My First Roadblock

[Mistie 201]

I just found out in early April that yes, my insurance does now pay for WLS. I was ecstatic!

I immediately did the online educational seminar, went to the support group meeting, and scheduled the doctor's appointment. I began exploring the forums here, as well as other places. I began studying diets, pre-op and post-op. I began testing shakes (I know, I was just getting a head-start, though), trying out how well they worked for curbing hunger, etc.

Today, I had my first appointment with the surgeon, and I left in tears.

1) The surgeon requires that I lose 115 pounds (he wants me to have a BMI of 55 or less, so to weight 335). While I logically understand the need for a lower BMI, again, if I could lose that amount of weight on my own so easily, WHY would I need the surgery? I have read many threads in the forums, as I waited to get started, about people who were told they were taking the easy way out. For me, I've never felt that way about others, but I felt that way about MYSELF. It made me feel like a failure that I could not do this on my own, and would need to go have surgery. I've never even let people know in the past if I was trying to lose weight, because I did not want anyone to know if I failed at it. So, I made the appointment and have worked on myself to accept that yes, I failed, but that's ok, I need help. Then, I go into this first appointment, only to be told that what I failed at? Yeah, need to go back and be successful at it to have the surgery... I admit to feeling a bit devastated. My mom, who is SO super supportive, does not understand why this is a problem. She has complete confidence that I can do this, and she does not understand why I am so overwhelmed and upset by this.

2) I was diagnosed with Crohn's Disease when I was 8 years old (up until that point, I was under weight. That's when I began gaining weight). The doctor walked in and almost immediately said he would not do surgery due to the Crohn's. We talked about it awhile, including that a doctor several years ago said he saw no signs of it, and I've had several colonoscopies since with no reports of seeing Crohn's, so he's referring for more testing. So, all of this may be completely in vain.

Like I said, I feel completely defeated right now. I thought all of the emotional stuff was suppose to start during pre-op diet when you're not allowed to eat and then after surgery! This first appointment alone has me completely overwhelmed.

[LipstickLady 25,682]

I'm sure he has your best interest at heart. He wants your surgery to be as safe as possible and for your recovery to be easier, I imagine. That said, I'm sure this was very hard to hear and it seems like a monstrous task.

Can you seek a second opinion? Find a surgeon who specializes in larger scale obesity? Did he offer you assistance in losing that weight? Did he give you a plan?

[Mistie 201]

I'm sure he has your best interest at heart. He wants your surgery to be as safe as possible and for your recovery to be easier, I imagine. That said, I'm sure this was very hard to hear and it seems like a monstrous task.

Can you seek a second opinion? Find a surgeon who specializes in larger scale obesity? Did he offer you assistance in losing that weight? Did he give you a plan?

Thank you, LipstickLady.

Logically, I know he has my best interest in mind. He wants to ensure a safe procedure. I just quickly got my heart set on it, and it seems so unattainable.

In my entire state, there are only three clinics. I'm going to go ahead and do the testing, to see the results. If he does not/will not proceed, I will see another clinic, as my general practitioner is actually three hours away, so therefore was actually more familiar with another clinic (my OB had referred me to this specific clinic, as it is closer to my home - sounds confusing, but I live between two places, as I have a home home, but a secondary home, because I teach at a University).

As far as a plan for losing the weight at the moment, they simply printed off the 10 day preop diet they use. That does not really work for me, however, as it incorporates a lot of 'green' foods, which I cannot eat (on blood thinners, so I cannot eat green veggies). I also asked him for suggestions for controlling hunger, as I am on Depo Provera shots, which his nurse practitioner said was more than likely increasing my appetite (I asked her how it influenced weight, as I was told by a doctor it does, and that was the reason I had regained the 74 pounds I lost last year, with friends). He had no recommendations.

[samuelsmom 670]

I think you are on the right track by getting the testing done. If there are significant issues you can work on them and reduce your surgical risk. There are plenty of people here with very high BMIs who have had successful surgery.

Does this doctor have a nutritionist or is there a team that can help you? If not, I would really recommend finding a practice that has a full team dedicated to helping you meet your goals. You can do this!

[Miss Meg 199]

Hi Mistie

I totally understand your devastation. Would be heartbreaking to hear that you have to lose weight in order for him to give you surgery to lose weight. we all know that surgery carries enormous risks and your health and wellbeing is of utmost importance. I would also seek a second opinion though, but please try to not feel disheartened, I am sure you will find a way to get what you want and need - as the saying goes - where this will there is a way and it sounds like you have plenty of will. Good luck xx

[JustWatchMe 7,117]

I just want to lend some emotional support as well, and encourage you to never give up. Keep seeking help and make some noise. You deserve health and happiness!

[BLERDgirl 6,417]

Find another doctor. You may have to do a medically supervised diet for a few months to take off some weight before they will schedule for surgery, but my BMI was in the 60's when I had my surgery and I had a much easier post-op time of folks on here with half my BMI. If the program doesn't offer a medically supervised diet, check if your insurance has a nutritionist you can see. You need more than just a printed out handout.

