Paying it forward.....or not?

Julie R.
on 6/19/11 3:12 pm - Ludington, MI
 I am the music director of a church, and have been there since pre-DS.    This morning, a younger lady from the congregation approached me immediately after the service, while I was still at my piano, and asked if she could speak to me.    She said that she has been having problems with her ovaries, and that her gyn doctor cannot perform surgery unless she loses weight, and has suggested bariatric surgery.   She probably has at least a BMI of 60 - maybe even closer to 70.   She asked if I would mind getting together with her to discuss surgery, and I told her I'd be happy to.    I am always thrilled to have the opportunity to help someone this way, but I have some concerns about whether this gal can handle the DS from a compliance and/or financial standpoint.    Here's the scoop.   She's kind of a simple gal....a single mom who has really struggled to cope in life.   She has two children who always appear to be poorly cared for (straggly haired and dirty, inappropriately attired, such as wearing shorts in the winter, etc.) and she struggles to maintain any sort of discipline with them.   She works part-time at our local grocery store, and I know that the church helps her out as best as they can.     She receives government financial assistance and is on Medicaid.   When she approached me this morning, she started launching into a story about how she was a victim of sexual abuse as a girl, and that's why she is overweight, etc, etc., and that her father died when she was young, which made her gain fifty more pounds, and although those are all very valid and unfortunate occurrences,  the place and time were not very appropriate for such a discussion.   I gently steered her away from the topic, as there were  many people milling about, and others wishing to speak to me.  I told her briefly about the procedure I'd had, I took her number and promised to call her this week so we could get together and talk.

This girl really needs the DS.    A VSG would likely not be powerful enough, nor the RNY.     I would so much love to see her lose the weight, and perhaps it would help her acquire a fresh start in life and raise her employability, thus raising her standard of living.    Here are my concerns, and I'll be blunt about it.   I'm concerned that she doesn't have the chops intellectually to have the DS.    I'm afraid that she'd have it, and not be able to comply with all of the complexities of lab-work and vitamin supplementation.  Criminee, she can't even manage to wash the three days worth of dirt off her daughters' faces before going to church or get them to sit in their chairs for five minutes, how can she manage the DS?    I live in a very rural area, and she would likely be the only other DS'er besides myself up here.    I know I could "mentor" her, in regard to hounding her about her supps and labs and to be there to answer questions, but there's no guarantee that either of us will be in proximity to each other forever, and I'd hate to set her on a path and then see her unable to stay on it.   Also, as a Medicaid recipient, I'm not sure if she'd be able to afford the high cost of protein and supplements.    I"m not sure as to how much Medicaid covers for these things.   I am so happy to be helpful, but this young lady might be rather emotionally needy, and I'm not sure if I'm ready for another full-time job of being her DS mom!  I already work two jobs as it is.   

Does anybody have any suggestion as to how I could make this work for her?  I want her to do well, but I also want to empower her to be her own advocate in this situation.   From what I know of her, she seems to be the type that sits back and waits for people to help her, and we all know that the DS requires an individual to be a self-starter.   I was thinking of emailing my surgeon and giving him the heads up, as I have a good working relationship with him, but I'm not sure if that's any violation of privacy standards.   Thanks for any advice regarding this rather delicate problem!
Julie R - Ludington, Michigan
Duodenal Switch 08/09/06 - Dr. Paul Kemmeter, Grand Rapids, Michigan
HW: 282 - 5'4"
SW: 268
GW: 135
CW: 125

Paul11011
on 6/19/11 3:57 pm
Hey Julie,

First of all I think it's very admirable of you to want to help this girl out.  She definietly sounds like she could use a positive role model in her life, WLS or not. 

I think your best route with her would be to give her your personal story, emphasize that WLS is a tool and not a magic bean.  Be very frank about the work that is required or one to be successful.  Provide the information to her, types of proceedures, sample meal plans, local surgery centers, etc.  I don't know of any in Ludington, but I do know there are some in Muskegon that accept Medicaid.  Dr. Glick I believe. 

I am not convinced that the DS is the only WLS which she can see benefit.  Being a high BMIer (70s) I can attest to the success of the VSG. 136lbs lost in 5 months post op.   

Good luck in helping this girl! 
VSG 1-10-2011 Dr. Randal Baker.   www.grandhealthpartners.com
                
Julie R.
on 6/20/11 12:33 am - Ludington, MI
 I know that Gluck does the VSG now too.    I don't know much about his track record, but it sure seems a lot of folks up this way use him!

Julie R - Ludington, Michigan
Duodenal Switch 08/09/06 - Dr. Paul Kemmeter, Grand Rapids, Michigan
HW: 282 - 5'4"
SW: 268
GW: 135
CW: 125

k9ophile
on 6/19/11 4:08 pm
Yeah, this one's a tough one all right.  As for your contacting your physician, there is no violation of HIPAA if you talk to him.  He can not discuss his patients with anyone since HIPAA applies to those who provide medical care.  For what it's worth, I have warned my surgeon about potential patients, yet it was unnecessary.  They're pretty good at judging who is a good candidate and how to avoid taking on disasters.

