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Here's what I just sent to my doctor:

I’m emailing you (albeit a little late) with my last set of labs, this was at 4 months post-op. At the six month point the weight loss is going slowly but surely, I am down to 308 from 384.

My issue with the hernia mesh resolved itself, magically when the insurance company didn’t want to pay for it any longer – at that point the wound care doctor told me to let the open wound close and it has not reopened nor do I seem to have any more seromas, so there was no need for additional surgery, thankfully.

Otherwise, my health is well, other than some issues with rashes under now hanging skin on my pannus, and some pain in my back which my primary care physician believes is caused by the shifting weight as Paul and I lose. My hair is falling out like crazy (I know it’s telogenic effusium, and perfectly normal), but if it keeps falling out at this rate I’ll be bald in no time flat and need a wig. Small price to pay for good health. My stamina level is much, much more than it has been – we go to the farmers markets every weekend during the summer, and where I used to have to sit down every couple hundred feet, especially when it was hot, now I can get through each one without stopping and still have energy left over. I’m hoping to start exercising regularly now that the hernia mesh issue is resolved; I just have to stop being lazy and get up and go do it.


And here's the picture I sent him:

Becke 7/22/08

Other than the fact that I look like Steve Wozniak, I feel just fine. :) Yeah, the weight loss is going slowly, but I'd rather it go slowly and keep it off than lose it quickly and have it come right back.
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I'm hovering at around 315 right now, and if the pattern continues, this time next month I'll be down another 10 or 15 lbs. and possibly be hitting "twoderland". Someplace I definitely haven't been since I was in my early teens.

The wound issue is almost a non-issue now. Ever since insurance stopped paying for the visits, all of a sudden the big deal isn't much of a big deal and they've told me to stop packing it. As soon as I did, it pretty much closed up immediately and there don't seem to be any new seromas forming along the incision line, so that's a good sign.

And finally, an updated pic - a bad self-portrait I took on Memorial Day weekend, during dusk, with no makeup, in raggedly ass clothes, with my hair back in a ponytail, but one of the first pictures I've been able to notice the weight loss myself.


Let's hope the downward trend continues.
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Well, here I am a little over 4 months post op - I'm down 70 lbs. from the date of surgery, and down 107 lbs. from where I was last April, and down 188 lbs. from my highest weight ever. So, now at 314, I'm the smallest I've been since high school (I went from 305ish to 335ish in the summer between my sophmore and junior years). It's really evident now - everything looks smaller, but with a lot of hanging skin. I'm in a 26/28 for most clothes, and even have a few shirts that are 22/24. I'm losing quicker on top than I am on bottom, and have gotten a little pear-shaped (blame the pannus!).

The wound issue is mostly cleared up - it's just a little pinhole now with very little stuff draining out of it, hopefully this means I'm out of the woods as far as needing more surgery.

I need to start exercising (now that I'm able to walk around with no real issues) and I need to lay off the sugar and carbs, but other than that, everything is dandy. :) I'll try to get around to posting an updated picture soon.
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Well, I'm back at home. I'm getting really confused with all the mixed messages I'm getting. The wound care nurse had me thinking I was on death's door, full of infection that would consume me if I didn't have the hernia mesh removed like yesterday.

So I go to the ER, and the doc in the ER says that he doesn't see any infection at all - just lots and lots of serous fluid that's running clear. They did blood tests, and my WBC count isn't elevated at all, and I don't have a temp, again which means no infection. He consulted with the wound care doc too, who just wants me to have the wound packed and cleaned daily until I see him on the 25th. So the ER took a culture (which the results will be back in 48 hours), pumped me full of Dilaudid, and sent me home with an prescription for Vicodin.

The funny thing is, the wound care doc told me himself that the hernia mesh was infected on Monday. And now it's not? Could the antibiotics have actually knocked the infection right out of me? I sure hope so, as the wound is starting to heal (Paul says that today he had like 12-15" of dressing left over, whereas yesterday he had like 6").

Either way, I'll be glad when this is all over with. At least now that the pain is being managed, things are a bit more bearable.
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Well, I'm headed over to the hospital in a few minutes. The wound care nurse came to my house yesterday to pack the wound, and said that if I wait two weeks to have surgery, I'll probably be dead. She said that the whole entire abdomen is infected, and that there is no way that this will heal at all in its current state. She says I should be on strong IV antibiotics and that they should be monitoring my sed rate, and that trying to heal a wound over an infection is nuts. Not only that, but the pain level has gone up A LOT, and it drained so much yesterday when they were changing the dressing that it left a big puddle on the couch.

So here's where we run into a problem - the doctor I saw in the wound care clinic is out of network for my insurance, so the only way I'll be able to have surgery and have it covered is to go back to the ER, ask them to bring him in to consult, and go from there.

The nurse says that once the infected mesh is out and they've got out of all of the infection, that with a wound vac and iv antibiotics, things may turn around for me in 6 weeks or so. Let's hope. I'm really scared, guys. If they admit me, I'll have Paul update for me.
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I'm tired at the moment, so I'm just going to repost what I posted to the Dr. M list - more details later.

