Now for a long-overdue update.  I seemed to be recovering okay from the last vitrectomy, except that the vision in my right eye has never gotten as sharp as it should have.  Reading text has been a problem.  One of my two eye doctors made an in-depth examination and said that I’m suffering from diabetic macular edema.  In short, the retina is a bit swollen, due to some blood vessel leakage.  Since things are swollen my vision isn’t completely normal.  She said that the blood vessels in the eye have a protective ‘sheath’ that keeps them from leaking, like a garden hose.  However, in diabetics that garden hose becomes like a ‘soaker’ hose–it gets holes in it that allow blood through.  That causes the swelling.  They’re not sure why it happens, and of course there’s nothing they can do.  It’s up to me to keep my blood glucose in check, eat the right foods, et cetera.

Two weeks ago I had another hemhorrage in that eye.  After it happened it took very little time for my vision in the eye to go completely dark and fuzzy.  After another trip to the doctor (this time the surgeon), he said that he wanted to see if things cleared up on their own.  Indeed, when I saw him last week the blood had been reabsorbed.  I commented that if the old vitreous fluid has still been there I wouldn’t have had my vision back so soon, and he agreed.  There are advantages to having the vitrectomy.  I expressed disappointment that I was still having problems with the eye; he said we were only two months out from the operation and that I should ‘give it time.’  Do you sense a pattern here with regard to my health?  EVERYTHING is ‘wait and see’ and ‘give it time.’

Kids, if you know someone who is a diabetic pass the following information along…if you’re a diabetic yourself, PLEASE read what I’m saying very carefully.  Your health is not something to play with or take for granted.  If you’re a diabetic, take it seriously.  Keep your blood glucose readings in check.  Do what you’re supposed to do.  Don’t screw around and ignore the warnings from your doctors.  YOU CAN SERIOUSLY HARM YOURSELF IF YOU DON’T TAKE CARE OF BUSINESS.  Blindness, loss of limbs, strokes, heart attacks, and many other door prizes await you if you don’t take care of yourself.

There’s a guy I met who runs a local tavern and restaurant.  He’s a member of my buddy’s high school graduating class, and seven years my senior.  He talks with us when we visit his fine establishment for their good food.  He knew that I and my buddy’s wife both had gastric bypass surgery and recently asked me a number of questions about  it.  He’s a big guy and he wants to lose the weight.  However, in the course of our conversation I learned that he takes several of the same medicines I do–and he admitted that he likes beer.  (Go figure.)  I don’t know about the medicine bottles he gets from his pharmacy, but mine have strict warnings about not drinking alcohol while taking the medication.  I told him the bariatric surgeon informed me that drinking alcohol was out (not a problem for me as I don’t drink).  His comment?  “Oh, I can’t give up my beer.”  My response was that he’d need to do it if he wanted to live.  He’s still considering the surgery, so I hope he goes through with it.  I also hope that he gives up the alcohol for his health’s sake.

Now to the current weight-loss news.  I’ve been hanging around the 70-pound-lost mark for several weeks now.  I feel better, and look better (at least to me).  The doc expressed disappointment at my six-month evaluation that my weight loss wasn’t a bit higher by now, but said I was doing it ‘efficiently.’  I took that to mean that I’m doing it slowly and healthily as I should.  Rapid weight loss can cause gallstones, and often results in surgical removal of the gall bladder after weight-loss surgery.  I’d like to be a bit farther along myself but I’m not worried.  I told him that my diabetes was being controlled better but that I still wasn’t off my meds.  That disappointed him as well.  According to my pre-surgical bloodwork, my c-peptide level indicated that my body was capable of producing enough insulin.  That generally indicates that a patient’s diabetes will come in-check after surgery.  I commented that I never did anything by the book, so it didn’t surprise me.  We shared a small laugh at that, but he left me with two admonishments: to watch my carb intake and get active.

My general frame of mind is better now, despite the disappointment about my diabetes progress and some matters at work that have been distracting me.  I’m getting better and feeling healthier.  Oh, and my appetite is back.  I’m sticking with the three recommended meals peer day with the between-meal snacks, but still find myself getting hungry.  I’m following advice to drink lots of water and other liquids to keep the hunger at bay, but I can see how easy it would be to graze all day long and gain the weight back.

