LT'S BLOW-BY-BLOW DESCRIPTION

July 9, 2000

For all the soon-to-be's, here's the revised and corrected

blow-by-blow description of my visit to Durham:

Friday, May 26, 2000 (Updated July 9, 2000)

Hi Ya'll!

The *worst* part of the surgery for me was being without a computer!

LOL! (but entirely true!)

Stats: I'm 47 years old, 5'4 " tall, starting weight 249, surgery

date May 18, 2000, current weight 224 (7.5 weeks). I lost 17

pounds in the 6 weeks before surgery when I had gotten up to an

all-time record high of 265 lbs.

Here's my blow-by-blow description of how my trip to Oz was for me:

GETTING THERE:

I'm from Alabama and Dr. Rutledge requires out-of-town patients to

attend one clinic prior to surgery. Since he is holding clinics on

Tuesdays now and my surgery was scheduled for Thursday, May 18,

2000, I arrived in Durham on Monday, May 15th, in order to attend

the Tuesday, May 16th clinic.

For anyone travelling alone, I was solo and it is definitely

do-able. I would have done a few things differently but my original

plans were made when I thought I would be accompanied to Durham,

which got changed at the last minute. Mainly, I would have stayed

someplace closer to the hospital and not fooled with getting a

rental car, but I was able to drive easily two days after surgery so

it wasn't really a big problem.

I got my airplane reservations from lowestfare.com for $130 ($156

after taxes and surcharges were added), with less than 7 days'

notice, round-trip from Montgomery, AL to Durham, NC on Northwest

Airlines. (Also, if you can't get a good ticket on lowestfare.com,

go to priceline.com. You put in the dates you want to travel and

the price you want to pay -- be ridiculous, it works -- and if

they find it, you've bought it. You don't get to check it over

and you can't change it, but the price will be great. When you

put in the price you want to pay, underestimate by about $25 because

they will add surcharges and taxes to the price).

Being on the conservative side, when I made my reservations, I

planned to stay in Durham for 5 days after the surgery, so I was in

Durham from Monday, May 15th through Tuesday, May 23rd, when I flew

back to Montgomery and then went to a friend's house in Florida to

visit until today (Friday, May 26th). I could easily have left

either the day after surgery or two days after surgery with no

problems.

I stayed at Extended Stay Inn on Tower Boulevard. The cost was $272

(total, after taxes) for one week for one person and it is about $20

more for the week to add another person. The room is on a par with a

Days Inn or Red Roof Inn -- not Spartan and ugly, nice but not

plush. It has a kitchen and it is located across the street from

South Square Mall and within 2 blocks of a 24-hour Kroger and

several restaurants and fast-food places.

However, I read where someone found a *much* better deal

at 1-877-Medstay, that has a free buffet breakfast, lunch and a

pool, so I'd try that first!

Rental Cars: The best price for one-week on Rental Cars was from

Dollar Rental Car at the airport. You could get a small truck for

$149 a week or a small car for $172 for the week. I lucked out

because they were out of small cars so I got a mini-van for the same

price for the whole week and 1 day I was in Durham.

======================================================================

HINT #1: BEFORE YOU LEAVE, CALL YOUR HOTEL AND GET *SPECIFIC*

DIRECTIONS TO YOUR HOTEL FROM THE RALEIGH-DURHAM AIRPORT AND WRITE

THEM DOWN AND TAKE THEM WITH YOU. My plane got in at 11:30 at night

and I forgot to bring my directions with me. The rental car place

gave me directions to downtown Durham, but I spent about 3 hours

driving around in the middle of the night, looking for *anyplace*

open just to get directions from downtown Durham to my hotel. I

finally ended up being shown how to get there by a security guard

from the Marriott in Downtown Durham. Don't go by the directions

from Mapquest because the major highways have different names on

the street signs than Mapquest uses.

======================================================================

CLINIC:

I showed up at Dr. Rutledge's office on Tuesday morning, May 16,

2000, for the 9:00 a.m. clinic. His receptionist gave me my file

and directions to go to a building just past the hospital, a few

blocks away.

The clinic was held in a small room in what appeared to be a

medical-annex type building. Dr. Rutledge spoke at the front of the

room. Behind him was a blackboard and above him and to one side was

a video screen.