For those of you following my ongoing saga with the seroma issue,
things just went from bad to worse. I went to an Urgent Care last
week, and they gave me a referral to a wound care clinic. I just saw
the surgeon at the wound care clinic, and he debrided the wound down
2-3" to the hernia mesh, and has told me that the internal sutures
and hernia mesh are infected. He packed the wound with salt wick
dressings, will arrange for daily repacking, but says that it's not
likely that the wound will heal on its own and that I'll most likely
need to be reoperated on in 2 weeks to remove the infected mesh,
insert a cadaver mesh, after which he'll need to leave the incision
open with a wound vac for it to heal from the inside out.

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I am so damned frustrated. As I may or have not mentioned previously, I developed a seroma by my incision about day 10 post-op. I had it drained three times sucessfully using a syringe (once in my hotel room, twice in the doctors office) before I left Brazil, with the instructions that I follow up with my family doctor on Friday (and probably on Monday as well, since it needs to be drained every 3 days or so until it's healed).

So I head to my PCP's office on Friday, and ask her to drain it. She refuses to do so, saying that it's a liability issue for her. After making a couple of phone calls, she says I'd need to have a CT scan, be admitted to the hospital impantient and have a drain surgically placed in me, and have to stay in the hospital (for 5? 15? 30?) days until the seroma is healed. Needless to say, this plan is asinine. I'd have to go through all that here in the US for something that could be done by a nurse in a hotel room in Brazil? Needless to say, I wasn't on board with that plan. I told her I'd check around and get back to her. Of course, this same doctor didn't even know what a seroma is, so it didn't inspire confidence. When I pointed out that a nurse did it with a syringe in a hotel room in Brazil, the nurse said, "well this isn't Brazil." My response? "Well, that doesn't say much for the US, does it?"

So all weekend, the seroma has been bothering me. I emailed Dr. M (the surgeon) and asked him what will happen if it doesn't get drained. He says that eventually it will drain on its own by creating a tear in my skin, and that it will be a breeding ground for infection. Not what I wanted to hear, and all of sudden this makes the issue more pressing.

So this morning, on the suggestion of some other people on Dr. M's yahoo group, I called a wound care clinic. Even though they list "surgical incisions" on their web page, they say they won't touch it unless it is an open wound. I tell them if I don't get it drained, it will be one, and I am trying to prevent that. They tell me it doesn't matter, they won't touch it in any case. Great.

In desperation, I call my original surgeon's office. She left BTC (Barix) years ago, and is now with the bariatric program at a local hospital. Her receptionist tells me that she doubts that Dr. Choban will drain it, since I had the surgery done out of the US and she won't want the liability. She said she'll ask anyway, but is sure the answer will be no. She asked about where I've been following up with - I told her I followed up with BTC for the first couple of years, and then after that, it was impossible to make an appointment for follow-up (they'd always tell you to "call next month when the appointment books are open"). So she says, "oh, so you've been non-compliant with your followup?". Uh, no lady - it was impossible to make an appointment. Big difference.

So the situation is looking bleak. I'm tempted to hurry things along by puncturing the seroma with a syringe myself, so some of this fluid can leak out, and so I can control the size of the hole, and so I can keep the hole meticulously clean to prevent infection.

It just makes me really sad that doctors, who have taken an oath to "do no harm", will let a person suffer because of "liability issues" - no, it doesn't matter if the wound gets infected and I die, as long as their hands are clean. Maybe I've just been spoiled by Brazilian medicine, but this US attitude makes me sick to my stomach. Literally.

Dr. M says that the seroma will never resolve itself on its own (most seromas get reabsorbed by one's body after a month or so) because of the hernia repair mesh. I'm not sure where to go or who to ask next. I'm truly left holding the ball on this one, and I'm angry, and upset, and extremely frustrated.

On the bright side, I weighed in this morning at 349, so I'm down 35 lbs. in 20 days. Not bad. :)
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...bruised, battered and beaten.

The past week of my life has been hell on earth. I've spent every moment of that time in so much pain that had I had the means to, I would have happily ended it all. Having never had any real headaches in my life before (other than the occasional small tension headache, or sinus headache), I used to think that people who talked about migraines were overreacting a bit. No more.

I've experienced more pain in the past week than I have in an entire 35 years on earth. If you added every single painful experience I've had up, collectively it still wouldn't have even come close to that headache. I would rather have natural childbirth 5 times in a row than to ever let an epidural needle anywhere near me again in my lifetime.

But no, the headache itself wasn't enough - add to that nausea that wouldn't (and still won't) let me keep anything down (projectile vomit salmon, anyone?), even saltines most of the time, and I'm still not out of the woods. I can see the edge of the forest but am still fighting to get there. But, as I've said, this too will pass, and in a month hopefully things will be back to normal. But in the meantime, life fucking sucks. Just because one can have a positive attitude about the eventual outcome doesn't mean one has to enjoy it while it's going on.

