Need some advice - trouble with BIL

I have a situation going on with my BIL (husband's brother) that I could use some help/perspective on.

He lives out of state. He's been obese for the 25+ years I have known him. He's managed to diet successfully now and then but like all of us, pops back up to morbid levels. He's diabetic and recently had to have a toe amputation because of an injury that wasn't healing. His eyes are failing, and his doctor recently told my SIL, "if you (plural) don't get this under control, he is going to die."

His insurance doesn't cover WLS. He was going to pull money from his retirement to cover the surgery. He found a doc at the Cleveland Clinic he liked and was interested in RNY but has been afraid to go through with it because of the self-pay implications - any complications aren't covered, of course. I have another BIL, the oldest of the three brothers, who lives in El Paso, and I had suggested looking to see if there are any docs in Mexico near there who might be good options and use that brother's house as a launch pad. I also put him in touch with Kelley Lindstrom, who I felt could give him great advice on fighting the denials and discuss the likelihood of his eventually winning. He didn't follow up on any of it.

He did express an interest to my husband about trying some of what my husband has been doing with regards to clean eating as a way to feel better and possibly lose some weight. My hubby was trying to coach him on this from afar, but after a few weeks it petered out. A couple of weeks ago and he asked my husband if we'd pay for any WLS surgery complications that aren't covered by his insurance. My husband explained that we have some big financial things going on (kid in college being just one of them) but we'd do what we could to help. Somehow this got twisted into the idea that we aren't supporting him and now he's not speaking to my husband. Although this is a fairly common theme in his family (so-and-so isn't speaking to this other person), I feel really bad for hubby who just wants to help his brother.

I'm just not sure what to do here. Being further along this journey myself, I know how much f^@#ing hard work is required to be successful at this, and I feel that what my BIL is doing ("oh poor me, someone else has to do it for me" ain't going to cut it. I really, truly believe that you have to be ready, willing, and able to live in the first person in order to be successful at this. But, I am also sort of afraid to say anything right now because it's going to be twisted into "well, you had the surgery and now you don't want me to have it". My husband knows how hard I have worked with my team of psych, trainer, image consultant, etc., and agrees that it is critical for success. He also doesn't feel my BIL's in the mental state to begin to understand this at the moment. He told my SIL this on the phone this morning. He also reiterated that we'd do what we can to support financially given our constraints.

Hubby's perspective is that BIL's not well controlled diabetes, plus what looks like a serious case of grain brain (google it) plus all of the toxic processed food he said he's eating, combined with the same potential thyroid issues that hubby had (strong likelihood that hubby's Hashimoto's disease is genetic) has made BIL incapable of being reasoned with. Indeed, before hubby's Hashimoto's diagnosis, he behaved similarly unreasonably at times. According to SIL, all BIL can see is that WLS surgery will magically fix all of this, and hubby and I, and potentially SIL are saying it's not a panacea and that he's got to be ready to WORK to be successful at this. How do we get that point across that it isn't JUST the surgery? How do we convince him that this is worth fighting for, but that he's got to be an active participant?

What would you do if you were me?

Thanks, all...
Laurie

You can lead a horse to water, and all that...

From what I've read, RNY will magically cure Type 2 diabetes.  Like the next day even.  Seems to me that that diabetes is what is going to kill him first based on your description.  So if you can get him under the knife, at least the medical emergency is removed.  Perhaps then you can work on him, but then we're back to "you can lead a horse..."

If you offered to pay for the medical expenses, what excuse would he find next?  Sounds like he isn't in the game yet, and is using your financial constraints as his excuse why he's not going to follow up.  Sometimes you just have to walk away, sadly.  

I hope for your family's sake that he takes the helping hands ya'll are offering him and does what he needs to do.  If complications arise, he'll still get the medical care he needs - and most hospitals will work out a payment plan with him.  But what is the next amputation going to cost him out of pocket?

I appreciate your reply. I found out last night that he is also mad at/isn't speaking to the other brother and sister in law (the ones in El Paso) because they didn't hop a plane and visit him when he had the amputation surgery.

