.) along with 2 cups of a vegetable. There are some limitations as to what kind of veggies and meat is ok and what isn’t. They want you to stay away from the real starchy veggies (so no potatoes, corn, etc.). There is to be no soda (diet or regular), no sugary beverages, etc. Only 2-3 cups of a caffeinated beverage per day is allowed. One strange thing about the diet, whether you go with the meal or not — you need to have 1 Tblspoon of an oil per day, which I believe is to keep the gall bladder working. This can be used in grilling your meat or in a salad dressing, etc. I have to be honest, I didn’t do entirely well following the diet…, I went out to eat a lot and I even had a glass or two of wine, too. I had pasta once, and carbs/starches are NOT allowed. Either way, I’m still lost weight so wasn’t that big of a deal. I found that having the one small meal a day was pretty hard sometimes because I’m an all-or-nothing kind of person. My boss agreed that doing one meal a day would have been really hard for him, and he was glad that he just did all milkshakes.

Over time, I found it difficult to do a full four shakes per day, especially as the weeks progress. I got so sick of them, the mere idea of them made me feel like BLAH. I decided that I’d rather eat nothing than have to choke down another chocolate shake. Even from the onset, I was only doing three shakes a day. 6 weeks into the diet, I was really only doing 1-2 shakes per day. I was so glad when the Medifast period was over! 

I had to go into the clinic every week to weigh-in. They tracked my weight loss progress on the Medifast. I also bought my supply of shakes at that time. (A pack of 5 shake mixes costs me $11.) Every time I went I neededo pay another $30 co-pay, which got a little expensive but I knew that it wouldn’t last forever. I purposely rescheduled my appointments for every 9-10 days instead of 7 days in the hopes of shaving off a week in the long run and saving me $30. (Ha ha, the scheduling lady didn’t catch onto my reuse!)

After the 8 weeks of the medifast, I lost, I think 20 of the 25 pounds they wanted me to lost. I was freaking out that if I didn’t lose the exact amount of weight that the surgery would have to be rescheduled. However, my doctor felt confident that I had lost enough weight, so the surgery progressed as planned. However, it’s worth noting that if you don’t meet your weight goal by 10 or more pounds, your doctor may decide that it shows a lack of determination, ability to follow the diet, or an indication that something is going on medically; the doctor may decide to postpone your surgery.

Pre-Hospital Testing #2
A week to go to the surgery, I went in for more testing. They call this “Pre-Admission Testing” or PAT. The first part involved filling out paperwork and signing my life away (ha ha, literally). Then I paid my co-pay for the surgery itself, which was $100 for me.

Then I went upstairs where I was asked to pee in a cup. Then they drew more blood (4 vials worth….one to determine my blood type, one was a pregnancy test, and I have no idea what the other two were for, I forget). Then they did an EKG, which involved putting little stickers around my left boob and hooking them up to the electrical machine. (It didn’t hurt a bit.)

Then a nurse came in to ask me a bunch of general medical questions (when was your last period, have you ever had surgery before? are you allergic to anything?) and then a pharmacy intern came in to ask me questions about what drugs I’m currently taking. This was all routine stuff….things I’ve answered about 4 times now!

I then met with my doctor….the actual surgeon who will do the work. He seemed nice enough. He went through what the surgery was and the side effects, which is all stuff I’ve heard about 4 times now. I also did my last formal weigh-in and bought more Medifast. He gave me the results of some of my past tests, recommended that I take Vitamin D vitamins, and told me to stop eating my one meal a day on the metafast and just do shakes-only.

The Pre-Hospital Testing #2 event was very easy and nothing at all to worry about.

Before the surgery, I was required to get a sign-off from my Primary Care Physician. I had my appointment the next day with my Primary. He weighed me, took my blood pressure, had me pee in a cup again, listened to me breathe, asked me how I was doing, and then said, “yup sounds great, you’re good to go!” and that was that! That appointment cost another $30 copay.

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