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I'm getting there! Now just the pre-admission clinic to go!  I was told today to expect more blood tests at the clinic and to go over all the test results I've already done. Then they'll give us info about what to expect on the day of surgery itself.

I'm a bit confused about my blood test results from a couple of weeks ago though. Krista (one of my Dietitions) said that my results came back completely normal but my family doctor said they were abnormal and that I have to go in and see her (so I'm scheduled to go in on Sept. 5th).  How can the same test results be both normal AND abnormal? Someone apparently has their facts wrong...

I was told that our last weigh-in will be on the Thursday before the Tuesday surgery (all bariatric surgery is done on Tuesdays). I'll need to go in for that weigh-in and to ask any last minute questions I might have.

Speaking of weigh-ins...I had another weigh-in today that I wasn't really expecting (since I was told that there was only one weigh-in left just before surgery). But I was down 6 pounds from last time, so all is really good there! 

Right now I'm 271 pounds (without clothes and before breakfast). With clothes, I weighed 273.5 pounds (which was my official weigh-in at the hospital today).

To prepare for surgery, I had to have the following tests:

Esophagus Barium Swallow (July 30th)
Chest X-Ray (July 30th)
Pulmonary Lung Function Test (August 9th)
Electrocardiogram (August 24th)
Blood Tests (August 24th)

My family doctor called and said that something was wrong with my blood tests though, so I'm a bit concerned that it'll be something that'll prevent or delay my surgery! I won't know what's wrong until Sept. 5th though because that's the earliest she could fit me in. She indicated it wasn't serious though...but I'm still worried that it'll be something that'll delay my surgery even longer!

I spoke to Lorraine at the booking office too. She thinks that I'll likely be called in for sugery in late October or early November. So a bit more time to wait than I was hoping...but that's okay, it'll give me more time to enjoy my new hot tub before surgery (WOOHOO!!!).

Anyway, just a shout out to Tanya...she added me as a friend today!  HI TANYA!

I met with Dr.Davey today (I was supposed to meet with Dr. Birch but for some reason Dr. Davey took over instead) and he approved me for Lap Band surgery! 

The appointment with him was so much easier than I thought it would be!  I didn't have to "convince" him at all to do the surgery.  He just came in and told me that at my BMI (50 BMI), that he can preform either surgery for me (either RNY or Lap Band).  He said that if a patient had a BMI over 55 and/or had diabetes, then he'd only do the RNY on them.  But if a patient is under 45 BMI, then he'd recommend the Lap Band.  Since I'm smack dab in the middle, I had a choice!  I chose the Lap Band! 

He said that the surgery itself will be in approx. 6-8 weeks from now!  Sarah (the booking receptionist) said that's not very realistic though. She said the waiting time is more likely 2-3 months.  So I'm likely looking at a surgery date in either September or October.  I'm so excited!!!  

He also said though, that if I gain even 500 grams by surgery time, that he will cancel the surgery.  They weighed me today at 279.6, so I HAVE to be under that by surgery time!  That shouldn't be a problem though!

I had yet another meeting with a dietician (I'm on a third dietician now....they first gave me Kim, then Sherry and now Holly.  I hope I get a permanent one soon).  I was told by Sherry that I could probably expect surgery in late September or early October...and now I'm told by Holly that it could be several more MONTHS...maybe even 6 months! :(

I hope she's wrong since she's just temporarily helping out in that position.  Beth's guess was December. *sigh*

I'm discouraged because I thought the process was finally speeding up.  They told me that this meeting with Dr. Birch could just be a meeting to determine if he thinks I'm on the right track or not and to give me information about the surgery but not actually a meeting to determine if he thinks I'm ready for the surgery or not.  I hope not.  I've learned pretty much all I can about the pre-op diet...and I'm consistently losing weight...so enough already. 

I'm disappointed because I was so excited that the process was moving along quickly and now I find out it could be several more months.  Enough already.  Do the surgery for the love of God.  Preparation for a healthy lifestyle is very, very important I know...but enough already.

But maybe I'm just discouraged for no reason.  Maybe Sherry was right and it'll still be Sept-Oct.

I guess I'll know when I meet Dr. Birch in two more weeks.

At least I learned a bit more about my post-op diet today:

* Fluids and solids need to be taken 30 minutes apart.  No drinking while eating because you are only allowed to eat such a small amount of food and the fluids will take up all the room in your pouch...so you need to eat the solids alone in order to get enough nutrients.
* No carbonated or alcoholic beverages (carbonated drinks fill up your pouch too fast and can make you "productive burp")
* No caffinated beverages (depletes calcium and bandsters already are in danger of reduced nutrients and minerals)
* Post-Op diet: First 2 weeks - full fluids, at about 4-6 weeks - 1/4 cup of food, at about 8 weeks - 1 cup of food.

