Getting Approvals and Signing Contracts

This morning I made appointments with a Cardiologist and a Pulmonologist to have them examine me, conduct the required tests and give me a medical clearance for surgery. These are required by the insurance company and the surgeon. The latest appointment is April 1. So we cannot expect all the paperwork to be to the Surgeon before early April, then he has to see me again and send in the medical packet to the insurance company to get their approval. Then, if that all goes well, I can have the surgery. I suspect this means about May 1, 2009.

I also made an appointment with a Dermatologist as recommended yesterday by my Primary Care Physician. I have a couple of lesions on my legs caused by my obesity and the inability to lay down. These are not infected, thank goodness. However, he wants me to have the Dermatologist to see what he can do about them before having surgery. He said, "You do not want to go into surgery with any open wounds!" Having just gotten over 4 months of treatment for Staph infection after my last surgery, I agree. So this is a preventative measure to make sure I am ready for surgery and face the smallest number of threats to my health as a result of surgery.

Last night I received a "Contract" from the Surgeon that I have to sign and return to the doctor. I also have to have my wife to sign it and have it witnessed by someone, all in the effort to create a team approach to the recovery and lifestyle changes required post-surgery. I list them here, somewhat modified to protect identity, so you can see what is required and so I can do more than sign a medical document (do you ever read them???), but internalize these requirements.

1. I will follow-up with the Surgeon as asked. At least every 3 months for one year, every six months for the next year, and at least annually thereafter.
2. I will not become pregnant for at least one year. (I like the easy ones since I am a male).
3. For the rest of my life I will take a daily multivitamin with iron and daily calcium supplement. (I took my first Flintstones vitamin yesterday. It was Fred, "Yabadabadoo!")
4. I will not take non-steriod anti-inflammatory medications (Motrin, Nuprin, Advil, ibuprofen, etc.) or medications containing aspirin without instructions and OK from the surgeon. (I take ibuprofen for arthritis. It works, somewhat. Will Tylenol work? I hope. I have asked my wife to pick up some Tylenol the next time she is in the store.)
5. I will not eat more than 2 ounces of food at one sitting. (No, that is not a typo. The food pouch - read stomach - can be stretched. To avoid future weight gain the pouch must stay small. As I understand it this is critical to success.)
6. I will eat mainly protein for the rest of my life. I will avoid eating or drinking carbohydrates, sugar, starch and fat. (I recognize this is not a choice if I want to get better. These will now be poison to me - or really already are.)
7. I will exercise three times a week. (This will require some help. My immobility makes this difficult. I need help with this. I do not mind exercise, fortunately. In fact I tend to enjoy it.)
8. I will attend support groups once a month. (I will have to work on this as my cynicism gets the best of me. I value effective support groups,but I have attended so many that were not helpful. I realize this is no excuse for avoiding them altogether. The best group I ever had was an accountability group which met once a week for over 10 years. Once of the members of that group has had this surgery and is willing to support me as a sponsor.)
9. I will contact the Surgeon before having any elective surgery or invasive procedures.
10. I will notify the Surgeon of any surgeries to be performed if possible.
11. I will follow up with my Primary Care Physician and get a comprehensive physical exam and routine lab work at least once a year. (At least one is easy since I have been doing this for several years.)