How did you first find out about bariatric surgery and what were your initial impressions of it?

I'd heard about stomach-stapling in the 70s, but heard all the horror stories about what went wrong. It was never an option. Then, about a year agao, a friend of mine was an early patient of Dr. Fobi's and discussed her experiences with it. Oddly enough, she was one of the problem cases (her weight issues were resolved, but she's had serious health problems), but spoke very strongly in favor the procedure and how her life had changed. Being perfectly honest, her experience initially scared me completely off. To this day, although I have heard many positive things about Dr. Fobi's procedure, I would still be afraid to have that procedure based on my friend's experience. My friend was the first person I knew well who had ever been as large as me (in fact, she'd been much larger), and she knew what she was talking about. She encouraged me, browbeat me, you-name-it, until I agreed to look into the procedure.

Describe your experience with getting insurance approval for surgery. What advice, if any, do you have for other people in this stage?

I had to document everything and get several doctors to coordinate their findings, but I ultimately received approval. Tenacity helps. The changes in laws helps. (I moved to Virginia after my surgery; in 2000 Virginia passed laws to make gastric bypass surgery MORE readly available at a time when other states and commonwealths were making it harder to obtain.

What was your first visit with your surgeon like? How can people get the most out of this meeting?

My physician will actually be Dr. Amaral's partner, Dr. David T. Harrington. My initial impression is favorable: he is knowledgeable and personable. His office staff are helpful if terrifically busy. What I liked least about him: he's new to the surgery; he's only performed 10 so far. What I liked best about him: he's honest and straightforward. He will be assisted in his surgeries by Dr. Amaral (who has performed hundreds of them), which partially mitigates his relative inexperience with this particular surgery. He is not yet a member of the Association of Bariatric Surgeons (or whatever it's called) but is applying for membership. Dr. Amaral is a member currently. The doctors are both in favor of aftercare. Neither he nor Dr. Amaral have a structured aftercare program that is comprehensive (i.e., more than just medical follow-up) at this time; they therefore are referring people to Miriam Hospital's weight management unit for sufficient aftercare work (Miriam's program includes psychologists, nutritionists, exercise therapists, etc.). They are more than capable of carrying out the medical aftercare follow-ups, and they do so. He informed me that the mortality and morbidity rates for people on the higher end of obesity (such as myself) are somewhat higher (2% instead of 1%, for example). He has not lost any patients. Dr. Amaral has only lost a few. In all cases this was due to problems of leakage. I feel that Dr. Harrington was honest and clear about the risks involved with surgery. I can only rate him subjectively based on our interaction; I will be able to rate him "better" after the surgery. But he seems very competent and certainly has a splendid bedside manner. *** overall rating of group *** 25% of the patients who see Drs. Amaral and Harrington for obesity surgery are on the high end (greater than 300 lbs.) but the office does not provide (a) armless chairs; (b) large examination gowns; (c) scales that can accurately weigh people who are greater than 400 lbs. I am told that these issues are being addressed. I am writing a letter to the general manager of the group as encouragement for these improvements. Because of their care and consideration, I am willing to cut them some slack, as it were, for their lack of foresight in physical comfort for the larger morbidly obese patients. This may change if they take too long to correct the problems! Their reputation is good; their staff is friendly and helpful. More news later as events warrant. *** I think it's important for people to determine the questions they need answered, and bring that list with them to the doctor's office. I think that subscribing to some of the various OSSG lists can be of great service. [I also think that being willing to go to extraordinary lengths to get what one needs oneself is also a plus. My doctor does not know about binders, nor does he supply johnnies large enough for those of us on the grander scale (75% of his WLS patients are less than 300 pounds), so I'm buying my own.]

What made you finally decide to have the surgery?

Desperation.

How did you decide which proceedure to have?

Research and discussion.

What fears did you have about having complications or even dying from from the surgery, and what would you tell other people having the same fears now?

Yes, I truly understand that I can die from this surgery. I am at a higher risk level than normal because those of us who are truly enormous are at double the risk, so my doctor tells me. Additionally, I come from a family with a dreadful heart history, so that increases my risk by another factor. I keep telling myself that I'd rather die on the table en route to a healthier life than die a few weeks or months later from the disease that is already killing me slowly. For me, that helps. In addition, I also keep chanting to myself that even a 10% risk (more than I face) still means a 90% chance of everything going splendidly, so the odds are in my favor.

How did your family and friends react to your decision? Would you have communicated anything differently if you could now? How supportive were they after your surgery?

