Kay B.
For March 2004 update, see below.
My weight-loss journey began with deceptive ease. In December 2000, my insurer approved the proximal RNY after only a day or two, and I got a surgery date early the following month. That afternoon, I read a posting on this site about the BPD/DS, and knew instantly that this one was the surgery for me, if only I could find a surgeon to do it. I thought I was lucky to find HAZEM ELARINY. At the consultation, ELARINY said that he had done only "six or seven" laparoscopic weight-loss surgeries at the time (December 2000) and seemed to be lowering the weight and BMI of patients on whom he would be willing to perform the operation laparoscopically. His practice was growing wildly and his office was chaotic. We were in the room with his overworked assistant, Shauntae, and the phone was constantly ringing as she fielded calls from patients. His consent form was solely for the RNY; patients who were to have the BPD/DS were asked to cross out the RNY and put in BPD/DS, and he had no written information about the BPD/DS for his patients. Although he had a large number of new patients going to him specifically because he offered the BPD/DS, all his printed information for patients (as of December 2000) was about the RNY. The two operations have important differences. My insurer approved the switch from the RNY surgeon to Elariny and to a new surgery date just three weeks after the original one. I counted the days, one by one--how they dragged. Finally, January 29, the night before the surgery, arrived. ELARINY had a lot of new patients, and was very busy. So busy that he could not find the time to review my pre-op EKG (which I had taken nearly two weeks earlier) until the night before my scheduled BPD/DS. He then called me, as I was in the midst of those night-before preparations, and informed this young female nonsmoker with no history of diabetes, high blood pressure, or heart trouble that instead of the gastric bypass, I might be a candidate for a triple heart bypass. He made this announcement in the casual tone that a waiter might use in informing you that the advertised special is all sold out, so you might want to try the chicken cacciatore instead. I went to the hospital the next day anyway--had to go through the motions. ELARINY did not bother to show up. The cardiologist thought ELARINY's diagnosis unlikely, the anesthesiologist thought his prediction of a triple bypass on the basis of an EKG preposterous, but still they canceled the surgery as I lay on the table. I was nearly suicidal. With no help or input from ELARINY, with not so much as a phone call from his office, I pursued heart testing on my own. My cardiac stress test the week after the canceled operation showed no heart abnormalities--meaning that the original 1/30/01 surgery date probably could have been preserved, had the EKG been timely read. So on February 9, I called ELARINY to find out when the surgery could be re-scheduled. He answered with a sneer that I could find myself another surgeon! Shauntae, he said, had been busy surfing the Internet for unflattering comments about him (no wonder he hadn't found time to review my EKG until the night before!), and had found a website in which he had been "compared to a waiter." He spouted some bitter invective I had never heard from any professional, let alone a doctor, and ended by suggesting that I see a psychiatrist.
(That's what I'd call projection...)
Be careful--there's bound to be more than one pouting prima donna out there who's willing to take the business that comes his way from the Internet, but not ready for the free exchange of information that comes with it. Nonetheless, you had a right to know. And I had a right to tell you.
I found Dr. Ren on the Internet that afternoon and had a good (and healing) conversation with her nurse practitioner, Gio, minutes later. I told Dr. Ren what happened with ELARINY, and she had enough character not to be frightened away by another physician's immaturity. ELARINY, meanwhile, was still causing me problems--the hospital at which he performed my endoscopy in January had to threaten to suspend his privileges to get him to dictate the report, which my new doctor needed before proceeding with my surgery. I'm happy to say that Dr. Ren performed my surgery a mere three weeks after ELARINY's tantrum.
March 2004:
It’s been three years since I underwent a laparoscopic biliopancreatic diversion with duodenal switch (BPD/DS), and now, for really the first time since I was a recent post-op, it’s time for an update.
My surgery is a success. From a tight 26/28 at the time of my surgery, I now fit easily into size 8 jeans, and some sixes. My total cholesterol is 99. My weight loss, always gradual, never plateaued, and came to a gentle end nearly two years after the surgery. There has been no rebound.
