Wednesday, November 12, 2014

Suz's Muses - “Another test?? I didn’t study for this one either!!”

Greetings, dear readers- and thanks for checking out my first contribution to Jonathan’s blog!  My topic today isn’t necessarily for women only, but it’s something I see a lot of folks ask about on WLS forums…all those pesky TESTS we have to take before we get taken to the OR.  I’ll begin today (as probably with a number of topics) by saying that though we’re all on this same journey together, how we get there is a very individual experience- everyone’s surgeon is different as are insurance companies.  You may not have to have as extreme of a testing conglomeration as I did, but it’s my hope that if you’re required to have any of the tests done that I did, this post can provide some clarification as to what to really expect when you go.

1.       Physician Supervised Weight Loss.  This is a touchy subject with insurance companies, and I can’t stress enough how important it is to make sure you stay on top of what your policy actually says if you’re going the insurance-paid route.  I can speak from personal experience that up until 1 month before my surgery date, my insurance told me there was no weight loss pre-requirement…until my surgeon applied for approval.  Then, bam!  The policy happened to have changed from the time I started this journey until I was ready to check into the hospital, and I was initially denied.  Talk about feeling like you ran a race just to be tripped at the finish line!  Fortunately, I had been working with my PCP and a dietician for nearly a year and a half anyway, so providing the documentation wasn’t that difficult.  Honestly, adding this attempt at weight loss is good for you and good for your surgeon to know, anyway.  If you’re going to take the plunge into WLS, I’d advise working with your PCP first to try and shed some weight.

2.       Pulmonary/lung X-ray.  This was one of the easiest tests I needed to take.  The X-ray was just that… hands over your head, breathe deep and hold still.  You’re given a copy of your films to take to your actual pulmonary appointment, which took about 10 minutes of me breathing into an incentive spirometer and being told my lungs looked good and I was approved for this portion.  The purpose of this test is to make sure that you don’t have a potential for pulmonary embolisms (blood clots in your lungs) or other hidden causes for you to have breathing problems during surgery/anesthesia.  Easy peasy for me.

3.       DVT/Abdominal U
ltrasound.  Another simple pair of tests that involved me just lying on a table in a dark room while a tech covered me in warm goo and ran the wand over my innards and legs. I asked a ton of questions (probably to the point of being annoying) but I found it fascinating to see myself from the inside!  These tests are done to check the status of your liver, pancreas, gallbladder and for those of us who are female, to double check that you’re not pregnant.  The DVT (Deep Vein Thrombosis) test gets done because there’s a risk of blood clots forming in your legs during surgery/recovery, and my surgeon liked to know that everything was free and clear.  (This is also why you might get put into compression leg wraps in pre-op that squeeze your calves periodically- it helps keep the blood from pooling)

4.       Sleep Study.  Obese folks have a propensity toward Obstructive Sleep Apnea- a condition where breathing is literally stopped for short periods of time during sleep that potentially limits oxygen to the brain, lessens the quality of sleep, and makes you snore like crazy sometimes to the point of choking yourself awake.  A scary thought, and a complication that can hinder healing from WLS.  If it’s found that you do have severe enough apnea, the technician will report to your surgeon the need for a CPAP (continuous positive airway pressure) mask while you sleep.  It looks basically like a gas mask that gets banded to your nose/mouth while you sleep and pushes air into your windpipe to keep your throat from closing up.  This test was one that caused me a fair amount of stress, simply for the fact that I needed to spend a night in a lab while someone literally watched and recorded me sleeping.  From a technical standpoint, it wasn’t an issue- just let them wire you up and go to sleep.  However, from a psychological standpoint it was a personal nightmare for me.  I was in a strange place with a stranger attaching wires and bands all over me, telling me (the perpetual night owl) that it was “lights out” at 11pm.  If you’ve ever seen an old-time picture of a woman getting her hair permed where each roller is connected to a wire and a huge contraption, that’s pretty much what it was like for me.  Being a belly sleeper didn’t calm my annoyance, either, but I got through the study well enough and didn’t require a CPAP.  In fact, the brain/movement scan showed I barely even moved the whole night!

