Gotta keep her alive! :o(

[Mr.H]

My wife is morbidly obese (Approx 400lb and 5'2").  We've had no health insurance for years so we've been trying to save $16,000 for a gastric bypass.  We haven't done very well.  

I recently landed a nice job with an excellent health insurance that will cover the surgery (but they want 6 months of doctor supervised diet/exercise recorded). At her first doctor's appointment yesterday her blood pressure was taken and was 150/110. Her doctor said that if some pills don't work she will have to be hospitalized.

I'm terrified that she will have a stroke, heart-attack or anuerism, before we get her surgery aproved. Does anyone have any experience/advice (or words of support!) in this area?

[Cleveland Clinic]

Mr. H

Im sorry to hear about your and your wife's ordeal.

While her blood pressure is on the higher side, it is not in a range that she should be in immediate risk of the complications you are mentioning. Medical therapy should help lessen this risk even further.

I think it will be important to establish the rapport with the physician that will take care of her now and after the operation so he/she gets to know her better. The workup and scheduling of this type of operation takes time and her physicans will not rush into an operation without making sure that it will be safe to proceed.

good luck

[Dr. Erik]

You should have the doctor write her a letter of medical necessity stating that "due to her failing health and high risk for stroke and other problems, she should be approved for surgery immediately as it is a risk to her life to wait any longer". Faced with the possibilty of even greater expenses from the consequences of waiting another six months, the insurance company should wave the six month doctor supervised diet and exercise request. Best of luck.

[ADrocks]

That is an unbelievably irresponsible post from Erik. Clearly he doesn't know anything about which he posts. Gastric bypass surgery requires at least a 6 month period of time for preparation and to determine if the patient will be a good candidate. The surgery itself is extremely difficult both in the immediate post-op period and in the long term. It comes with multiple possible complications, and if someone can avoid it and achieve weight loss with other conservative approaches they should. It is not a quick fix, people can die from the complications, and recurrent weight gain is not uncommon.

That is why the board had to resort to putting in the disclaimer after the physicians response.

[nurse12hr]

While your wife is clearly at some danger from morbid obesity and hypertension, a blood pressure of 150/110 should be controllable and is not per se something of imminent danger requiring hospitalization.  

It sounds like she needs to get right in with someone to get her started on the evaluation process, and begin a diet and mild exercise program, with her doctor's ok.  Many insurance plans will cover the expense of a nutritionist, if it is recommended by the doctor.

You really need for her to be in the best shape possible before going down this road.  This surgery is grueling and not without the possibility of major complications.  

Good luck to you both.

[Dr. Erik]

I do happen to know a heck of a lot more about a Gastric Bypass (Rou-En-Y) procedure than probably you my friend. I know the anatomy and what takes place before, during and after. I know the mortality rate involved as well as the morbidity percentages as well. It was was proposed that I have a modification of this procedure for severe Acid Reflux as I have had three failed surgical Nissen Fundoplications and three failed Endocopic Gastroplications. I have had three recurrent Paraesophageal Hernias and currently have a small component to a new paraesophageal process. Through lifestyle changes and medications I have avoided the procedure.

All I said in my comment was how to get the insurance company to wave the six month waiting period if it was necessary. Obviously no surgeon is going to operate on this woman immediately without exhausting other means and following protocol. The wait list for this procedure alone can be anywhere from six months to two years. Let's grow up now.

[tessa0825]

I don't mean to butt in on some one else's thread here but I wanted to ask you some questions pertaining to your failed reflux surgeries..I also had fundoplication combined with collis gastroplasty last year at CCF. I have Barett's and also scleroderma. I wondered if you had considered an evaluation there for your esophageal problems? They have a great gastroenterology dept. and an excellent thoracic surgeon who is known world wide for his expertise. I only weighed 118 going into this surgery and Im the odd guy out who has actually gained weight following surgery, presumably from prednisone use for all my inflammatory issues...If I had this surgery 3 times and they all failed I would be going someplace where they have an excellent success rate and have any further work done by a top notch surgeon...Dr. Rice is wonderful!

