Need help with research
Hi, I have just begun my research into gastric bypass surgery. I went
to my GP today and she agreed that the surgery would be a good option
for me. My BMI is 59.4 so I would qualify without much objection.
How do I begin? What questions do I ask? Do I go with the doctor
that my GP suggested? How long do you think it would take from the
time of my first visit until the surgery? What type of emotions
should I expect? What type of reactions did you receive from family
and friends when you first told them?
Thanks
July 15th, 2007 at 2:15 am
I’m going to answer your questions inline, based on my experience.
This is a LONG response <G>
Pam in Niceville
What questions do I ask?
Of who? You’ll have different questions for insurance and for the
surgeon, and for your doctor - who may be doing your follow-up care.
Do I go with the
> doctor that my GP suggested?
Depends. How long has that doc been doing surgery? what is his
morbidity rate? What does he require/provide for follow-up? How
well based is he in nutrition and the kinds of deficits that occur
because you no longer have access to your duodenum where a number
of very important vites and mins are absorbed? Some docs
have "bariatric nutritionists" who know very little about the
changes that occur and who tell their patients to use tums
flintstones vitamins. If your potential surgeon says "there’s no
malabsorption with this surgery" then run as fast as you can in
another direction. There’s always some malabsorption, because you
no longer have access to a duodenum. Expect to do some research on
those deficits yourself. I’ve found that there are some really great
docs out there, but the majority really do not know what the outcome
of the surgery they do is. For them a success is if you lose 50% of
your excess weight. And they tend to run behind deficits, playing
catch-up. (i.e., when you develop deficiencies, they start to
address it, when it’s harder to correct it). Bloodwork after
surgery should check for a series of vitamin and mineral
deficiencies as well as PTH (when PTH elevates, the body is pulling
calcium from the bones to keep it constant in the blood - you want
to catch it BEFORE the blood calcium level drops, because by that
time, your bones are swiss cheese. Another one for us is Vit D
(actually, all the fat soluable vites, and it’s absorbed in the
duodenum) - but Vit D is required for calcium absorption - see,it’s
all intertwined - but if you will continue your research, you’ll
understand and be able to compensate for deficiencies you will have
because of the surgery.)The following will need to be compensated
for - Calcium (use citrate, it doesn’t require stomach acids to
digest), Vites A, D, E, K (fat soluable vites), Iron, Zinc, B1, B12,
Protein (you don’t have a stomach that can churn the meat into
slurry and then you don’t have the enzymes that can break down the
amino acids), and they’re finding selenium deficiencies now.
I’m a proxi, have had b12, and D deficiencies, have osteoporosis…
but the osteo is from before surgery. Ask for a baseline DXA scan.
There is an old wives tale that if you’re heavy, your bones are
weight bearing, so you can’t be osteoporotic or osteopenic. Not
true. Most of us have been on so many diets that we’ve been
deficient in our vites and minerals, and a LOT of us are
osteoporotic before surgery. If you don’t know it, you’ll always
blame it on the surgery. Oh, and don’t let them tell you that b12
at 200 minimum on your labs is OK. You need much more than that -
600 at the minimum. I’m now on 2 shots a week for 6 months.
What kind of surgery does he do? If he does a one-size fits all
surgery (usually a 100cm proxi)then you need to consider that you
might need a more distal surgery with more malabsorption, to
actually completely lose the weight you need to lose and to keep it
off. But it’s possible that your insurance will only pay for a
proximal surgery. If that’s the case, then you’re going to either
have to self-pay or do the best you can with a proximal surgery.
High BMIs have lost a lot of weight with proxi surgeries, BUT it’s
harder to keep it off.
How long do you think it would
> take from the time of my first visit until the surgery?
Self pay is quicker. Insurance usually around 6 months average. I
was self pay in 2002, and it took me 4 months.
> What type of emotions should I expect?
Lots of emotions get stirred up. All those unaddressed things that
being heavy might have protected you from. And in addition to that,
your will have estrogen going crazy because estrogen is stored in
fat cells, which you’re in the process of emptying out. Just expect
your emotions to be very labile.
What type of
> reactions did you receive from family and friends when you
> first told them?