5.       Cardiac Clearance.  (Insert dramatic music here)  This was the one and only test that I got the scare of a lifetime with.  Initially, if the gods are with you, it involves only an EKG test, where for just a few minutes, you’re wired up with a few sticky pads while you’re lying on a table and a monitor records the electrical activity of your heart.  Simple enough, you’d think?  Not for me.  When my EKG was over, the cardiologist (a nice enough fellow) began to explain to me that I had an “abnormal T wave” (oh, thank you very much, that makes complete sense to me) and while it’s possible it could be normal for me, it wasn’t…normal.  It was his recommendation that I report back in a couple of weeks for a stress test.  Being the obedient sheep I am to the medical world, I went for my stress test.  The cardiac stress test involved several things- a resting heart monitor, an active (read: walking quickly on a treadmill until you reach a specified heart rate based on your height and weight.  If you’re unable to physically exercise, you’re given medication to artificially raise your heart rate to achieve the same effect), and lying in a CAT-scan like machine while a series of images are taken of your heart after drinking a solution that makes your arteries glow like a firefly’s backside.   From my end, I thought it was perfectly easy (though it took nearly 3 hours).  I felt fine!  But sure enough, the next day I received another phone call with another “problem”.  The cardiac images from the stress test indicated that the front area of my heart wasn't getting proper blood supply, and my name was submitted to Hospital X for a heart catheterization.  (Begin panic mode here)  Next I knew I was going to an unfamiliar hospital to allow a doctor I’d never met run a wire through the artery in my wrist, up to my heart to root around in there and decide if there really was something wrong.  I could hardly believe my ears, but again, off I went because if I refused there would be no surgery for me and I wasn’t about to let this last test knock me off my journey.

I’m very laid back by nature, but the heart catheterization was the single incident where I was truly rattled.  I didn't like the hospital I was sent to for a number of reasons (which I’ll refrain from listing here), nor did I see a doctor until moments before I was taken to the cath lab.  All I knew about the procedure was what I learned online.  Just before the fun began, one of the doctors did come to my bedside to explain the possible outcomes.  According to him, stress tests are 90% accurate, and one of two things was going to happen.  I was either going to need a stent put in (a wire mesh tube-like appliance that holds a blocked artery open), or if the blockage was severe enough, they would have to wheel me over for open heart surgery.  Excuse me, what??  All of a sudden I didn't particularly care about weight loss, RNY, or anything else.  I felt perfectly fine, nestled into my mid-40’s with no symptoms or history of any heart problems!  With a charming smile and a pat to my leg, he left me to go scrub up.  Great frame of mind to be in, eh?

At any rate, off I went to the cath lab.  Now, in retrospect, the procedure probably isn't that uncomfortable or painful.  My frame of mind, however (and yes, you’re awake for all of this) had me hyper sensitive to everything at that point, and I didn't care for the burning sensations of the wire traveling up my arm and the feeling of the dye being injected into my heart.  After trying for a while to desperately find my happy place in wanting the whole thing to be over with, one of the doctors came to my end of the procedure table with a charming smile and said “Susan, you’re 1 in 10… your heart’s just fine… the stress test was false.”  Good heavens.  All that for nothing.  I didn't know whether to laugh or cry- I think I did both.

6.       The Dreaded Pre-op Liquid Diet.  Some do, some don’t… mine did.  This is a huge variance I’ve found from surgeon to surgeon, but the reason behind it is all the same for those who require it.  It’s not a test to see if you really have the fortitude to stick to the liquid diet you’ll have to do anyway right out of surgery, but rather the purpose is two-fold.  First, to make the procedure easier on your body, reverting to a liquid diet for a preoperative period “cleanses” your body of all the processed toxins that helped get us into the state we’re in in the first place.  (your surgeon doesn't really want to see what you've indulged in right before surgery, neither do they want to subject your digestive tract to any more stress than necessary) Second (and in my opinion the most important) reason being, when you have WLS, your liver is front and center, and often “fatty” or large if you’re obese.  Being on a low carb/low sugar preoperative diet literally shrink the fat deposits around the liver, and the liver itself, making surgery a bit less difficult (and can make it go quicker, which is always a good thing). 

If you have any of all of these tests to complete before your surgery, I wish you the best of luck, and a score of “A+” on all of them!  Want to talk or have questions? 

 You can always reach me at:

 Until next time, my friends, stay the course- you’ll be glad you did!