The final step to getting surgery after insurance approval and scheduling a date was completing the required 2 hour pre-op diet and lifestyle class and the 2 week low-calorie diet. The class was scheduled for almost 3 weeks before surgery in order to give enough time to do shopping before the low-cal diet, as well as to procure groceries for the first couple weeks after surgery.
I arrived at the surgeon's offices at Perelman around 8 AM. The class wasn't until 9, but Marissa (Dr. Murayama's amazing admin) had managed to schedule my pre-admissions testing and screenings bookended on either side of the class. The office visit was quick and painless - a review of my medical history and medications to make sure nothing had been overlooked, vital signs taken, and then a visit with Dr. M to go over the consent forms. I was surprised that I didn't have any final questions for him before the day of surgery. It was comforting, though, to realize that I didn't have any doubts or hesitations that required a reassuring reply.
Back to the waiting area until just before the start of class, then a group of about 12 pre-op patients were led to a conference room. "Oh joy," I thought, "a Powerpoint presentation". Usually this spells disaster. However, I was pleasantly surprised to find that this slideshow (presumably through many years of feedback and editing), was well-constructed, informative, and did not require an abundance of reading exactly what was on the slide, word for word. The 5 stages of post-op diets were reviewed (clear liquids, full liquids, pureed, soft foods, whole foods), and helpful tips regarding protein supplements and stage-appropriate choices for the time right after the hospital stay were relayed. The vitamin regimen was also reviewed again, with special attention to dosage and frequency. Both these were mostly another look at what had been discussed at the MWM sessions and was written in the surgery binder, but it was helpful to have another chance to go over the "rules" to make sure everything was absolutely clear and that I had no questions or clarifications. The final topic was the 1000 calorie pre-op diet. The whole point of this is to help you drop a few pounds fast, which not only makes a bit of room in the abdominal cavity, but also shrinks the liver. This is important because, during laparoscopic RNY, the liver must be retracted to provide full access. If it's too large or rigid, chances are you will end up with an open procedure instead, which means more pain, more recovery time, and more chance of complications. That was motivation enough for me to stay the course.
Near the end of the 2 hours, the head of bariatric nursing for HUP came in to discuss the hospital stay and give us a sense of what to expect. She discussed that when we arrived and were checked in for surgery, we would change into 2 gowns (1 to the front and 1 to the back, very sexy), have a pregnancy test (females only - discrimination, I say), go over more paperwork, and get an IV started. We were told to expect to wake up after surgery with 2 IVs (an extra in case the main one failed), a foley catheter, an NG tube (goes through the nose into the stomach), a JP drain (tube with a ball at the end that sticks out of you to allow fluids to drain from the abdomen), and a pain pump (morphine, hooray!). She also mentioned that we would likely have a dry, scratchy throat since we would be on a breathing tube during surgery. The catch? No liquids on the day of surgery. Nothing to soothe that throat...not until day 2, after getting cleared from a barium swallow study. I thought about the Hippocratic Oath..."First, do no harm". Yeah right.
I started the 1000 calorie diet the following Thursday. Breakfast was Carnation Good Start with 1 cup of milk (high in protein), lunch and dinner were Lean Cuisine or Smart Ones prepared meals, and a mid-morning and afternoon snack was either a 6 oz Chobani yogurt or a low fat cheese stick. The first couple days were a bit disappointing as I watched delicious items delivered at lunch time, my stomach grumbling as if to say, "go on, there's still 2 whole weeks to worry about this!" But I was steadfast. That Sunday and Monday I hit the wall of grumpiness that I had been anticipating. My body had gotten tired of the calorie deficit and, instead of just grumbling, was ready to throttle anyone who looked at me sideways. The fear of that potential large midline incision kept me in check. I was careful to plan my meals and snacks for the day ahead of time and, upon realizing that I had a little wiggle room, added a daily treat such as a low-cal sugar-free pudding cup. It helped a lot.
The biggest reward was being able to arrive at the hospital on the day of surgery, 13 pounds lighter than at pre-admissions testing only 3 weeks prior, and to be able to truthfully say that I had met my protein and liquid goals each day, and stayed within the required calorie limits. Sticking to the plan helped me prepare for surgery not only physically, but mentally, and pushed me further down the path towards success.