On Monday, the 5-week anniversary of my surgery, I get my first “fill,” where they will inject saline into my band to provide more restriction.  It’s probably about time, as I still get full pretty easily but it doesn’t last very long.  That said, I’ve lost about 15 pounds since surgery, so I guess it must be working.

Well, tomorrow is the first official day of my "mechanical soft" diet, which technically means anything that can be mashed with a fork.  I've been cheating a little on my pureed diet, increasing mashable foods over the past week, because, well, let's face it: Baby food is not meant for adults.  I've been taking it slow, and I've been really very careful to thoroughly chew my food so my stomach doesn't get too much of a workout though.  And I've been sticking with soft foods, nothing too fibrous or tough like beef or celery.

I'm able to take my pills down now without crushing them, the exception being my metformin, which I still split.  My blood sugar is doing really good.  In fact, it's going too low (hypoglycemic) every day now, which leads me to think I need to cut back on my glyburide (a drug that stimulates insulin production).  I'll meet with my  family doctor sometime in the next few weeks to put together a game plan on my meds.

As far as eating goes, I really am feeling full on a relatively small portion of food (less than my wife eats, but more than my kids), and I haven't found any foods yet that give me trouble so long as I chew it thoroughly and take my time.  When I get my first fill and get some more restriction from my band, I should be able to take even smaller portions.

Assuming nothing noteworthy happens, I don't expect to blog about this anymore for a couple weeks when I transition back to a "normal" diet.

I'm not in any pain anymore, nor do I feel bloated.  The swelling in my stomach must be going down, because I'm getting hungry now, and I'm not "filling up" on liquids like I was.  Well, maybe a bit, but it doesn't last nearly as long.

Speaking of liquids, I'm sick of them.  I'm sick of clear liquids, I'm sick of full liquids.  I'm sick of cream soups, popsicles, Cream of Wheat, Malt-o-meal, fruit juice, decaf iced tea, water, and everything else liquid.  I want real, solid food.

To that end, I cheated a little.  I'm not supposed to start pureed foods until after my follow-up appt. Monday.  Well, tonight I ran some of my wife's chili through the blender and ate it with a small piece of cornbread, which I chewed really well.  Michelle's chili never tasted so good, even if it was more like refried beans than chili.

I actually feel a bit better this morning.  The port incision still hurts a little, but bloating is down and my fever has broken.  It's easier for me to get up from a sitting position. 

I'm feeling kinda drained, probably because there isn't a whole lot of nutrition in a clear liquid diet.  Tomorrow I move to full liquids, so I'm looking forward to some nice creamy soup or cream of wheat.

Speaking of liquids, the swelling around the band has made it hard for me to take liquids down.  I have to go really slow, just a sip at a time, or the band punishes me.  I guess this is a good preview of what normal meals will be like.  It's not horrible, just uncomfortable.  I can learn to work with that, I guess.

Here's a handy tip I discovered: My daily meds are way to big to fit through the swelling around my band, so I'm having to crush them.  The easiest way I've found to get down a handful of nasty crushed pills is to mix the powder with children's Tylenol.  That seems to pretty much mask the taste.

Not a whole lot new to report today.  My port incision is still pretty sore, but I'm a lot less bloated today, at least in my chest.  My belly is still kinda bloated.  And I've got a mild fever of 99.3°F.  Yay.

We (my dear wife Michelle and I) reported to the surgery center dutifully at 6:30, and were then informed that we'd have to wait a little bit because my surgeon moonlights as a trauma surgeon and got called in to patch somebody up.  At about 7:30 they called me from the waiting room to get ready.

They took me to my room, where I was instructed to don the backless robe, surgical cap, etc., and let them know when i was ready for my IV.  After gettting me all hooked up, Michelle was allowed to see me. 

These were some of the longest minutes of my life.  As you may know from my previous posts, I've really felt conflicted about this decision.  I'm overweight, yes,  but not enough to contribute to any serious health conditions other than my type 2 diabetes.  I'm relatively pretty good about my diet (with some exceptions), but I have had the hardest time losing weight since I got my blood sugar under control, thanks to side effects from my medications.  So on the one hand, I had a voice in my head imploring me to back out, that I'm not that fat, and it wasn't too late to call it off.  Then I had another voice reminding me that the only way to reverse diabetes is to lose huge amounts of weight and this is the best possible thing I could do for it.

Finally the anesthesia nurse gave me a shot of something that made both voices just shut the hell up.  My RN called it the "I don't care" drug.  It was definitely that.

