A Whirlwind of Appointments

 When we last let off, I had just had what seemed like half of my blood taken from my body and what has followed can only be described as a complete whirlwind of appointment after appointment.   As if I wasn't already exhausted from my current sleep predicament!!!  To say I'm beyond tired would be an understatement. 

I had all the blood taken on the 27th of July, which was two days following my consultation with my surgeon.   The following week, I had three various appointments. 

First up was with Behavioral Health.  This was for the bariatric psych evaluation, basically to find out if I have any addictions or mental issues that might need to be worked on prior to being approved for surgery.  For this appointment, I went up to the hospital where they did a urinalysis and took my vitals and then plopped me into a room with a huge TV where I had a virtual appointment with the psychologist.  She and I discussed my childhood, my eating habits, what I've done in the past to lose weight, and what my understanding of the surgery both before, during and after would entail.  Honestly, it was an easy appointment for me because yes, while I've had some childhood trauma, it's something I've dealt with and doesn't seem to have any lingering effects, especially not on how I eat.  I'm not a binge eater or an emotional eater, nor do I eat a lot of unhealthy foods.  I went into this appointment with complete honestly and transparency.   Her outcome was basically that I am a good advocate for myself and that "Patient is a suitable candidate for bariatric surgery and is cleared for the procedure.".   Okay, so that's one hoop jumped thru. 

The next day, it was off to another appointment, this time for the results of my sleep study.   Out of everything I've done so far, this appointment is probably the one that had me stressing the most, because honestly, it's the one that triggered all the other appointments, if you really think about it.  My whole reason for visiting my PCP the first time was because I was having problems with being fatigued all the time.  This visit hopefully was about to provide all the answers I needed - however, during the sleep study, I had only slept for a total of three hours.  I didn't know if this would be enough information to get any sort of diagnosis.

Waiting in the Sleep Room for my results

Thankfully, it was.  The doctor walked in and started going over the results with me, stating that once I finally fell asleep, I quickly showed signs of "mild obstructive sleep apnea with an apnea/hypopnea index of 6.9 per hour and a respiratory disturbance index of 10.2 per hour"...  Okay, so, my head hears "mild OSA", okay... 

But wait, there's more.. 

His exact words - "Then you hit REM sleep and things got interesting"....  

So it turned out I have what is called " REM Related Obstructive Sleep Apnea".  So, when I'm in the other cycles of sleep, I have mild sleep apnea.. However, once REM hits, my AHI (Apnea/Hypopnea index) jumps more than 300% - from 10.2 to 30.6 in just 20 minutes of REM sleep (and with my stopping breathing on average for 63 seconds during those REM events).   Bottom line - it's time for CPAP when I sleep.  

 

Unfortunately, this also means I have to do another in lab sleep study in order to titrate the machine to the pressures needed to keep my airway open when I'm asleep.  The next available appointment was more than a month away, although the Doc wants me in sooner if it's possible, so my name is on the cancel list, meaning if someone cancels their study that night, they will call me and I have to be ready to go at a moments notice.  Hopefully, my machine will be ready by the time I actually get into a lab.  We shall see, but at least we have answers.  To help me get thru until I get the machine, I ordered a wedge pillow to keep my head elevated in hopes that that might help me sleep better with less apnea events.  

 

The following day was yet another appointment, this one for the bariatric surgery.  My surgeon wanted me to have a Fitness assessment done prior to surgery, I guess to see if I have any physical restrictions that might create a problem with recovery or whatever.  For this appointment, I went to a Physical Rehabilitation center where I met with a physical therapist that made me do a series of tests. 

 This took less than an hour and was pretty easy.  The first test I had to do was basically walk up and down the hall for 6 minutes, while the therapist followed beside me with this counter on a wheel that measured the distance I went.  The next test was where I had to sit in a chair and for 30 seconds I had to sit down and then stand up over and over again. Following that, she had me put my arms or legs in different positions and she would press against them and I had to keep her from moving them.  The last series of tests were for balance - stand on one foot, point the toe of the other one and stay that way for 30 seconds type of deal.  With all that done, she declared me in good physical shape with no restrictions that would hinder surgery.  Easy peasy.. but dang, I'm glad that my insurance is paying for that, because that appointment alone was $1600 bucks.. lol

Luckily, that was the last of the appointments for that week.. with only 1 appointment for the following week - the Echocardiogram. 

