A big milestone: 100lbs

I reached a big milestone last week: I’ve now lost over 100 pounds. It’s been about 1 year and 4 months since I started on this journey, and it’s been nothing short of amazing. I continue to get periodic adjustments to my lap-band. I can definitely say it’s working as designed.

I could make a long list of health-related problems that have either disappeared or been greatly reduced, but the best part about the weight loss has been the improvements to sleep. (Miraculously, I’m able to wake-up feeling like I’ve actually slept.) I rarely fall asleep during the day anymore! Words cannot describe how much better I feel due to the improved sleep alone.

My sleep apnea has not been “cured,” however. According to my BiPAP and oximetry data, I still do have notable episodes of apnea while I sleep. So I still need to use my BiPAP, and I’d say there’s still some room for improvement. True, I’m awake during the day, and not sleepy, but I don’t feel quite as alert and “on the ball” as I think I could be. So I’m still working with a sleep doctor and taking measures to reduce my apnea even further.

In short, my apnea has gone from out-of-control to manageable. My quality of life is remarkably better now for just that reason.

1 year after Lap-band surgery

Today marks one year since I had lap-band surgery. Wow… so much has changed.

I don’t like to place too much emphasis on the exact weight lost; it was never about the number of pounds, but more about my health. But for general reference, I peaked at about 348 pounds in 2008. Let’s just say I’ve lost more than 90 pounds, and not yet 100. I updated my little graph… see for yourself.

The scars have healed quite nicely. I don’t even see them in the mirror unless I’m looking for them. (Having a little bit of belly hair has helped, too.)

Since the surgery, my taste in food has changed somewhat. I used to love fried food. One of my favorite things was a big ol’ cheeseburger with a giant pile of fries. But it just doesn’t have the same allure anymore… I don’t crave that kind of thing these days. I used to eat a lot of bread. Now I can only eat a little bit of bread. (No more bagels, thick sandwiches or buns). I thought I’d really miss it but it hasn’t been a problem at all.

Conversely, I didn’t used to have a sweet tooth… but I now have fairly regular cravings for chocolate. I’m told that after weight loss surgery, many people do experience a shift in their food preferences, but they vary by individual. I guess the important thing is to be aware of these kinds of shifts so you can make the best decisions.

There have been a few downsides. Ok, so I have some excess skin. I’m more gassy than I used to be. And I have to be careful not to eat too fast or too much or I’ll vomit. (Thankfully this has only happened to me twice… hopefully I’ve learned my lesson!)

All of this is a very small price to pay for the benefits. I’m not complaining in the slightest!

Now please allow me to celebrate some victories:

• Last week I fit into a front seat on the "Scream" coaster at Magic Mountain without even trying. (I didn’t even have to use the "big boy" seat. Just last year, I didn’t even fit on the ride at all.)
• I easily fit into my size 38 jeans again. (At my heaviest I wore a size 46.)
• My triglycerides and HDL have gotten a lot better. (They’re not perfect. But they are better.)
• I feel more upbeat these days. I think I’ve been smiling more.

By far the biggest benefit has been the improvements in sleep. Consider:

• Since the surgery I have missed zero work due to daytime sleepiness.
• On the Epworth Sleepiness Index, I jumped from a 14 to a 4.
• I’m sleeping 6, 7 even 8 hours straight through the night, with no tossing and turning.
• When I wake-up, I no longer feel like I’ve been hit by a truck. I feel like I’ve actually slept.
• I don’t get sleepy during the day anymore.

I still have sleep apnea but now it’s manageable. I may always need my CPAP. And you know what? I’m ok with that.

Contrast all this with where I was in 2008:

I’m drained. I’m not motivated. I’m sleepy. My head is fuzzy. I’m moody. I can’t get anything done.

I’ve managed to keep it somewhat hidden from the view of my friends… usually I accomplish this by staying in my cave when it’s really bad. And I’m usually pretty good at putting-on the brave face.

(For a little history, you can read my original lament here, or follow the whole, chronological tale here.)

I’m still paying the bill for the procedure. I’m on a monthly payment plan, and it’ll take another 2 years to pay it off. But it has been completely worth it. My only regret is not doing it sooner.

If you’re considering having weight loss surgery, definitely talk to a doctor. Find out if you’re a candidate. Learn more about it. Make sure you know what you’re getting into.