A bit later, they wheeled me into the OR, where I can remember cracking a couple jokes with the staff, and that's pretty much the last thing I remember.

My next memory was coming to in the recovery room.  What a crappy feeling.  I could tell that I had some sore incisions, and I was trying to have coherent thoughts, but I could only manage two-word sentences to the RN.  My throat being sore from the breathing tube didn't help, either.  I couldn't focus my eyes on  anything, nor could I keep them open for any length of time.  And my upper back hurt, which it always does when I'm in a hospital bed.  I know I said something to the RN, but I can't remember what.  Eventually I was moved back to my room.

The next few hours consisted of lots of walking, and before I knew it, they released me.  It was about 3 PM, and I could have left earlier if I had peed sooner.  Michelle drove us to Hy-Vee to pick up my pain prescription while I dozed a little in the car.  Next stop was home.

So here I sit, perfectly conscious.  Most of my incisions don't really hurt at all, with the exception of the incision where they installed my port.  That's really tender, and it's the one that really hurts whenever I put too much strain on  my abs.  I'm on a clear liquid diet for the next few days, but I don't think that'll be too hard, as I'm passing liquids through my new pouch really, really slowly due to swelling.  I actually got a full stomach on a popsicle earlier today.  I'm also feeling really kind of bloated thanks to the gas they used to inflate my abdominal cavity.

All in all, it's a pretty easy procedure and I don't feel too bad.   We'll see if I feel like this tomorrow.

Part of the preparation my surgeon requires pre-operation is a clear liquid diet the day before surgery.

My brother-in-law Brian is here this weekend because I hired him to put in laminate flooring.  The timing could be better, but the factory where he works is going to be closed the next two weeks, so Michelle and I decided to take advantage of her brother’s unwanted availability and at the same time help him out at a time when money is kind of tight.  He’s an absolute artist when it comes to handywork, so the floor is going to look fantastic.

Brian is a Mountain Dew fanatic, so while I was making a hardware store run this morning, I decided to stop by the grocery store and pick up some Mountain Dew for him.  If Dante had added another circle to hell, I’m pretty sure it would have consisted of being in a grocery store while on a clear liquid diet.    Being there in the grocery store was absolutely torturous.  I was mildly hungry when I went in.  Within a few minutes, I was famished.  I stocked up on South Beach Diet “Tide Me Over” drink mix, basically Crystal Light with extra protein to help you feel full.  And I bought a lot of sugar free Jello.  Also some pudding and protein shakes for Thursday, when I transition off my clear liquid diet to my “full” liquid diet.

I hope that Mountain Dew is the best Mountain Dew Brian has ever had.

As I've discussed this decision with my friends and family, I've gotten a lot of questions about it and encountered a few misperceptions.  My mom, for example, thought it was a much more extreme procedure, like gastric bypass.  The official Lap-Band website has a short animation about the procedure.  It's totally G-rated and is actually very informative.  If you have any questions about it, please take five minutes to watch this and I guarantee you'll have a much better understanding of what it is and what it does.

As the date draws closer, I'm a little nervous.  Make no mistake:  I'm not particularly crazy about this whole idea.  But as I consider my age and the long-term complications of type 2 diabetes, and the horrible health problems my dad suffered before he finally died at the relatively young age of 58, I see this as my best chance at maintaining a relatively normal life.  I actually compare my feelings on the subject to those who have to consider pre-emptive surgery because they are at high risk of cancer.  I'm not comparing diabetes to cancer; I'm just saying I feel like this is a pre-emptive action that will require short-term cost to provide the best long-term outcome.

Besides, as I told my friend Todd, it'll be nice to fit in my favorite suit again.  :)

I've had several people ask what happened after my last post. 

Well, I did call them the next day and scheduled my surgery for late November.  However, due to my family's travel schedule around Thanksgiving, I rescheduled for early  December.  Then my surgeon had to cancel due to a conflict, so we rescheduled yet again.  I'm currently scheduled for surgery on 12/22. 

I guess something like bariatric surgery is something a lot of folks would consider personal information and might be a little wary of putting on a blog.  I do feel a little weird announcing this to the whole world.  I'm slightly embarrassed about it, too, because when you think about lap-band surgery,  you think of huge people who can't even get out of bed.  I'm far from that.  I'm overweight, sure, but I have lots of energy, I don't waddle when I walk, and I don't have to shop at big and tall stores.

