A few days ago I had my regular appointment with my Rheumatologist who monitors my injections of Humira for my Psoriasis and Psoriatic Arthritis. I advised him that I had started on a path towards weight loss surgery and I wanted to get his input towards med management after, etc.

He basically told me my weight is definitely a factor in some of the issues he's involved with treating, my med regimen won't need to change and with weight loss most patients find relief of symptoms BUT. (Ugh, there it is.) But, he has some patients that have had the surgery and been successful but tell him they 'wish they would have just eaten correctly prior to getting the surgery and they wouldn't have needed it.'

I get that point. I still felt agitated and a little insulted. I have tried eating correctly but I can't sustain it long term and gain it back plus and weight loss is very slow for me. Also, with my conditions and recent injury (broken leg/ankle) if I don't get some weight off exercise is a very slow build that may not get much of anywhere, but I'm working on it.

Am I flawed in thinking that weight loss surgery is going to help me? Aren't there factors having to do with hormones the stomach produces etc. that will be impacted? If I've done my research and listened to my WLS Doctor why is this Doctor's conflicting attitude shaking me so bad? This is common, right? Help talk me down a bit please.

If weight loss was easily achieved through dieting and exercise, most of us would have been there, done that. But it is almost impossible following that regime. That is why we seek an alternative, especially one that has a proven track record. I don't know if significant weight loss will affect your medical conditions of Psoriasis and Psoriatic Arthritis, but I do know that surgery put almost all my medical conditions into remission very, very quickly; where they have remained ever since. I am 28 months post-op RNY and I would do this surgery over again in a heartbeat.

Since my issues are generally auto-immune issues it is very probable I will see improvement or complete relief of symptoms. That being said, if I don't get the weight off the same auto-immune issues are directly related to diabetes and fatty-liver. I'm doing this surgery. I really believe I can work the program and it will help get me back to good health. Thanks for the input

AMEN! When you add in hormonal and autoimmune issues, thing are even more complicated. My ortho who I love when he's treating my bones, once said he lost weight by no eating breakfast. Instead he had a cup of coffee then ate lunch and dinner. The side eye I gave him for that was epic. He's fine when he's addressing my arthritis issues, but since he doesn't have a degree in nutrition I don't care what he has to say about my eating habits.

Here is an article my surgeon gave me for a Pulmonologist who was not supporting my decision. He has changed his toon somewhat - or he no longer says it to me when I have my check-ins.

http://www.thelancet.com/journals/landia/article/PIIS2213-8587%2815%2900009-1/abstract

@@sleevedup very well thought out post with excellent points!

@@gobeit

Hi there! I too have severe psoriatic arthritis. My disease was misdiagnosed for the first 40 years of my life.

I was on everything under the sun and nothing controlled it, it kept causing severe damage to my joints. I tried humira, remicade, methotrexate and a slew of very harmful drugs. Tons and tons of light therapy, I even had my own. The drugs used to treat my psoriatic arthritis actually caused stage 3 kidney disease.

About 4 years ago when my dermatologist stopped remicade because I developed antibodies and it no longer worked they started me on humira which is actually less potent than remicade. My psoriasis got so severe that I actually lost the soles of my feet and palms of my hands completely. This caused a severe staff infection and put me in the hospital for 5 days on IV antibiotics. I had absolutely no trust in my dermatologist and rheumatologist at all. The hospital sent in another dermatologist for a second opinion and that day my life changed.

I met an incredible physician who took one look at me and said my god, this disease has taken its toll on you.

I think we should be stepping outside the box with your disease and treating it more agressivelt because traditional methods are not working. He said he would talk to my dermatologist about a plan and they would work together. I said don't bother I am clearly done with the doc I had and began seeing him immediately.

He put me on a drug called Stelara which was very new at the time but very powerful. In the beginning we also used a very small dose of cyclosporine to get me cleared quickly. I have been nearly 100 clear since then.

Stelara in the meantime also got approved to treat the arthritis portion of the disease. I happened to know it would because within 6 months of starting it, my joints improved as well.

Of course I also knew that getting this weight off would improve this disease as well. And I knew that I needed to improve my kidney health or I was looking at dialysis in my future and quite possibly a transplant.

Well, I had my surgery 12 months ago, I am 121lbs down with 24 to go! My kidney disease is in remission. My joints feel much better although I did so much damage to my spine waiting so long to lose the weight. If I had anything to do over it would be doing this 10 years ago before all the damage to my joints.