There were about 35 people, including potential patients and some of

their family members, in the room, seated in plastic chairs. Some

of the chairs don't have arms on them but some do. Don't get there

last if you want a chair without arms . . .

In the back of the room, Debbie, Barbara, and two other women whose

names I didn't get, all of whom work for Dr. Rutledge, worked on

getting patient information, weights and waist sizes from everyone.

I was given another Patient Information Form to fill out.

======================================================================

HINT #2: Print off TWO copies of your patient information sheet

when you submit it to Dr. Rutledge, one for you and one to take with

you to your clinic visit, otherwise, you will get to fill out

*another* Patient Information form (just like the one on the

webpage) at the clinic.

======================================================================

I was weighed (249 lbs., argh!) and my waist was measured (45

inches. Sigh.)

Dr. Rutledge calls on each person in the room, asking them to

introduce themselves, then he answers any questions they may have.

He illustrates things using the blackboard. Towards the end of the

clinic, he shows a videotape of an actual Mini-Gastric Bypass being

done, as he explains what you are seeing (which was very helpful for

me since I had no clue what organs were what). It is remarkable how

tidy the inner organs are and how skillfully Dr. Rutledge can work

with those tiny little tools, looking at a camera image of what he's

doing. He also explains why the MGB is readily reversible. The MGB

takes about 35-40 minutes and a reversal takes approximately 1 hour.

Both are done laparoscopically so there is very little blood loss,

an average of 1 day in the hospital, and a very fast recovery time.

Dr. Rutledge then goes into an area of individual patient rooms and

each patient is called back to speak with him individually.

My questions were:

" After the MGB, does the larger part of the stomach that is cut away

from the new small stomach growl or send hunger signals to the brain

and if not, why not? "

Dr. Rutledge explained that the stomach does not send hunger signals

to the brain. It is the small intestine that does that (and

approximately 6 feet of that is bypassed by the MGB). I didn't

think to ask if the bypassed small intestine sends hunger signals to

the brain since it would be empty all the time, but I think the

cutting of the Vagus nerve that occurs during the surgery alleviates

that (I may be wrong on this point). Dr. Rutledge also explained that

The bypassed stomach doesn't growl because it doesn't have any air

left in it. It also does not atrophy, which is one reason why the

surgery can be reversed.

MISCELLANEOUS, DAY BEFORE SURGERY:

You are supposed to wash with Hibiclens the night before surgery and

the morning of surgery. This is a red-colored liquid cleanser that

will pretty much permanently tint your washcloth pink (good thing

you're staying at a hotel, right?) For those not staying at a

hotel, don't use your good washcloths for this.

I found Hibiclens in a small bottle for $3.59 and a somewhat larger

bottle for $6.79 at the Drug Emporium next to Circuit City, across

the street from the Tower on Tower Boulevard in Durham. I bought

the larger bottle, but there was more than half left. The smaller

sized bottle would have been sufficient.

Remember not to eat or drink after midnight the day before your

surgery.

Call Durham Regional Hospital after 3:00 p.m. the day before your

surgery, ask for " whoever schedules surgery, " and they can give you

the exact time you are scheduled for surgery. You are supposed to

get to the hospital 2-1/2 hours before your scheduled surgery time.

THE DAY OF SURGERY:

About 6:30 a.m., I parked my rental car in the patient parking lot

in front of Durham Regional Hospital. There is no charge for parking

there. I walked through the main front door. There is an information

booth just inside the front door and I asked where a pre-operative

surgery patient should go. I was directed to a waiting area on the

third floor. There was a receptionist there with a sign-in sheet

which

was used to call patients for processing. I only had about a 10

minute wait before I was called. While I was waiting, I met the

woman who was scheduled for surgery with Dr. Rutledge before me. I

was scheduled to be the second one of the day.

When my name was called, I was directed to a small room just behind

the receptionist's area. A lady asked my name, address, and

insurance information. Dr. Rutledge stuck his head in to say " Hi. "

Next I was directed to another lady who made a patient i.d. bracelet

and put it on me and then led me to the next area.

I found myself in a fairly large room with nursing supplies and

counters down one wall, with patient cubicles formed by large

curtains hanging from ceiling tracks going down the other side. Each

patient area had a gurney with sheets on it. A nurse gave me a

patient gown, surgical stockings and some footies to put on. I was

told to remove *everything* before putting on the gown. The surgical

stockings are thigh-high heavy-duty support hose. These stay on

until the day after surgery.