The lap-band surgery doesn’t always work for everyone:

• Some people don’t lose as much weight as they want to.
• Some people have vomiting problems.
• Some people gain the weight back. (There are ways to cheat the band.)

Some people say that before getting the surgery, you need to change your relationship with food. Others say that the surgery changes it for you. The truth is, it’s a little of both. (As the doctor said repeatedly: the lap-band is a tool, not a cure.)

Even with the lap-band, I still face daily choices about what I eat, and I must make time for physical activity. Not long ago, the mere thought of exercise made me cringe. But now I actually have the energy to do it. A 30-minute walk is now easy for me.

I’ll let you in on a little secret. Since the surgery I haven’t spent a single moment in a gym. Instead I’ve been doing other types of activity: walking, biking, even occasional yoga, kayaking or a volleyball game. (Of course, it helps that I live in a city where I can enjoy these things year-round.)

Whenever I can, I try to bike or walk with a purpose. Whether it’s a trip the grocery store, the dry cleaners, or a restaurant, it makes it feel less like a chore if I have a destination. (Also, thank goodness for iTunes.)

I look back and I’m amazed at the progress that I’ve made. I once wondered if I’d ever be able to escape the vicious cycle of weight loss (every time I lost weight, I’d gain it all back… and then some.) The surgery seems to have been the vital catalyst that allowed me to achieve escape velocity.

Miraculous? Yes. But the surgery is no magic bullet, and it’s not a free pass. It still requires work. I’m still learning every day.

And now comes the hard part (the Mormons like to call it "enduring to the end.") There’s still more work to be tackled, more choices to be made every day.

In the meantime, Mikey’s got his bounce back.

Lap-band Report Card: 6 months post surgery

Click above or here.

So here’s my little report card. It shows, at a glance, how I’m doing since having my lap-band surgery 6 months ago.

The biggest news here is my progress on the Epworth Sleepiness Index. This is a number that helps the doctor know the severity of daytime sleepiness. I leaped from a 14 to a 5… which is simply amazing… and much better than I’d hoped. I no longer require daytime naps… and I haven’t missed work due to tiredness.

Even though I didn’t meet my full goal for O2 desat levels, I’ve done really well! So exciting. I’d like to do a little better, but this is just awesome.

A new BiPAP mask (a full-face model that actually fits me, thank you!) has made a big difference for me as well. Hence the nearly perfect score for BiPAP leak rate.

My triglycerides and HDL have improved as well. As my friend Nick says, there’s only so much you can do about them. (Still, I’d like to improve my score a bit more.)

I wasn’t able to find numbers for blood pressure and neck size, but my blood pressure’s always been good. I think my neck size has gone from about 21-ish to 18-ish. (Reducing neck size is important because it correlates to a more open airway… allowing more oxygen to flow, and decreasing sleep apnea.)

I’ve taken all of my vitamins and supplements every day, and I have not had any caffeine or soda since the surgery. (At first I missed my Diet Pepsi, but I honestly don’t miss it anymore.)

My Apnea/Hypopnea Index (AHI) has improved significantly, which I’m happy about. The doctor says a number under 5 is considered normal… woah. But I want to do even better. I think that with a little work, and maybe some tweaking of my BiPAP settings, I can do it.

During all of this, I have not had a single complication. I’ve never vomited. I’ve had my lap-band filled twice without incident. I barely even know it’s in there.

Now comes the hard part… being persistent, and continuing to get at least 30 to 45 minutes of physical activity every day. (As you can see, my daily compliance was umm, pretty good, but not great. But I have plans up my sleeve!)

Overall, I’m VERY happy with my progress. I only wish I’d done it sooner!

Life = good

Today I’ve noticed a lot of good things are happening for me, healthwise!

• I now have a bunch of clothes that are too big for me. Pants, shirts, belts. Yay!
• The incisions are healing faster than expected. (Pic coming soon.)
• I am getting a good seal on my new CPAP mask… last night I had one of the lowest leak rates yet.
• My energy level is climbing, slowly but surely.
• My feet always used to be kinda puffy. They’re not anymore.
• My left eye used to twitch a lot. The doctor says it was a side effect of the Provigil. I’m not taking it anymore, and the twitch is gone.
• Several folks have commented that my eyes don’t look as baggy anymore.
• I’ve been 100% compliant with my daily supplements, in attending the nutrition support group, and in getting 30 minutes of activity every single day. (Mostly walking, some biking.)
• Remember that sinus surgery I had last year? I actually have been reaping the benefits (finally!) over the last several months. I can breathe freely through my nose now. Not just sometimes, but every single day, and every single night. Which is making the CPAP therapy more effective.

