So I’ve decided to go forward with surgery today (Monday). It’s Monday morning, November 10th, 2008 at 9:16 am Spain time. My surgery is scheduled at 3:00 pm today – the first surgery of the day. I’ve just enjoyed my breakfast of tea and a nice glass of agua fria (cold water) and that’s it for a while. Nothing by mouth now until tomorrow, when it will be blue dye test (blech), then tomorrow night (probably) big leak test (aka upper GI), and then if everything is PERFECTO! I will be allowed to start sipping water.
I have peace. I really waffled before making the decision. It would be so easy to just do nothing. The ankle would continue to deteriorate and then my mobility would go, yes. But it would be the path of least resistance. I’ve never been one much for that, I guess. I don’t want to just lay down and not fight.
Okay – so if this seems a little disjointed as to what exactly I’m having surgery for, let me recap a bit.
I had my original DS July 2, 2002 at 3:00 pm with Dr. Baltasar in Alcoy, Spain. I weighed 365 pounds and had a BMI was 64 – although Dr. B insists it was 66. I don’t know – it was up there, and I was dying. Going forward with DS was a no-brainer. It was that or die. I was dying, there was no question in my mind or in the minds of my medical team. It wasn’t hard to decide to go forward.
So what is a reasonable goal weight for a woman who starts the DS post-op life with a BMI in the 64 to 66 range. There’s a mathematical formula that has been worked on recently (Dr. Baltasar and some colleagues are working on a paper regarding this) that a mathematician has labored over in trying to extrapolate what a REASONABLE goal weight would be for any given patient. It’s beginning BMI times .33 plus 14. That means that my goal BMI should be somewhere in the 35 range. A normal BMI is 18.5 to 24.9. Most of us who are bariatric post-ops are told to shoot for a BMI of 25. But is that reasonable? Especially if you start out as a super, super morbidly obese individual?
So I’m 5’2″ tall. I weigh (well I did Friday night) 86 kilograms (that’s 189.2 pounds). That means my BMI is about 34. Totally in the range of success if you use that extrapolation.
So why would I pursue a revision to my standing DS?
Because my orthopedic issues are winning. Specifically, the thing that is the driving force right now is the fact that my total right hip replacement last year left me with a right leg that’s 5 mm’s longer than my left, totally changing the alignment and gait, and accelerating the level of degeneration in my left ankle. I have Grade 4 degeneration throughout the ankle/foot. I would be a candidate for an ankle replacement IF I weighed at the low end of normal BMI for me.
Do I want an ankle replacement? Not sure yet – but after having seen SEVEN orthopedic surgeons thus far, the unified theme that all of them have stressed is the fact that I need to lose weight – a lot of weight – and not exercise. Yeah, right. You ever try doing that? Not very realistic is it?
So why do it? As I stated previously, I’m not willing to give up without a fight. They say I will lose my mobility in the coming few years if I do nothing. Even if I did go forward with an ankle replacement, there’s no guarantee it would be a success. The statistics curently are that the ideal candidate (someone in the lower end of the BMI range being a key ingredient) has a slightly less than 50% chance of having a successful outcome. Not great odds. However, if I’ve learned anything thus far, it’s that getting any excess weight off will afford less continued damage on my poor joints – and that can only help.
Of course, having a revision to my DS offers no guarantees and in fact carries a fairly significant amount of risk. Every surgery does. It’s only after much prayer, contemplation, study, and several sets of diagnostics that we’ve arrived at the decision that it’s a reasonable course of action.
The plan for my surgery today is to make my sleeve more narrow – down to the 50 cc size. My common channel will be re-measured and if it’s found that it has lengthened over time, then it will be shortened. I don’t have a problem with that at all – I really believe my level of malabsorption has lessened over time. And that will be that.
Things potentially complicating this surgery? The fact that I have a full sheet of mesh across my abdomen from my hernia repair 5 plus years ago – and this will be a laparoscopic procedure. Dr. Baltasar and team have done this previously with success – but it won’t be as easy as if it weren’t there, of course. And the potential for adhesions is very real. First – will I have any? Or will there be lots? Or somewhere in between? The nature of the adhesion is really the big wild card here. If they are there and are soft and easily cut away – no problem. However, if they are there and hard and fibrotic then it may well not be possible to proceed.
Of course, Dr. Baltasar’s driving force is never to do harm. I go into this with complete peace that I’m exactly where I am supposed to be, doing what I ought to do.
So, we’ll spend the rest of the morning packing up our room here at the Hotel AC, checking out, and then heading over to the Clinica. I’ve already been over for labs this morning. Then at noon surgery prep will begin.
I’m hoping Ann will feel up to getting dressed and heading out for a walk up to the Mercadona (grocery store) to check out some of the soup options for after she leaves the Clinica. MJ could have been discharged yesterday, but chose to stay one additional night. Her husband arrived here late Saturday evening and it’s been wonderful having him here. He will likely move her to the AC this afternoon. Honestly, Ann is doing so well, I wouldn’t be surprised if she’s discharged today as well. We’ll see.
So it’ll be a pretty quiet day. I’ll get settled at the Clinica, maybe do a little work, then spend some time reading my Bible and praying. Seems like the perfect way to head into surgery to me.
Time to go.