Apr
06

Weight Loss Surgery: The Preop Phase

One of the aspects of this experience that I really appreciate was how thorough the bariatric surgery preop approval process was. It made me feel confident that it wasn’t just about the $ for my surgeon. Even more importantly, it showed me that I could see this through. The number of appointments and evaluations I had to get through in the midst of school, work and clinical, was a little bit nuts. But I did it.

Did I bitch and moan along the way? Perhaps a little. ūüėČ

Of course, part of the reason this experience was so detailed is because insurance requires it. Since this is considered an elective procedure, there are a lot of hoops to jump through to demonstrate you’re not too unhealthy to have the surgery in the first place (ironic, no?). But regardless, I feel much better about going into fairly major surgery knowing that we have prevented potential complications as much as we can.

Here is a run-down of my preop life, in calendar view:

  1. December 18, 2014: Attend an information seminar led by my practice’s case manager and one of the surgeons (the surgeon I ultimately chose to do my procedure). Learn about insurance requirements and the different types of surgery available. S comes with me and tells me he will support whatever decision I make. What a guy.
  2. January 21, 2015: Initial consult with the surgeon to talk about my options. We’re weighing SIPS versus sleeve gastrectomy. While I’m there, have labs drawn and get an ECG and chest x-ray done at the neighboring hospital. Also meet with the case manager to discuss the entire process, step-by-step.
  3. January 29, 2015: Tell my family that I’m planning to undergo weight loss surgery. Get nothing but love in return. I am a lucky lady.
  4. February 4, 2015: Seven-day food diary review with the physician assistant in the office. We discuss some of the changes she recommends I make now. Also find out during this visit that I had an abnormal ECG, which means I’ll have to get a cardiologist to clear me before I can be approved. Rats.
  5. February 12, 2015: Evaluations with the in-house nutritionist to talk about the pre-op and post-op diet requirements, and with a psychologist to make sure I can cope with the lifestyles changes I’m going to face. Also fill out two psych tests to make sure I’m not (too) crazy. ūüėČ Accomplish both evaluations in one day. Fun.
  6. February 18, 2015: Initial evaluation with cardiologist. He thinks the ECG was probably due to “low voltage given [my] body habitus”. In other words, I was too large to get a good signal. But just to be safe, we schedule a stress test and echo for later this month. This is also supposed to be the night I have my sleep study, but then it starts to snow and all of North Carolina goes into lockdown mode. Sleep study is rescheduled.
  7. March 4, 2015: Long-awaited sleep study to determine if I have obstructive sleep apnea (OSA). I’d been diagnosed with mild OSA years before but never got a CPAP because insurance wouldn’t cover it at the time. I have a feeling it’s worse these days.
  8. March 12, 2015: Undergo EGD (aka esophagogastroduodenoscopy…say that five times fast) with my surgeon. Nothing too scary ¬†in there. I’m cleared for surgery from a GI standpoint.
  9. March 13, 2015: All required testing for insurance purposes is done. Case manager submits me to insurance for pre-approval and tells me it will take about 14 business days.
  10. March 17, 2015: Stress test and echo. Cardiologist says everything looks good, except for my markedly reduced exercise capacity for a woman my age. No sh*t. But I get my cardiac clearance.
  11. March 18, 2015: Sleep study #2. Sleep apnea was confirmed (much more severe this time around), so now I come back to be fitted for a CPAP and figure out what settings I will need at home. Find out I have to meet with the sleep center medical director (who also happens to be my surgeon) to review the results before I can be scheduled for surgery. He is booked for two weeks. Start to panic that I won’t be able to schedule surgery¬†during the very narrow window I have in between semesters to get through it and start to recover. Want to cry. Sleep center manager sees my distress and fights for me to get an appointment by the weekend.
  12. March 19, 2015: Receive notification that insurance has approved my surgery! What a relief!
  13. March 21, 2015: Early Saturday appointment with sleep center director/surgeon to review my sleep study results. He knows I’m pressed for time as well and his medical assistant flips my visit to a results review – to go over all of my diagnostic testing at once. It’s the last step before I can be scheduled. I love these people. Before I leave he checks his calendar and gives me a date: April 23. I could kiss him.
  14. March 23, 2015: Get a phone call from the surgery scheduler that I am officially on the books for 4/23. They email me preop instructions and we pick a date for my pre-op appointment with anesthesia. One month to go.