Granted, my medicines are down by half.  My blood pressure’s great, and I no longer have to take my powdered sulfuric plastic for high blood potassium.  But, I’d wanted to put a nail in diabetes’ coffin once and for all to stop the continual damage to my body.  I’m told to give it more time, that sometimes it’s a good six months before that happens.  Well, I had a reminder two days ago of why I wanted free from diabetes.

I awoke that morning with the vision obscured in my right eye.  This was the eye that had given me problems for several years.  A trip to the eye doctor confirmed what I already knew–that I’d had another hemorrhage.  After the exam the doctor gave me two options.  I could wait and allow it to clear up or have a vitrectomy.  I’d wanted to have one last year after another hemorrhage, but it had cleared sufficiently before surgery that the doctor wouldn’t proceed further.  I told him I wanted to do the surgery now.  Tomorrow afternoon I go under the knife for my second vitrectomy.

I should pass along a humorous moment from the pre-exam.  A nurse was filling out paperwork, asking questions from memory about my current medicines and so forth.  She knew why I was there but asked this question anyway: “Have there been any changes in your vision since the last time we saw you?”

Without missing a beat, I said, “I see dead people…they’re everywhere.”  She looked up with a strange expression on her face, then busted out laughing.  At least I made her day.

I’ve lost a tad over fifty pounds in the last three months.  People I work with can see the difference, but don’t notice it as often as people who don’t see me on a daily basis.  It’s funny how we can get used to things, and adapt without thinking about it, if those things happen slowly over time.  I slowly put weight on, and eventually hit a tipping point where everything was more difficult to do.  It seemed as if I could bend over and pick up some dropped item one day, then have great difficulty doing the exact same thing the next day.  Tying my shoelaces used to be easy; suddenly I had problems getting my legs up to tie them.  Yesterday I reached to the back of my closet and pulled out an older pair of jeans.  I wore them last around four years ago, then cast them aside when they became too tight.  Now they fit again (although a little snugly but that will pass in time)!

I made the above statement about gradual change because I had an epiphany a week or so ago.  I was in the store to buy dog food and the forty-pound bag I wanted was on the lowest shelf.  I pulled the bag out, then struggled with the awkward, shifting weight to get it up and into my cart.  As I got it balanced in my arms, the thought occurred to me: “You’ve already lost this much weight and another ten pounds besides.”  Wow.  I stood there for a few moments, adjusting the weight of the bag in my arms, feeling its heft and knowing that I’d been lugging that much flab with me just three short months ago.  My right foot had gotten measurably better since then, so much that I’d been placed back into a regular shoe nearly a month ago.  No wonder I’d been having foot problems…

I’ve also had a kind of energy resurgence.  I don’t run around the block yet (though I’m sure the physical therapist would love me for it), but I have more energy and feel less tired in the past month.  

Losing the weight has been a nice benefit of the surgery, but it doesn’t take away the bitter disappointment of still having to manage my diabetes. At least for now.

I went to see the bariatric doc the other day for my first checkup.  I’ve lost 35 pounds so far (down from 291) and am on half my diabetes meds, but my diabetes still hasn’t resolved itself.  The doc expressed the disappointment I was feeling, and said that my diabetes might be caused by heredity and not by weight.  That crushed me…my entire goal for this ordeal was to kill off this disease.  However, he told me that it’s still early, and reminded me that I’m off half of my meds already.  He encouraged me to give it more time.  I don’t suppose I have another option, do I?

In the meanwhile, I’ve learned a few things which could be dangerous.  I’ve tried two different types of pizza and have suffered no ill effects.  I tried a bowl of Skyline’s chili with beans and tolerated it (although it was a little spicy), so I tried a “Skyliner” (hot dog with chili/cheese/mustard/beans) and was able to eat it.  I used to be able to eat three at a sitting.  I can only have one before feeling full but that’s all right.  Now that I know I can have those foods I don’t really want any more for a while.  A long while.

