ObesityHelp

 Last year, I had almost four months of misery.  I couldn't breathe or sleep.  It was like chronic bronchitis or asthma, but didn't respond to my asthma medication.  When we went on our vacation to Hawaii, I couldn't go to see the observatory on the Big Island, because of my respiratory condition.   Fortunately, after our vacation, I began to feel much better (even with a cold!).  I'm still not sure what was wrong, but it's likely it was some kind of acid reflux disease.  

 

When I got better, I started evaluating things again.  I drew up a wishlist of things I want to do in life, and it turned out that #1 was pursue a career in travel and #2 was pursue weight loss surgery.  The second goal was more obviously achievable than the first, so I started in on the process.

 

I checked into local bariatric centers, and enrolled in a program.  I was about a third of the way through the process when I discovered that the insurance that I had chosen two years ago, because it DID cover weight loss surgery decided that it did not want to cover it anymore.   No coverage.  Some people encouraged me to appeal the no coverage issue, but I just couldn't see that a clear policy exclusion warranted a different result.   

 

Rant:  I do, however, think that it is ironic that the number one killer of Americans is obesity and that only successful, documented cure for obesity is weight loss surgery, and that the health care industry would rather pay to treat millions of people with diabetes and heart disease than to pay for weight loss surgery.   From the insurance company's point of view, it appears to be that by the time a particular individual requires expensive treatment for diabetes and heart disease, it'll be Medicare's problem--not theirs.   

 

Anyway, once I accepted that I had no insurance coverage, I had to figure out how to get a surgery that would cost between $25,000 - $30,000 at the clinic I had enrolled in.   Quite frankly, the numbers were just not adding up, especially when you remember that yours truly wants to start a new career in travel even above having weight loss surgery.    (Don't worry clients, I am not planning up giving up my present career anytime soon).    This is when I started to think outside the box.  A friend of mine got Sexual Reassignment Surgery in Thailand for a fraction of the cost of that charged in the U.S.  I read an article about the same time she went to Thailand in Time Magazine about medical tourism.   I reread that article, and I said, Hmmmmm...   

 

The internet is an amazing thing.  I began to research the idea.  It turns out that weight loss surgery is done in a number of places in the world, with surgeries costing as little as $4,000 in parts of Africa and South America.  People who travel for weight loss surgery usually to go India or Mexico, though.   The cost of surgery in India would be between $7,500-$9,000.  The cost of surgery in Mexico varies a little more, but it tended to cost about $11,000.  

 

Deep breath.  Yes, I could do $11,000.  Not easily.  It would take a lot of hard work to get there.  Okay, Mexico it was.  

 

For those of you who might wonder how one eats their way into a Lane Bryant store, I suggest you read Gary Taubes' Why We Get Fat And What to do About It.  Here is the link on Amazon:  http://www.amazon.com/Why-We-Get-Fat-About/dp/0307949435/ref=sr_1_2?ie=UTF8&qid=1330205559&sr=8-2.   You might also want to consider that even when we are successful at losing weight, some ridiculous number of people relapse.    Current medical thinking suggests that the reason for this failure of dieting is linked to a hormone called ghrelin, which is produced in your stomach.  http://www.nytimes.com/2011/10/27/health/biological-changes-thwart-weight-loss-efforts-study-finds.html?_r=2&scp=2&sq=obesity&st=cse  When you lose weight, your body freaks out about having lost the weight, and produces more ghrelin, which makes you hungrier and lowers your metabolic rate..  Studies show that ghrelin levels remained increased for years after you've given up on your diet, and generally cause you to gain more weight than you took off during your diet.

 

If the above sounds a little defensive, it is.  You cannot imagine how many people asked me why I didn't just eat less and exercise more.  In fact, my diet has never been out of control.  I stopped eating french fries in 2010, and I rarely eat out in restaurants.  We work out a few days a week, although it's pretty hard to be enthusiastic about working out when you feel like unmitigated crap.  No excuses here.  Just read the Taubes book.

 

Anyway, given the range of symptoms I was experiencing and my family's medical history, I chose to have a gastric bypass.  This procedure divides your stomach and reroutes your small intestine into the upper portion of the stomach.  The lower portion of the stomach remains dormant, and because that is predominant place where ghrelin is produced, the surgery works for long term weight loss.   There are easier weight loss surgeries.  This particular surgery results in permanent malabsortion of calories and nutrients, and require a life-long commitment to take vitamins and maintain a low-glycemic diet.  Another more modern surgery is called a gastric sleeve and is much easier on a person's body.   A third procedure is called a lap-band, which I did not even consider, because there are just too many stories of failure.  And because I don't want a foreign object living in my body that has a port.  It's to avoid that result that I am having weight loss surgery in the first place.