I’m exhausted just re-creating this list! Let’s just say I’ve already met my out-of-pocket maximum for the year, and I haven’t even had the surgery yet. Lots of ups and downs over the past few months, but when all is said and done I’m glad they were so thorough.

Next up: the dreaded pre-op “liver diet”. It’s only temporary, right?


Apr
03

About My Choice

By now you’ve had a few days to digest my big news (pardon the pun). You may have mixed feelings about it. Trust me, I’ve been preparing for this experience for four months now, and I have my moments.

If you are curious, the exact procedure I will be undergoing is called a SIPS (stomach intestinal pylorus-sparing surgery). It is a fairly new surgery that pairs two procedures: the vertical sleeve gastrectomy and a modified, less technically-complicated version of the duodenal switch. A version of this procedure was first trialed in Spain, with amazing results and few complications. It is currently offered at five centers across the U.S. and thus far outcomes have been phenomenal. By combining both restrictive and malabsorptive processes (but avoiding some of the malabsorptive issues common with a gastric bypass), it is being touted by some as the future of bariatric surgery. My surgeon has been doing these since last year and has been really pleased with the results. Granted, it is new-ish (first performed in 2007), so long-term outcomes are not yet available.

Check out this video for more detail (and somewhat gross surgical footage, for those of you who enjoy that sort of thing ;-):

I’ll post more about the preop process I had to undergo, as well as some of the postop requirements, in the next few weeks leading up to surgery. Rest assured that this will not become a personal diary about my weight loss journey. But I also believe that this experience is an important part of my overall journey. And being transparent about the struggles as just as important as celebrating the victories.

In the meantime, tell me what you think! Do you know anyone who has undergone weight loss surgery? How did it go? What are your thoughts on this process? I want to hear from you.


Mar
30

The Emperor of All Maladies: The Documentary

You may remember my awed review¬†last year of Siddhartha Mukherjee’s incredible book¬†The Emperor of All Maladies.

Turns out Ken Burns has been working on a documentary of the same name, based partially on his work.

Pardon me while I squeal like a kid in a candy store. (Yes, I am aware that I am a weirdo).

(Source)

Airing tonight and all week on PBS. Check it out.


Mar
28

Time for Drastic

Well, hullo there, strangers! Miss me? ūüėČ

For those of you who have stuck around, bless you for your patience. The past few months have been a bit of an emotional and physical roller coaster. But I have some big news to share.

Last December I went for my annual well-woman exam and mentioned to my midwife that S and I were earnestly starting to talk about getting pregnant. She point blank told me that was a terrible idea. Not because she thought I would be a terrible mother. But because she didn’t think it would be healthy or safe, on account of my weight.

Ouch.

We ended up talking for a long time. She listed all of the potential health consequences of being pregnant and obese. She mentioned that a few more pounds and my BMI would land me in the hospital as a high-risk delivery. Basically, she scared the shit out of me.

Then she suggested thinking about weight loss surgery. I told her the idea had crossed my mind in the past but it always seemed like it was a little too drastic. She looked at me sadly and said “I think we’re there, love”.

Ouch.

So I went home and cried for about two days straight. I was so ashamed. So sad. So … everything. But also so, so grateful. Finally someone told me what I needed to hear.

I’ve never had any serious co-morbidities because of my weight. No diabetes and my cholesterol is beautiful, as is my blood pressure. I had a touch of sleep apnea diagnosed in the past, but it was so mild my insurance wouldn’t pay for a CPAP. So my providers have always encouraged me to lose weight, but never really had that “come to Jesus” talk. I’m still young and fairly healthy. Perhaps they thought (as did I) that I just needed time and support and I’d get back on track. When I started slowing down over the past couple of years because I’ve basically been carrying around another person, I got freaked but just thought I needed to buckle down and go to the gym more, or eat better. The problem is, I did those things for a while and then I’d have a setback and I’d get discouraged and I’d be back to square one. Plus 20 more pounds. Being a perfectionist has its perks, but it can also really mess things up. That whole self-care thing? Setbacks just tend to send me into a tailspin. I believe one of my doctors once called it being “tightly wound”.