After reading through the book of information they gave me before surgery I’ve realized a few things.  They say the surgery is a weight loss tool, not a cure-all in itself.  The book says that, to lose weight as I should, I need to stay at an 800-calorie per day intake.  Honestly, I can’t eat that much without feeling full so that should be a great help.  But in looking at their suggested meal guide, I have to laugh…for example, one meal suggestion is for “3-4 ounces of fish (1/4 cup) mashed with a fork, a teaspoon of mashed potatoes and four (!) green beans.”  I’m able to eat a bit more than that amount now.  So, what needs to be stressed to myself is that I have to be extremely careful, not only about what I eat but the total amount as well.

Everyone I’ve talked to, when I tell them I’ve had a gastric bypass, gets a big smile and expresses some sort of congratulations.  Then they ask how I’m doing and how much I’ve lost already.  I have a lot of support and that’s highly encouraging.

Oh, and I fell backwards trying to go in my backdoor a few days ago.  I had an armload of stuff and must have bonked my head on the fence on the way down.  The damages?  A cut and badly bleeding finger and stressed neck muscles.  My brains were also scrambled for a little while.  I got up and did some things automatically that I remembered partially later.  That scared the crap out of me, and made me realize how quickly I could end up in trouble (or dead) if I wasn’t careful.

I went to a local tavern/eatery that’s known as Harrigan’s with my friend Jim.  Good food, family-friendly atmosphere.  He wanted a bite and I remembered that they had a house chili there that won some awards.  While he scarfed down a pizza and salad I had a bowl of their award-winning chili.

Oh, damn.  It tasted soooo good, right from the first bite.  Now, I’d had nothing but pablum for a couple of weeks, so I knew I’d have to try it again.  It was a little spicier than I like, but not too bad overall.  I had them bring some sour cream and shredded cheese along with the chili, so I’d put a small amount of sour cream into my spoon, sprinkle a bit of cheese on the chili, then scoop up a bite.  Lots of beans, chunks of ground beef that dissolve in your mouth…what can I say?  It was awesome.  I almost felt like a prisoner who’d gotten parole and was eating his first hamburger in 20 years.  I followed the doc’s advice and asked for a to-go container, and saved about half my chili to take home with me.  I was pleasantly stuffed and had another meal waiting.  The best part was that I spent under $5.00.  I’ve never spent less than $11-12 in there before.

Next up a few days later was Frisch’s chili.  It was pleasant, not spicy, lots of beans.  I also had a second meal from my portion.  Then I went to Wendy’s a day or so later.  I was a bit disappointed after Harrigan’s best, but it was as good as I remembered it to be.  I have yet to try a bowl of Skyline Chili–just a bowl, with sour cream, cheese and beans, no hot dog or spaghetti to accompany it.  I will do so soon, though–I must go back and say hello to my friends.

The biggest drag about my new eating habits?  I can’t drink anything while eating.  I have to wait 20 minutes to an hour before doing so.  I have cheated a little, though, by taking the smallest of sips from a water glass as I eat.  Just enough to wet my whistle, as it were, not enough to wash down my meal. I think that works especially well if the food I’m eating is thicker in consistency as it should help in digestion.  I’ll have to ask the dietician when I see her in a week or so.

Oh, and about the cheese…from what I can tell, I didn’t become lactose intolerant as a result of the operation.  Thank God.  I’ve always loved milk and milk products, and they’re also a good source of protein.  I am, however, grease intolerant.  I found that out after eating two silver-dollar hash browns at Steak and Shake.  Perhaps if they were baked instead of fried it might have made a difference, but they’re off-limits as-is.

Laparoscopic surgery is wonderful in that it allows a much faster recovery time.  It leaves fewer scars as well.  The deceptive thing about having laparoscopic surgery is that you often think you’re ready to do more than you really are.  For example, I have to keep stopping myself with reminders like, “You can’t lift that yet,” or, “Don’t stress yourself too early.”  I don’t want to end up with a hernia and have to go back into surgery.