[Miss Mac 6,261]

While you are exploring ways to eliminate these roadblocks, you could get a head start on the pre-op process. Many of us are / were required to be on a six month or three month low carb diet so that we could begin to develop new habits to carry us through a successful recovery and weight loss.

This includes concepts such as:

Drink no calories, but do drink Water until your eyeballs float.

Eating low carb is easier if you reduce or avoid foods that are starchy or white in color, such as bread, rice, noodles, biscuits, cake, pies, etc. Dessert needs to be an apple, not apple pie with ice cream.

Try to get in 60-80 grams of Protein a day.

Try to not eat anything made in a factory. Eat real food from the perimeter of the grocery store.

Use a smaller plate. Weigh and measure your portions. My fitness Pal is just one of a number of websites that have tools for helping you track what you are eating. This is so useful because it forces you to be aware of just exactly what is going into your mouth.

Don't become part of the sofa. If it is difficult or painful to exercise, you can at least get up every hour or so and move around. David Stamps has several videos for people who face challenges to exercise. I have his Chair Boxing, Chair Salsa, Chair Tai Chi, and Exercises for the Bedfast.

Leslie Sanson has a video Walk Your Belly Flat which consists of three fifteen minute segments where you cover approximately one mile of walking. This can even be done standing in place if that is all the room you have. On bad orthopedic days, I do it standing in place while holding on to my walker frame. On good days, I do my Sweating to the Oldies.

Sometimes I just crank up loud crazy music and move and groove while doing my housework. On nice summer days, I do laps in the back yard. There is a lot you can do without having to spend money on a gym. I can do lunges in the house holding onto a gallon of laundry soap in each hand. I do push-ups off the third stairstep because I have trouble getting up and down from the floor. I do squats at the kitchen chair. I can do backward rows with the same gallons of soap. Plus there are all kinds of free videos on YouTube.

Anyway, hang around here for other great ideas. If there is a certain topic you want to explore, go to the search box and type it in. There is a small arrow that will open a drop down menu. Click on that and then click on Forums, then the Search magnifying glass.

I hope you continue to pursue a great surgeon who will help you addreess your issues. Good luck. Visit us often.

[Djmohr 6,965]

I am so happy that you are taking steps to improve your health! Please don't lose faith that you can do this!

I would definately get a second opinion and try the other clinic. Make sure if you are expected to lose that much weight, that you ask for a food and exercise plan that will assist in you getting there. Like someone else said, make sure their program includes a nutritionist and physiologist that can help you work through your eating issues. You need a solid support system around you including your surgical team.

In the meantime it sounds like you lost 76lbs last year. How did you do that? Most of us have no problem losing the weight, it is keeping it off where we fall down. It sounds like you have experienced this as well. I would work really hard to move to a high Protein low carb diet now. It will only prepare you for what is to come.

Also like someone else said, if you are drinking any calories stop that now, you won't be able to after surgery and many times this is where a lot of weight gain comes from.

I know you can do this, you have done it before. Don't let yourself get discouraged to the point you give up, it will only cost you more down the road.

I wish you the best of luck! I hope you are able to find a clinic that will give you the support needed for a successful surgery and recovery. I will say a prayer for you!

[Inner Surfer Girl 12,015]

Maybe it's just me but I have never heard that green vegetables and blood thinners are incompatible. Is this just for you or is this something that is generally known? Just curious.

[BLERDgirl 6,417]

Maybe it's just me but I have never heard that green vegetables and blood thinners are incompatible. Is this just for you or is this something that is generally known? Just curious.

It depends on the medication she is on. The Vitamin K in certain green veg can intervene with the effectiveness of the drug.

This is why she needs and intensely medical monitored weight management program.

[NikkiDoc 312]

Don't wait for the testing results. Schedule a consultation with another clinic. You need to find one that will be supportive pre-op. If they aren't supportive pre-op why would you think they are going to be better post-op? I know some doctors require some weight loss prior to the surgery but I have never seen one require 115 pounds.

If you mentioned which WLS you were considering I missed it. The sleeve was orginally used as part of a two part surgery for those with really high BMI to get some initial weight off. Therefore needing to lose 115 pounds pre-op makes no sense to me.

I would understand if the doctor required a supervised weight loss program of 3 or 6 months and a reasonable amount of loss during that time. 115 pounds does not seem reasonable to me.

It almost sounds like he still is concerned about the Crohn's and put the 115 pound weight loss out there figuring either he would never see you again, or if by some miracle you lost 115 pounds on your own he might be willing to reconsider.

My surgeon is about an hour and a half to 2 hours away depending on traffic. I am in PA so went to Barix Clinic there. For me it was well worth the trip. Yes, I have only been to one support group meeting pre-op. I don't have lots of time post-op since I go to the gym and ride my horse. I use this forum and a Facebook group to answer questions. Many people on this board flew across the country to go to Mexico for their surgery. A few hour drive is nothing. I have seen mine post op at 2 weeks, 2 months, 3 months. I will see him at 6 months and 1 year. I only saw him pre-op twice. So making a bit of a drive 7 times in say 15 or 18 months is nothing.