So, I think we are dealing with a new level of unreasonable. There is deep stuff at play here. Perhaps psych is the next most logical step. I am hoping and praying he can get stuff straightened out.

Laurie

Unfortunately RNY does not cure diabetes. I have to mention that in some cases RNY can put diabetes into remission, but that depend on the person and the person condition. Some - who are insulin dependent for long time - may still need to take the insulin - just less of it.  Some people - even if they maintain the weight loss - may get the diabetes back after a few years.  ( i know few people like that) . Some remain symptom free as long as they maintain very healthy life style. 

This is exactly right.  He needs to look into the DS which does.  He may need to do it in two stages, the sleeve to lose down to a safer weight and than the DS.  If he is cash pay, Mexico might be best.

If he is in this state of mind, nothing may help but the DS is the best choice for those that can't get there heads right.  His weight is HIS problem.  You are bending over backwards to help him because you love him as it is.  Some people the more you help the more they think you "owe" them.  I have a BIL and sister like this.

Good luck, you can't put your family in a bad position for him, especially if they don't have their head right.

Resolution of Comorbidities

Following bariatric surgery many obesity related comorbidities can be improved or cured. The RNY and DS statistics for the resolution of comorbidities can be found in Buchwald et al. Bariatric Surgery: A Systematic Review and Meta-Analysis. [58]

RNY

Type 2 Diabetes   84%
Hyperlipidemia      97%
Hypertension       68%
Sleep Apnea        80%

DS

Type 2 Diabetes   99%
Hyperlipidemia      99%
Hypertension       83%
Sleep Apnea        92%

The Duodenal Switch weight loss surgery procedure has seen the highest rate of type 2 diabetes cure, often before leaving the hospital following surgery! For more information on how DS surgery can have such a quick result see the metabolic effect in our section on theDuodenal Switch Procedure.

 

You can't convince someone whose mind is made up.  If he really believes the surgery is a cure all, nothing will convince him otherwise.  My dad felt the same way, managed to get RNY anyway (I have no idea how he passed the psych eval), and has lost almost 200 lbs.  I do not see him as as being able to maintain the loss long term, but for now, even just letting the surgery do the work, his diabetes and blood pressure are under control, and his arthritis pain is significantly decreased.

My suggestion is to encourage your BIL to have surgery, answer any questions of his you know the answers to, and let him figure out the rest.  I'm doing self-pay in Mexico with Dr. Alvarez, it's $8700 inclusive, and that includes treating any complications.  In my case, I'm too far away to go back if there are complications, but with you having other family in Texas, your BIL should be able to make it back if there are problems.  I would not suggest offering him financial support.  I think it will cause more problems in the long run.

One other thing.  You mention your BIL isn't rational.  I noticed the same thing with my father, and it turned out to be untreated sleep apnea.  Once he got that under control, he became much more stable.  Before he died, my grandfather also had major personality changes, and it was uncontrolled blood sugar.  With is health, your BIL probably really isn't quite up to par mentally, and the longer he goes with uncontrolled blood sugar the worse it will get.

Thank you for your reply. BIL was diagnosed with apnea years ago and was prescribed a CPAP. This wasn't part of my medical background, so I don't know that much about such topics. Do you have to get it adjusted now and then? If so, I have no idea if he has done that, but it's worth mentioning to my SIL.

Laurie

Used to work in a sleep lab... Yes, it is entirely possible he may need it adjusted now and then.  Particularly if there was a change in weight!  

I don't have a lot of advise other than to say I would not commit to anything financial in this situation. Seems to be a lot of issues happening all at once and perhaps establishing boundaries would be a healthy thing for you and your family~~just my opinion. Good luck.

I appreciate your response. All of the feedback is making me feel ok with not rushing to throw money at the situation. I want him to get help, but this strengthens my resolve to say that HE needs to take the first step and take ownership. It's his journey, ultimately, not ours.

Laurie