Being on Medicare, I had to consider only the surgeries that Medicare will cover. I've researched all of those and quite a few that Medicare doesn't cover, just to compare. In general, the surgeries with the highest "success" rates (where success is generally measure only in terms of weight loss and maintenance, not other health effects) also have the highest incidence and severity of side effects. The most "successful" procedures also have the highest death risk during surgery and in the first year (and possibly further out as well, because there is a severe shortage of research following weight loss patients beyond one year - those that I found that did, did not consider any deaths after one year to be "relevent" to the study and did not attempt to explore cause of death for those patients).
Banding is probably the safest with the least side effects, and it also has the highest incidence of relapse. Probably a lot of reasons, but the lesser side effects may make it easier to "cheat." Also, it requires a lot of diligence to know when to go in to have the band adjusted, and there are often insurance problems (adjustments may not be covered, or may be severely limited).
Because of it's safety, I would consider lap band in a minute, if it weren't for the autoimmune disease, but the problem I had with the nasal button was scary enough and the doctor could SEE the inflammation at every visit. I've been in a position in which doctor's have dismissed my concerns with potentially fatal results (On several occasions, I asked for an MRI of my sinuses and was told I was being ridiculous - two years later a new ENT recommended an MRI and found a large ball of fungus growing in my sinuses and a sinus deformity that made a "perfect home" for the fungus because it created more nooks and crannies for the fungus to grow). The new ENT said that the fungus had definitely been growing for more than two years, possibly as many as eight and could have been causing a lot of the health problems I was having.
The gastric bypass procedures that Medicare covers all tend to have vitamin absorption issues. Which many people can address with supplements, but since I have vitamin absorption problems even with supplements now (even though the prescription supplements would be stronger), there's a high probability that I might not respond to them.
I'm also seriously prone to staph infections. I told my surgeon this when I had to have a breast tumor removed (luckily benign) and he dismissed my previous staph infections as being due to poor wound care (nope, I know how to care for a wound). At my follow-up appointment a couple days later, he removed the bandage for the first time, he removed the layers of bandaging and packing (obviously I hadn't disturbed any of it) and the wound was already very red and he said in astonishment "Wow, you really are susceptible to infection, aren't you?" (Uh, yeah - that's what I said).
I also have other issues that make any surgery higher risk than average.
I think everyone who is considering wls needs to know what the risks and special considerations are for each of the procedures they are considering, not only for the "average" patient, but for themselves, based on their own unique medical history, and the experience of the surgeon(s) they are considering. It's a difficult decision, and not one to be taken lightly on any level.
I've known a few people who didn't understand what they were getting themselves into, but even then some of it was "voluntary" ignorance on their part. Saying what they knew (or often were even told) the doctors needed to hear during the screening process. Even the mental exams where they're required can be fairly easily "faked."
WLS is by no means an easy choice, and if anything, doing the research to realize it isn't right for me, gave me alot more respect for those who choose it. The research is fascinating and complicated. There's some evidence, for example, that some wls procedures improve insulin function in the body - even when weight loss doesn't occur. There are also some studies that suggest that some wls procedures reduce the hunger response itself (perhaps, some of the experts theorize because of the stomach nerves that were severed during the procedure). It does disturb me that there's a shortage of long term research, especially on the folks who do suffer severe complications, but there are also some very understandable reasons for that. Following patients long term is difficult and expensive. People who aren't successful often drop out of the research, and can't be reached. The researchers often have no way to know whether a person isn't responding to follow-up requests because they've died or because they're not wanting to co-operate. Folks who aren't in compliance or who have gained the weight back or even those experiencing difficulties and complications through no fault of their own are often reluctant to talk about it, out of a fear of being blamed in some way.
Obesity is a very complicated problem, and so are its therapies.
kaplods, I can't really disagree with anything you said (I won't get into the discussion of higher risks with certain procedures). I am having the Duodenal Switch (which Medicare covers), but if you have problems with vitamin absorption, then you're right that it is absolutely not for you.
In addition to people not thoroughly understanding all the possible complications/effects of surgery, I see MANY people not thoroughly researching all the WLS procedures available. Before I started researching, I thought the only options were a band or gastric bypass. How wrong I was! And yet, so many still think those are the only options. Sadly, most doctors think these are the only options, too, and even the majority of surgeons only perform these procedures, so they don't mention the others. WLS will always be more succesful when people choose the procedure that is best for them, but when only offered 2 options, sometime neither is a perfect fit.
Not to mention if you have a metabolism problem like mine it radically adjust it.
I'm not as knowledgeable about WLS as those of you that have had it or are considering it and have researched it, but I have never read anything that suggests that WLS changes your metabolism. What are you referring to here? Can you expound on it? Thanks!
I agree Jill, that patients (or prospective patients) need to know and understand their options, but it doesn't help that there are a lot of doctors out there who aren't good at explaining the medical details, and a lot of people who don't understand, or aren't interested in the medical details and treat their doctor like they might their mechanic (I don't care how you fix it, I'm not interested in the details, just fix it).
