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Post by jojo99 on Mar 21, 2015 0:39:32 GMT -5
I have sent in my application to Duke and Dr. Sudan and am expecting a call to schedule the first set of appointments next week.
After a great deal of reading across several forums, I wanted to get some pre-op plans in place. Here's what I'm thinking.
1 - full set of vitamin/mineral/etc labs - like the ones we will pull post-op to check levels. Is there a list somewhere that I can print out a list I can take to my PCP for her to order.
2 - I want to order a bone density scan pre-op to have a base line. I am feeling most anxious about the calcium/bone density issues for later on. Anything I can do to stay on top of it I want to do. Once I have some baselines in all my labs I will be back for suggestions for the exact vits I need.
This is just to get me started on a list for my doctor. Is there anything else I should have going on pre-op. I am actually seeing a hematologist in the next month because of a high WBC reading. I plan to ask if they have experience with DS patients and if they can help monitor certain labs. Which in particular are the issues that are best suited to a hematologist?
Any other suggestions I can add to my list would be helpful! Thanks so much.
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Post by jpcello on Mar 21, 2015 5:54:23 GMT -5
These are all great things to discuss with Dr. Sudan. Make a list of questions.
My suggestion would be to wait until you see or talk to Dr. Sudan before you start doing anything. Most DS surgeons have a full pre-op plan and each one is different. Some pre-op tests may also depend on your overall health, any co-morbidities you have, and your age. Also insurance has certain requirements. You will probably need a psych consult (I believe this is now an insurance requirement), you may need a cardiac clearance, sleep study if you have or they suspect sleep apnea, colonoscopy, etc.
Hematologists who understand malabsorption helps. Since alot of WLS patients (some RNY and some DS) end up with iron deficiency anemia at some point (especially females who are pre-menopausal) many hematologists "get it". Mind did and it helped me.
Most surgeons will order a full set of labs at some point.
It can't hurt to get a baseline bone density. Insurance may pay depending on your age. It does help - I had a baseline done about a year after my DS that was normal, and now 12 years later I have osteoperosis. BUT (and this is a big but) I'm also post-menopausal and I believe part of it is from genetics. I take and have always taken massive amounts of calcium, D, did weight bearing exercises, etc. but still ended up with osteoperosis. I just had my first reclast infusion in January so we'll see if that helps.
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Post by goodkel on Mar 21, 2015 9:26:56 GMT -5
You can and should follow your labs on your own. You can find the basic list of what we take here: weightlosssurgery.proboards.com/thread/8611/vitalady-basic-vitamin-mineral-scheduleAnd a template of the labs we get here: weightlosssurgery.proboards.com/thread/8800/lab-templateIt is always a good idea to go into any surgery in the best health possible. I am sure that Sudan will have his own pre-op tests and labs he will want run, but there is no reason not to get a head start with a set of labs now so you can address any deficiencies before surgery. Increase your lung strength by working with a spirometer (a couple of dollars at any medical supply store) or by blowing up balloons. Come back with what Sudan requires of you and we will see what, if anything, you can add to that. |
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Post by jojo99 on Mar 22, 2015 22:51:08 GMT -5
I have an issue I'm a little concerned about as to whether or not it will keep me from having the surgery. I had a standard CBC done - twice actually in the last two weeks. My WBC was 11.7 then went to 13.4 in the next four days. I am supposed to see a hematologist but not until the end of April although I am trying to find a different doctor and move it up.
I don't think there is anything really wrong, but I'm worried that if a cause can't be found, they won't allow the surgery as long as the WBC is up.
Did anyone have similar blood work prior to surgery and is it a deal breaker?
