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Health and Fitness

Life at 335 Pounds

How one woman lost 150 pounds and found her freedom

Nancy Sheppard had never had a weight problem. Growing up, she was one of those girls who ate what she wanted and didn't think twice about stopping for fast food or adding additional bread items to her meals.

Although Nancy's heart went out to both her mother and sister who struggled daily with their weight, she never put much thought into what she was putting into her body.

As a junior in High School, Nancy was diagnosed with severe Attention Deficit Disorder. The medications doctors began prescribing brought Nancy's appetite to an all-time low. Through the rest of her young educational life, meals would be routinely skipped or barely picked at. When Nancy graduated high school in 2001, she weighed about 190. Because of her large and proportionate frame, 190 appeared thin and healthy.

Around this same time, Nancy's doctors finally settled on a medication to treat her ADD and what followed was something Nancy wasn't prepared for; a slow return of her appetite.

This is not a story about Nancy at 190. This is a story about Nancy at 335, and how the Navy's Tricare Standard program, which funded Bariatric Surgery, helped her to become Nancy at 185.

How It Started

After high school, Nancy made her way to college, and like many college freshmen, Nancy gained 15 pounds. However, unlike many of her peers, Nancy didn't gain that weight through a liquid diet. She had settled into a relatively lethargic routine and was no longer skipping any meals. Nancy's weight continued to yo-yo over the next five years while Nancy was trying to "find herself" and the direction she wanted to take in life.

In March 2006, while working in a musical instrument store, a young man came in to look at guitars. He was tall, and handsome, with striking blue-green eyes. For Nancy, it was love at first sight. By August they had moved in together and by June of the following year they were married. But wedded bliss didn't bring with it cooking skills, so the couple relied mostly on fast food. Nancy walked down the aisle at 250 pounds.

Mere weeks after the wedding, Nancy found out she was pregnant. She went off her ADD medication and concentrated on the baby.

"My pregnancy with Emory was a very difficult one," said Nancy. "I was getting sick at least five times a day and often ending up in the ER for dehydration, while also struggling with preeclampsia."

On top of this, Nancy couldn't keep up with the physical demands of working at the music store. She opted instead to go to work with her husband Josh at the travel agency call center.

Then disaster struck again. In December of 2007 Josh was laid off and Nancy was put on temporary leave without pay due to the amount of absences her difficult pregnancy had caused. The couple was forced to give up their apartment as well as their health insurance and move in with Nancy's parents.

The doctors informed the Sheppard's that they suspected their baby was having trouble swallowing, which led Nancy to believe that the baby had inherited Pierre Robin Sequence, a disease she was diagnosed with when she was born.

"It was a very terrifying time," said Nancy. "Josh was able to get another job pretty quickly, but we both made the mutual decision that the best thing for our family would be for Josh to enlist in the Navy."

In February, Emory was born, and it was confirmed their daughter had Pierre Robin Sequence. From that moment on, Nancy wasn't thinking about herself. Her baby spent the first month and a half in the Neonatal Intensive Care Unit due to breathing difficulties and feeding issues. She came home from the hospital, still using a feeding tube and requiring specialized equipment. Their daughter also suffered from colic and acid reflux during her first six months of life. It was clear Nancy would not be able to return to work. Her daughter needed her to be a full time mom. At 272 pounds, Nancy knew her weight wasn't going anywhere anytime soon.

By October 2008, things were looking up. Emory had her cleft palate repaired and 10 days later Josh left for the Navy. And two weeks after that, Nancy found out she was pregnant with their second child.

"When Josh completed boot camp, we moved with him to Annapolis, Md., so he could attend "A" school at Fort Meade," said Nancy. "Because of my previous Preeclampsia and Pierre Robin Sequence, I was considered high risk."

Fortunately, this pregnancy wasn't plagued with the same difficulties that haunted Nancy's first pregnancy. There were no signs of Pierre Robin Sequence and she did not have any issues with preeclampsia. Her amazing son, Benjamin, was born in June 2009. The Sheppard's made the decision that their family was complete and Nancy had a bilateral tubal ligation.
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Navy Life

After nine months of living in Annapolis, the Sheppards moved back to Virginia Beach where Josh began his first sea tour. Nancy started taking her ADD medication again, although this time, it was far less affective at curbing her appetite.

"Josh's sea duty was somewhat of a mess for us," said Nancy. "As a couple, we were very ill prepared and did not manage our finances or our relationship very well. We had no idea how to communicate with one another while apart so frequently, and Josh was going through his own trials, having never been separated from his family. I was trying to hold everything together. Luckily, we had a very solid foundation in our relationship and loved one another so incredibly much. However, I struggled with depression during this period of time and, as was indicative during my childhood, relied on food to comfort myself."

Everything was going haywire. Nancy and Josh had been apart for too long and they were feeling disconnected from each other. Nancy, having no opportunity for a break, was completely burnt out. Ben was having trouble speaking and threw violent temper tantrums. He had to be removed from preschool due to his biting and outbursts. He was soon diagnosed with Pervasive Development Disorder - a high functioning Autism Spectrum Disorder and later a Sensory Processing Disorder. Ben would experience delays in socialization and communication. Ben didn't speak until he was more than three years old. Nancy aggressively sought treatment for him through intensive occupational and speech therapies. When he was not in therapy, she would work with him nonstop on what he was learning in therapy. Once again, she was not focused on herself or what she needed to do - her children's health was all that mattered.

When Josh returned from deployment, it was difficult for him. While he could clearly see how much Emory had grown over the seven months that he was away, Ben had not. Nancy knew she would have to teach her husband about their son and about how to relate to him.