 

So, having made the decision, on February 16th, Tom and I packed our bags and left for Mexicali, Mexico, the capital of the state of Baja California, and located about 90 minutes west of San Diego.   We were met at the San Diego airport by a driver from the medical clinic and driven to the hospital in Mexicali, where I had my blood drawn, was hooked up to an EKG and had a chest x-ray.  I met the surgeons for the first time, and I handed over my hard-won certified check for $10,500 (I'd already paid a $500 deposit).  We were then driven to the hotel and we had a nice "last" dinner in the hotel restaurant.   I ate chocolate cake and had a diet coke.

 

Early the next morning, we were picked up at the hotel and driven to the hospital.   We were checked in our room, and I met the anesthesiologist (who was ridiculously charming, btw).   They stuck me with an anti-coagulant, and shortly thereafter, I was wheeled into the operating room, where the last thing I remember is having the IV inserted.  I think I woke up in a recovery room, but I don't remember any of it. 

 

The thing about medical tourism is that there are horror stories.  I read about a woman who had become badly infected after having a full body lift in the Dominican Republic.  There was a woman who had weight loss surgery in Puerto Vallarta, and almost died from the conditions.  Right now, there is a doctor in Tijuana whose surgery is located in a storefront in a stripmall.  His rate of infection is extremely high and his patients have been robbed at his "recovery house".  

 

So, you have to know that I was really comfortable that I had not placed myself in one of these situations.  Reputable providers of medical tourism will have all the accreditations that a local medical provider would have.  Their business practices will appear streamlined.  They will have in-house patient coordinators, preferably.  (There are free-lance patient coordinators who are paid on a commission basis for the surgeries they book).    You'll have consistent information given to you throughout the booking process.   And there will be positive reviews on the internet from people who you can contact.  Finally, the provider will have some sense that they are providing services to a population that is traveling long distances and may not have appropriate aftercare available to them at home.

 

So, I wasn't really worried going in, except that this is not minor surgery so much as it is routine surgery.   I would be in the hospital for about five days, which is a ridiculously long hospitalization compared to U.S. doctors, who usually release their patients after one night in the hospital.   Tom would stay with me in the room, getting his meals from the hospital cafeteria while I ate broth and water.

 

The recovery was uneventful.  I didn't eat or drink anything until Saturday night (the night after surgery), when I was allowed to sip water.  The next day, I had a dye test to ensure the integrity of my new stomach.  The day after that, I had a barium test to ensure there were no leaks.  Once I passed that, I was good to start phase one of the diet, broth, apple juice and water.    

 

On Wednesday, I was released from the hospital as planned, and Tom and I were driven back to San Diego to catch our flight.    We returned home late.  

 

Since then, I have struggled with the things most bariatric patients struggle with.  I'm not able to keep my food down.  Nothing tastes good.  And it's hard to remember to take tiny sips of water.  These things will pass.  I'm not worried about them.  I do hate the fact that my emotions are all over the map, and that I can't seem to manage to keep my medications down.   I'll probably contact the after-care coordinator tomorrow if my situation doesn't improve.

 

Here are the things you can do to help me.   You can ask questions and check in with me about my progress.   If you host me, understand that my diet will be extremely limited for the next month or two, and after that, I will be eating very, very small portions of meat and green leafy vegetables.   It's not an insult to you if I don't eat more.  My stomach can hold 2-4 ounces.  

 

I won't be drinking for the next six months, at least.  After that I'll have to limit what I drink substantially, because I'll be a serious light weight.   I may choose to stick to tea or water instead.  (Yes, in this process, I had to go cold-turkey on diet coke... my only true addiction).   

 

It might not be so helpful to tell me that I'm looking sick or tired.   (Weightloss surgery patients tend to lose a lot of weight initially in their faces, and it takes a while for things to even out, resulting in a gaunt appearance).  You can always admire my beauty, but I'm not doing this because of any sort of feelings of inadequacy about my appearance. That train left the building a long time ago.  My future self would really appreciate it if you would not look at the plate of food in front of me and wonder why the heck I'm eating THAT!  As time passes, gastric bypass patients begin to eat more normal size quantities.  They may be able to eat things that are not entirely healthy for them.   I will be able to eat pizza and sweets in moderation.   And if your goal is to question my recent weight gain, realize that some rebound weight gain is common, and I'm probably aware if I've gained more than is good for my health.  That doesn't invalidate the years I'll have added onto my life by deciding to take this jounrey.

