SunburyGirl
November 2, 2006
Karen and I have been friends since second grade which makes us friends for 45 years! Hard to believe. She’s a wonderful strong person who has always been much more than the sum of her weight! She’s vivacious, strong willed and fun and at this point in her life is getting a new business started with approximately 15-20 employees. She’s been very heavy for a long time now (ever since the babies) and if anything, has gained, not lost.
I have also been reaching new heights on the scale in the last seven years. Some things have been totally great with my life (lovely second marriage with a wonderful loving husband, renovating Civil war house, great warm and crazy families on both sides (we have the medication to prove we’re nuts). The kids are doing great which just means we’re lucky, not great parents. I have three cats and a funny cute papillon dog named Buddy! But my weight is getting more and more out of control and it has aggravated or caused most of my health problems. At this point I am officially obese. Oh, the horrors! I’m am at this point 37 BMI. With my family history of heart, cancer, diabetes, high blood pressure, arthritis, gall bladder and thyroid problems, etc., I’m know I’m walking the edge, although I DID QUITE SMOKING TWO YEARS AGO (only one episode of smoking since, with my cousin when her mom died. My doctor called that a ‘mercy smoke’!)
My love affair with food and repeated diets: Food has always been a big part of our family experience and most of us have moderate to serious problems with weight. Sad to say, none of us are naturally thin, which is a bitch, but there you have it! I’ve always loved food and had an enormous appetite and enjoying cooking hasn’t helped!
Since this resulted in weight gain once I reached puberty, I started the cycle of dieting. I could lose weight as long as I had a high motivation to battle the hunger, but it always came back and over the years my low weight (on my bell curve) has continued to climb, even though I’ve conducted numerous crusades and exercised fairly regularly. I doesn’t get easier as you age. Call it lack of willpower, self control or gluttony if you want, but I’ve continued to get fatter. I know have realized that diets suck and are usually only a short term solution. The studies say that all diets have a 90-98% failure rate, which back up my theory. I realize it’s a big money making industry, and that most health professional buy into the official wisdom of dieting, exercise, lifestyle changes, etc. I agree that I need lifestyle changes, but I need some big help doing it, because my willpower ain’t cutting it!!
What’s this? Karen and I seriously started researching the different types of baratric surgeries this past year. We’ve dallied with all the different weight loss strategies over the years, but were waiting for the magic pill! (still waiting) In the last year, we’ve come to the point of making decisions and since we’ve always been that way, we did it together! We talked several times with three of my cousins who had the RYN surgeries within the last five years and that, along with our increasing weight gain and health problems.... well, desperation and failure can be wonderful catalysts to help you focus on solutions!
After we went to the WLS seminar at Wood County, which does all four of the WLS operations, we are both in agreement on our pursuing a surgical solution, regardless of whether we can get the insurance companies to help. Unfortunately, her insurance has an exemption clause, but after talking to the Brian Lane, the surgeon, he wants her to work with the hospital insurance liaison to see if they can work around this. She might end up getting the surgery ahead of me and if so, I’ll be in her cheering section!
Emotional support hasn’t come so easily! Steve, her husband is a good man in many ways, but can be a real jerk in others. His first retort when Karen discussed this with him was to say it was a crazy idea and that she should just stop eating (she’s been through diets I couldn’t have taken!) Well, it might work out okay. This wouldn't be the first Steve has said no and Karen went on and did exactly what she wanted!
My husband was much more supportive. After we talked about it, he said it was pretty extreme, but it was my body and he was behind me if I wanted to pursue it. The family members who are aware of our plans are behind us in whatever we decide, which is a blessing. Regardless, we’re both pretty ready to make serious and permanent changes that force a lifestyle change.
What surgery? After all the research we’ve done so far, we are both sold on the Vertical Gastrectomy (VG) over the other procedures. Here’s some of the reasoning behind that decision.
The RNY: My three cousins had the RNY in the past five years and while they have lost a lot of weight and are healthier on the whole, one of them almost died from strictures of the bowel that came from adhesions. When I say almost died, I’m not exaggerating. She was rushed into emergency surgery and was in intensive care for several weeks.
That procedure is much more restrictive in diet, with more complications and problems over the long term. It seems that protein, vitamin and mineral deficiencies, ulcers, strictures and other problems are much more common. The dumping syndrome and inability to eat so many foods is another reality I don’t know if I’d be comfortable with. Some surgeons feel this is a good way to provide a ‘consequence’ for patients that have a sweet tooth or like starchy carbohydrates like corn, pasta, potatoes or rice. I understand their reasoning. Repeated torture is a great deterrent! But I’d like to be able to have those foods, even if in small amounts.