For what it is worth I love Barix Clinic in PA. I personally like the idea that WLS is what they do. There is less chance of infections since there are no sick people there that might be using the same xray machines and being seen by the same nurses, having food brought to me by the same orderlies, breathing the same air. These doctors and nurses really know WLS and what is normal and what they need to worry about. They can specialize in it not just in general abdominal surgery.

[Mistie 201]

First, I want to thank everyone for your replies and support. It means SO much to me. I am generally not a weepy person - as a professor and counselor I've learned to keep pretty tight control of my emotions. Yesterday, however, I was crying at the drop of a hat! All day long. Even until I went to bed. Every time I would get a new response here in my email, I started all over again. What most people would not understand (except you guys!) is that the appointment itself was shocking and a disappointment, and I left feeling defeated - in ways I never would have imagined. I really felt like I got shafted yesterday. Not only with what I expressed earlier regarding the weight loss and Crohn's, but I went in expecting to be setup to see the nutritionist to start the supervised weight loss (ie. as required by insurance), to talk with someone about insurance and how much the total would be, etc. Instead, he seemed to just be going through the motions without any real plans to see me - just shuffled me out the door.

To respond to everyone's questions/comments.

The center IS one of the Center's of Excellence. My insurance company requires it - so they do have the full team of nutritionists, psychologists, etc. My insurance requires three months of supervision by one of the centers, as well. The doctor did not require the weight loss specific of me - the nurses told me before I ever saw him - he requires everyone to have a BMI below 55 before he will operate. The diet they gave me - their pre-op diet, IS a low-carb/high-Protein diet - unfortunately, many of the foods they are telling me to eat on it are foods I cannot eat due to my blood, for example. As for the surgery - I told them I was interested in the Sleeve. Although it is irreversible, which makes me more nervous, I did my research. Research says that it is better for patients with a higher weight, it is better for patients with Crohn's and Anemia (due to absorption issues, I am guessing), etc. Although some of the stats say RNY has a higher overall weight loss, the sleeve seemed a better option due to my own health issues - which I took into consideration before ever meeting with the doctor.

In regards to the green stuff + blood thinners: It's not the blood thinners with which the green stuff is incompatible with, it's blood in general. Whenever you have blood clotting issues, you are suppose to eat a VERY limited amount of green, leafy items. Ie. cabbage, lettuce, broccoli, etc. Last year, they said that included other 'green' veggies, as well, as I was eating a lot of asparagus (it was my go-to veggie when losing weight) - it was messing up my blood. The 'green stuff' thickens your blood, in the same way alcohol thins it (it's the reason you are not suppose to take aspirin for a hangover - they both thin your blood). I mean, I guess I COULD eat a salad and then drink some alcohol, but that might be defeating the purpose

As far as what I do now - I cut out salt years ago. If I DO ever drink soda, it's diet - I drink Water almost exclusively. I eat minimal carbs - I am simply not a bread, rice, Pasta type person. I use a Fitbit and walk a set number per day. I have been using LoseIt! for a couple of years and log every bite of food I eat and every minute of exercise I do. I go to Water aerobics several times a week. So, in a lot of ways, I feel that I was somewhat ahead of the game in preparing.

I acknowledge I've had a lot of health problems. Oddly, none of them are weight related! I have perfect BP, low cholesterol, etc. I would like to KEEP it that way!

I have already called a clinic I went to several years ago which said they did NOT see any signs of the Crohn's. I have asked for my records. This can be 'proof' for him, with or without additional testing. As well, I have looked at another center. As I said, there are three in my state. He's about an hour away. The second I have seen mixed reviews. The third is about three hours away, but my general MD likes it. I looked on their website, and they require a weight below 400 lbs. That I can manage.

I THINK I got everyone's questions...!

Again, I appreciate all of the support. I have never opened up about my weight to anyone, and although I have a beyond supportive family, they simply do not understand. My mom keeps saying she has struggled with weight all of her life, and this is true, but not to the same extent.

To everyone on here - keep doing what you do for everyone else on here. Your words of encouragement, no matter how strong the support system of others, are so much more meaningful than you can ever know...

[Inner Surfer Girl 12,015]

Thanks for the info on blood thinners and green (sounds like cruciferous?) vegetables. I'll add that to my "learn something new everyday" file.

My surgeon is excellent and did not require me to lose a significant amount of weight before surgery and I started with an extremely high BMI. I agree that you may want to see if you can find a surgeon who has experience with and is comfortable with treating higher BMI patients.

I know I was so far at the end of my rope with such a broken metabolism that losing weight on my own became next to impossible. I count it as a victory that I didn't gain beyond my starting weight in the year and a half that it took me from starting the process to surgery date.

Thankfully, I was sleeved on April 20 and couldn't be happier with my recovery.

Best of luck. The process can be daunting but if you are anything like me, by the time surgery roles around you will be eager to get it over with.

[newmebithebypass 713]

im so sorry that your hitting this road block but maybe try the clinic that says under 400 pounds.