I don't think Echos are common for Bariatric Surgery.  However, back in the 90s, I took the drugs Fen- Phen (Fenfluramine/phentermine) that was prescribed by a physician for weight loss.  Turns out, the two drugs in combination with each other caused a lot of people to have issues with their hearts and many people even died from taking them together.  My surgeon wanted to make sure that there wasn't any lasting effects on my heart that we might not know about.  So, off to the hospitals Cardiopulmonary lab I went. 

I had a really great technican named Scott who, as it would turn out, was also in the process of having bariatric surgery with the same surgeon and we had a ton of stuff in common.  He was an absolute hoot, cracking jokes the entire time he was doing the test ("here's your liver.  You know what I think that liver looks like? It looks like it would go well with fava beans and a nice chianti...fffff fff fffft).  He explained that he was going to take about 72 photos of my heart and he explained what he was looking for with each angle.  The entire test took about 20 minutes with no abnormal findings.  Turns out, not only do I have a heart (contrary to what my ex husband might think) but it's a very healthy heart.   

With only 1 appointment that week, I had a bit of time to relax before heading into another week of multiple appointments. 

Week 3 started off with an appointment with my dietician. (Has it only been 3 weeks since I started this??). 

The View from my Surgeon's waiting room

My dieticians name is Stephanie and is a really nice individual.  First, I had to get weighed, which showed I am maintaining my weight (although, I would be willing to bet I lost a lb or two, but I was on my monthly cycle and usually gain 2-3lbs for the first few days of it).  They honestly want me to maintain where I am at and not lose too much before surgery and definitely not gain anything.  We talked about what I've been eating and she was happy I had both switched to a smaller plate (from a 12 inch dinner plate to an 8 inch dessert plate) and had started making sure half of my plate was vegetables.  I then had to speak with my surgeon's nurse who informed me that as soon as I have my endoscopy, they would be putting me on the schedule for surgery. The estimated timeline for that would be about 3 weeks following the test.  Yeah, THAT was a shocker, as I was expecting it to take much longer to get a surgery date.  She said that since all my tests are showing I'm ready for surgery and that the endoscopy would be the very last thing, there's no reason that my insurance wouldn't approve it and that I was more than ready.  Okay by me.    

Appointment 2 - the following day.  This was an appointment with my PCP, Dr Palmer. 

Another waiting room

 

One of the things my surgeon wanted me to do is to see my PCP once a month, so this was my August appointment.  I brought all of the current test results with me and we discussed everything that was going on.  Dr Palmer reiterated that she is very happy that we are going down this route as she feels this surgery is the perfect tool for my situation.  She explains that weight loss surgery isn't something she routinely suggests for her patients because too many think it's a quick fix to their overeating but explains that in my situation, she knows that my weight is more of a hormonal situation and not a result of too much food.   She states that once I get on my CPAP and I have this surgery, that in about 6 months she thinks I'll be very happy with where I am at as it will be a totally different life for me.  I sure hope so..  I am ready for my body to stop fighting me at every turn.

One final test for the week.  This one isn't really related to my surgery, but is one of those routine tests that I have put off and put off for a few years now - my mammogram.  I know it's important, especially since I have a family history of breast cancer.  It's not that I was scared to have it done - but when it was scheduled last time, Covid hit almost immediately and the hospitals in California shut down "elective" procedures and were only doing emergency tests.  Routine Mammograms weren't considered emergency so it got put off.  Then we moved to New Mexico and I just didn't think to reschedule it. However, my surgeon decided that I might as well get all of my routine stuff taken care of before surgery - so that's why I'm having both the mammogram and the colonoscopy done prior.