What pisses me off is that it took that stupid anesthesiologist a week to agree to do the blood patch (which is, BTW, the first line protocol for a dural puncture in the US) - he wanted to be "conservative" and "treat the symptoms" with fluid, drugs, and time. After 6 days of "time", by yesterday morning, my attitude was "fuck that, give me the fucking blood patch". He still didn't want to do it, warning me of all the risks "menningitis, infection, paralysis, etc", I'm convinced because he would rather me stick out the pain until I got to the US and then I would have become someone else's problem. Nevermind that there is no morphine drip on the plane, and that I would have been in abject misery. I, in no uncertain terms, yesterday argued protocol with him, told him that if he didn't have the skill or the confidence to perform to the procedure, that I would find someone who would, no ifs ands or buts. My surgeon (who I have nothing but respect for, btw, and agreed with me completely on what the treatment should have been for this) backed me up, and I got the blood patch done yesterday.

About the blood patch. Let us just say that the procedure itself hurt and traumatized me as much as the headache. The procedure should be somewhat straight forward, bascially they're supposed to sedate you, insert an epidural needle, pull some blood from your veins, insert in through an epidural catheter into the space where the dura leak occured, then within a few minutes the blood is added to your epidural space is supposed to clot and seal the leak that is causing the cerebro-spinal fluid to drip out and cause the headaches.

For me, the procedure was totally unsedated, where I sat on the edge of the OR table while this guy rooted around in my back with a heavy-gauge 6" epidural needle, with no idea where he was going, hitting nerves along the way in a game of and hit and miss that went on for about an hour - with him pulling out the needle occasionally and trying a different angle of approach.
Eventually he said "I got it - don't move a millimeter" and I sat there sobbing, scared to death, while the stupid catheter in my artery had already clogged and they needed to rip out the iv in my other wrist, to go rooting around for enough blood to fill the syringe no matter how they got it. It was absolutely excrutiating, so painful at times that I almost started screaming. The only thing I could think of during this time was that it was my weakness that had gotten me into this position in the first place; that if I weren't such a undisciplined fat pig, I wouldn't have needed to get a revision to my weight loss surgery in the first place, and that my vanity and/or need to not weigh 400 lbs. may end costing me the use of my legs or even my life if I were to breathe the wrong way. I have never felt such a loss of control in my life, and I never want to feel that way again. I still don't know how to parse the emotions of the last week - it's not a painful experience that I can asborb into my life experience and learn from, instead it's something that bring to tears whenever I think about, and haunts my nightmares (I keep reliving the experience whenever I sleep).

Having said all that, I don't regret coming here to have the surgery. I have no question of the skill level of my surgeon, or the caring of his nurse. I would once again with confidence put my life in the lands of this surgeon. He has done everything possible to make this whole ordeal tolerable, advocated for me when I've needed it, and basically has checked in on me one way or another day and night. I do have few choice things to say about the hospital itself, but that's another post for another day, and again, doesn't reflect on the skill of the surgeon.

And please note - while my experience has, admittedly, been nightmarish, bear in mind that out of over 400 North American patients, plus 2,000 Brazilian patients, I am the first one who has experienced this particular complication with the epidural anesthesia. Not that it makes any less shitty, but complications happen, and I just happened to get hit with one.

So thank you everyone for your comments and well wishes, and I'm sorry I haven't been able to post previously. I just hope that this all ends up being worth it in the end.
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Paul here.

Becke came through the surgery (well, surgeries -- a revision bypass and a hernia repair) with flying colors.

She tells me that she's in much less pain after this surgery than she was with the first gastric bypass in 2001. She'll probably be up and typing her own entries tomorrow once the residual effects of the anesthesia fade away.

Her incision, for what it's worth, is considerably shorter than the original... almost a third so. Go figure.

Right now she's reclining on a comfy chair, watching some weird-assed movie on one of the few English-broadcast channels here in Brazil. People getting grabbed into the sky by some invisible force; and then there's Gary Sinise... what the hell's with that?

On the subject of the surgery and its aftermath, she'd like to point out that the single, wide, properly designed binder is a hell of a lot more comfortable and functional than the pair of crappy cheap-assed junk binders that BTC provided back in 2001. Sure, it's a tad itchy, but she's gotten over that already.

Oh, also, the intubation was a breeze -- Dr. Mohammed got her intubated on the first try.

Signing off,

Paul (I'm under the knife on Thursday morning, folks...)
Current Mood:
okay okay
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Well, it is now the morning of surgery, and I'm happy to say that I'm not even a little bit nervous. The tests over the weekend went smoothly (especially the endoscopy, which I was expecting to be far more difficult/traumatic than it actually was), and everything came out normal (no fistula, yay!) so it's a go for me. Paul caught my cold, and is still quite congested, so his may be postponed a day or two.

We've so enjoyed our time here in Curitiba so far. We've made a wonderful friend, Gilberto, who has had us in his home twice now for homecooked meals, and he and his family have made both of us feel so very welcome and far less homesick for our own families. And I've been able to communicate with mine using video Skype for free, so that helps too.

When I post next, it will be from the hospital, post-op, hopefully letting you all know I've made it through OK. I have every confidence in the world that I will.

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