[Dr. Erik]

Thanks for the info. You had the collis procedure used to lengthen the esophagus. Over time the reflux can  cause a shortening of the esophagus which increases tension and actually pulls the stomach back into the thoracic cavity. I actually did go from my home in Syracuse, NY to Rochester, NY for a consultation with a thoracic surgeon that specialized in Esophageal diseases. He suggested the Gastric Bypass but with the connection of the small intestine further down as to allow more absorption of nutrients so I didn't lose much weight. I am doing well at this time.

[tessa0825]

I'm very happy you are doing well now. Yes the collis was to add length to my esophagus. I had a bad stricture that refused to stay dialated and also a large hernia. Of course, I also had alot of chest pains and was certain I was having a heart attacke many times. I hope you continue doing well..Tessa

[BigBoy2u]

I have had gastric bypass surgey 3 years ago and have had no complications.  I am a male 41, I was 417lbs and 5'11" today I am 255lbs.  The best information on gastric bypass surgey along with help files and letters can be found at www.obesityhelp.com  good luck on your venture. It was the best thing I ever did and never regret doing it.  It took me 2 months to adjust after the surgey, after that I have been fine.  If any one needs more answers just ask me.

Shawn

[netrox]

I am against the idea of stomach stapling. It is totally unnecessary and can cause serious complications.

Obesity can be cured permamently through a permament lifestyle change. Obese people argue that there are skinny people who are able to eat anything and they don't gain a pound. What a lousy excuse. The fundamental rule for all of us is that we must maintain our ideal weight, no matter how different our metabolism is. If you have a slow metabolism, you must eat LESS. If you have a fast metabolism, you must eat MORE. That's simple. Don't make excuses.

-jeff

[tessa0825]

Im 52 yrs old, female, and I weigh 118lbs..But, I gotta tell ya...Your support tactics stink..We are not here to judge anyone. As far as lifestyle changes go I would imagine they are responsible for many many illnesses that are medically treated, including alot of coronary diseases, HBP, GI illnesses, and the list could go on..You wanna be the guy that separates who receives treatment and who doesn't based on your personal discriminations? As for lifestyle changes you could do with some yourself, start with your attitude!

[Mr.H]

Thank you all so very much for your comments relatign to my wife's upcoming Roux-en-Y surgery. I'm very releived to hear that the current blood pressure readings are unlikely to cause any immediate complications. My wife has scheduled a meeting with the a dietitian/nutricianist, has been prescribed some blood-pressure medician, and it's full steam ahead into the 6-month preliminary surgery process.

BigBoy2U... Thank you. It is you, and the hundreds of other people I have met (mostly through the chatroom, and archive of obesityhelp.com) that have given me the strength to deal with the worry surrounding this proceedure. I wish you all the very best. Remember daily that you are very blessed to have had the opportunity to undergo the surgery. We've struggled, prayed, saved, and worried our way through the past 6 years tryign to find a way to have the surgery. Only now, with my new job's insurance are we finally in a position to feel even mildly hopeful. Please keep my wonderful wife Robin in your prayers.

netrox... I don't wish to "rub-you-up-the-wrong-way" but you obviously have no experience in this field whatsoever. Cosmetic "stapling" is not being discussed here. You may wish to visit our friend Kurt's website http://www.92inches.com for more info. He was approx 800lb with A NINETY TWO INCH WASTELINE!. You may also want to get a couple of your friends to sit on your shoulders for the next few days and explain to me how it feels to even stand up, let alone excercise!  You may also wish to visit http://www.barixclinics.com/how_it_works/animated_surgery.jsp for an animated (cartoon-type) movie of the surgery that is being discussed. AND... finally... you may also wish to offer a a more sympathetic ear to those whose live's have been so abused, mistreated and miserable that they spent decades in a severly depressed sedantary existance who's only chance at staying alive is a surgery where one-in-four die.