The terminology can also be confusing. Like even many doctors, I was lumping duodenal switch into the category of gastric bypass (because the stomach is remodeled and part of the digetive tract is rerouted), but you're right it doesn't fully belong there. It's really more of a "partial bypass."
Insurance issues are rough too. It can be difficult for a patient, if the procedures their insurance covers, or their network surgeon performs are limited. That's the status of medical coverage, even when you're informed enough to identify the procedure that for you would be best, you still generally have to work within your insurance coverage. If the "best" procedure isn't available to you, do you accept the second best surgical option or do you choose a non-surgical treatment? Good non-surgical treatments aren't generally covered by insurance at all. Pretty much sucks, but what are you going to do?
I would like to see more options, especially non-surgical. Our hospital has a state-of-the-art weight management clinic with an excellent reputation. The funding for the clinic was combined with funding for a YMCA, so the YMCA is open to the public, but is also a fully certified rehabilitation and physical therapy program. It's an amazing program, and includes a discounted gym membership (but they have only one patient who was able to get their insurance to cover part of the cost of the program). They do have a lot of patients who are in the program because their insurance requires proof that they've tried such a program and failed (which seems kind of sick and backwards to me, that they're going in wanting or even trying to fail, so that insurance will cover the surgical procedure they really want).
In a sense, it's kind of whacky that insurances will cover surgical procedures (because they do have a significant success rate), but not intensive behavioral programs (because there's no proof yet, that they're more effective than dieting alone), and it is the lack of funding that makes these programs very difficult to determine their successfulness. It just seems weird to me that in the treatment options for obesity there is so often a giant leap from trial and error dieting on your own to surgery with nothing in the middle.
I'm not as knowledgeable about WLS as those of you that have had it or are considering it and have researched it, but I have never read anything that suggests that WLS changes your metabolism. What are you referring to here? Can you expound on it? Thanks!
I can say that with a malabsorptive procedure, it doesn't actually change your metabolism, but it appears so outwardly (if that makes sense). I know most people who get the surgery I am getting can eat 3000 calories a day without gaining weight because many of the calories are not absorbed.
Also, malabsorptive surgeries have an effect on the way the body handles sugar, which is why they can send type 2 diabetes into full remission while still in the hospital, before any weight loss occurs.
My sister had a gastric bypass five years ago. She weighed over 400 lbs. She is now around 200. That part worked fine. The part that is scary, is she went to her support groups, gave herself injections of vitamins, followed the doctors orders to a T. Now, five years later, she is addicted to pain meds because she has to take them daily, anti-nasuea meds daily, acid reflux meds daily. She vomits every time she eats, she had a twisted bowel that was repaired, she is skin and bone (except for the water she retains in her legs because her lymphnodes don't work.) In June of 2007 she was admitted into the hospital in Liver failure, we were told three different times she would not survive. She had to be flown to OHSU in Portland. She was in the hospital over 60 days. Her liver somehow made it through, but is permanantly damaged, and will most likely need a transplant. She was sent home with a feeding tube that she had to have for three months, it came out in November and now she is sick again, and has barely been out of bed since Thanksgiving. The doctors will not let her work, not that she could in her current condition. Has anyone else had any issues like this???
You have inspired me today. Can I quote you, "People look at me and see me as fat but this is my own struggle, not theirs." I love that. It makes me feel real good. Thank you
I just got the news that my 34 yo niece is having lapband surgery on Tuesday.
In most cases I would be thrilled and supportive, but I have mixed feelings about this.
I have several friends who have had lb surgery and done very well with it. But they followed Dr.s orders to a T!
There is no way my niece is going to do this. She does not have the temperament to take orders. That's why she's unemployed most of the time.
She's loud, mean, *****y, twice divorced, does not want her kids but keeps them because of the welfare check. Last weekend she got the s**t beat out of her at a drunken party. Now she has to go to court on assault and battery charges, since she threw the first punch.
She's been arrested several times for driving under suspension, writing hot checks, etc. All in the last year.
I don't think she is in any way, shape or form ready for the commitment or lifestyle change the LB surgery requires. Plus my tax $'s are paying for it. GRR!
i hear ya, janelle. but unfortunately, there's not much you can do about it. she'll do whatever she'll do, and her surgeon will support her, or will read her the riot act.
and she'll be in for some rude awakenings when she has bad reactions. hang tight, darlin! it's gonna be a bumpy ride.
I don't see a lot of the niece. We don't run in the same circles and she knows DH & I won't put up with her antics.
She does however take advantage of MIL (her Grandmother), a lot. Her Mom won't hardly have anything to do with her either, but that's because her husband has no use for family, it costs him time and money.
The only person I knew (besides on this website) to have WLS was in a similar situation. She had gastric bypass and as soon as I heard, I knew it was a mistake. I didn't believe she was a proper candidate for the surgery and she was looking for a quick fix. Medicare paid for it and she was happy for the weight she lost but she gained most of it back until she had other unrelated health issues which actually resulted in her death.
Hi all! Just an FYI, you can catch the Biggest Loser episodes for free on NBC.com. Just click on 'Videos'. Just watched the premiere episode last night on NBC.com and they did show the part where the doctor is talking to the patient who had the Bypass surgery.
Anyone else????
Nelie