The common thing the RNY and the more radical DS surgery share is a malabsorption mechanism. That is, they cut out and reroute some of the intestines. This takes out an important part of the intestine that absorbs some calories in food, but also many important nutrients. It also takes out some of the plumbing that regulates food passage. That scared both of us. Supplementing with vitamins is all well and good, but I wonder how you would stay well nourished in the long run. Studies indicate that deficiencies are more common than initially supposed with those operations, although if you’re really careful with your diet, you can be healthy.
The DS surgery probably lets you eat more junk than any of them, but it has some lousy side effects with odorous gas and stool and the highest risk of nutrient deficiencies and potential complications. I can see reducing the size of a stomach, but something in me cringes at rearranging the way digestive system are set up and creating new connections that aren’t designed the way the old ones were. All of the operations that rearrange things make any gastro testing in the future possible, but problematic. I also don’t like the idea of leaving all that stomach hanging around in there, almost but not quite detached, but still producing bile and appetite hormones. As one person on the forum commented, it seems like a great way to create a good environment for stomach cancer.
The Lap Band: I was initially considering the lap band thing because it's minimally invasive, cheaper and not permanent. Of course, if you take it out you regain the weight so it being temporary isn’t a real advantage! You have a port in your side that they use to increase or decrease the saline band. The band can slip and/or grow into your stomach at any point! Food can also get ‘caught’ and there are many foods that are prohibited. Personally, if I’m going to go through the expense and grief of a surgery I want it to be a permanent and good change that I can live with.
So many of the people on the lap band forum seemed to be having problems and many reported feeling hungry all the time and/or not being able to keep anything down without throwing up, particularly after they had the thing ‘filled’! Can you imagine feeling starved and not being able to eat without tossing your cookies!? The complications many of them were going through to lose weight seemed far worse than being overweight or dieting the traditional way. After all the agony, many of them stopped losing weight. Of course maybe all the happy people who were content with the system weren’t writing, but I’ve found that many surgeons don’t recommend that surgery anymore because so many people have been unhappy with the results and had complications.
Caveat: I keep in mind that all of these surgeries above have many happy customers. My cousins are happy with their decision to have the RYN surgery. If you are seriously obese and/or have serious health problems, even the most radical surgeries are probably better than remaining obese because you have a better change at lowering your risk of premature death and improving your quality of life if you are at a health weight. That said, I still wanted to pick the best one out there!
The VG surgery is relatively new (2-3 years) as a stand alone procedure, although it’s been done for a long time as a 2-stage operation and for other problems. The VG is less restrictive in ultimate diet, and you can eventually eat a bit of anything that agrees with you. Because they aren’t taking out intestines, there is rarely a problem with deficiencies. You do need to make sure you eat ‘good foods’ first, drink lots of fluids and take a multivitamin.
Protein foods are a priority in all of these diets, because the body can replicate other vitamins and minerals out of protein, but can’t make protein. The surgical assistant at Wood County said that if you keep the high protein content of your diet up to their recommendations, it fools your metabolism to some degree so that, even know you are taking in very small amounts of food the first 18 months or so, you don’t go into a starvation state where your body hoards calories. Eventually many people maintain at about 1000 calories, more or less, depending on their activity levels. I can live with that! From what I’ve read, if you overeat, you can have some dumping symptoms or vomiting, but it appears to be rare and not as severe as with the RYN procedure. Another advantage is being able to take your pills whole and are able to take Advil. Since I have arthritis, that’s important to me.
Because the big stretchy part of stomach that produces ghrenlin is removed people who have had this surgery don’t feel much physical hunger (emotional hunger is something else) and many people have reported that their desire for 'bad' food has gone away or been reduced. I would LOVE to have less appetite and desire for bad foods.
The VG seems like a great balance of low risk with lots of positive aspects, but I don’t kid myself that it would be effortless. IfI abused it with bad diet or lack of exercise I’m sure the results would be poor. From what I’ve learned, the benefits of all of these surgeries can be overcome if the person is determined enough.
More long term studies will need done on the VG, but the results for most have been excellent with few complications. The operation is shorter, has fewer complications and is safer for older and/or heavier folks. When talking to the surgeon, Karen asked him what surgery he would choose if he was the one getting the operation. Without hesitation he said the Vertical Gastrectomy, hands down.
Risks: I keep in mind that every one of these surgeries are serious and can have some side effects or a percentage of people with whom it goes seriously or minimally awry. But you know what? Nothing in this life is risk free! Realistically, I take far more risks on a daily basis, whizzing along at high speeds and dodging big oncoming objects that could snuff my life out in a second. It’s called driving to work! That’s where I have the most chance of dying, not on a surgery table! As it is, I’m putting myself at substantial risk by remaining so heavy. That risk climbs as I age. So for me, surgery is a very reasonable risk, offset with a high potential of wonderful benefits.