I still have a long way to go, but things are improving even faster than I expected. Yay!

You may have noticed that I’ve not been focusing on my weight (as a number). I don’t think the number is a good way to measure one’s health. However, I suppose it would be good to give a rough idea of how much progress I’ve made; let’s just say I’ll easily surpass the 50lb mark by mid-June.

And I haven’t felt like I’ve been depriving myself of food at all. A small serving of food tames my tummy with no problem.

By the way, I finally did receive a letter from the insurance company, in which they let me know the denial was upheld. I’m not really surprised, and, as I’ve mentioned previously, I don’t blame them. (It was never a question as to whether the procedure was medically necessary; the fact is, the procedure is simply not available through my particular coverage plan.) Ah well, it was worth a shot.

Life = good.

My Health Goals

A friend asked me how much weight I hope to lose after having the lap-band surgery. The truth is, I’m really not focusing on that. (I’ll still keep records of it, but my point is that it’s just a number.)

Instead, I have my eye on the goals written-out here. I believe these will give me a much better picture of my health and improvement.

Some of the items listed here may really be the means to accomplishing a goal. But I still list them here as goals because I want to monitor how well I do.

If I reach my goals at the 6-month mark, I’m going to treat myself to something suitably loverly… perhaps a next-generation iPhone or something.

Updates, status, catch-up, the latest and stuff

Some quick updates…

• Stopped taking my Provigil for now. Though it’s a little harder to focus in the afternoons, hopefully it’ll be easier to stay asleep all night.
• After a full week of only pre-op eating (3 protein shakes + 400 calories per day) I am feeling verrry… um. Regular.
• Been getting my 30 minutes of activity every day. Mostly biking and walking so far.
• Henry made me an awesome salad on Saturday with fresher-than-fresh veggies, a simple but tasty dressing and strawberries and whipped cream for dessert. (I love me some strawberries…) Spent the afternoon with Henry catching-up, playing XBox 360, sitting on the balcony, hittin’ the grocery store, etc. Also learned a thing or two about food and produce and such. It was a very a nice afternoon, Henry!
• Went to my first bariatric surgery support group last night. The group was a mixture of people both post- and pre-op, with the majority being post-op. About half of them had gastric bypass, while the other half had lap-band. It was useful to talk to other people about what works, and what doesn’t. The point was reiterated that there is still a lot of hard work ahead.
• Tomorrow is the big class. This is where we learn all the details about everything… surgery scheduling, eating plans, etc. Matt’s going with me and I am lucky to have him by my side.
• Today I go in for one final blood test.
• Still haven’t heard back from the insurance about my appeal. But moving forward regardless. (I did call them to confirm they had received the letter and it is currently being reviewed.)
• Surgery is 7 days away. I’m ready.
• The doc assured me that I’ll be able to ride roller-coasters (once I heal. Yay!) In fact, he said you can do just about any kind of sport, etc. once things have healed. In the meantime, the next few weeks are going to include walking every single day, even the same day of the surgery.
• My sleep has been up and down, as usual. Last week was particularly rough; Friday I was practically a zombie. Since then I’ve had perhaps three nights of sleep that didn’t totally completely suck… I slept perhaps four or five hours for three nights in a row, so that was welcome.
• Sunday I biked to The Hole (San Diego’s “world-famous dive” bar) with the uber-awesome Tim. We had a nice, six-mile ride through the neighborhoods of University Heights, Hillcrest, Mission Hills and Old Town. Hope to do that again sometime!

More soon.

Updates

Some quick updates.

• Surgery still on schedule.
• Stopped taking Claritin and Nasonex. Gonna see how I do without them.
• I’m on Day 3 of pre-op eating plan. I want pizza. (Don’t worry, I’m not going to.) Just tried cottage cheese for the first time. It’s gross. Gonna try a few suggestions to make it edible though.
• Still sleeping really poorly (not that I expected anything to change yet. It’s gonna be a couple months before I’m sleeping soundly, methinks.)
• Haven’t heard back whether the insurance will cover the procedure. But continuing as planned, regardless.