It’s never been a matter of not knowing intellectually that I need to lose weight. Or not understanding how to do so. I’m a nurse, for crying out loud. I know. But I’m also a human being with angels and demons of my own, and my particular demons are of the deliciously indulgent variety.

So in all my “free time” this semester, I’ve been doing more homework. Figures. ūüėČ

But this time, the homework has been to figure out what this whole weight loss surgery thing is all about. I’ve gone to seminars and read websites and blogs, and talked to the people I love. I was afraid I’d feel ashamed by sharing this struggle. I was afraid that my husband and family would have the same gut response that I first did … Isn’t it a bit drastic to have your guts rearranged, “just” to lose weight? Instead I’ve been inspired by the outpouring of love and support I have received. Turns out that everyone’s been as worried as I am, and they are proud of me for taking this step. For making the big, drastic commitment to change my life. Because the more I’ve learned about this process, the more I’ve realized that the surgery is only the first step. It helps me lose enough weight that I¬†can¬†do the stuff I must do to get the rest of it off. It’s up to me to¬†take steps two, three and four.

wls_ecard

(Source)

Soooo, long story short, on April 23rd I’ll be undergoing weight loss surgery. Step one, on the books.¬†


Dec
23

2014: Learning to Say “No”

So far my 30s have been anything but calm. The traditional cultural perception that your 20s are tumultuous certainly held true for me, but I am beginning to think that the whole idea of settling down and really being a grown up (whatever that means) is total and complete hogwash. Every year feels like a new transition, with a new moral of the story.

So here was 2014’s hard-won¬†lesson: this year I learned to set limits.

With one health setback after another and promises to myself broken, I came to¬†two seemingly incongruous conclusions: 1) I will never be¬†not¬†busy because that is just how I operate. 2) On the other hand, it’s important to keep myself busy with things that bring me joy and start moving away from things that drag me down. Being busy for the sake of busy-ness is no fun anymore.

So I learned the word “No”.

I said “No” to a school schedule that was borderline-sadistic and was sucking the enjoyment out of my education…very unusual for me.

I said “No” to working night shift in order to salvage my health and my sanity. I then said “No” to a job that was starting to drain all of my emotional, physical, mental energy.

Then I said “Yes” to three new jobs. Sigh. ūüėČ

But they are all jobs that sustain me, and will open doors to new opportunities as a nurse practitioner. I’ll be cutting back on some of my hours next semester in order to focus on clinical residencies, but I ultimately decided to keep all of the positions on a very¬†part-time basis, to keep my options open when the time comes to transition into my new role.

I am also saying “No” to self-defeat. As many of you know, I have struggled with my weight for many, many years…for many, many reasons. I’ve always rebelled against weight-loss programs in solidarity with my fellow curvy women and in rejection of a societal ideal that is impossible for most of us. But reality hit me right in the gut this year, when my usual exercise routine¬†became almost impossible due to joint pain and deconditioning, and it then became impossible for me to walk down a long hallway or climb the stairs at home without getting out of breath. It’s no longer a matter of rejecting a Size 2-lifestyle. It’s a matter of wanting to be alive when I’m 50 without being totally disabled. It’s a matter of wanting to get pregnant without being “high risk” just because I weigh too much. It’s a matter of wanting to participate in my life more fully. I have turned down social invitations because my closet is full of clothes that no longer fit. I have failed to participate in family outings because I am too embarrassed to break a sweat when I climb a hill in my mother’s hill-y Berkeley neighborhood. I am halfway dreading an upcoming family trip to the Caribbean because wearing a bathing suit is an exercise in humility and I’m worried I won’t be able to snorkel or hike with everyone else because I won’t be able to breathe. I’ve been in a downward spiral for so long that I’m about to crash and burn.

So 2015 will be different. That’s the only pseudo-New Year’s Resolution I am making. There are specific plans being made, but I’ll share when they are more concrete. For now, let’s just say that as I’ve learned to say “No” to the choices that bring me down, I am also starting to learn how to say “Yes” to the choices that lift me up.


Dec
11

Another One for the Books

Gah, someday I will recapture the art of blogging whilst studying, but apparently it’s not today…

Tuesday I submitted my final paper/project of the fall semester. Today I saw that my final grades were posted.