The rest of the week went well.  On Wednesday, the day before Thanksgiving, I had my staples taken out and my drainage bulb removed.  The doc told me that my diet was going to advance to the next step (bariatric soft), so I could indulge in a few things for Thanksgiving!  I was told to stick to this diet for two weeks; the following week I was to go back to “normal” food.  The week following I’d be seeing the doc again.

Thanksgiving saw me at my coworker and friend Bob’s house.  His family was having a huge get-together and it was a feast.  I got to enjoy some turkey, mashed potatoes, a small spot of dressing, and a little gravy over all.  I couldn’t pass up the pumpkin pie (one of my favorites), but I did it carefully.  I was presented with two pieces in a pie plate, so I took a 1/4″ wide strip off the wide side of a piece and put a little whipped topping on it.  Everything was delicious and I was stuffed!  Keep in mind that all of the food I ate would fit comfortably in the palm of an average-sized hand…

I also went out once for breakfast, to a regional restaurant called Bob Evans.  I ordered one scrambled egg and a dry piece of toast.  I left most of the toast but demolished the egg.

I was told my bowel movements would be slow to re-start after surgery, and after they did, that they might not happen everyday. This isn’t surprising since my intake is way less than before.  My first one was a week to the day after the surgery–since then I’ve gone almost daily but it’s been something of a hassle.  After eating I also feel a bit bloated even though I don’t eat that much.  I believe that will eventually straighten itself out, but for now, I think I need to hit my fiber supplements again.

Scenario: You’ve gone to WalMart to pick up some supplies you’d forgotten you needed.  It’s Saturday afternoon and every family in town is there.  Additionally there are numerous white-haired old women tottering about, calling to Walter or Charlie and blathering about something or other that makes no sense to you.  You have to blow gas, now, in the worst way or your guts will explode.  Every freaking aisle has someone standing in it and you can’t make it to the restroom.  What do you do?  Discuss.

My answer was to go to Sporting Goods.  I figured that, if I had to make a manly sound, that would be the best (and nearest) place for it.  I could then clear my throat and say, “Oh yeah!” or something like that, smile at the members of the audience, and swagger off stage left like an old pro.  I made it to the department but found that the urge had left me.  I was able to leave the store and get to my vehicle before knocking myself out from the fumes.  Face saved.

Sunday was more of the same…I got to walk around the block with dog number one and I puttered around the house a bit.  I had to keep reminding myself to stop before picking up some heavy piece of something-or-other.  I can’t lift anything over 10 pounds or so for a few weeks. That seriously limited the number of projects I wanted to do in my time off.

Thankfully one of the nurse assistants picked up on the problem.  She urged me to lay on my left side (which also happened to be the sorest side) so that I could pass gas.  She related that her bariatric doctor told her that the left side was called the ‘recovery’ side. “Don’t worry,”  she assured me, “after laying there awhile you’ll blow gas like nobody’s business and you’ll feel better.”  It was true!  Not only that, but I produced so much gas that I thought I should practice how to play something.  You know, like Mason Williams’s  ”Classical Gas.”  Small attempt at humor there.

Friday morning I got up and felt 100% better.  The only problem I was having concerned the medications that I still needed to take by mouth.  Most pills come with a hard coating on them, and sometimes the coating is flavored.  There’s a reason for this.  It’s also the same reason that some pills carry instructions not to break or crush them.

They taste horrible.   Take a half-dozen different types of meds and crush them up, then try putting them into water and stirring (if they’ll even dissolve).  Or, take that same witches’ brew and try mixing it up in lukewarm Jello.  Oh. Dear. God. In. Heaven.  Now, you may ask why anyone would crush their medications–this is something most people don’t think about.  In bariatric patients food (or whatever you swallow by mouth) does not stay in the stomach for very long.  That’s one reason you are supposed to wait 20 minutes after eating to drink any liquids, as the liquids force the food out of your stomach too quickly  Additionally you have less small intestine for any medication to dissolve in and be absorbed by the body.  Gastric bypass surgery is also referred to as “malabsorptive” surgery because of this–the body does not absorb nutrients from the food as easily as it did before.  A pill that’s swallowed whole would, most likely, be halfway through your system before its outer coating would dissolve…by then the meds would be on their merry way out of your body and would do you no good.  Well, I can tell you that mixing meds with water and warm Jello does nothing to make them better.  In fact, I couldn’t get the horrid taste out of my mouth for most of the day.  I have since decided to ‘cheat’ by breaking my pills in half or quarters, placing a small group of them on the tip of my tongue, and swallowing them with just enough water to take them down.  Afterward I feel a bit queasy for having swallowed that much at one time, but it’s better than the other way.  By breaking them up I’m exposing their malleable innards to water (or digestive fluids) to they have a chance at being absorbed.  It’s not the best scenario but the only one I can handle right now.  By the way, this is why bariatric patients are instructed to take certain types of vitamins in chewable form for the rest of their lives.