By the way, regarding that insurance appeal letter I posted last week. I did not intend to demonize the insurance company. They actually do offer a medical insurance package that includes coverage for weight loss surgery; but last year, my employer (who admittedly has a lot of other employees to consider, as well as other operating expenses associated with being a small business) had not selected that package.

I really don’t blame anyone for the situation. It is what it is. Hopefully the insurance company will come through. But I’m going to proceed regardless.

So why did I post the appeal letter? I felt it conveyed my situation well… and I don’t think I’d been communicating it clearly up until then. I also thought perhaps the appeal letter might be useful for others who might need to write their own.

The next few weeks…

My calendar over the next few weeks:

• April 23 – Final appointment with the bariatric surgeon, finalize paperwork and plans.
• April 27 – Start the eating plan (details forthcoming).
• May 7 – Attend pre-operation class.
• May 9 – Should have an answer from insurance whether they’ll cover the procedure.
• May 13 – Surgery.

The doctor is going to have me stay in the hospital overnight because of my severe sleep apnea; otherwise it would be an outpatient procedure. Then I’m planning for about a week off from work (many people require less.)

If the insurance company doesn’t cover the procedure, I’m still going to do it. I’ve arranged for financing through Capital One Healthcare Finance. The process was very easy, beginning with a secure application form that you complete online. Once I was approved, they worked directly with the doctor’s office. They offer reasonable fixed-rate loans, with an APR based on your credit rating. (For some reason they categorize bariatric surgery underneath “cosmetic loans,” which I disagree with, but otherwise was quite impressed with their services.)

It’ll be around $19,000 for the procedure and all the associated charges. While I’m not crazy about acquiring such a debt, I believe it will be worth it. (I’m so anxious to get back on track.)

About that lap band thing..

Just to pre-empt a few comments:

• This may seem out-of-the-blue, but it’s something I’ve been considering for a very long time.
• If the insurance won’t cover the procedure, I’m going to finance it personally.
• I’m fully aware of the risks of the surgery. I’m fully aware that there is the possibility of some weight re-gain. I know that the eating regimen is strict. I know this is not an easy way out. I know that it will still require discipline, support, and determination. I do not see this as a magic bullet. Instead, I see it as something that greatly increases the viability of getting to a healthy weight.
• I know that physical activity is going to be required for long-term success. I’ve been drawing-up plans for awhile, and am getting ready to execute.
• I’m aware of the various types of gastric surgery. I’ve reviewed the pro’s and con’s of each with the surgeon, and we decided on the lap band. (I’ll try to post more about this later.)

The Appeal

To whom it may concern:

I am writing to appeal your decision to deny authorization for laparoscopic adjustable gastric band surgery, a decision which was made in February 2008. It is acknowledged that weight-loss surgeries are currently excluded under my insurance plan. However, this surgery is medically necessary to treat my case of Obstructive Sleep Apnea (OSA). I implore you to reconsider coverage for the reasons below.

I have been fighting OSA for nearly my entire adult life. Over the last 12 years I’ve endured excessive daytime sleepiness, fallen into deep depression, nearly died one night when I stopped breathing for an extended period of time during sleep, missed countless hours of work, and suffered through relentless side effects. These include depression, memory loss, mental dullness, sleep paralysis, general fatigue, restlessness, dizziness, numbness in my upper body, morning headaches, mood swings, panic attacks and general lack of motivation.

My sleep apnea has been maddeningly resistant to a myriad of treatments. I’ve had 12 overnight sleep studies since 1996. Each time, doctors have prescribed treatment, which I have followed carefully, but in the end have been ineffective. I have undergone four surgeries in attempt to open my airways:

• Tonsillectomy/Adenoidectomy in 1996
• Uvulapalatopharyngoplasty (UPPP) in 1997
• (Repeat) Adenoidectomy in 2003
• Sinus surgery in 2007 (cauterization of turbinates, removal of scar tissue and clearing of sinuses)

In addition, I’ve tried four different CPAP and BiPAP devices; tried 15 different CPAP masks; tried countless combinations of CPAP air pressures, both heated and non-heated humidifiers; chin straps; embarked on exercise and eating regimens; gone through repeated CPAP mask desensitizations; tried three different adjustable mandibular advancement devices; tried two different tongue restraint devices; and taken two years of allergy shots in attempt to improve my breathing. With my current BiPAP device, I’m using the maximum air pressure available (25 cm H2O, which is extremely high) and still have not had relief. I’ve taken various prescriptions in attempt to mitigate the effects of sleep apnea and improve my breathing. (Currently I am taking Provigil, Paxil, Nasonex and Claritin daily; and Albuterol as needed.)