The gown tied in the back and snapped at the neck and down the short

sleeves. It was plenty roomy and large enough, but it didn't tie

well in the lower back, so that if I got up and walked around in it,

my bare behind was flapping in the breeze. I quickly parked myself

on the gurney with the gown tucked around my hinterparts and stayed

there.

Shortly, a nurse came and took my temperature, blood pressure, and

used a nifty little gadget to stick me in the finger to get some

blood. That did not hurt one iota (a *big* improvement over the days

when they used jagged metal for finger sticks, let me say!)

I was told to put anything I brought with me into a bag and the bag

was marked with a sticker with my patient information to be sure it

got to my room (it did). I had brought my Walkman, some books, a

gown, and my purse.

The nurse handed me Dr. Rutledge's Consent form to read and fill out

then. Dr. Rutledge requires a short paragraph to be written below

each of the items on the consent form so it takes a little while to

complete it.

======================================================================

HINT #3: Don't take your jewelry and purse/wallet to the hospital.

If you have a family member with you, leave your valuables with

him/her; otherwise, you should check your valuables in with the hotel

and have them put them in a safe for you. It's a nuisance to keep

up with them at the hospital and you are going to be asleep a lot,

plus your bag of items can easily get misplaced from the time you

check in at pre-op and get moved to a room. Valuables are *not*

insured against theft if you just leave them in your hotel room,

either.

Don't take anything with you to the hospital except a loose

gown or shift (that you can wear back to the hotel or home the next

day), toothbrush & toothpaste, a fresh pair of undies and whatever

music or reading material you need. (I was told the hospital supplied

a toothbrush and toothpaste but I didn't ever see those).

======================================================================

Shortly, a nurse came for me and wheeled the gurney and me to the

surgery staging area. This is another room, just outside the

surgery rooms, where patients for different doctors are lined up

side-by-side, waiting their turn for surgery. It's a pretty plain

room with a nursing station in the middle. It seems that patients

are expected to be laying down so I did.

Now, this is the part I dreaded most. I've had several surgeries

and I've given birth to three children, and each time, I had to have

an I.V. I knew from these experiences that the I.V. needle is

usually stuck in the back of the hand between the thumb and wrist --

where there are hundreds of nerve endings -- and it hurt like hell

and beyond.

Pre-Op Nurse Sheila Weeks sets up all the I.V.'s. She is clearly

expert and she has a wonderful technique. She first gives a small

Novacaine injection into the hand. This hurts a little (not much)

and it is wonderful, because I then did not feel the I.V. needle

(which is quite large) *at all* when she put it in place. I did not

have so much as a tiny bruise at the site when the I.V. was removed

the next day, either. Truly wonderful. Thank you, Sheila!!

Before anyone goes sticking an I.V. needle in you, particularly if

it is not Sheila, make sure they are going to give you the Novacaine

shot in the hand first.

Presently, the Anaesthesiologist and shortly thereafter, the

Anaesthesia Nurse, stopped by to see me. This was a good time to

mention any drug allergies. Both of them asked me to open my mouth

and say " Ah, " so they could see if I had a good airway. (Anybody

who knows me knows I have a big mouth and plenty of airway!)

It didn't seem like 2-1/2 hours had zoomed by, but before I knew it,

I was being wheeled on the gurney into surgery. There seemed to be

several people in the brightly lit room and everyone was wearing

blue gowns over blue pants, with blue hair covers and face masks

(E.T. phone home!). Dr. Rutledge was standing off to one side with

his back to me. I think he was washing his hands. I was told to

slide sideways off the gurney onto the surgical table (which is

narrow).

It's hard to see much laying flat on your back, but I knew Dr.

Rutledge was there because he immediately started in with his usual

chipper chattering. Assured that at least I was in the right place,

I laid my head back and relaxed. Momentarily, a gloved hand appeared

and put a mask over my nose. I started breathing into it and conked

right out. The gas didn't stink or have any odor to it at all that

I could tell.

I woke up in the post-op recovery room. Things are a little hazy

but I had no tubes in my nose or anywhere else. There was a nurse

next to me saying things like " Your oxygen isn't high enough.