Stick a fork in me.

That’s a wrap.

Another one bites the dust. … Can you tell I’m a bit punchy? ūüėõ

For being my “lightest” semester credit-wise, there was nothing really light about this fall. I worked my tail off, while learning three new jobs. No, I wasn’t stressed at all.¬†In the midst of everything, I also had another crash/burn cycle of migraines, and had to take an incomplete in my oncology residency, which I will wrap up next spring with a new preceptor. I will apparently never learn how to truly slow down.

So what’s next on the docket for Nurse Teeny?

  • Finish up my oncology residency. Just have 50 hours to go. All of my assignments were completed this semester, so it’s a matter of getting in the clinical time.
  • Start my primary care residency in … wait for it … PALLIATIVE CARE! Double bonus – it’s with the medical director at my current workplace, who already knows me well. I was literally sitting next to her at a retreat when I got my clinical assignment via email and almost fell out of my chair. I don’t exactly know how I swung that (I certainly didn’t request it), but I have a sneaking suspicion that someone is trying to tell me something.
  • Resume my DNP coursework with a finance class. *Shudder*
  • Take my first official nursing education class. Woop woop!

I’ll be taking on more responsibility at hospice, which equals fewer shifts in hem/onc. Which is okay because I officially hate giving chemo (another story for another day…). And, I get to continue teaching, which is my newfound love. I’ll be continuing as a clinical instructor in the same class I was teaching this fall, and I’ll also be a lab CI for the students’ health assessment teaching time.

But first I pick up some extra shifts to make some much-needed $$$ and then S and I head to Antigua for five days! Couldn’t be better timing … we both need a break from reality!


Nov
06

Thoughts on Brittany’s Choice

Chances are, you’ve heard the name “Brittany Maynard” uttered frequently over the past several weeks. Chances are, your social media feeds have been full of videos, articles and opinions posted about the decision the 29-year old made to publicly share her decisions related to her terminal glioblastoma diagnosis.

Chances are, you have strong feelings about the choice she made to end her life over the weekend, utilizing Oregon’s “Death with Dignity” act.

As much as I’m sure Brittany valued her privacy, I appreciate her giving a voice¬†to this debate, for coming out and sharing her story, in the face of strong criticism. In many instances, her experiences have sparked a healthy and important debate, from the philosophy and ethics behind the death with dignity concept, to whether there should be a distinction between how Brittany died and other forms of suicide, to whether we have over-idealized death. It has certainly led to conversation about whether death with dignity legislation will reach beyond Oregon, Washington, and Vermont. It has also raised awareness about the important and thought-provoking work of Compassion & Choices, the organization that advocates on behalf of and directly supports terminally ill patients throughout the country.

I’ve also been disappointed (but not necessarily surprised) about the vitriol and judgment that has come across my computer screen..I won’t dignify this hatefulness¬†by linking to it, but you wouldn’t have to look hard. I was shocked to hear a hospice physician declare that she didn’t understand why Brittany wanted to “off herself just because she had a terminal diagnosis”. I feel compassion for the patients with their own terminal illnesses who came forward and begged Brittany not to end her life. I was amused by the comments on Facebook and Twitter that we live in a death-obsessed society, when in my experience, it’s been exactly the opposite.

The reason we struggled with Brittany’s public (and in my opinion, courageous) choice was exactly because we don’t know how to talk about death.

In an era of medical technology that far surpasses the imagination, accompanied by a religious movement that believes that cures for cancer come from prayer, we don’t like to acknowledge that we will all be there someday. We use terminology like “battles” and “courage” to describe those who pursue aggressive treatment, sometimes at all costs. Then we turn around and call people like Brittany Maynard a coward for acknowledging the inevitable and going out on her own terms, after she crossed off the last item on her bucket list (a trip to the Grand Canyon) and after she celebrated her husband’s October birthday.

Working in palliative care and hospice (and with a background as an oncology nurse),¬†I’ve seen “good deaths” and “bad deaths”. But the important lesson I have come to understand is that I don’t get to decide what makes them “good” or “bad”. I may have emotions or opinions, but it isn’t my death to face. And when the time comes for it to be mine, I can only hope that I live in a state that gives me the freedom to face death on my own terms, in my own home, surrounded by my own family.