 

Ultimately, some people think that weight loss surgery is the easy way out.  If having your innards rearranged, your food choices permanently limited, and your nutrient absorption permanently affected is the easy way out, so be it.  The truth is, that weight loss surgery is still a last resort.  If we could have done it any other way, we would have.  

 

So, that's my story.  I didn't come forward about this before I did it out of a desire to be all Star Jones about weight loss surgery.  I simply wanted to be done with the surgery before I told the world.  It's not my way to be secretive about my medical life, but initial reactions were definitely mixed, and I didn't need pushback while I was preparing for surgery.  It wouldn't have changed my mind; it would have caused stress that we know is NOT good for us.

 I started this journey in November 2011, confident that I had insurance to cover my surgery.  I'd chosen my health insurance two years earlier based partly on the representation that weight loss surgery was covered, after all.   So, when my office manager informed me ever so politely that they'd stopped coverage for weight loss surgery that policy period, I was flown for a loop.

My research told me that weight loss surgery would cost about $25,000 or $30,000!  I'd already determined that it was the only real hope for lasting weight loss.  We looked for insurance that would cover me, but short of changing jobs, there weren't any options.  That's right.  There was no existing insurance available to cover a surgery that would probabably add years onto my life and probably save me from the ravages of diabetes and heart disease.  

I had a hard time blaming the insurance company, although I kind of did, you know?   I blame the entire medical system of my country.  And because that system is so wrapped up in national politics, I blamed the politicians as well.  Blame doesn't do much to advance the cause, though.  So, my focus quickly changed to figuring out how to get it done.

Some people advocated appealing any denial.  Some insurance contracts allow for non-covered procedures in cases of necessity.  However, I had no real co-morbidities.  My blood pressure is normal.   Although I'd had a couple of incidents of sleep apnea, they'd occurred primarily when I was ill.  My asthma is managed without medication, for the most part.  And I'm not diabetic.  Forget that all these conditions were written on the wall.  Right now... no co-morbidities.  Moreover, it could take years.

I asked how others paid for it.  Some took out second mortgages.  Others took money out of their 401K accounts.  I just couldn't see doing that.  And, I also couldn't see incurring consumer debt.  

That's when I remembered how a friend got her sexual reassignment surgery.  SRS is a surgery that also costs about $30,000, and is rarely covered by insurance.  My friend could never afford SRS in the United States, but she knew she could get it done for less than half the price in Thailand.  I also knew that she had one of the best outcomes ever documented, and that she'd had an amazing experience in Thailand.

I decided to see if I could manage the same sort of coup.  My web research indicated that gastric bypass for Westerners is done primarily in Mexico and India.  There are less expensive places.  Apparently, you can get it done in Africa for about 1/5th the cost of the United States.   Prices in India were about 1/4-1/3rd the price of the United States, and Mexico's costs were about 1/3rd to 1/2 the cost of US surgeries.

I then researched specific clinics to determine what the standard of care was.  I found that India and Mexico both had bariatric centers of excellence with well regarded practitioners who were either as qualified or more qualified than the surgeons I was considering in my home town.  I researched good experiences as well as not-so-good experiences and then decided to go with the best possible surgeon I could afford.

I also decided to limit my search to Mexico, because I wanted to minimize the risk of blood clots developing as the result of air travel so soon after surgery.  

So, yes, price was a very important factor... but so was safety....  There are medical tourism horror stories.  I read about those, as well.   I used this site to help me find a surgeon that had a lot of good reviews.  And I contacted the surgeon's patients to verify their stories.  I asked on the forums for help.

I'm presently scheduled for surgery on 2/17/2012.  I'll blog about my experience, but so far, I have no real qualms about going forward with my decision to have gastric bypass in Mexico.  It's a well-researched decision.   And I can afford to pay for it out of my savings.

I weighed 262 in November.  At 5'5, that's about 120 pounds more than I "should" weigh, although I haven't weighed less than 160 since jr. high school.  The number wasn't a shock.  I'd grown out of my size 18 and 20's in the prior year, and I had to buy a lot of new clothes.  Shopping for clothes wasn't fun.  Nothing looked or felt right on me.  