The lack of weight regain (when some people who underwent other surgeries at the same time I did already are seeking revisions), and my ability to eat whatever I want, affirm my reasons for choosing the BPD/DS. I wanted to be able to eat like a normal person, and, thanks to the surgery, I do. I did not want or need an internal policeman, in the form of dumping, to punish me when I ate something sweet. I didn’t want a “tool” that would enforce a diet–I wanted a cure for my obesity. I found one.
Of course I recognize the value of avoiding empty calories and of embracing an exercise regimen, and I intend to begin doing both these things. I really do. Understand that I’m not hugely motivated.
On a serious note, I have had a problem with high levels of parathyroid (meaning that my body is stealing calcium from my bones), and low levels of vitamin D, despite heavy supplementation. A recent scan showed my bone density to be normal, and I’m seeing an endocrinologist. He’s a very caring man who’s very anti-WLS. When he preaches against the surgery, I just laugh at him–to his face. He knows that as far as I’m concerned, my BPD/DS and I are married, till death do us part.
It’s amazing how soon I got used again to being looked at admiringly and flirted with. On the other hand, sometimes, when a man winks at me or smiles, I catch myself turning to see who’s the object of his attention.
Three years ago, I wouldn’t have believed I could ever get used to being a size “small,” to wearing size 5 panties, to having a necklace chain cut down to fourteen inches so that I could wear it as a choker. I did. I take all that for granted now. It’s no big deal anymore. That’s almost sad.
You’ve all heard that “such a pretty face” canard. One of the others we grew up hearing is that we’re “big-boned.” Well, now that my wrists measure 5-1/2 inches, I know that I’m not big-boned.
I still dress conservatively, the major difference being that I used to favor full skirts. I wouldn’t be caught in one now. I like those straight, show-off-my-slim-hips ones.
My surgeon, Dr. Ren, still keeps in touch to track my lab tests and how I’m doing. She has my profound gratitude, and always will.
As for not-ready-for-the-Internet Hazim Elariny, I continue, when I recall that awful January night and morning three years ago, to be amazed at his callousness and at the juvenile display of temper in which he thereafter indulged himself. I’m now grateful (not to him) that he did not perform my surgery. As he was then newly embarking upon and aggressively marketing his “sleeve gastrectomy” or “vertical gastroplasty,” his stomach-only surgery that he tried to sell me on the night before my BPD/DS was scheduled, I’m sure that I would have awakened the next day with only the “top half” or “sleeve,” had he actually performed an operation on me. I’m told this is what actually happened on the day of surgery to at least one other person who’d signed up for the BPD/DS, Elariny’s explanation being that he only had time that day to do a top half. It wouldn’t have done for me.
Bariatric surgeons have their fan clubs–BPD/DS surgeons in particular, as there are so few of them–and Elariny’s fan club went after me in 2001 for saying "nasty" (!) things about their hero. I was undeterred and unsurprised. Fat and formerly fat folk seem to be particularly susceptible to hero worship, having suffered so much abuse and so much exclusion for so much of our lives. Comes the savior with the scapel–how dare anyone speak ill of him? Empathy for the fellow sufferer Elariny left lying on the stretcher--that they lack. I’m not a hero worshiper, but then I also never liked Elariny’s looks. Back of some of that vitriolic garbage Elariny’s fans flung at me was undoubtedly some frustrated lust: some people find him handsome.
No doubt all of us long-term post-ops have some advice we’d like to pass on to those of you awaiting surgery. Here’s mine:
1. Get the surgery that gives you the best odds of ending your lifelong battle with the scale. Do not tell yourself, “I can always get a revision,” because chances are you won’t be able to.