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Post by Joanne on Mar 23, 2015 8:06:34 GMT -5
I have an issue I'm a little concerned about as to whether or not it will keep me from having the surgery. I had a standard CBC done - twice actually in the last two weeks. My WBC was 11.7 then went to 13.4 in the next four days. I am supposed to see a hematologist but not until the end of April although I am trying to find a different doctor and move it up. I don't think there is anything really wrong, but I'm worried that if a cause can't be found, they won't allow the surgery as long as the WBC is up. Did anyone have similar blood work prior to surgery and is it a deal breaker? A WBC can fluctuate each day, even by the time of day. The increase might not mean anything unless it's continuing to go up. Trends and patterns of WBC matter much more than one result. It is a bit on the high side, which can mean an infection somewhere in your body. Are you having any symptoms, like a cold or a UTI? I think it's likely that they will repeat it and either you'll see it come back down, or you are getting sick. |
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Post by jojo99 on Mar 24, 2015 0:26:46 GMT -5
Actually, that's the weird thing. I'm not sick at all. I haven't even had a cold recently. The only real symptom I have is overwhelming exhaustion. Some days I literally can not function. Last week I even called my mom to come help me - just to clean my house because my FIL was coming to spend the night. I get up, make lunches, and it takes everything in my power to get my children safely to school. It's a 30 minute drive and I struggle to stay awake the whole way. Most days, I drop them off, then go to the park next to the school and literally pass out in my car sometimes for hours. If I do go home, I fall on the couch and often sleep until 2:30-2:45 when I have to go pick the girls up from school.
It's not every single day, but recently it's been a lot. It doesn't seem to matter if I sleep 4 hours, 6 hours or 12 hours. I can sleep 12-15 hours no problem.
It's getting to be pretty annoying, and I feel like a terrible wife and mother. One reason I really want to lose weight is because I believe it will help my energy level and let me do more things with my girls (7 year old twins).
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Post by jpcello on Mar 24, 2015 5:32:29 GMT -5
Actually, that's the weird thing. I'm not sick at all. I haven't even had a cold recently. The only real symptom I have is overwhelming exhaustion. Some days I literally can not function. Last week I even called my mom to come help me - just to clean my house because my FIL was coming to spend the night. I get up, make lunches, and it takes everything in my power to get my children safely to school. It's a 30 minute drive and I struggle to stay awake the whole way. Most days, I drop them off, then go to the park next to the school and literally pass out in my car sometimes for hours. If I do go home, I fall on the couch and often sleep until 2:30-2:45 when I have to go pick the girls up from school. It's not every single day, but recently it's been a lot. It doesn't seem to matter if I sleep 4 hours, 6 hours or 12 hours. I can sleep 12-15 hours no problem. It's getting to be pretty annoying, and I feel like a terrible wife and mother. One reason I really want to lose weight is because I believe it will help my energy level and let me do more things with my girls (7 year old twins). How's your iron? Are you anemia? or Do you have sleep apnea? Is the sleep you get restful? |
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Post by newyorkbitch on Mar 24, 2015 6:37:49 GMT -5
I agree. You should rule out anemia for sure. Do you snore? Sleep apnea could indeed be an issue. Have you talked to your doctor about your exhaustion? Do you have thyroid issues?
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Post by goodkel on Mar 24, 2015 9:04:18 GMT -5
Losing weight will help your energy levels, but there is definitely something else going on here and you need to have it diagnosed. As jpcello and NYB noted sleep apnea, anemia, and thyroid issues can all cause exhaustion, but you need to get it checked out. It is dangerous to be driving, let alone with your children in the car, if you can barely keep from nodding off.
Needing a nap after a 30 minute drive? Losing weight won't solve that level of exhaustion. This is caused by something else.
Make an appointment with your doctor asap.
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Post by jojo99 on Mar 24, 2015 12:54:55 GMT -5
I do have sleep apena and just recently received a cpap. I also have restless legs and periodic limb movement which can cause my legs to literally kick a foot off the bed. It's horrible. I do have medication for it though. The thing is that it is totally random. Yesterday I woke up about 9. I wasn't tired and didn't go to bed until 4am. And that was when I finally took an ambien. Up at 9 today and going strong. Sometimes I can sleep 10 hours or more and can barely move.
I do not appear to be anemic. My hemoglobin was 14.9 (11.1-15.9) and hemacrit 43.8 (34.0-46.6), platlets 298 (150-379). My neutrophils absolute are a little high 8.8 (1.4-7.0) as are the lymphocytes 3.2 (.07-3.1).
My thyroid has been tested a doesn't times but is always fine. But my sister recently discovered she has a thyroid condition that only finally showed up when she insisted on some special kind of test. So, I'm going to ask for that as well.
