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Through Thick and Thin #3 (August 5, 2002)
Jumping Through The Hoops to Gastric Bypass Surgery
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At long last. Hope!
For the first time in 45
years, I‘m truly believing that, through the miracle
of this bariatric medical intervention, I can achieve a healthful weight and
physical state. Although I have come to
feel hopeless about resolving my morbid obesity through careful eating and
exercise, I no longer feel helpless.
I‘ve come to realize that I
have a medical condition that requires a medical intervention. That my obesity is not an issue of my character, intelligence or competence. There‘s no shame in that realization. For the first time, I feel hope.
Research indicates that only 5% of dieters are successful, i.e. they lose their weight and maintain the weight loss. Research shows that 85% of
individuals who have some form of gastric bypass surgery lose at least 40% of
their excess weight — and keep it off. Hopeless, but not helpless.
 I remember reading about the
procedure years ago, and fantasizing about it — much like I have fantasized
about the discovery of the magic pill that will melt away my unwanted extra pounds, or that will speed up my metabolic rate, or that
will otherwise solve my weight problem for me. But I‘ve had a very negative and painful
experience with “elective surgery”, and something that involved stapling my
stomach seemed unacceptably bizarre and still too experimental to consider.
This time, however, when I
read the June 10th Newsweek article about the gastric bypass
procedure, it seemed that the surgery was now a relatively safe and
proven-successful intervention. So I surfed the web and checked out the websites of the American
Society for Bariatric Surgery; Web MD; the Obesity Surgery Journal; the Center
for Disease Control; and other similar sites, including several hosted by
ecstatic survivors of the procedure. I
voraciously gathered and devoured the voluminous information about the surgery
at these sites. And the more I learned,
the more interested and hopeful I became.
In 1991, the National
Institutes of Health endorsed the procedure as efficacious. Death rates from
the surgery remained at a relatively modest rate of about 1.5%, and the rate of
surgical complications seemed to be within reasonable range. Patients who had the
procedure lost the weight in rapid and dramatic fashion, and kept it off. Often, their diabetes, sleep apnea and other
“co-morbid” conditions disappeared or ameliorated. So, after discussions with my wife, I decided
it was time for us to have a frank “heart-to-heart” discussion with our family
physician. I let him know, when I made
the appointment, what I wanted to discuss so that he could be as prepared as
possible.
I told him at the outset that
we wanted straight talk and answers, complete candor and honesty. How did he assess and compare the risks of
this procedure to the potential benefits?
He delivered. He told us that
the risks were minimal, and the potential benefits enormous. My
morbid obesity would kill me prematurely, one way or another. And,
along the way, the extra weight I‘m carrying around would continue taking a terrible toll on me in terms of the daily pain and wear and tear on my muscles
and tendons and joints. Taking off the excess weight would probably prolong
my life significantly, and prevent a great deal of the painful episodes and
conditions. It might even “cure” my diabetes and sleep apnea. From his
perspective, the surgery made great sense.
After further discussion, we agreed, and chose a highly-trained and
experienced bariatric surgeon in Seattle who has performed about 1300 gastric bypass
procedures.
I called to request an
initial consultation. At first I was surprised
and disappointed, and then eventually quite pleased, when his receptionist advised me that the doctor preferred to invite me and my wife to a free orientation and question-and-answer session held monthly at his hospital of choice in Seattle.
Within the first minutes of
the orientation, I was almost ready to give up and leave. It became clear immediately that this
procedure would not be covered by my medical insurance plan. Fees for the primary surgeon and his
assistant surgeon would run about $7,500, and the costs of hospitalization for
the 3–4 days required
could bring the total cost as high as $30,000. Even
if we had this kind of money available, how could I ever justify spending so
much on this elective procedure?
Actually, it was pretty easy,
once my wife and I had a chance to process the information and talk it
through. We had received an inheritance after
the death of my parents that was sufficient to pay off all of our consumer
debts and the mortgage on our home.
This was stunning and incredible gift that brought us an enormous sense
of peace, security and optimism about our future. And yet what were we saving it for, if I was
going to die prematurely? What greater or wiser investment could we
possibly make than in my health and prolonged life?
I have a man of many talents
and gifts, and I‘ve never had more exciting creative projects on my desk than
now. We quickly decided that there was
nothing more important for us to have than a chance at many, many more years
together.
As it turns out, an abdominal
ultrasound required by the surgeon as a precondition to the procedure revealed
the presence of one or more stones in my gall bladder. Its removal is a “medically necessary”
procedure covered by my health plan. So a portion of the surgery and the
hospitalization costs will end up being covered by my insurance. And we would have proceeded with the surgery
in any event.
The surgeon also insists upon
a slow and careful process leading up to the procedure, including the abdominal
ultrasound; a psychological evaluation to assure appropriateness for the
procedure and the emotional resources to deal with its aftermath; a nutritional
evaluation; and he may also require a sleep apnea study, pulmonary function
test and serum cortisol blood test.
I‘ve begun, slowly and
carefully, to share my decision and plans with a few family and friends — my
daughter; my aunt and uncle (who are my surrogate parents since the death of my
own); my sister and brother; a cousin; and a few special friends and
colleagues. Their response has been
heartening — after an initial shock and concern about the risks inherent in the
surgery, total support for anything that will help me to live longer and
healthier.
I don‘t have many fears about
the surgery itself. I have lots of
questions about the mechanics of living and eating with a stomach pouch the
size of my thumb. Fortunately, I‘m in
touch with a few people who have successfully undergone the surgery and are now
celebrating its successful outcomes, and I plan to question them until all of
my questions are answered and my anxieties addressed.
Also, I was fortunate to find
a book called Living A Lighter Lifestyle, A Guide To Successful Weight Loss
and Maintenance Following Gastroplasty or Gastric Bypass, by Dr. Gaye
Andrews (http://www.drgaye.com/ )
addressing these issues. The first part
describes the surgical procedures and how they work; the second part discusses
lifestyle changes that patients must make in order to live comfortably with the
procedure and to maximize weight loss; the final part shares the experiences of
others who have undergone the surgery. Occasionally I consider the
possibility of dying during or from the procedure. More often, I‘m struggling to imagine what I
will look like, what I will feel like, as the excess weight comes off and I
become more and more comfortable and flexible and healthful within my
body. What will it feel like to be able
to move and bend and twist normally again, without constraint or
limitation? To look normal? To travel normally? To live without the daily pain?
I‘m becoming increasingly
excited about the Zen of Gastric Surgery.
Less will be more. Less food will
make my stomach feel more full. Food will become a fuel, to be carefully and
consistently administered in small, periodic doses. It will no longer be a raging obsession, an
enemy, an invader, a killer.
This last weekend, as I
enjoyed a regional jazz festival, I noticed a young musician who reminded me of
myself as a young man. He was strutting
around, resplendent in a tight-fitting black silk shirt, black silk pants, and
a handsome black blazer. Just for a
moment, I saw a glimpse of my future.
And it felt so delightfully, joyfully, deliciously good! At long last, hope!
Glenn
Next Issue (#4): Preparations for the Surgery
or
Food As Fuel -- Not Drama, Mama, Karma or Trauma
Click here to read another newsletter.
Click here if you have a “fruit and vegetable problem” to see if my solution (see Through Thick and Thin #19) will work for you.
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