I've been happiest at a size 14W or 16W....  and wondered what it might be like to shop in the regular size department.  For a glorious summer a few years ago, I fit into 16's, but I got hungry and fell off my diet.  (There were a lot of other reasons for falling off my diet... lyme disease and endometriosis amongst them, but isn't there always?)

When I talked about dieting, my husband would say, "What will make this diet different?"  He would tell me that "I'm just going to outsmart myself right out of the next diet."   In the winter of 2009, I spoke with a dietician at yet another doctor's office and realized that he's right.   I will outsmart the next diet.  I was arguing with the nutritionist about how many eggs it's safe to eat in a week.  It's not that I have a burning desire to eat eggs;  it's that this meeting was evidence that I knew more about nutrition than any doctor or dietician who would ever advise me.  That's not to say that I know more about the science of nutrition.  God forbid that I understand molecules and stuff!  But I did know that eggs are off the naughty list for those of us who are fortunate enough to not have a tendency towards high cholesterol.  I was wondering whether I'd hear the old saw about sodium next.

It really doesn't matter if I was right or wrong at that moment.  I just knew that I couldn't survive another diet filled with greens and low fat yogurt.  If you have to take away my granola, at least give me eggs!  After all, I knew I was already giving up cake, donuts, chocolate, vanilla malts, french toast with maple syrup, and that really amazing bread they serve with spinach dip.  

I'd tried and failed at Diet Center, Jenny Craig, Weight Watchers, Sugar Busters!, Atkins, the nutritionist-recommended diet with supplements that cost $100 a week, the liquid diet (with shakes and supplements that cost $125 a week), and the most recent attempt---diet pills that resulted in gall bladder surgery.

Sound familiar?

But here's the thing.  I love myself.  I have always loved myself.  Even as I failed at diets, I never failed at self-love (well... except for those deep dark moments when you can't help but give in to the monsters inside you, but those were few and far between).  And it was my self-love that brought me here.

In 2004, my father died.   I had a really complicated relationship with him.  He had a really complicated relationship with food.  One day when I was in seventh grade, my mother made her famous homemade cake donuts.  She put them in the cookie jar, and she and I went shopping for school clothes.  When we got home, the cookie jar was only a third full.  Dad had eaten over a dozen donuts.  Dad denied he'd done it, but this was no whodunnit.  It was him... whether he'd eaten them consciously, I don't know.  But it was him.

A few years later, he was diagnosed with diabetes.  For a few years, he made an effort to keep his weight down, but like me, Dad was great at dieting, but not so great at maintaining.  And less great at dieting if something got in his way.

I don't know how much Dad weighed when he went to the hospital for the last time.  He'd been scheduled for a mitral valve replacement.  It was fairly routine surgery, but in all likelihood, he'd be on the bypass machine for quite some time.  I drove him the morning of the surgery through the woods of northern Wisconsin.  It was dark, and there were deer everywhere.  He was on lookout while I drove.  Mom and my husband slept in the back seat.

I stayed with him until they took him in to be prepped for the surgery.  I said goodbye and see ya later.  About 10 hours later, he was out of surgery, and we went home.  That night, he had a stroke.  In the coming days, it looked like he might make it through the worst of it with few problems.  A few days later, I was visiting him, and he mentioned that his doctor wanted him to have weight loss surgery next.  I told him I thought that was a great idea, and we left.

Two days later, he stroked out again.  This time, they couldn't do anything for him.   We made the three hour drive up to the hospital and took him off life support.  A few days' later, we drove up again.  He hadn't recovered, and we knew he wouldn't last much longer.  While we were in his hospice room, the nurse mentioned she wanted to turn him, but the heavy lift team wouldn't be available for at least an hour or more.

That got my attention.  They needed a team.  That was when I knew that weight was not just a health risk.  It was something that robs you of dignity.  Not that I hadn't experienced my fair share of weight related discrimination in my time... oh man... did I have stories!  But I could handle that.  What I couldn't handle was the idea that some day, they might need a team to turn me over on my deathbed.

So, that's what led me here.  To the decision to make one final attempt to lose the weight.   This time, I'm going to change biology.   Hopefully, I'll change the levels of ghrelin enough to reach the right weight for me, change my stomach capacity enough to make it possible to maintain the weight loss, and maintain the necessary changes in my diet long enough that cake, donuts, chocolate, vanilla malts, french toast with maple syrup, and that amazing bread they serve with spinach dip won't take over my life again.