I had an appointment scheduled for April 30, which did not please me. I was able to get a different hematologist and reschedule for Monday April 6, so I'm thrilled about that. Hopefully I can get some answers and treat it asap.
AAAAND... I just got the call to schedule my first appointments. I meet Dr. Sudan at Duke on April 27, the dietician May 5 and the psychologist April 14. I'm pretty excited.
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Post by jpcello on Mar 25, 2015 5:09:55 GMT -5
I do have sleep apena and just recently received a cpap. I also have restless legs and periodic limb movement which can cause my legs to literally kick a foot off the bed. It's horrible. I do have medication for it though. The thing is that it is totally random. Yesterday I woke up about 9. I wasn't tired and didn't go to bed until 4am. And that was when I finally took an ambien. Up at 9 today and going strong. Sometimes I can sleep 10 hours or more and can barely move. Restless leg syndrome is a symptom of sleep apnea. For me, once I started using the cpap and started sleeping normally, the restless legs went away. You may think you're sleeping for 10 hours but if you have sleep apnea, those 10 hours aren't good sleep, which is why you wake up exhausted. IMHO sleep apnea is the root of all evils. I had severe sleep apnea diagnosed about a year before my DS. Once I lost about 75 pounds the sleep apnea completely went away and has never returned. |
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Post by teetster on Apr 3, 2015 12:16:01 GMT -5
Hi JoJo,
Another Dr. Sudan patient here, so I just wanted to say congratulations on choosing a wonderful surgeon. I can't say enough positive things about Dr. S . He is very quiet, but really very compassionate and quite brilliant I believe.
Strangely, a few months before my DS surgery with Dr. S, my WBC elevated also. It worried me, and I did call his office and talk to them as well as see my PCP, and nothing was ever found to be wrong with me. I never felt any differently, just had the elevated WBC. My PCP continued to monitor up to my surgery, and the WBC stayed elevated. I though they may cancel my surgery, but in my case, Dr. Sudan was not concerned that it was anything to worry about and proceeded with surgery. My WBC stayed elevated for about 6 months and then just went back down as strangely as it had come up. In your case, as you are having exhaustion, please make sure to get checked out well by your doctor as well as mention it to Sudan.
By the way, I will also be at Dr. Sudan's office on April 27 for a yearly check in, so I want to wish you a fabulous first visit with his office. It is very exciting!!
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Post by jojo99 on Apr 9, 2015 19:29:41 GMT -5
So glad to hear good things about Dr. Sudan! - and the white blood count. I just saw the hematologist and she basically said some people just run high - like their temperatures. Unless something really weird comes back with the blood work, I'm fine. Hi JoJo, Another Dr. Sudan patient here, so I just wanted to say congratulations on choosing a wonderful surgeon. I can't say enough positive things about Dr. S . He is very quiet, but really very compassionate and quite brilliant I believe. Strangely, a few months before my DS surgery with Dr. S, my WBC elevated also. It worried me, and I did call his office and talk to them as well as see my PCP, and nothing was ever found to be wrong with me. I never felt any differently, just had the elevated WBC. My PCP continued to monitor up to my surgery, and the WBC stayed elevated. I though they may cancel my surgery, but in my case, Dr. Sudan was not concerned that it was anything to worry about and proceeded with surgery. My WBC stayed elevated for about 6 months and then just went back down as strangely as it had come up. In your case, as you are having exhaustion, please make sure to get checked out well by your doctor as well as mention it to Sudan. By the way, I will also be at Dr. Sudan's office on April 27 for a yearly check in, so I want to wish you a fabulous first visit with his office. It is very exciting!! |
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Post by jojo99 on Apr 9, 2015 19:33:10 GMT -5
I'm so bummed. The insurance person from Duke called today. Apparently, I DO have to have 6 months worth of visits to my PCP to note "a consistent sustained effort at weight loss". I'm so ticked. I called my insurance and asked twice, specifically, if their were prerequisites. I was told there were none - other than the BMI requirements.
Now it will be September at the earliest. I'm so disappointed. I had visions of half of me by Christmas....
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Post by goodkel on Apr 9, 2015 20:31:14 GMT -5
You will still lose a lot of weight in your first three months. Start this month with the PCP and you could have a date by September or early Oct.
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