As for your involvement with the young lady in question, I have no doubt you have the compassion to do it.  However, she does sound like a very needy and bottomless pit.  I think you're right about the amount of time it would require and that's not accounting for the emotional toll it's bound to have on you.  I wish I had the right words of wisdom for you, yet I don't.  I do have faith however, that you will do what's best for both the young lady and your own well being.

"Our ultimate freedom is the right and power to decide how anybody or anything outside ourselves will affect us."  Stephen Covey

Don't litter!  Spay or neuter your pet

nightowl
on 6/19/11 7:02 pm - Topeka, KS
I'm totally torn.  And I think there are many other SMO folks out there that are in similar cir****tances to this woman's.

I know this isn't an answer to what you asked, but I wonder if her gyno. doctor was just being dismissive of her?  Maybe other gynecologists would find it appropriate and possible to wade through the fat to her ovaries?

It is truly heartbreaking.  Thank you for trying to find the best thing for her (without becoming a doormat yourself in the face of her many needs).
nightowl
on 6/19/11 7:39 pm - Topeka, KS
I forgot to say, I am leaning toward thinking (like some of the other responders) that the VSG would be best for her.  She would still end up obese, probably, but at least it could help some, for a while.  It wouldn't have the big ongoing extra expenses of high protein, heavy supplementing, and more frequent labs.
airbender
on 6/19/11 7:10 pm
Julie,

this is a very difficult situation.  On one hand the best surgery for someone with a bmi of 70 is the ds, but only if they will be compliant if not it could be the worse if the pt. would not consume vit/min and follow up blood work.  Thisis really a call of what type of person she is.  The DS is an "expensive" surgery post op, with the protein, vit/min, blood work.  Can she afford that?  I have seen people just not take the supplements or blood work or poor quality protein.  Very difficult, becuase it is more than obvious you want to help her, because having the ds yourself you know how much better it can be (if you are compliant) yes you can mentor her, but you can't be there everyday to make sure she takes care of herself (actually no one can as the ds puts a level of personal responsibility on us) Maybe you could feel it out with her, explain that if she didn't take vit/min, blood work, follow up she could be putting herself in a world of hurt in the future post op, potentially affecting her children?  it really is up to no one but her, if she is the type to sit back and wait for others the ds may not be more her and maybe a vsg is a better option.  sometimes you just have to let people hit bottom etc and have them themselves.  I hope you find some answers this is really tough........
marriedmom
on 6/19/11 7:51 pm - Middleville, MI
julie, you have already gotten some great advice and mine is really simple..maybe direct her here to OH and see if she will research her options on her own.. if she doesn't, to me, that kinda answers the question about whether she really wants to do something about her situation. Of course, if she doesn't have a comp, she could go to the local library and that "may" take more energy than she wants to invest.
I know "the kind" of person you are talking about.. they "want" help, but are they willing to help themselves and the DS isn't the type of surgery that you can do half heartedly.
You have a gift in the way you communicate with people and perhaps if you just share your story, give her the facts (? DS facts.com) and stress the importance of compliance, that is all you can do.
She sounds like an individual that could potentially drain you dry emotionally and that's not healthy for either one of you. I know your heart is to help her but she needs to want to really help herself too. I believe you will know after you talk to her what the story with her really is.. is she looking to make a life style change or someone to feel bad for her and make it all better. I know it sounds crude but we all make choices and she will have to make hers. It wont be your "fault" if its too much for her.
Please keep us updated.
*hugs*

Barb
  5'1.5  HW 280 pre-op 270  GW 150  CW 147

        
Julie R.
on 6/20/11 12:31 am - Ludington, MI
 I think you might be dead-on with this girl, although she seems to be a sweet soul.    Some people of this nature are heartless users who know how to play people and the system, others are just too passive and helpless to go out and really make things work.   I think she falls into the latter category.    I just called GHP and they said that they do not take straight Medicaid, but Nettie told me to have her call them to let her know what kind she has, and that she'll help her.   I think starting her off that way will show her that she's in control of the situation.   

Hey, I'll be coming down to Grand Rapids for a few doctor's appointments this summer - perhaps we can get together for a DS dinner or lunch!   I want to see the new you!
Julie R - Ludington, Michigan
Duodenal Switch 08/09/06 - Dr. Paul Kemmeter, Grand Rapids, Michigan
HW: 282 - 5'4"
SW: 268
GW: 135
CW: 125

marriedmom
on 6/20/11 2:03 am - Middleville, MI
I want to see you too Julie! Do you know when your appts are? I have wed and fri off from work so hopefully its one of those days.. if not, if I have enough "notice" , I can ask for time off and meet up with you. If lunch doesnt work on either of those days, I can do dinner anytime! :)
Its been waaaay too long.. we need to catch up!

Talk to you soon,
Barb
  5'1.5  HW 280 pre-op 270  GW 150  CW 147

        
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