If you’re going for, say, the vertical banded gastroplasty (VBG), or the LapBand (adjustable gastric band), or the no-band vertical gastroplasty (also called "sleeve gastrectomy" or just "sleeve"), and are attracted to them because they don’t entail any re-routing of your intestines, stop and give dieting another go-round. If, after that, you’re still saying that bypassed intestines aren’t for you, do not go into any of the purely restrictive surgeries with the thought that you can “always get a revision.” Though big cities have weight-loss surgeons on practically every corner nowadays, surgeons who do revisions are few. Insurance is much less likely to cover a revision. Revisions are much more technically difficult and more likely to result in complications. And because of adhesions–internal scar tissue from the previous surgery–revisions often aren’t possible. There are heartbreaking stories of people who jumped through all the hoops to get the revision who wakened in the recovery room only to hear that it couldn’t be performed.
When I direct people to the WLS-Revision Yahoo group, it’s not to lull them into a false belief that they can always get the surgery redone (read the posts there and you’ll soon be rid of that notion), but to encourage them to make the right choice the first time. Do thorough research, and then insist on the surgery that’s right for you–not the you that you wish you could be, who would have iron willpower and the ability to subsist on protein shakes forever, but the real you, whose appetite will return after that six-month or so post-op “honeymoon,” and who will, yes, will, want to eat sugar again. Of course I love the BPD/DS, which I regard as a near-miracle, but the RNY really does work well for most people–most of whom, yes, are eating some sugar again within a year or so after the operation.
2. Tell as few people as possible that you’re having the surgery. Start with a list that is as spare as you think you can make it, and then pare it down again. This has nothing to do with any risk that your surgeon might pull an Elariny on you. It’s about the attitude of society toward surgical weight loss, and the way personal medical information carelessly disseminated can come back to haunt you–especially in the workplace.
Some people have had lifelong friends, and even close relatives, turn their backs on them after they announced that they were having weight-loss surgery. Before that happens, you’re likely to hear again and again how dangerous weight-loss surgery is (objections people are unlikely to raise at the announcement of any other major surgery), and apocryphal stories about Nettie’s sister-in-law’s cousin’s office mate’s staples popping out after one bite too many, resulting in a gruesome death. The real problem, I think, aside from people’s ignorance about the true risks of the surgery, is that people don’t like the very idea of surgical weight loss. They think we’ve been living it up with a lifetime of overeating (I’ll never forget the salacious shine in one thin woman’s eyes in my pre-surgery days when she asked, “Just what do you eat every day?” Yes, salacious, as if she were about to hear about an orgy), and that we need to do penance by slowly starving ourselves thin with diet and exercise, “the old-fashioned way.” Some people will always dismiss this surgery as “the easy way out,” and there’s no changing their minds. They’ll denigrate your weight loss as “unearned.” You don’t need such attitudes darkening your post-op life.
(By the way, pre-ops, if you too think surgery’s the easy way out, talk to some recent post-ops. You’ll learn there’s no cakewalk in store for you.)
Back of loved ones’ objections to the surgery, aside from some real fear of actually losing you to the surgery, is their fear of losing the you they’ve always known. With surgery a virtual guarantee of significant weight loss, as compared with the (fill in the blank) Diet, which is anything but, the friend/sister/husband foresees a fundamental change in her or his relationship with you–an unwelcome change, in which you’re no longer the dependably needy doormat. I’ve come to the sad conclusion that no matter how much everyone from total strangers to our loved ones may ride us about losing weight, few are the people who really want us to get thin and stay thin.
Then there’s your workplace. Tell no one–no one–what kind of surgery you’re having. To this day, nobody in my office knows how I got thin. They’ve asked; three years after my surgery, occasionally someone still asks. They all get the same answer: a smile. Why? Because privacy laws, and laws prohibiting discrimination on the basis of disabilities, and so on, don’t keep Pandora’s box closed. They don’t protect you from the repercussions of your medical information’s being passed around and misused. They just let you sue over it. Trust me: you don’t want to go that route. Keep your business your business, and you won’t be sorry.
I remember how it is in those giddy pre-op days: you want to tell the whole world about the wonderful, life-changing thing that’s about to happen to you. Resist the temptation. You can always fill in anyone who really needs to know. You can never un-tell anyone who didn’t.
3. Do not put identifying information into your profile. You don’t know whether my first name is Kay, or starts with K, and you don’t know whether my last initial is B, or whether there are any K’s or B’s in either my first or last name. If you think you know where I work, or what I do for a living, you don’t. You don’t need to know.