So far, nearly everyone has been supportive. My younger family members have been supportive and my older family members have been idiots. Their idiocy is centered around asking questions like "Can you die from the complications?" and "Can you guarantee you won't screw up THIS program too?" and asking me this information while I was either still in the hospital or just discharged from the hospital. I expected better.

How did your employer/supervisor react to your decision? What did you tell him/her? How long were you out of work?

So far, everyone is being very supportive. My boss happens to be a friend of nearly 10 years' standing, so I was totally honest and straightforward with her. On the other hand, I have not heard from her at all since I left work for surgery.

What was your stay in the hospital like? How long where you there? What things are most important to bring?

Most of the staff were wonderful. Hospital administration is always stupid. Always. Ask lots of questions and keep being proactive. Bring: comfort object (teddy bear, comfy pillow), personal care items (hair brush, deoderant), and just a few paperback books or some such. Since security is not great even at a hospital, don't bring a boom box with you, or an expensive Walkman or anything. If you don't like television you MUST bring something to read for the rare day when you will want to read.

Did you have any complications from the surgery? If so, how did you deal with them?

I had serious trouble being hydrated enough and I'm still working on that. They tested me for blockage (try another upper GI series when you can only drink 2 oz. of the solution -- it was almost worth the price of the operation not having to drink more of the stuff!) and found nothing. For me the worst complications are the emotional reactions, and they should pass.

In the weeks after you got your surgery date, how did you feel? How did you cope with any anxiety you might have felt?

I'm one week post op as of yesterday. I cope with my anxiety by crying a lot. My anxiety is not totally related to the operation; I have about 25% anxiety about my operation and I talk about it and try to find work-arounds for things I find difficult now that I'm post-op.

Describe your first few weeks home from the hospital. What should people expect from this period?

Surround yourself with people who love you, understand you, and want to understand WLS. You don't want to know how my first week went. Trust me.

How far did you travel to have your surgery? (If far, how did this affect your aftercare?)

My surgery was local, but then I moved just before the surgery so I had a two-hour drive for follow-up.

Please describe in detail what things you could and couldn't eat in the weeks and months following surgery. What foods have been off limits? Please explain how your dietary tolerance changed week-by-week, and then month-by-month since surgery.

Early on, coffee and meat were completely out of the question. At two months in, I still am most comfortable eating cheese, soups and stews. I find that if I eat something 'undesirable', I don't have any problems with dumping, but that the food itself tastes terrible. My doctor and I are in agreement that I try to maintain a high protein, low carbohydrate eating plan. I am constantly worried about having stretched out my pouch, because I keep thinking I'm eating too much. I do have some problems with vomiting, but I don't usually have physical discomfort with it, so my doctor tells me to quit worrying about it.

What was your actvity level in the days and weeks after surgery?

Initially I was fairly sedentary, but I started taking care of my niece's two young children (four and seven) about three weeks after surgery, so my activity level became moderate.

What vitamins and/or dietary supplements have you taken since your surgery?

CVS Children's Chewable Vitamins. Tums for calcium.

What side effects (nausea, vomiting, sleep disturbace, dumping, hair loss etc.) were worse for you? For how long after surgery did they persist? How did you cope with them?

I still have some problems with nausea. I wake up several times in the middle of the night with anxieties, but I had this problem before surgery as well. I've lost about half of my hair, but this is complicated by the fact that I received a dreadful permanent a few weeks after my surgery, so I'm not sure how much is due to the perm. :) I try to avoid foods that make me vomit. Otherwise, I ignore the nausea. I try to avoid foods that make me gassy (usually it's meat protein).

What was the worst part about the entire bariatric surgery process?

The worst was the lack of support from my family during my early recouperation. They were constantly critical and unsupportive. Within a week of my release from the hospital, one family member actually made me take full care of her two children, aged 4 and 7 in a house with three flights of stairs. NOT the ideal thing. The surgery itself was what I expected. The battle to get the procedure insured was harsh.

What aftercare support group/program do you have? How helpful/important is this?

None, and it might make a difference.

What is your scar like? Is this what you expected?

My scar continues to fade. There's some puckering but not much. I am where I expected to be as far as the scar is concerned.

Please describe any plateau experiences you have had since surgery.

I have been virtually the same weight for nearly nine months now. My therapist thinks that I have a great need to stay stable and adjust to the magnitude of change. I am anxious and unhappy about this, which probably doesn't help.

Do you notice people treating you any differently now?

Yes. In part, I suspect, my change in self-confidence has improved my chances of being treated well. In part, because even though I remain (as of 05/16/2001) around 280 pounds, I look more nearly normal.