Your life will absolutely improve, your disease will improve. Don't let one doctors comments sway you. You need to do this now before more damage occurrs.

Incidentally, my ankles would swell so big prior to surgery. Now they are actually teeny tiny! I could wear an ankle bracelet if I wanted to! My body seems to look better and feel better every day even with all the excess skin.

I saw my favorite doctor (Dermatologist) yesterday for my Stelara, he gave me a big giant hug and told me how great I look. We both worked hard through this process together learning how to treat my disease.

This is all about finding the right doctors willing to step outside the box when it is needed. Using Stelara and Cyclosporine together had not been done before and it was not recommended but I understood the risks and was willing to risk it because nothing else had worked. My rheumatologist was dead set against it. I no longer see him, my dermatologist treats my Psoriatic arthritis and I see a new rheumatologist who provides cortisone in my left shoulder.

I have learned you have to find the right doctors and once you do, don't let them go. I moved states recently and I literally fly into Minneapolis and go out of network to see my dermatologist. He gives me a break on my bill knowing my situation and I see him every 8 weeks for my Stelara shot.

I wish you the best of luck with your surgery and hope you find peace with your decision.

Losing this weigh via WLS was the best decision I ever made for myself!

Here is an article my surgeon gave me for a Pulmonologist who was not supporting my decision. He has changed his toon somewhat - or he no longer says it to me when I have my check-ins.

http://www.thelancet.com/journals/landia/article/PIIS2213-8587%2815%2900009-1/abstract

This is great. Thanks for sharing the article. It looks like something that would be worth sharing with all of our doctors.

In my opinion, this comes from our "pull yourself up by the boot straps" puritanical work ethic that has been so engrave in our American psyche. As if the millions and millions of obese folk on planet Earth haven't tried that oh-so-simple method of "just eating better" and somehow statistically (and overwhelming) failed. There is a reason why weight-loss is paved as an elusive road to success, there is a heap of factors that work against us in our efforts to shed. Those who have are versed and understand all the components that adverse us in our efforts (the Good Lord knows) would think thrice about making such a comment. Obesity is a disease and yet it is still being treated and reflected in our minds as an inability to somehow fail to "get it together," which, in my perhaps hypersensitive mind, I feel this Rheumatologist comment implicitly captured.

The truth is there is a mount of biological, psychological, physiological factors that work against our favor and make it extremely hard to lose and most importantly maintain. Our bodies are wired to hold on to fat for survival sake, not vis versa. Sure, superficially logic would dictate this simplistic view and of course there are always the (God bless them) successful outliers who prove that weight-loss can be attained and maintained, but the truth of the truth is that they are the rare needles in the stack, not otherwise. If it were as simple as such, we would all be thin by now.

My soapbox, which I'll get off off, is rising because I feel this type of attitude, which seems harmless on the surface and of course makes sense to those who are ignorant on the nature of obesity and weight-loss, leads to the perception of us "fat" folk as somehow not being able to manage our lives properly because some type of inheirant character flaw (lazy, stupid, weak-willed, no-will, pick-your-poision etc.) because after all, if we had just "eaten correctly" all would be well. But us fat people, aesthetic failures as we are, just can't seem to even do that one gosh darn simple thing right. What a group of defects..sigh.

Now, I realize your docs rabbit hole of thought may not run so deep, but I have come to see that there is general ignorance about the realities of weight loss and here is the shocker...even in the medical community. Doctors are not Gods, they miss beats and can have pockets of ignorance too. I recently mentioned to my derm (I also have psoriasis) that I was planning on having weight loss surgery in December and her sentiments were to summarize very much "eat less, fool. you don't need no weight loss surgery." But for those of us who are beyond doctors and have lived with this and maybe even taken some steps educated ourselves on this issue, I reckon it ain't that easy.

Surely, we have all tried eating correctly and massively failed, otherwise why are we on this board. I wish it were that simple for most of us, but give the biopsychosocial realities of this beast, this is mainly like wishing I looked like Jennifer Lopez. Nothing but a pipedream..lol. Yes, there are those who are victorious in their natural efforts, but for how long? And let's not forget those who are obese may have been dealt a different deck than the average Jane, that our bodies may be even more stacked to stack than the average human anatomy which is also predisposed to hold on to fat in general.