That said, I look ahead to the future and I see diabetic complications.  This is something that has been proven to be extremely helpful for type-2 diabetics to avoid complications. So, in spite of a huge out-of-pocket expense, I'm doing it.  I'll blog my experience, so with any luck, I might be able to help persuade other people to take this step for their health.

Wow, it's been a while since I visited my own poor neglected blog.

I was diagnosed with type 2 diabetes in 2003 at the age of 25.  I don't think it phased me at the time.  My dad was diabetic, so I always expected it would happen sooner or later.  I was a little shocked that I was so young, but I dealt with it, I moved on.  I've been taking meds for it ever since, and basically maintaining effective control of my blood sugar.  That's a good thing, because the complications from mismanaged blood sugar are awfully scary:  Heart disease, blindness, hearing loss, kidney failure, neuropathy, impeded immune system, gum disease...  the list continues...

Well, over the past year, it became apparent that my original drug regimen was losing its effectiveness.  My past two A1C tests have been high.  My last urine test showed an elevated level of proteins in my urine, which is an indicator that my kidneys are definitely being damaged.  Not enough to be too concerned, but enough that they're not filtering as much protein as they should, which is a precursor for more serious kidney damage.  My doctor and I tweaked my meds, and I've got good control again, for now, at least.

The loss of my blood sugar control bothers me.  It bothers me quite a bit.  My new medication regimen will work for a while, but it'll probably lose effectiveness after a few years, and we'll tweak again.  Up and down.  Constantly fighting my diet, constantly living under the threat of complications.  Eventually suffering from some of those complications.  Very likely dying relatively young after years of being miserable.  I've seen it first hand in my father, and I don't look forward to it, nor do I particularly think my wife or kids deserve it. 

So...  I consider all that, my future, the drugs, the up and down battle, and the complications, and I desperately feel like I have to do something to get it under control.  The only thing that can put type 2 diabetes into remission is major weight loss, but I've fought that battle constantly my entire life, particularly since I became diabetic.  Diabetes meds make it very difficult to lose weight.  Believe me, I really, really tried. 

So what other options do I have?  Well, the one I've been considering, with the blessing of my wife and my doctor, is laproscopic gastric banding (aka Lap-Band).  This is a low-risk, completely reversible, outpatient laproscopic operation wherein a ring is placed around the upper part of the stomach, creating a very small stomach pouch.  The smaller stomach pouch helps the patient feel satiated very easily.  It successfully causes significant weight loss (generally a loss of around 20%) in almost all patients.  The really interesting thing is that a study in Australia last year showed that 70% of patients who were type 2 diabetic when they underwent the procedure went into complete remission within a year, while most of the rest had a far easier time controlling it.  It's generally thought that this is almost entirely attributable to the weight loss, although it could be tied to reduced nutrient intake, or some other unidentified cause.  The difficult part of it is that it's a complete lifestyle change:  The patient's stomach pouch can only hold 4-6 oz, so that nice big juicy porterhouse is out of the question.  In fact, there are a number of foods that are very difficult to eat, never mind the quantity.  It's also pricey, running around $17,000 in my area, and my employer's insurance plan specifically excludes it.

I've been wrestling with two factors:  The first is the cost.  We can afford it, but it'll have an impact on the family budget for a few years.  And something about having another monthly payment higher than my car payment is making it a little difficult for me to pull the trigger.

The other factor is fear.  I don't think I'm particular scared of the surgery itself (link is a YouTube video of the actual procedure, and is not safe for lunch).  Well, I guess I am maybe a bit scared of the surgery, but my rational mind knows there's nothing to be afraid of.  When I say Lap-Band is "scary," I mean it's scary like it was when I quit smoking - being afraid of a lifestyle change.  The first month will be a liquid diet of varying consistencies.  After that, when I'm back on solid foods, I'll have to completely re-learn how to eat my meals.  Compared to the prospect of diabetic complications, like losing a foot, or my eyesight, or a kidney, I suppose it should be an easy choice.

I've been to a local surgery center.  I've had my initial consult, and I cleared all my pre-op tests.  They called today to get my CareCredit (surgery financing) account number so we can schedule the surgery, and I chickened out.  I said I couldn't find my wallet with the CareCredit card, so I'd have to call them back.  The truth is, I'm trying to summon the courage to go through with it.  The thing I have to keep reminding myself is that my dad would have done it, had he the option when he was young and healthy.  And I don't want my kids to have to watch me suffer and die young like I witnessed with my dad.

Besides, I call myself a geek.  What could possibly be more geeky than having your own body's plumbing modded for improved efficiency?

I'll call the surgery center back in the morning.