My morning labs came back A-OK, and I just had to wait to see the doc on his afternoon rounds to get my discharge paperwork.  When I did, I was instructed to stop allof my diabetic meds except for one. (I was on four, including insulin.)  I got to take a shower, put on clean clothes, and walked around the floor a few more times before Jim arrived to take me home.  The nurses all said ‘so long’ and urged me to return and say hello later.  It felt great to be back home in my own bed that evening.

For example–the bariatric patients are given strict instuctions to walk.   A lot.  The purpose is to prevent blood from pooling in our legs, and thus prevent a life-threatening clot. This is somewhat complicated by the fact that we wear these “compression cuffs” on our calves when we’re in bed. These are flat wraps that have multiple air chambers in them; they are blown full of air and deflated in order to push blood up out of our legs and toward our bodies.  We need assistance to put them on, and to power the pumps on.  Theoretically this would require about one nurse visit per hour.  Now, add in the occasional call for pain medication if you need it and you’ll understand that we’re high maintenance.

Two times on Wednesday I tried calling for a nurse and got either no response or a very late one.  A little before 1 p.m. I called for a disconnect of my leg cuffs.  Twenty minutes later I called again.  Both times I was told help was coming but never arrived.  I finally struggled with and disconnected my cuffs to take a walk.  Later that evening I called for pain meds with a similar response.  I finally caught the attention of another nurse who sent my nurse in for me.  That day must have been an aberration as it didn’t happen again, thankfully, but it was frustrating.

Wednesday evening brought a plethora of visitors.  My friend Jim stopped for a while, and while he was there I received a phone call from a lady I’ve known for years.  She wished to know if I was receiving visitors so she and another old friend could stop by.  Jean and Becky stopped in an hour later and provided excellent conversation and a few laughs.

After they left another two visitors stopped in.  (I’d use their names but since I hadn’t asked I’m not sure I should.)  These two young ladies work at a Skyline Chili I frequent on the weekends.  (Did I say I like Skyline Chili?)  They came bearing gifts: a large unsweetened tea and a ‘classic’ design T-shirt with Skyline’s name on it (appropriately sized smaller than I normally wear).  They also provided excellent conversation and I found out a bit more about them than I knew from our restaurant visits.

I found out a long time ago that there are perks for being a ‘regular’ at a restaurant.  In these rough financial times, please don’t forget to patronize your favorite restaurant especially if they’re a small business or are family-owned.  Better yet, if you don’t normally eat at smaller family restaurants, find and pick one, then go there often.  Small businesses are being hit hard and many are closing their doors–please do your part to keep this part of our economy alive.  (Disclosure: I am not affiliated with, or in the employ of, any such business nor am I promoting any business in particular.  Except Skyline.  Because they r0ck!)

Day three saw the attempt of my bariatric doc to send me home.  He seemed to feel I was doing great and ready to go. I didn’t feel quite right in my body, though.  I couldn’t identify it but something wasn’t right.  Later I talked with the attending physician and was told he wasn’t pleased with the results of my bloodwork–my phosphorus and potassium levels were way off so he wanted to keep me another night.  I was relieved.  When the nurse came by with the discharge paperwork I had to send her back to see the attending physician.  I never thought I’d want to spend another night in the hoosegow but was truly glad I did.

Ah, technology.