Death comes to us all,¬†whether we like it or not. I’ve often heard fellow hospice nurses refer themselves as “end of life midwives”. I think this is quite poignant. Just as coming into this beautiful world need not be medicalized to the hilt, neither does leaving. We can love our lives, we can cherish our loved ones, we can grieve for ourselves and for what we might miss when we finally say goodbye. But the truth is, we will¬†all¬†be saying goodbye at some point. How (and with whom) we choose to say it is our last chance to make a choice.

And what a profound choice that can be.


Oct
31

Product Review: Tafford Plus Size Scrubs

I am constantly in the market for scrubs that are comfortable, fit well and will effectively cover me when I’m on my feet for 12 hours.

This is not an easy task when most scrubs retailers feature models who wear a size 0 and make it appear as if you could run a marathon in their trendy low-rise, cargo pants. Here’s a hint: Trendy low-rise cargo pants may look cute but they’re not so helpful when you’re in the midst of a code, doing chest compressions on a patient who fell out on the floor. Trust me, I’ve been there.

It’s fun to look nice, but nurses need scrubs that will stand the tests of time and rigor (and hopefully look nice as a bonus). Add a few extra pounds to the equation and it gets even more challenging.

So when Tafford Uniforms contacted me about trying out a pair of their new plus size scrubs, I jumped at the opportunity. On the Plus Size line’s website, I read that they emphasized slimming lines through color blocking and strategic seam placement, elastic smooth waistbands, full coverage sleeves, and longer length tops.

I was not disappointed. I went with the comfort waist flare leg scrub pants in black (to potentially go with other scrub tops in my closet), and the color block V neck scrub top in “Coastal Surf”. Here is a nice video (with Tafford’s permission), highlighting the features of this particular duo:

My only concern about the top I chose was whether it would be too low cut – a common issue for busty girls everywhere (amiright, ladies?). I need not have worried – apparently whoever designed this line knows our plight, and I felt covered.

I was told that the scrubs intentionally ran big in order to accommodate variations in size and shape. That wasn’t my experience, however. I found that the sizes I ordered (which were my typical sizes these days) fit me just right, except the pants were too long. This is not a new issue for me, as I have had¬†to hem almost every pair of scrub pants I’ve ever bought. I really must learn to sew…

What I really loved about these scrubs:

  1. The full coverage. Not only were “the girls” well concealed, but the top was the perfect length to prevent riding up from the back or the side.
  2. How the top felt breathable yet sturdy. I could wear this in the middle of a North Carolina summer and not feel stifled to death. But it also neither felt nor looked like it was going to fall apart at the seams.
  3. The color. “Coastal Surf” turned out to be a beautifully rich aqua green.¬†Even my husband commented that he really liked the color when it came out of the box.
  4. How the pants did not feel like they would drop the minute I bent over or sat down. I trust that in the aforementioned code scenario, I would remain appropriately dressed.
  5. The flattering cut. The first day I wore these scrubs, I can’t tell you how many people complimented me and told me how flattering they looked.

My only (minor) complaint was that they didn’t offer varying pant¬†lengths. Again, my fault for being a shorty, but I think it would be helpful to acknowledge that plus-size girls can sometimes be petite as well.

The final test…would I buy another pair for myself? And that answer is a resounding YES! I was pleased beyond belief with these scrubs, and delighted that someone has finally gotten a clue and designed a line that is both flattering and appropriate for busy nurses of all shapes and sizes.

*Note: All product reviews are my opinion and mine alone. I was not paid or perked for this review, except for receiving this product for my personal use, so that I could offer honest and informed feedback.


Oct
18

Juggling

I have been fully immersed in my new role(s) for over a month now. I’m surely still in the honeymoon period, so take this with a grain of salt, but I am soooooo much happier in general. I even went back to my old hospital to visit a friend who had been admitted, and one of my former co-workers commented that I seemed like I was in a better place. Boy am I.

Hospice nursing is as rewarding as I expected it to be. It is also a place that seems to attract staff with an unbelievable work ethic and team-oriented spirit, which means that management comes in to work the floor when needed, our supervisors and attending physicians often “stop by” on weekends to check in with patients, families and staff, and most of us stay at least 1-2 hours past our shift time to finish our documentation or simply help the oncoming staff with patient care. Although we could be criticized for lack of boundaries, for now I am (mostly) refreshed by the dedication I see on a regular basis. The people who work in hospice – from the nurses to the volunteers – consider it a privilege and a calling, and the sense of commitment is inspiring.

