I am pre-op with Dr. John P. Daly and am hoping to have a laparoscopic Roux-en-Y gastric bypass (RGB or RNY).
I am a 46 year old married man. My wife, Julie, had a laparoscopic VBG with Dr. Champion in Nov. 2000. She has lost over 200 lbs with a lot of exercise and dedication. She ran in the Peachtree Road Race last year and finished in the time required to qualify for a t-shirt. She is planning to run in it again this year.
My sister, Gail, had an open RNY in Jacksonville, Florida in August of 2002. She has lost over 70 lbs and says she is never hungry and has no problem eating anything. I suspect she is exceptionally lucky that she has no eating problems, but I am happy for her. She has been encouraging me to get WLS, specifically a RNY.
My BMI is high enough to qualify me for surgery without any comorbities. But, I also have several co-morbidities including high blood pressure, high cholesterol, type II diabetes, severe sleep apnea and arthritis with joint pain.
I also have a rich and lengthy history dieting and losing weight and gaining it back including Weight Watchers most of my life, Overeaters Anonymous, doctor prescribed “diet pills” (amphetamines) in 1975, Redux (dexfenfluramine), which I was sad to lose to the legal industry, Meridia which had to be stopped due to high blood pressure and Xenical (Orlistat), The Just Say NO to Pizza Drug.
I have been considering getting Weight Loss Surgery (WLS) for quite some time. My wife encouraged me to try Weight Watchers and Xenical again. She has a lot more confidence in me than I have in myself. She knew I have always been able to lose weight successfully. But, I knew I could never keep it off and always seemed to gain back more than I had lost.
The only weight loss I have ever maintained was the 20 to 30 pounds I lost after I had my sleep apnea diagnosed and started sleeping with my CPAP. If any of you suspect you might have sleep apnea, please discuss it your doctor. You may need a sleep study.
Near the end of my last stint with WW, I became increasingly curious about my sister’s claims the she was “Never Hungry” after her RNY. My oldest brother couldn’t believe anyone could be “never hungry”, because, like me, he was almost never not hungry.
My wife, who has been very successful after her VBG did have problems with hunger that sometimes became pretty bad when she swallowed something the wrong way and couldn’t eat anything else for a while even though she was very hungry.
I decided to do some research about WLS and hunger.
I knew from personal experience that the Selective Serotonin Reuptake Inhibitors (SSRI) Redux and Meridia would help you be more satisfied after eating normal portions at meals. That didn’t explain why my sister was never hungry.
So, I began researching, trying to find out why my sister was no longer hungry. I found numerous references to the hormone Ghrelin including an article in The New England Journal of Medicine: http://content.nejm.org/cgi/content/short/346/21/1623
It looked like the naturally occurring hormone Grhelin was a strong, long-term appetite stimulant. In everyone the Ghrelin level seems to spike prior to meals further stimulating the appetite.
Apparently, in big people the Ghrelin level is much higher than in small people. Furthermore, when anyone lost weight through dieting, medication, exercise, etc. the level of Ghrelin in their body rises and continues to rise as they lose more weight. They get hungrier and hungrier with the increasing levels of the Ghrelin hormone.
I recall reading in one article that the pharmaceutical companies are very interested in a potential medication to manage Ghrelin levels, but it would probably take about 10 years to bring it to market. When I think about my experience with Redux, I have to wonder if when such a medication did reach the market, how long we would have it before some legal conglomeration decided to make their fortune from it causing it to be taken back off the market.
What interested me most was the research indicating that after people have gastric bypass surgery, their levels of Ghrelin dropped below the levels experienced by smaller people. Furthermore, the post-op’s Ghrelin levels stayed lower and didn’t spike as high prior to meals. As the gastric bypass patients lost weight, the Ghrelin levels still remained low and they were not hungry.
It was also interesting that Ghrelin levels were not significantly affected by restrictive-only weight loss surgery like the VBG. Which could explain why my wife still experienced hunger after her VBG, but my sister does not get hungry after her RNY.
My sister really does not get hungry.
That’s when I made the final decision to get a Roux-en-Y gastric bypass.
I attended the last two Wings Around Atlanta meetings, the last Northside Support meeting, the last Emory Bariatrics Center Seminar and a few of the Lawrenceville WingNUTS meetings. My wife attended the last two Wings meetings with me and has been very supportive since I’ve decided to have surgery.
I am planning to attend this Thursday's Northside pre-op class, this Thursday's Northside support meeting and the June 21 Wings meeting.
Dr. Daly requires a nutritionist consultation with a registered dietician, a bariatric psychotherapy evaluation and a PCP pre-op physical with letters of clearance from all three prior to submitting the requests for insurance approval.
My psychotherapist, Dr. Steven Ritz 770-270-5488, has cleared me for surgery. I would highly recommend Dr. Ritz.
The Registered Dietician Rachel Brandeis (770) 667-4308 has faxed the results of our nutrition consultation to the surgeon.
My Primary Care Physician (PCP) has sent the results of my physical and a letter of clearance for surgery to my surgeon.
That takes care of all of the pre-insurance tasks. Now Dr. Daly’s office is sending the request for pre-approval with documentation to my primary insurance company, Definity/Southcare, and to my secondary insurance company, Horizon NJ Blue Cross Blue Shield.
After receiving insurance approval, we will set a surgery date.
The Dr. Daly also wants me to see a Pulmonologist/Sleep Specialist because of my sleep apnea and a Cardiologist because of my high cholesterol, high blood pressure and family history of heart disease. Both the pulmonologist and the cardiologist will need to give clearance for surgery.
This Thursday June 12 I have an appointment with a pulmonologist. I have an appointment with a cardiologist Monday June 16.
I hope the pulmonologist doesn't require another sleep study because there are usually long lead times for sleep study appointments. Maybe I won’t need another one since I had one October 2002.
I have had EKG's with my PCP and they are always ok. I think the cardiologist will give me a stress test EKG.
The support and information I have gotten from this group has been a great help.
Thanks,
Curtis Green
[email protected]