I have family history of stroke. As you know, OSA dramatically increases the chances of having a heart attack or stroke. On several occasions this year, I have felt as if blood was not circulating properly to my head. On one occasion I nearly passed-out. On another occasion, I fell asleep on my keyboard at work. In 2007 I had five episodes of sleep paralysis, during which I was alert to my surroundings, but unable to move my body.

In the space of just 6 years I gained 100 pounds. I’ve made repeated attempts to lose weight, including two periods supervised by medical professionals. Each time, I lost some weight, but it rebounded within months, and I gained more.

Over the same period of time I have missed approximately 500 hours of work, and spent approximately $30,000 on various treatments, devices, medications and copays. (Similarly, my medical insurers have already paid-out over $150,000 in sleep apnea-related medical bills for me; a large portion of those were paid by your company.) It’s become agonizingly clear to me that devices, prescriptions and diets are wholly insufficient to treat my severe OSA.

Obstructive Sleep Apnea is defined as five or more episodes of apnea or hypopnea per hour of sleep in individuals who have excessive daytime sleepiness. According to my most recent sleep study a few months ago, I have 120 apnea/hypopnea episodes per hour; quite literally I can’t even sleep for 30 seconds without stopping breathing. (After my last surgery, the doctor insisted I stay in the hospital overnight because my apnea was so bad.) I am over 100 pounds overweight, I have a BMI of 45, and I score 14 on the Epworth Sleepiness Scale, which is considered dangerous. As you can imagine, I’m at extremely high risk for some very big health problems.

As my condition has grown worse, I have had several episodes where I wake-up choking. My significant-other has witnessed events where I stop breathing for long periods of time. When I lay down to go to sleep, I sometimes really do wonder if it will be for the last time.

My doctors have advised me that I should have weight loss surgery, since we’ve exhausted all other possible treatments (other than tracheotomy). These doctors include Dr. xxxxx, MD (my family doctor), Dr. xxxxx, MD (ENT specialist and surgeon), Dr. xxxxx, MD (sleep specialist), Dr. xxxxx, DMD (sleep dentist) and Dr. xxxxx, MD (gastric surgeon), and they consider the surgery medically necessary to treat my condition. Over the long term, weight loss surgery has a significantly higher success rate than eating/exercise regimens alone. By losing the weight, the layers of fat in my throat will shrink, thereby clearing my airways. This is my only hope of escaping the stranglehold that OSA has had on my life.

I fully understand that under my policy, gastric surgeries are normally not covered as treatment… at least, not for morbid obesity. However I would respectfully ask you to please consider it as treatment for severe and otherwise un-treatable Obstructive Sleep Apnea. We’ve exhausted all other options, and I’m barely able to function. Without the surgery, I fear I will be stuck in an endless cycle of failed attempts to lose weight, risking stroke, losing more work, taking endless prescriptions and aimlessly trying variations on treatments that just don’t work for me.

I am certain that by covering the cost of the Lap Band procedure, your company would save a lot more money down the road. If left untreated, my condition may require even more complex and costly treatment in the future.

I have included a few documents with this letter, notably a letter from my first diagnosis in 1996, as well as the current surgery authorization request from Dr. xxxxx. I am happy to furnish any additional documentation that you may require, including medical records, doctor letters, sleep studies, weight histories, receipts, etc. Please let me know if any additional information will be helpful to my request. I can be reached any time at (xxx) xxx-xxxx (cell/home/work).

Thank you for your immediate attention to this matter.

Sincerely,

Michael _____,
Subscriber # __________

A little dramatic? Yes, but it’s all true.

My intention here is not to demonize the insurance company. They actually offer packages that cover the surgery, but last year my employer elected not to spend the additional funds required. In any case, I’m still waiting to hear back if they’ll cover the procedure. But I’m going to have the surgery done, no matter what.