My letter of Intent

I am required to write and give to the surgeon a letter of intent detailing my reasons for wanting bariatric surgery, my understanding of the surgery and the lifestyle changes that will be necessary, and what knd of support I’ll be receiving. This is what I wrote, and will be giving to him at my appointment tomorrow ( I chose to adapt some of what I’ve written in this blog for part of the letter):

All of my adult life, I’ve battled with weight/food issues.  I’ve lost weight, lots and lots of it, but never enough, and never for very long. People who don’t struggle with obesity and weight loss problems don’t often “get” it; a lot of the time they think it’s just a matter of will power. But when you have well over 100 pounds to lose, it becomes overwhelming, and you just give up. So then, you’re seen as a big fat failure, yet again.

That’s how I’ve felt for so long it’s the only way I really recall feeling.  I remember that even when I was a teen, my parents were constantly on me about my weight, and the ideal when I was in high school (the 1970’s) seemed to be slim body, long, straight hair, and I didn’t fit either description. So, my memory is that I was a fat girl who was just a failure.  But after my mom died, I got my senior picture back, the big one that she had in a frame, and the girl I saw was NOT a fat girl. She was definitely a CURVY girl, and tall, so she definitely weighed more than a lot of the girls at school, but that girl was not FAT.  Food became a control issue. My parents would monitor my eating, so I snuck food when I was out of the house. Sweets and junk food, for the most part.

Then, when I was 18, I went out on a date with someone who violently assaulted and raped me.  Before that, I was a virgin. This was extremely traumatic for me, and I realize now that I began eating more to kind of put a barrier between me and any intimate physical relationship.   

Even later, as an adult, I’d come home from family gatherings and head straight for food to soothe my hurts, my anger, over whatever happened that day.  Over the years there were a lot of stress factors in my life, and I’ve gained well over a hundred pounds just since I got married almost 20 years ago.

Four years ago in May, I was in Karmanos cancer facility (in Detroit, MI) having a total hysterectomy as the result of being diagnosed with endometrial cancer.  The surgeon told me then that if I didn’t lose the excess weight, my cancer would most likely come back, and that I had to do it even if it meant bariatric treatment. Well, I did try. I lost about 30 pounds, and then gained it all back, plus more.  As usual.

For the past few years, I’ve been researching bariatric treatment. I finally came to the decision that this was what I needed to do, so I spoke with my primary care physician about possibly having lapband surgery. He felt that it would not give me good enough results because I have so much to lose, and he recommended gastric bypass.  He was able to show the insurance company (Health Alliance Plan, or HAP) why it’s medically necessary for me to do this now, as opposed to being made to go through a 12 month hospital based/supervised weight loss program (thankfully, as the ones the insurance would cover are not where we live), because it’s riskier for me to wait at this point with my BMI of about 51 and co-morbidities to go with it, such as diabetes.  So, HAP gave me authorization to go to Detroit (about 2 hours away, depending on traffic, etc) and have the psychological evaluation, which I did on March 23rd.  When we got home from Detroit it was after business hours and there was a voice mail waiting from the HAP insurance person with a call back number, saying they’d received my information from the psychological evaluation and to call back.  I, in turn, left HER a voice mail.  She called the next morning to tell me I had passed the evaluation and gave me an authorization number for my surgery, putting me officially on this journey!

I called the Henry Ford Hospital Bariatric Center as instructed by my insurance company, and got my appointment for the six hour orientation, held on April 6. It was so informative! The nurse who presented the information was wonderful, I found her to be informative and really funny.  She explained to us why HFH has been designated a Center of Excellence in this specialty, which made me feel better about the insurance company requiring me to go there.  After her section was finished, the bariatric nutritionist/dietician took over, and also gave so much great information, along with answering so many questions.  During her section another person was there to speak with us, and answer questions, a very nice lady who had this surgery 4 years ago.  She even brought a pair of her old jeans so we could see how far she has come since then.  She answered every question asked of her, including questions one might consider personal and/or intrusive, like how “much did you weigh before surgery” and “what weight are you down to now”.  The entire thing helped my husband and I understand what would happen during surgery.

I understand that part of my stomach will be cut away to create a much smaller stomach pouch, and both sections will be staple stitched to close. My intestines will be re-routed so that food can exit the stomach pouch.

I understand that I will need to make major lifestyle changes in order for this tool (the new stomach pouch) to work, and that it isn’t some “miracle cure” that would require no work on my part. I will make the changes necessary. I will learn to “eat to live” as opposed to “living to eat”. I will make some kind of exercise a regular part of my life.  I know that I’ll have to take vitamins and supplements for the rest of my life because some nutrients will no longer be able to be absorbed via my stomach.

I want to have this surgery because I want to be a better wife to my husband. I’d also like to not be too tired to take care of our home. I want to be able to go walk with him, and not have to constantly have to ask him to slow down for me.  I want to never again need to have him push me around the Detroit Zoo in a wheel chair.

I have four boys, 3 that are special needs, having been adopted after spending time in the foster care system. My eldest is age 17, was adopted at age 2.  He has Fetal Alcohol Syndrome, and is developmentally delayed.  My step-son is 13, but in many ways also younger than his chronological age, and has exhibited symptoms of Reactive Attachment Disorder. My twins are age 8, but one is effectively about 5 – 6, has mild mental retardation, and up until two years ago had been having seizures.  His twin is more seriously mentally retarded.  He is in many ways still a toddler, effectively.  We adopted the twins last year, finalizing in November.  My kids are home-schooled.  I want to live to care for them. I want to be able to do more things with them, like play, walk the nature trail in our county, and go for walks. 

I want to be able to buy my clothes in a regular store.  I can’t do that now.  

I want to get rid of the extension that is on my seat belt in the car. I want to go back to Shipshewana and not be afraid to try and go for a ride in one of the horse drawn buggies. I want to be able to ENJOY walking around to shop there, and in the giant Shipshewana flea market.

I want to be able to stop taking my insulin, diabetic meds, cholesterol and blood pressure meds.

I am now, and will continue to receive social support from my friends and family through blogging about my journey and reading their comments. I have friends who have been helping with child care so I can come to my appointments. I have one saint of a friend who has agreed to keep our children at her home (which is two and a half hours from our home) for the time I’m in the hospital. 

My church family is being very supportive, especially our Pastor and his wife, as their son-in-law had this very surgery two years ago. He is also a pastor and has sent me encouraging email.  Although it’s too far for me to come to the support group meetings (and would be difficult to get child car for those times), I am, and will continue to be, an active participant in the Henry Ford Hospital bariatric patient support group on yahoo groups. After my surgery, ladies from our church will bring meals for my husband and children for about a week, and will be of help in whatever ways they are able.

I am very excited about receiving this tool that will help me change my life.