I would love no surgery. Lord you know that. And God knows I've tried. If it were that simple, then the statistics would tell that tale, but it doesn't. There too much working against us. And well intentioned comments like that (whether truly from other weight-loss patients or perhaps from just one person who has experienced difficulties in the surgical route. To be even more cynical, perhaps your docs way of letting you know what they thought without potentially offending you) are flat out ignorant and problematically and don't hit us as they should. Many of us harbor that same frustration and guilt of "what the f+++ is wrong with me, why can't I just keep this weight off/take this weight off!" and I think it is high time we recognize that yes while it is possible in theory, life moves so far beyond into the realities of practice, it's not even funny. The truth is (recommended read "The Fat Trap" to name one) telling somehow who is clinically obese to just eat better is like telling a clinically depressed person to just smile more to be happy.

Many many good points here!!! Thanks for sharing your insight--soapbox or no!

Sure, anyone would prefer to lose weight without surgery, and maintain the loss.. but the odds are like 5% that you would be able to. I hemmed and hawed for over 10 years wanting the surgery, and really just wasted 10 years of my life. I'm much happier.

For me, this is the first time I feel like I have a fighting chance of KEEPING it off. I'd lost the same 60 pounds several times by several different methods. By far, I was the most successful with the "eat half of whatever it is, but eat what you like" diet. But I never took off ALL the weight I needed to and always lapsed back into old habits and regained with interest. Yes, the weight came off quickly post op. I was a pretty compliant patient, monitoring Protein, taking supplements as directed, starting an exercise program. I reached goal by about month 9 and have been maintaining for over a year now. I maintain the exercise habit. I still do at least one protein supplement per day to get at least 75g. I still take my Vitamins. Through about month 4 and since maintenance, I've just pretty much eaten what I like in small quantities, protein first. I eat bread and Pasta if I want it and have a bit of sweet almost every day so it doesn't feel like a "diet". There isn't a lot of room for that stuff when I put protein first so I don't get much bread\pasta etc.The cycle of eating something forbidden\guilt\binge\repeat is broken because nothing is forbidden and I simply can't over eat, which is KEY for me. If I lapse and over do it, I puke, even 2 years out. It sucks, (for hours) so I avoid it now. If 5 pounds creeps back on, (I weigh at least once per week but not every day) I cut back on the junk until I'm back where I belong which generally takes no longer than a week or 2. It's helped me succeed at the long term battle.

@Djmohr After reading about your previous issues it makes me feel lucky that I only have the issues I have.

Congrats on your strength and improvement.

I have to agree with most of the responses on here. Your doctor was stating what he has heard. Every person is different. Of course, I WISH I could have just lost weight on my own. I wish I would never have been morbidly obese to begin with!! For me, the surgery has been the best decision I've made.

Think of it this way. The patients who have had success with weight loss surgery and have found their health improve no longer go to the doctor to treat those diseases caused by their obesity. The ones who haven't had success still see their doctors. SO, the doctor's impression will be skewed by who still comes to the clinic. The doc probably hasn't wondered, "Where is Patient X these days?" if Patient X is well and fine after dropping 127 pounds, because Doc has plenty of other things to do.

gobeit,

I agree with some of the other posters. I think it is your doctor’s duty to tell you the truth – that weight might be making your conditions worse (or even causing them), and that improving your eating could help you lose weight and improve your conditions.

It doesn’t sound like your doctor was necessarily anti-WLS – or even that your doctor addressed it. It sounds like he was talking about the WHAT (weight loss) and not the how (dieting on your own versus adding WLS as a tool in addition to dieting).

MichiganChic makes a really good point – losing weight to achieve a healthy weight without surgery is preferable. Heck, maintaining a healthy weight from childhood without ever GETTING to the point of overweight or obesity would be preferable. And, like she said, it’s not an option for all of us. That’s why some of us need WLS – it’s not perfect, but it’s the best thing we’ve got.

Anyway, back to your doctor. From what you’ve said, it doesn’t sound like he’s said anything wrong. The next test comes when you tell him you understand and agree with his assessment, but you feel that WLS is the only way you can actually lose weight long term. Then see if he is supportive, or if he refuses to listen. If he refuses to listen, you might want to get a new doctor – not because he disagrees with you, but because you need a doctor who gives his opinion, listens to yours, and supports you no matter what.

Good luck!

I went to my GP two weeks after surgery. He said congratulations Shelley, you just added 15 years to your life!

I had sleeve surgery almost two years ago. I was never able to maintain lost weight and now I am. I am NEVER sorry I had the surgery. I am only sorry I did not have it sooner. With that being said...I had absolutely no complications. I was always heavy...since childhood....btw. Best wishes to you!