Anyway... EVERYONE... Thank You for your thoughts.  I'll be checking the board again soon so if you have any additional food for thought (not thoughts of food!) please let me know. :o) God bless.

[cardiogirl]

Hi.  Let me apologize in advance for butting in ;o)  I notice that you posted about gastroesophageal issues.  I'm having an issue that my doctor seems to believe is reflux.  I have episodes where it actually makes me short of breath and I feel a cold sensation in my throat and chest area.  I've been checked out very thoroughly from a cardiac standpoint, so I guess it's time to give in an believe this really is a digestive issue.  I was basically just wondering if you've experienced this similar coldness in the throat and chest, shortness of breath, etc.  Also, any positionally induced bradycardia or palpitations during acute reflux episodes?  I'd love to hear from someone who has been through this.  Look forward to hearing from you.

[Dr. Erik]

You've hit the nail right on the head. Your symptoms sound like acid reflux. I used to have the same exact symptoms. I was always short of breath and whenever my reflux acted up I would get palpitations. You should try Nexium and that should stop your reflux. It has made me feel a whole lot better. Good luck!

Erik

[tessa0825]

I wondered if you had seen this study? Yahoo news, released this on Thursady May 20th about obesity surgery? I'm having a hard time getting the website to open for me but I will post the news release and then you can find it directly through yahoo news (health).

Obesity Surgery Safely Performed on Outpatient Basis

"New Orleans (Reuters Health)- A "key-hole" type of stomach surgery called the "Lap-Band" procedure provides good weight loss and markedly reduces obesity-related illness, investigators reported this week at a large medical conference. They also found that the procedure was safe enough to perform on an outpatient basis.

The Lap-Band is an inflatable silicone band placed around the a portion of the stomach to limit the amount a patient can eat and slow the emptying of food into the stomach and intestines, Dr. William Scott Helton told conference attendees.

These findings are important, Helton told reporters, because "the only way to manage (severe) obesity long-term is surgery." The Lap-Band procedure costs about one third that of conventional stomach bypass surgery and poses far less risk of complications. the technique is also reversible, he said.

Helton's associates performed Lap-Band procedures on 925 obese patients at the University of Illinois in Chicago and at the Hamilton Weight Management Center in Dalton, Georgia, between 2001 and 2004.

Except for 30 patients who developed a post-operative blockage, all went home the same day as surgery, and only one required readmission after surgery. During 1 year of follow-up, patients lost approximately 42 percent of their excess weight.

Even though surgery to treat severe obesity dramatically reduces health care costs over the long run, insurance companies are still reluctant to reimburse for these procedures, Helton told Reuters Health.

A Presentation at the same meeting by Dr. Hadar Spivak reinforced the value of obesity treatment. Spivak, from Park Plaza Hospital in Houston, and colleagues have performed Lap-Band procedures on 535 patients between 2000 and 2003, 163 of who, were followed for at least 16 months.

Similar to the other study, patients lost 45 percent of their excess weight, Spivak said. The operation also had a beneficial effect on blood pressure, resolved diabetes in several patients, and reduced acid flow out of the stomach.

The findings were presented at Digestive Disease Week, a medical conference jointly sponsored by the American Association for the Study of Liver Diseases, the American Gastroenterological Association, the American Society for Gastrointestinal Endoscopy, and the Society for Surgery of the Alimentary Tract."

http://story.news.yahoo.com/news?tmpl=story2&u=/nm/20040520/hl_nm/obesity_surgery

[starion]

Gastric issues & GERD (gastro-esophogeal reflux disease)

If the docs believe you may have gastric reflux, there are generally two ways to find out.  As was suggested, you can ask the doc to prescribe medication such as a proton pump inhibitor (also available over the counter like Prilosec).  If that makes a substantial difference, you can ask to get an evaluation for gastric reflux, which is often a 24 hour pH-probe test (that's how I was diagnosed).

You can read more about reflux at www.NationalJewish.org/medfacts/reflux.htm

Good luck!
Starion