Breathe deep! You must take deep breaths! " So I did. I'm laying

there sucking enough wind to take the chrome off the bedrails. (I

found out later that they seem to say this to everybody so when you

wake up, just start breathing deeply!)

At some point, I remember somebody, I think it was Dr. Rutledge,

saying " Your operating time was 37 minutes. "

As I got more awake, within what seemed like minutes, I was being

wheeled down a hallway to my room.

Lori Honour, an angel who lives in the Durham area and is having her

surgery the end of May, had come to wait for several of us who were

having surgery that day and she was the first person I saw when we

got to what was obviously the hallway with patient rooms. I thought

we were just a few feet from her (she says I was actually at the

opposite end of the hallway) when I hollered out, " IT WAS A PIECE OF

CAKE! " And, indeed, it was.

DRUNK AND DISORDERLY:

The anaesthesia had made me goofy and drunk-like because I was in

high spirits, to say the least, when I got to my room! I don't

remember getting off the gurney and into the bed but I did. The

nurse came and gave me some pain medication. I wasn't feeling any

pain at the time, at all. Within a few minutes, I got up and went

into the bathroom which was just a few feet from the bed. I called

over my shoulder to Lori, " You've seen a fat ass before, I know! "

since it was useless trying to get the gown to cover mine and I was

laughing too hard to care anyway. I fell asleep sitting on the

toilet three times. Fortunately, Lori would wake me up. I'd laugh,

try to pee, then fall back asleep each time. I finally succeeded

and then got back into bed. The nurse put some plastic air-pumped

sleeves on my legs. These automatically pump air into them every few

minutes, gently squeezing the legs, then releasing the air. These

are to prevent blood clots in the legs. I wore those all the first

day and night after surgery.

Right about that time, a friend called me on the room phone. I tried

to talk, but fell asleep on the phone.

The next time I woke up, about 3 hours later, I had some pain and

discomfort. This is mostly from the gas that is blown into the

belly during surgery so the doctor has room to work and see what he

is doing. This gas is *not* like " having gas " when you get the burps

or farts. It gets in all sorts of places, like up under your ribs

and in your shoulders and there is a lot of it and it is really

uncomfortable. It's not terrible pain but it is painful and

annoying and at the same time, you're tired from the anaesthesia, so

you feel pretty washed out.

The gas *will* go through membranes, though, so it will go to your

throat and lower intestines on its own. If you can force yourself

to burp or pass gas (the men ought to be good at this. Just

remember your Boy Scout campouts), you can get rid of it faster. I

put my best efforts into it and within about 6 hours after I got out

of surgery, I was feeling pretty good. I had the burps and passed

gas more frequently for several days, though, and I also got the

hiccups a few times after eating.

======================================================================

HINT #4: Keep your bed in as much of a sitting position as is

comfortable for you. This helps get the gas up faster and it

doesn't put tension on the 5 wounds with a staple in each that you

will have from the surgery. Lying flat on your back keeps the gas

under your ribs and it also stretches on the incisions so it is a

lot more uncomfortable.

======================================================================

Good pain medications are available. I preferred to get a shot of

demeral with phenergan every 4 hours, which is what I got the first

day and it worked great. Other people get a " pain pump " which lets

you hit the pump when you need pain medication. Ask for the strong

pain medications the first day. They will alleviate the pain and

you will be able to get up and walk and move around, which will

speed your recovery. By later the same day (about 6 hours),

the pain was markedly less for me. I didn't need any pain

medications at all after the first day and I felt fine.

Lunch and dinner the first day and breakfast the next day at Durham

Regional consisted of a clear broth (be sure you get salt), jello

and 4 ounces of fruit juice. I would keep the broth from breakfast

to lunch, sipping it as I could and I saved the jello and fruit

juice to take back to the hotel. Just the broth was plenty. I

never felt hungry. I was extremely thirsty frequently. My mouth

would go so dry my lips stuck to my teeth. So I guzzled a lot of

water and ice.

POST-OP:

I was discharged from the hospital the next morning after surgery.

After Dr. Rutledge came by, I remembered something I needed to ask

him and I actually ran down the hall (no pain at all) to catch him.