I found that the reactions were of 2 types. One was enthusiasm for
me, the other was fear for me. If someone has a fear of surgery,
they will also be fearful for you. If your husband has a fear of
losing you, (don’t know if you’re married) or afraid of surgery,
then he will be against it, usually. If your husband is secure and
happy in the marriage, then there’s usually no problem. If you’ve
got sibs or friends that are competitive with you on weight issues,
then they’re probably going to give you some grief. You’ll get to
examine all those things. Some of them will support you, some will
sadden you. You’ve got to think that you’re doing this for YOU, so
that you will be around and in better health in the future.
You will have a lifetime of increased vitamins and minerals and
protein intake. If you’re financially strapped, this might be a
difficult decision for you. Those things will need to come first.
You will probably want reconstructive surgery when you’re finished.
Our skins are all stretched out. That’s another expense, and rarely
paid for by insurance. If you want to go the insurance route, then
every time you have a skin rash from skin rubbing on skin, take it
to the doc and get it notated on the chart. If you have back aches,
once you’ve lost your weight, (sometimes caused by the imbalance of
having the weight of the panus hanging off the front), go to the doc
and get that notated….
You CAN regain your weight. Sugar will put it on you in a
heartbeat. (Ask me how I know :PPPP) It may not happen the first
year, or even the second, but it will creep back up.
If you’re willing to take responsibility for yourself and your
health, this surgery is a good thing, IMHO. But if you can’t or
won’t, if you tend to leave everything in the doctor’s hands, then
you conceivably be putting yourself at risk.
If you have more questions, don’t hesitate to ask.
July 15th, 2007 at 5:48 am
If you trust your GP, then I’d trust his/her choice as long as there is a
relationship between the surgeon and the GP that’s been going on for several
years.
My surgeon has a web site: www.thinnerfuture.com that was a good starting
point for me.
Jen
75 down, 75 to go after 6 months…
July 16th, 2007 at 3:14 am
Pam,
Thank you for all the information. I called my Insurance company and
they cover it completely. I have to submit referrals. I live in
Syracuse and we have a Bariatric Surgery Center. I have printed out
the application and will bring it to my doc to have her fill out the
rest of it. This surgeon has been performing the RNY for over 6
years. There is a complete staff of nutritionists and counselors.
I have a friend who is going to start this with me. It is so
encouraging to have someone to talk to about this. I appreciate all
the wonderful people who have shared their stories and ideas.
I am single and have hit the wonderful age of 50!! I am surrounded
by wonderful family and friends. I have struggled all my life with
my weight and have always been on the "plus" size. But the last 3
years have been extremely difficult. I have struggled tremendously
with just trying not to gain weight. I have been through weight
watchers, TOPS, weight support groups at work and almost all
the "fad" diets, safe and not safe. My last attempt at a serious
diet, I lost 100 lb. I did it with excersize and watching my food.
It lasted for over 2 years. But then little by little, it came back
along with an extra 40 lb. I have never felt so tired, depressed
and just discouraged as I have been these past 6 months. I always
seemed to be able to deal with my weight, but it is the highest it
has ever been. I was also so proud of my garden and flowers.Now it
looks like one giant weed!! I want to be able to move again, get
out in the garden and work more than 15 minutes without haveing to
take a break.
I am making an appointment in the next couple of weeks to start my
new journey. I look forward to being on the other side and really
begin to live again. I will let you know what my next stip is.
Thanks so much for listening. shell
July 19th, 2007 at 6:05 am
Hi . . .
My name is Rachel, and I agree 100% with what Pam told you.
Abd I would add . . . do much research. Go to a couple (or more)
info seminars by surgeons. Go to support groups. Find some people
who are 5+ years out, and look like you want to look, and ask them
what they did.
Stay away from docs whose patients all look grey, or fat, or sickly
and balding. Or all of the above.
Look for a doc with 20 years experience (or something close), not 6
years. Check and see if your ins. will cover Dr. Ki H. Oh, in
Federal Way, Washington. He’s the best . . . :o) And yes, it’s
worth it to travel cross country to get excellent surgeon.
For someone with your BMI, I’d look for a doc who’ll do a distal
bypass with about a 60" common channel. Not 60" bypass . . . 60"
common channel. That’s 60" left in use.
Good luck with your decision/surgery! :o)