Am I betraying my fellow fatties? Should I just Celebrate my Large Loveliness ? Hummm..... I think everyone should feel good about themselves and enjoy life. For some, that means not fretting about the fact that they are obese. That’s cool! I don’t hate myself because I’m fat and I realize I could just choose to celebrate my increasing fatness. Big and Beautiful! I’ve done that to some degree and feel I’m still a fairly hot chick! My husband, bless his heart, has loved me (literally) through thin and thick. He says I’m the best thing that’s ever come into his life and the most wonderful wife. (now you know why he is really The Best!). Where was I....?
The downside of being big and beautiful for me is, I don’t enjoy being that way. Oh I enjoy gobbling food, but my size limits my choices and drains me of energy. I feel like I'm dragging around another person sometimes and ache by the end of the day! It increases my inhibitions and I find myself hiding my body, even from my sweetie. I could handle all that I suppose, but I’m also getting the ailments associated with being overweight and I don’t see that improving with age. I don’t have a problem with getting old and getting wrinkles. I don’t hide my age or fret that I’m (gasp) 51! Hell, I’m enjoying life and feel so very blessed in many ways! But... I hope to be active and able to enjoy myself as much as possible in the coming years.
My decision: I’m going for it! If I could go in tomorrow and get the surgery done, I’d do it. As it is, I’ve started the process. I talked to my general practitioner and presented an abbreviated version of this story, along with our family history and my own set of ailments. He said that I sounded like I’d done my research, had a good idea of what I was getting into. In short, I seemed a good candidate and he’d support my efforts. So I’m doing the first requirement our insurance has which is a doctor supervised diet. The doctor thought it was as big a crock as I did, but said he’d document.
Insurance Companies and looking behind the curtain: I’ve done my research and read all of the horror stories from other WLS candidates dealing with their horrible insurance companies. I thought I was prepared but dealing with my insurance company has been a revelation. I knew that corporations in general, tend to be sociopathic in nature. There’s a lot of pressure to make money and little to be ethical. I figured my insurance company, Medical Mutual, wouldn't give anything away for free... but I naively assumed they would be clear about what their coverage criteria. Don’t they have to give full disclosure if you ask? (silly girl!) In the official handbook they have a vague blurb that says…
Benefits are available for the surgical treatment of morbid obesity, which is defined as involving having a Body Mass Index (BMI) of 40 or greater; or 35 or greater if severe comorbidities exist. Certain weight loss medications are covered under this diagnosis.
Seems straight forward enough, doesn’t it? But wait! There might be more (I knew there was more just from talking to the surgical folks)! So I called Ohio Med’s customer help line and talked to Ms. Alford. It was enlightening in a perverse way. I explained that I would like to get a written explanation of my WLS coverage and the criteria used to decide whether a candidate was eligible for coverage:
- After hearing my question, she said that she didn’t really have the materials on hand to answer my questions fully. (this is the help line remember). She was having computer problems, her aunt came in from out of town, she’d run out of gas, etc., etc.)
- When I asked what she could tell me, she said all that was required was stated in the blurb above (Body Mass Index (BMI) of 40 or greater; or 35 or greater if severe comorbidities exist). Very simple and she was sure that was all that was needed.
- When I asked her to elaborate on the phrase ‘severe comorbidities’ she couldn’t define what comorbidities were considered valid or of how they defined ‘severe’. “The committee makes that decision.” (They have nothing written?) Not that she knew of. You just have to submit your request.
- I asked if any specific medical records were required and if so for what period of time. She thought that we might need three year medical history, but wasn’t sure... it could be one year.
- How about required tests? None that she could think of. After I mentioned a psych evaluation, she remembered that was also required.
- “Anything else you can think of?” I pressed. “No, just what the clause says...” I idly suggested, “How about a record of recent, six month doctor supervised diet? Is that required...?” Pause... “Oh, you know I think that is one of the requirements!” (sur-prise, sur-prise!)
- Even when I pressed, she couldn’t supply anything written or give me any idea of what the determination board used as criteria for their determinations. When I asked why I couldn’t find out what my insurance covered when I was paying for it, she had no answer. When I asked why we had to pursue this blindly without any upfront guidance from the insurance company, she had no answer. It got to the point where even she laughed at the absurdity of our conversation. We promised to do lunch and I hung up!
Of course I realize the insurance companies are setting their policy holders up for a denial by refusing to give full disclosure on their policies. They might deny a request because the poor sucker doesn’t have the six month documented and uninterrupted diet or search for something else. They know that a majority of people will take the denial on the chin and walk away. Every person that does, means money in their stockholders pockets and that is, bottom-line, what they are in business for. They also know that they will probably lose on the later appeals if a person has a well prepared case, but those people are in the minority. Even so, every time they approve a surgery they are setting a precedent, which widens the door to a large (literally!) group of possible candidates considering the surgery. How scary is that, when you’re trying to make money!? I just didn’t realize they were that sneaky and deceptive in their practices!
So…. That’s it! My journey so far!