Since Dr. Rutledge's discharge instructions say, " No driving for two

weeks " (until you are off pain medication), and I was concerned

about the effects of anaesthesia, Lori came and took me to the hotel

and I left my rental car at the hospital. Since I had five days

until my plane left, I spent the rest of that day lounging, but by

the next day (Saturday), I went with Lori to a support group meeting

at the hospital and drove the car back to the hotel. That night, I

went to Krogers to buy some juices. Sunday, I went to the mall and

went shopping. Monday, I went to the mall again and packed my

things for the early morning plane on Tuesday. I hefted my 80 pound

suitcase into the mini-van, drove the 25 miles to the airport,

checked the rental car back in, rode the shuttle over to the airport

and hefted the suitcase another time to get it checked in. I had a

long walk in Memphis to change planes and it was uneventful. When I

got back to the Montgomery airport, a friend was waiting to pick me

up and we went to Florida, where she lives, for three days. We went

shopping and generally did ordinary things and I had no problems at

all. So that's my first 5 days post-op. Ask somebody who had the

RNY what theirs was like! Ha!

I haven't had any problems with dumping, nausea, or vomiting and

I've had milk, a bite of double-fudge ice cream, jello, soups

(including some creamy mushroom soup the other day and chicken

vegetable soup today), apple juice, orange juice, cranberry juice,

and grape juice, and a banana in the week since my surgery. I

haven't been hungry. I got a couple of cravings in the past day or

so, but nothing serious.

================================================================

Revised at 7 weeks post-op:

I've had *severe* dumping after trying a drumstick icecream cone. I

was nauseous, with chills and hot sweats for four hours and had to

lie down the entire time. It felt like the first stages of catching

the flu. It was awful.

Another time, I tried a Nestle's Crunch bar with no problems but the

next time I tried one, I got terrible dumping. Sweets no longer hold

the attraction for me they once did.

I found that you can actually drink and hold a little more the first

weeks after surgery than you can later and I speculate this is due

to scar tissue formation in the stomach and the hole from the

stomach into the intestine.

Now, if I eat too fast, or eat something that is the wrong texture

(lumpy or hard), I will upchuck. Usually, by the time I upchuck,

I am glad about it because I don't like the feeling whatever it

was I ate gave me, and I don't want to be stuck with calories

that day from something I didn't even like. It seems to be

the texture of the food, or eating too fast and not chewing well,

not the food itself, that makes me upchuck. If chewed well,

and not eaten as if in a race, just about any food can be eaten,

but it still may not feel good in my stomach. This phenomenon

doesn't develop well until about the third or fourth week after

surgery so if you don't experience it, it doesn't mean your

stomach is " too big, " or anything. Just wait.

I discovered that there is a component to food, before surgery,

that requires that it hit your stomach before it is comforting

or satisfying (which you don't realize until *after* surgery).

A few weeks after surgery, though, this is gone. It is a

little like the feeling you would get if you chewed your food,

but didn't swallow it. There is something missing. The stomach

no longer registers a " content " signal to the brain. Food stops

being a reward for every occasion. Food is still okay, it just

isn't comforting anymore. It's just food. I think that the

period that this begins to register, is what brings on a

depression, because you don't realize exactly what the problem

is, but something is just not right.

Now, realize, again, most of these things take 3-4 weeks to begin

to have effect (and also may just be different for you than it

was for me) so don't expect to notice these things the first

couple of weeks post-op. But if you begin to feel out of sorts

the third week, see if you aren't angry that there just doesn't

seem to be a single " fun " food anymore. I wrestled with this

for about 2-3 weeks. Each day, I would try something new, and

each day, find that it just wasn't fun. So then, what to do

with my hands and mouth? It was a frustrating 2-3 weeks but

that is now wearing off and food has ceased to be such a big

deal as it was.

Also during this same time, you may also not see any weight loss

on the scales, which adds to the frustration factor. The third

and fourth weeks post-op can be particularly trying.

================================================================

I haven't had over 600 calories in any given day and I am usually

averaging about 350 calories a day.

=================================================================

Revised at 7 weeks post-op:

I average 723 calories a day now. My favorite food is

vegetable-beef soup, followed by popsicles. I can eat

whatever I want but most of my previously favorite foods

don't have the " comforting " feeling they used to have and

no longer interest me.