Speaking of technology, I had a Star Trek moment.  A nurse came to check my temperature.  She pulled this wand out of her pocket and placed it on my forehead, then traced a line down the side of my face and ended at my ear.  The wand beeped, and she wrote a number down.

“What’s that?” I asked her.

“It’s a thermometer,” she answered, “and it’s a lot quicker than the older ones we have.”  Wow.  That was pretty cool.

I spent a good deal of time resting, but forced myself up to walk around the halls. “Walk walk walk!” they tell us, in order to prevent blood from pooling in our legs and causing clots.  Those clots could break loose and cause nasty things like heart attacks, strokes, or problems breathing.  So, I’d have to wait until I got back to the room for my next morphine hit for a while.

Dawn, Jim’s wife, stopped by to visit for a bit in the morning.  I was glad for the company.  However, until Tuesday my two-bed suite had me as its only occupant.  That day I got a roommate, and though I’m sure he was nice, we didn’t talk much.  He enjoyed watching TV late at night with his volume up.  Goodbye, rest.

After a short wait I was escorted back into the inner sanctum, where the prep rooms were. I was given a room and told to change into the provided robe, then place my personal items in the large bag they provided. The rooms were nice enough, things were clean. I changed behind the pulled curtain and bagged my street clothes, then sat on the bed and waited. Soon the first of several nice people came to greet me. THe nurse assigned to me had my paperwork, and she asked a lot of questions to verify information. I decided it would be a good time for a restroom break and stepped away a short distance to the loo.  Coming back to my room I bumped into the nurse, and then noticed my prep room’s number: 13.  I pointed to it and said, “You’re kidding, right?”  She laughed and said this was her favorite room, but she didn’t know why. Hmm. Next a lady came by to shave my stomach for surgery. As I sat on the edge of the bed with my gown top down, I made a small joke in my best Droopy Dog voice about not having much chest hair. She told me that I was not as hairy as some women she’d prepped.

“Chest hair on women?” I’d responded.

She said it was sad but true. One woman she’d shaved told her that the men she’d made love to loved her hair. She took on a look something akin to a young fawn in truck headlights, then commented, “I never seen a man who liked a woman with chest hair.” That was a good moment and we laughed. After I popped onto the gurney my two friends Jim and Dawn came back to keep me company. It was a good thing they did. My surgery had been pushed back, and would probably be at 1 p.m. now. The nurse popped in occasionally to talk. I also got to speak with the doctor’s PA, and Doc S. himself stopped by to look over my charts.

“You’re on a lot of medications.” he commented as he looked through the charts. I acknowledged that was true, and he said, “At the end of three months the only pills you’ll take will be vitamins.” My “c peptide” level, which is an indicator of how well the body can produce its own insulin, was normal. That was indeed good news!

I told the doctor to make sure not to use any Chinese Heparin on me and he smiled. A while later the anaesthesiologist stopped by to explain what would happen, and I made two requests of him because I watch those evening newsmagazine shows on TV. The first: make sure I don’t wake up in the middle of surgery. The second was to not set my face on fire. He agreed and was gone.

Then I was in the room. I looked around at all the equipment as I was moved to the main table. A blood pressure cuff was snapped on, and I commented how cold the room was. Then…I don’t remember anything else. I’m sure I given an IV to start the process, but I don’t remember one. I was out cold.

The very next thing I remember was being moved from somewhere onto another bed, and being asked to help. I couldn’t keep my eyes open, but could hear and respond. There was horrible pain coming from my stomach and I groaned, “Oh God, what did I just do?”

“It’s to early to say that, ” a woman’s voice responded.

The next hours of the first day were something of a blur. A voice instructing me how to use the morphine pump button and telling me where my nurse call and TV remote were. My friend Jim flipping across the channels on the TV, parking it on TV Land, and me recognizing that Andy Griffith was on. Laughter. My friend Jerry, his wife and son coming to visit. Jerry saying, “Thank God they didn’t remove your sense of humor.” Then…nighttime. I believe I called the nurse because I lost the morphine button once. My sleep was interrupted several times by nurses testing my blood glucose level, blood pressure, and oxygen levels. I got a couple hours worth of sleep.