I also found out another reason that exercise is so important.  When you lose weight by dieting alone, you lose lean muscle mass...when that happens your metabolism slows down!  The more muscle you have, the faster your metabolism is!

Well I found out a bit more information about the Pre-Admission Clinic...thanks to Monique.  Hi Monique!

At the Clinic, a nurse will go through what to expect the day of surgery and what to bring and not bring.   It's not a one-on-one meeting...many other patients will be there as well.  Then after the Clinic, they will fill in the paperwork and give you another blood test (and possibly more tests as well).  The whole thing only takes just over 2 hours.

Then we will meet with a dietician seperately to go over the post-op diet (what we can and can't eat for the two weeks following surgery).

Monique also mentioned that there are some foods that bandsters might have trouble eating after being banded:

* Lettuce
* Celery
* Steak
* Rice
* Hamburger patties

But if these are chewed extremely well, then they may not pose a problem.

Just a shout out to Brenda, who just added me as a friend! HELLO!

I wrote her a bit about the process and I thought I'd post my email to her here in case it can help anyone else interested in the Bariatric Surgery program at the Royal Alexandra Hospital in Edmonton...

- - - - -

It took me just over a year from being referred to the program until I had my initial assessment (I was referred in December 2005 and had my initial assessment in January 2007).  Supposedly the average wait list is 1 - 1 1/2 years.  At the initial assessment, you will meet with a Registered Nurse.  You need to provide her with the following completed forms (which they will send you): Your Medical History, Readiness Questionnaire, and Methods of Weight Control.  Take great care filling out these forms and provide them with as much information as possible.  These forms will be your greatest chance to make your "case" to go the bariatric surgery route.  These are the forms that the assessment team will be looking at to decide if they will allow you into the program! 

At this initial assessment meeting, you technically aren't considered part of the program yet.  That is still to be determined.  Based on your answers on your forms and your meeting with the Registered Nurse, the assessment team will determine which program you are best suited to...the Adult Weight Management program or the Bariatric Surgery program.

The Adult Weight Management program is the non-surgical route.  You will work with a dietician and try to lose weight, without surgery, based on the Canada Food Guide.  With the Bariatric Surgery route, you will still meet with a dietician, but your main purpose will be to prepare yourself for eating healthy AFTER your surgery and to help you lose a bit of weight before your surgery in order to help shrink the size of your liver to make the surgery itself safer.  They also want to make sure that you are able to make these changes now to prove to them that you can do them after the surgery.

Since your goal is to go the surgery route, make sure that you fill out the Methods of Weight Control form very carefully, with as much detail as possible.  They want to make sure that you've tried a TON of weight loss programs before even thinking about the surgical route...because bariatric surgery is considered a "last resort" and if they don't think you've tried hard enough to lose weight in the past, then they will assign you to the Adult Weight Management program.

They do two bariatric surgeries at the Royal Alex...RNY (gastric bypass) and the Lap Band.  I personally want to go the Lap Band route because it is less invasive, less dangerous (less serious complications) and reversible in case something goes wrong.  With the Lap Band, the weight loss is slower initially...but after the two year mark, the results are very comparable between bandsters and the patients that went the RNY route.

You won't find out at the initial assessment which program you've been accepted into since the Registered Nurse still needs to meet with the assessment team.  I waited almost 3 months to find out if I was even accepted into the program.  Happily, I was accepted into the Bariatric Surgery route!

During this waiting time is often when the patients attend two Weight Wise classes (two 2-hour classes), where they will teach you all about the Canada Food Guide, label reading, and the importance of exercise, etc.  The purpose of these classes are to help you to start losing weight before the surgery and to give you a guide to healthy eating that you will be using after surgery as well (once you finally get to eat solid food that is!).

I also had to attend an Impaired Glucose Tolerance (pre-diabetes) class because I have "insulin resistance".  So if you have diabetes or borderline diabetes, they will likely have you take this 2-hour class as well.

Assuming you are accepted into the Bariatric Surgery Clinic, you can expect to meet with the dietician anywhere from 2-6 times before you meet with the surgeon (the average is 3-5 times).  You meet with them approx. once a month, so this part of the process could take up to 6 months.  I required 3 meetings...my third and last meeting is scheduled for July and then I am already scheduled to see the surgeon two weeks after that (July 23rd).

As well as seeing the dietician, I also needed to see a Social Worker (because of my "emotional eating"...I reach for carbs and chocolate when I am stressed or sad) and a Physiotherapist (because I have a hip injury).  So they may assign other team members to work with you as well.

Once you meet with the surgeon, he will decide if you are a good surgical candidate or not...and what surgery (RNY or Lap Band) he thinks is best for you.  It's possible (but not likely) that he may feel that you are not ready for surgery yet and will make you continue on in the process until he feels you are ready.  But usually if your assessment team members (or just the dietician if you aren't seeing any other team members) determine that you are ready for surgery enough to schedule you with the surgeon, you usually aren't sent back into the process....but again, it is possible. 