=================================================================

At the end of the first week post-op, I'd lost 11 pounds and 1 inch

off my waist. So far so good.

=================================================================

Revised at 7 weeks post-op:

I didn't lose another ounce for 2 weeks, then I began to lose 2

pounds a week. By the end of seven weeks, I had lost another

12 pounds for a total of 23 pounds in 7 weeks. Not exactly

earth-shattering but better than gaining.

=================================================================

Also, let me mention here that before surgery, I received replies to

my queries from 94 of Dr. Rutledge's patients and the majority of

them related that they had discomfort the first day and little or no

pain, nausea, etc. thereafter, the same as me, so my experience at

feeling great after surgery, is very much the norm, not the

exception.

Dr. Rutledge, you're the best!

Kind regards,

( " the Barbie Wannabe " )

email: lindat@f...

website: http://www.fourlane.com/lindat

Stats:

47 years old, 5'4 "

Surgery date: May 18, 2000

Wt. @ Surgery May 18, 2000: 249, Waist 45

Wt. @ 1 week May 25, 2000: 238, Waist 45

Wt. @ 2 weeks, June 1, 2000: 238, Waist 45, Upper Arm 17

Wt. @ 3 weeks, June 8, 2000: 234, Waist 44, Upper Arm 16

Wt. @ 4 weeks, June 15, 2000: 232, Waist 43, Upper Arm 15

Wt. @ 5 weeks, June 22, 2000: 230, Waist 43, Upper Arm 14.5

Wt. @ 6 weeks, June 29, 2000: 228, Waist 42.5, Upper Arm 14.0

Wt. @ 7 weeks, July 6, 2000: 226, Waist 41.5, Upper Arm 13.25

Note: In between weighing weekly (on Thursday), I was weighing

daily, sometimes several times a day, and the weight would go

up and down like a yo-yo. It would usually go down *4* pounds

on Monday, then come back up 3-4 pounds, and bounce around at

the same weight for 2-3 days, then by Thursday drop 2 pounds, but

by Friday (the day *after* I take my official weight!) it would

be down *another* 2 pounds, then go back up 2 pounds by Sunday,

dropping 4 pounds on Monday, then back up. This was maddening

and driving me nuts. Weighing weekly at the same time shows

a consistent weight loss.

Dr. Rutledge says that the initial weight you lose after the

surgery in the first week or so is just water weight. I was

concerned when I did not lose weight the second week. He explained

this is because it takes the body longer to break down actual fat

(and we come into the surgery " well nourished), so that true weight

loss (fat loss) generally begins in the late second week to third

week. He said a better measurement of actual fat loss than using a

scale was to measure one's waist and upper arm.

My abdomen was still slightly swollen the second week so that

didn't help because my waist was still 45 and since I had no prior

measure for my upper arm, I can't tell you what it was before

surgery, either. I should have taken measurements before surgery.

I mention this because it seems to be common for people to get very

discouraged when they don't lose weight the second and/or third week.

All of us are just sure we will be the only people to not lose weight

with the MGB. Rest assured it is normal if you don't lose much or any

weight the second week.

======================================================================

HINT #5: Using a standard measuring tape (the yellow kind, like you

use for sewing), measure your waist and the fattest part of your upper

arm and the fattest part of your thigh BEFORE you have surgery.

You will see big changes in these areas even when the scale doesn't

show weight loss, if you are like me, anyway. My body would break

down the fat (and my thighs would get areas that resembled large-

mushy curds), then the fat would be liquified, but, like a camel,

I would still carry the water around for days or even more than

a week (Just call me " Clyde! " )

So the scale would not show weight loss, even though there were large

pockets of fat gone and I could *see* they were gone and measuring

*proved* they were gone.

It is *really* depressing to see the scale refuse to budge, so it

is a major psychological boost to have these measurements which

prove conclusively, yes, you are actually losing weight even if

you carry the water from the fat around like a dromedary for a

few days!

Go to http://www.Dietwatch.com and you can chart your weight, your

BMI, and make notes about your measurements on a calendar. You

can also keep track of all the food you eat, to get an idea of your

intake after surgery, which I have found very useful in learning

how I was eating after surgery. Start this before surgery for a

really startling " before and after " experience!

July 9, 2000