"Now here I was," said Nancy. "Learning to cope with the constant fluctuations and unpredictability of military life, while raising two children with special needs and trying to keep my relationship with my husband intact. I obsessively pursued all of these things; giving my children every single part of me to ensure I was not only giving them a wonderful, loving childhood, but also what they wanted and needed for their lives. I had no hobbies, interests, friends or even time to myself. I didn't care about taking care of myself because my focus was completely on my family."

However, Nancy wasn't blind. She knew she was overweight. She tried exercising, herbal supplements, Weight Watchers, and although these programs were a temporary solution, none of them could change the relationship she had with food. By the time Josh rotated to shore duty, Nancy's weight had ballooned to 335 pounds. She had high blood pressure, her asthma had gotten significantly worse, and she was considered prediabetic.

Ben looked me straight in the eyes and it was like he was telling me, 'Mommy, I need you.' It was a wakeup call for me. I realized how much my son needed me and that, at the rate I was going, I wouldn't be around much longer. Over the next day, I began thinking about how much my weight had impacted my family."

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Wakeup Call

Then something happened. In June 2013, her son had one of his most difficult sensory overloads to date. Nancy took him into his bedroom, wrapped him in his weighted blanket and did a joint compression/limb squeezing exercise his occupational therapist had taught her. While holding him, she had a moment with her son.

"Ben looked me straight in the eyes and it was like he was telling me, 'Mommy, I need you,'" said Nancy. "It was a wakeup call for me. I realized how much my son needed me and that, at the rate I was going, I wouldn't be around much longer. Over the next day, I began thinking about how much my weight had impacted my family. We couldn't go and do things like a lot of families could because I simply physically couldn't. I was easily overwhelmed and tired when Josh would have to travel for work because I physically couldn't keep up with my active children. I was forcing my family to sacrifice because of me. This was very counterintuitive with my mindset because I made it my goal that they wouldn't have to sacrifice a thing in life. Something had to be done."

Nancy turned to Dr. Alex Gandsas at Anne Arundel Medical Center in July 2012 for a weight loss surgery seminar and had her first appointment with him in September.

"I definitely met the criteria for surgery, having a very high BMI and comorbidities," said Nancy. "Unlike most insurance companies, Tricare Standard did not have a specific timeframe between when someone entered a program and when they had surgery. I decided to make my pre-op process as short as possible."

That process was rather intense. Nancy had to write a statement to Tricare, outlining why she wanted to have surgery and detailing all of the avenues she had tried before in order to lose weight. She also had to go through a slew of medical tests, including a cardiac evaluation, pulmonary function test, psychology evaluation, sleep study, upper G.I. study and an EGD. Through these tests, Nancy found out that she was bordering on having sleep apnea, had a hiatal hernia and that she also had Celiac Disease.

"I also went through six nutrition classes as well as one-on-one training with a nutritionist," said Nancy. Those classes were not covered by insurance and required out of pocket fees. However, any legitimate bariatric program requires its patients to go through nutritional counseling. It was a small price to pay in the big scheme of things. I made a point to exercise as much as I could. I also joined a couple of social media bariatric support groups, which helped make the process less terrifying."

Like most Tricare Standard patients having the Roux-en-Y gastric bypass, Nancy was able to have her pre-op process, surgery and post-op care with a civilian team at a civilian hospital. She didn't need a referral or to go through the rather lengthy approval process that is normally required under Tricare Prime. She was able to choose her surgeon, hospital and care options. This surgery is also available to Tricare Prime patients as well; though they are required go through an MTF for surgery. This isn't a dismal option by any means. The other difference between Prime and Standard is that Standard does cost money. However, for Nancy, her family's catastrophic cap (the most they will ever pay out of pocket for medical care) is $1k each year. Between her son's therapies and her pre-op testing, Nancy had met their catastrophic cap by Nov. 1, 2013 so her bariatric surgery and all of her family's medical care for the next fiscal year was covered 100 percent by Tricare.

"There is an extreme disconnect between what most families understand about their insurance options and what those options actually are," said Nancy. "It saddens and frustrates me that more people do not take the time to educate themselves, and that they end up signing up for Tricare Prime without truly knowing their options."
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Life Minus 150 Pounds

In December of 2013, Nancy had laparoscopic roux-en-y gastric bypass and hiatal hernia repair.

"While I am obviously very verbose about the journey that led me to that day, it is more difficult to sum up into words how much my life has changed since other than this: I am alive and I'm living," said Nancy.

Just shy of a year out of surgery, Nancy has lost 150 pounds. She no longer has high blood pressure, her Celiac Disease is under control, and her asthma isn't a bother. She has no sleep issues and she's more active than perhaps she has ever been.

But to really sum it up, she points to the little moments.

"I can run and play with my children," said Nancy. "I am able to get on amusement park rides with them. I can traipse museums and go to activities with them without feeling tired, winded or overwhelmed. I can keep up with my son's intensive therapy schedule without problems. My daughter and I took a vacation, just the two of us."

Nancy's husband is also more at ease, because less of the daily burdens fall on him to handle. Their relationship is better than it has ever been, and Nancy is more self-confident. She has even started pursing her lifelong ambition to be a historian and is in the midst of writing a book.

"Until I began losing weight, I never realized how miserable I was," said Nancy. "I never want to be that person again. I love my life. I couldn't be more grateful for surgery and this process, which has taught me so much. I am disgusted at the thought of what and how much I used to eat. I have become very in tune with my digestive system and listening to my body."

Nancy's father has begun to look into the surgery as well. He sees how much it has done to improve his daughter's life.

"If ever I start slipping, I think of the look in my son's eyes that night I made up my mind to change my life and that puts me back on track. I've been given a new lease on life, and I couldn't be more thankful."