My new hem/onc floor is also going well. I’ll finish my orientation next week, but for the most part I am operating independently. Unlike my former floor, they give chemo¬†all the time so they are fairly relaxed about the process and not nearly as anxious. These are helpful qualities for a nurse who loves oncology but is terrified about giving chemo. The laid-back environment pervades the unit, although ironically is it also a floor with a disproportionate share of rapid responses and codes. The nurses are still remarkably vigilant. It’s hard to explain. It’s also a nice counter-balance to the emotional intensity of hospice. And the staffing, oh the staffing. The MAXIMUM number of patients any nurse can have is four. Yes, four. We always have three nursing assistants. Charge nurses do not take patients, period. Coming from a place where I can easily have six patients, where more than once I worked as charge nurse with three patients (two of whom were getting chemo), and where we are often short one, even two, NAs, it’s almost a vacation.

Almost. ūüėČ

And then there is teaching. I love teaching. After a bad shift or an emotional encounter, I go to my clinical site and spend time with students who are bursting at the seams about everything they get to learn. It reminds me why I love this profession. It’s an opportunity to adopt the roles of mentor and support system that have always sustained me. Granted, I have an incredible group of students this semester, and next spring I may be eating my words. But somehow I doubt it.

I love it so much that I’m considering a fourth potential position (yes, I know I’m crazy). Another nursing school in the area, where I applied for a full-time teaching position last summer, contacted me about a possible clinical instructor job for the spring. The details have yet to be worked out and no official offer has been made, but it’s a distinct option. Bonus: It pays $5/hour more than any of my current jobs.

The beauty of working per diem is that I can work when I am available. The challenge is piecing together multiple schedules and not over-promising my availability to one job, to the detriment of work options with another. Not to mention balancing these schedules with school and my own clinical rotations.

Sigh…I suppose I wouldn’t be me if I wasn’t busy. ūüėČ


Sep
25

Ch-Ch-Ch-Changes

It’s been three weeks since I worked my last shift in the hospital. My departure was rather anticlimactic. Whereas most staff who leave get a send-off potluck or at least a card, I arrived on my last day¬†with most people not even aware that I had resigned. I got individual well-wishes and hugs from co-workers I loved, which mattered more to me anyway. But it still stung a little that my manager didn’t even try.

Not that it surprised me. When I went to the ER the night before my second-to-last shift, I emailed him an update and told him I would do my damndest to be at work in the morning. And I did show up and worked my tail off. He was there all day and couldn’t be bothered to check in and make sure I was okay. Sigh. And so it goes.

Enough complaining though… Although it was a bit sadistic of me to start three new jobs in the same month, I have to say it’s been a refreshing process. Here is how September has gone.

  • Hospice – My transfer between departments (from hospital to hospice) has been a little messy. But damn, do I love hospice nursing. It is physically, mentally, and emotionally hard as hell. But rewarding as hell too. What a privilege to be part of such an intimate part of people’s lives. To be trusted and counted on to give comfort. It’s why I became a nurse, all rolled into one incredible job.
  • Hem/Onc – I have yet to start orienting on the floor but general orientation has gone quite well. I feel welcomed already. The whole health system seems to be built on a foundation of gratitude, which is really encouraging. When I mentioned to the manager that I was hoping to travel over part of the holidays to see my family, she had our scheduler email me so that we could work out my holiday shifts. In September. Before I had even officially started working. I think I will learn a lot here. Plus, they’re going to cross-train me to the bone marrow transplant unit so I can float both places. The nerd in me is delighted.
  • Teaching – I adore this job. I adore watching nurses-to-be grow and push themselves. I am refreshed by their energy and their positive outlook. I am inspired by our post-conference discussions. I feel like I get to relive The Makings of a Nurse ¬†every day I am with them. What an incredible journey.

I’ve been reminded again and again this month why I chose this profession…or why this profession chose me. Through all of the frustrations and health setbacks, I get to go to bed every night thankful for what I do.

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