I love as much as anyone else those wonderfully newsy profiles some members (especially the pre-ops) write, with their diary-like accounts of all their thoughts and feelings and of the upheavals in their lives. It’s the genuineness of the experience that’s important–not whether you can look the member up in the phone book.
So, especially if you’re going to use your profile as your place to pour out your heart, use the space bar instead of filling in the name of your town. For yourself, pick a cute nickname–not one you’re actually called. Talk about your office, but don’t reveal details that people could use to pinpoint where you work. You’re not deceiving anyone. You’re just not giving us–and any number of others browsing the Internet–information we don’t need.
If you doubt the value of this advice, just imagine those soul-baring details in the hands of that two-faced co-worker of yours. Or in the hands of your husband’s divorce lawyer.
4. Expect your marriage to change. Some of us have learned that the husband who we believed loved us “no matter what size I am”—didn’t. Other husbands, who once badgered us to lose weight, didn’t stop the criticizing when we got thin. They found something else to criticize us about–and perhaps they also found a fat girlfriend. “Even fatter than I used to be!”
And what of the really strong marriages, those founded on mutual respect and all those other good things? Some of those end, too. I know of none that are wholly unchanged. Sometimes, when the fat is gone, we discover that the man who saw under the fat the real woman that others couldn’t see, really did choose us, at least in part, because we were fat and “safe,” so the belief was, from attention from other men. And maybe that isn’t as awful as it sounds. Let’s face it, if there weren’t a good many guys out there looking for “safe” women, many more of us would have spent those years of morbid obesity alone.
So when the fat is off, expect the marriage to change, because you’ve changed, in ways big and small, some of which you aren’t even conscious of. But that brings me to my last point:
5. It isn’t all about size. So don’t put your life on hold until you lose weight. It may well be too late to tell you now, but if you have to wait a long time to have your surgery, start now to stop doing what so many of us do: postponing your life until you get thin.
It’s a hard thing to stop doing. Most of us probably aren’t conscious of just how much of our lives we put on hold until we’ve achieved an “acceptable” appearance. And how can we be blamed for doing so, when we’re bombarded with moms and other relatives and friends and strangers in the street and doctors and TV commercials that harangue us to “lose weight and feel good about yourself”–as if we’re not entitled to like ourselves until we get thin!
And what does all that postponing do, but encourage us to spin Cinderella-like daydreams about the golden life that’s awaiting us when all the fat melts away. The sobering news is that while you’re waiting to be thin to earn the world’s permission to participate in life, life isn’t waiting for you. Life is going on without you.
When I say it isn’t all about size, I mean that losing weight is likely to confirm for you that you didn’t get some of life’s goodies because you were too fat, but it will also reveal that some you didn’t get because...well, because you’re you. And you, even minus the fat, aren’t likely to be Cinderella.
Yes, you will get more attention, most of it quite pleasant, when you lose weight, and you’ll be most aware of it when the weight loss is new. Men will look lingeringly at you, and smile hopefully. They will be more likely to hold the door open for you, to help you with your bags, to offer to do you small favors. Even other women will be more pleasant, more respectful. You won’t be invisible anymore; people of all ages will be more likely to look at you, not through you. You won’t shrink inwardly at the thought of meeting a business associate who’s only talked to you on the phone. You won’t have to cringe when you see teenagers headed in your direction. And so on.
But the world won’t beat a path to your door once you’re thin. In general, you’ll have to be the one to go out there and get yourself involved in those parts of life that are, or you used to believe were, reserved for regular-sized people. We aren’t automatically included now. We just aren’t automatically excluded. There’s an important difference.
So have the surgery–by all means, have the surgery. Go into it with eyes wide open as to the risks it entails, physical and otherwise. But remember that all those years, probably decades, of morbid obesity shaped the person that you are. When the pounds are gone, important things about you will have changed, and important things will remain the same.
Have the surgery. But remember:
It isn’t all about size.