I was told that if the surgeon accepts you as a surgical candidate, that it normally only takes 6-8 weeks until the actual surgery itself.  There are two doctors that perform the bariatric surgeries at the Royal Alex...Dr. Doug Davey and Dr. Daniel Birch.  Both are highly competent surgeons with great reputations in the bariatric community, so either surgeon is desirable.

During the wait until surgery after being accepted as a surgical patient, then you'll get all your medical tests done.  Most patients will need the following tests: blood tests, chest x-ray, electrocardiogram, pulmonary function (lung capacity) testing, GI evaluation, etc.  If you need a sleep study done for sleep apnea (if you are not already using a CPAP machine), you might be delayed a bit...but they usually will arrange for a sleep study referral a way back at the initial assessment if sleep apnea is suspected.

You will also have a pre-admissions clinic as well, where they will tell you all about what to expect on the day of surgery and then you'll have another meeting with a dietician to prepare you for your post-op diet.

At my initial assessment (before being officially admitted into the program), I was told to expect a wait of 9 months - 1 year before my surgery date.  Of course the speed of the process is largely up to the effort of the individual patient though.

Oh wow, do I ever have a lot to update here!!!

My consultation with Dr. Birch is finally scheduled!  WOOOOHOOOO!!!!  July 23rd is the big day!  Things are going a bit faster than I originally anticipated, which is awesome!!!  Supposedly after the consultation with the surgeon, it's only a 2-6 week wait until the surgery itself (assuming he feels that I'm ready for sugery).  It might be a bit longer this time just because both Drs. Davey/Birch are not scheduling any surgeries for the month of August.  So I'm thinking I'll likely be looking at sugery for late September or early October.

Before that though, I have one more meeting with the assessment team...Donna (PT), Beth (SW) and Sherry (who took over from Kim) on July 9th.  So July will be an important month for me!

Assuming I'm accepted for surgery on July 23rd, then that will mean that it only took 6 months from the point of the pre-admission meeting with Catherine (the Registered Nurse) until getting approval for surgery!  I was expecting it to take 9 months - 1 year.  So YAY!!!!!!!!!!!!!!!

I can wait to be a bandster!!!!!

Actually technically I was officially accepted back in April.  Can you believe I get the best news in almost 3 years and I forgot to post about it???  Sheesh!

Anyway, I am THRILLED that they are putting me through the BARIATRIC SURGERY route (rather than wasting my time in the much slower Adult Weight Management route...it's a slow enough process without having to go at a snail's pace!). 

My first official appointment in the program was with Catherine again on April 9/07.  Then today (May 7/07), I had appointments with the rest of the team.  ALL of which are AWESOME people.  Donna (Physiotherapist), Beth (Social Worker) and  Kim (Dietition).  All 4 ladies are so nice and helpful...I couldn't have hand-picked a better group of people to help me along on this journey!

I still have a long way to go...with MANY steps in between (mostly behavioural/diet changes)...but at least I'm officially in the program and am on my way!! :)

Kim said that the "average" person has about 3-5 (but as wide as 2-6) appointments with her until they move on to the pre-admission clinic/surgery stage, INCLUDING the appointment I just had.  So if I stay on the "average" timeline, that's just 2-4 more appointments to go!  So not toooo bad. ;) 

I almost forgot to post on of the most important things that Catherine said to me at the assessment!  Since she knows I have sleep apnea and can't wear my mask, she told me that when you don't have at least 4-5 "dips" in your sleep (and have a lack of good, sound sleep) that your body sends out hormones telling your body to hold on to your fat and not let it go!!!!!  So proper sleep is essential to losing weight!!! So make sure you geat enough sleep at night everyone!

I want to write down what I've learned about the process so far in order to possibly help any pre-consultation patients of Drs. Davey/Birch that may be reading my blog:

* Waiting list for initial consultation: 1 - 1 1/2 years long
* Wait from acceptance into the program until the actual surgery: 9 months - 1 year (plus the time from the initial consultation until acceptance into the program)
* After the initial consultation with the RN, you don't find out immediately if you will be accepted yet since a whole Assessment Team has to review all your forms. My consultation was Jan. 23/07 and I was told that I wouldn't find out if I've been accepted or not until March, so there is a bit of a wait there too.  But the RN will give you a pretty good idea if you are likely to be accepted or not.
* Edmonton (Royal Alexandra Hospital) only started doing Lap Band surgery in Jan. 2006.  They now do 1-2 Lap Band surgeries a week.
* Your BMI must be 40 or higher, or 35 with co-morbidities (i.e. sleep apnea, diabetes, heart disease, high blood pressure, etc.)
* Operation length: 1 1/2 hours
* Stay in hospital: 1-2 days (usually can go home the next day)
* Alberta Health Care pays for everything (surgery, band itself, fills, etc.); no charge to patient