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High Risk -- Scared of complications



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Hi everyone. Need some serious reassurance. I’ve gone through my full program. I have been approved for surgery (the sleeve). I met with my surgeon yesterday and he was very blunt.

I’m one of the highest risk people he’s willing to operate on. I hit 4 out of 5 factors that put me into a high risk. BMI, prehypertension, sleep apnea, and one other I don’t remember. The only one I’m not hitting is age. I will also need to take injections for 28 days of a blood thinner because my clotting risk is so high. He seriously freaked me out. He said while he was still comfortable operating, he was not confident there would be no issues and needed me to be aware that there are incredibly serious risks for someone like me.

I’m 35, 6’3”, CW is 497. I’ve lost nearly 50 pounds in the past few months and am continuing to lose on my current diet.

I’m having serious second thoughts. I need someone, anyone, who can help talk me through this. Maybe someone who also was considered high risk and went through with it?

Please and thank you!

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I don't have any solid advice.

All I can say is to weigh the risks of living at that weight with those health problems and see if it out weighs the risk of surgery or not.

I don't think any decent surgeon would operate unless they were confident they could succeed. Not that there may not be some hiccups but still a successful surgery.

I was 38, 6ft tall and 422 lbs but I had no health concerns other than high BP kinda controlled by meds.

Not exactly the same stats but pretty close, less the heath issues. There were no emergencies that came up and everything went smoothly. I ended up having 3 surgeries in 1 too, per my surgeon. Hernia repair which was planned but it was much worse than they thought, I had massive esophagus damage (unexpected) that they removed and corrected and then I had bypass. My 2 hour surgery ended up being 5 and still went without a hitch.

I really wish you the best!

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While my weight is lower than yours. I am 34 years old, high blood pressure, sleep apnea, previous heart attack, Heart valve problems, IBS, Diverticulosis. I got the surgery and so far almost 3 weeks post op i am doing fine. I did not have the blood thinners beyond the hospital tho. But thats good that you get that mediation. Its a prefilled type needle that automatically injects it and then a cover comes down to cover the needle once you come out. I got those at the hospital and i will say i am a huge WIMP when it comes to needles and i barely felt it. it goes in your stomach

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23 minutes ago, ZackAttack1 said:

Hi everyone. Need some serious reassurance. I’ve gone through my full program. I have been approved for surgery (the sleeve). I met with my surgeon yesterday and he was very blunt.

I’m one of the highest risk people he’s willing to operate on. I hit 4 out of 5 factors that put me into a high risk. BMI, prehypertension, sleep apnea, and one other I don’t remember. The only one I’m not hitting is age. I will also need to take injections for 28 days of a blood thinner because my clotting risk is so high. He seriously freaked me out. He said while he was still comfortable operating, he was not confident there would be no issues and needed me to be aware that there are incredibly serious risks for someone like me.

I’m 35, 6’3”, CW is 497. I’ve lost nearly 50 pounds in the past few months and am continuing to lose on my current diet.

I’m having serious second thoughts. I need someone, anyone, who can help talk me through this. Maybe someone who also was considered high risk and went through with it?

Please and thank you!

When I had the surgery, I was 41, 6'1", HW of 505, CW 490, surgery day weight of 460. I had sleep apnea, prehypertension and a BMI of ~60. I also had to take blood thinning injections post-surgery. I also had bypass surgery (which has a higher risk of complications). So you and I are/were in roughly the same ballpark.

I came through the surgery fine. Definitely sore. But it drastically improved my life and I would make the same decision in a heartbeat. Heck, I was able to look down today and see my toes, instead of them being covered by stomach. I've gotten to experience stepping on a scale and having the first number be a 2. I am approaching the nine-month mark and I weigh 295 and wear 2xl/3xl shirts (I'm like a 2.5xl at this point, I was a solid 6xl pre-surgery).

Do you have risk factors? Yeah. But here is what I noticed from that list: you don't have a major condition that will obviously cause complications (like some disease that makes it difficult for your blood to clot or something like that). Do you have a higher potential for complications than someone who only weighed 400 pounds? Yeah. But its a generalized risk, not a specific risk.

My recommendation, if you are still interested in the surgery, is to determine right now that you are going to follow your surgeon's post-surgery advice to the letter. If you need 28 days of injections, decide right now that you will do all 28 days. Whatever meds or Vitamins he tells you take, take them. Commit right now, "I am not going to disobey my surgeon in a way that increases my risks." You cannot eliminate the risks entirely and if I am being honest, those risks will come to mind when you are being wheeled around on the gurney. You have no guarantees about what the other side of the surgery will look like and feel like. And you will wake up from the surgery in pain. But if you decide that you will do everything you can control to minimize the risks, I think you will be happy with a decision to have the surgery.

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5 minutes ago, Splenda said:

When I had the surgery, I was 41, 6'1", HW of 505, CW 490, surgery day weight of 460. I had sleep apnea, prehypertension and a BMI of ~60. I also had to take blood thinning injections post-surgery. I also had bypass surgery (which has a higher risk of complications). So you and I are/were in roughly the same ballpark.

I came through the surgery fine. Definitely sore. But it drastically improved my life and I would make the same decision in a heartbeat. Heck, I was able to look down today and see my toes, instead of them being covered by stomach. I've gotten to experience stepping on a scale and having the first number be a 2. I am approaching the nine-month mark and I weigh 295 and wear 2xl/3xl shirts (I'm like a 2.5xl at this point, I was a solid 6xl pre-surgery).

Do you have risk factors? Yeah. But here is what I noticed from that list: you don't have a major condition that will obviously cause complications (like some disease that makes it difficult for your blood to clot or something like that). Do you have a higher potential for complications than someone who only weighed 400 pounds? Yeah. But its a generalized risk, not a specific risk.

My recommendation, if you are still interested in the surgery, is to determine right now that you are going to follow your surgeon's post-surgery advice to the letter. If you need 28 days of injections, decide right now that you will do all 28 days. Whatever meds or Vitamins he tells you take, take them. Commit right now, "I am not going to disobey my surgeon in a way that increases my risks." You cannot eliminate the risks entirely and if I am being honest, those risks will come to mind when you are being wheeled around on the gurney. You have no guarantees about what the other side of the surgery will look like and feel like. And you will wake up from the surgery in pain. But if you decide that you will do everything you can control to minimize the risks, I think you will be happy with a decision to have the surgery.

VERY well said. Kudos!

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My stats aren't quite the same as yours, but when I had surgery, I was 375. I think my BMI was 60 at surgery. I had hypertension (well controlled with meds), insulin resistance, dilated cardiomyopathy (with reduced ejection fraction), and who knows what else. They all assumed I had sleep apnea too, even though I didn't have indicators for it. I'm not sure how high risk I would be considered, but I have no illusions that I was low risk in any way.

I was terrified of complications, and made sure to have a will and advanced directive in place just in case. As self pay, I was even more terrified that complications would bankrupt us. I needed a super low dose of Xanax the night before surgery I was so scared. But, I knew that staying at my weight, with my issues, was absolutely a death sentence, so for me, the risks were worth taking. Even at elevated risk, the risks of staying this heavy were much higher.

I agree with @Splenda - follow the surgeon's recommendations to the letter. Those blood thinner injections suck (not gonna lie, I had to do them for 14 days post surgery) but they are literal life savers, and us heavier folk are at greater risk. Between now and surgery, keep doing what you can to ensure you are as healthy as possible. Eat well, if you are on any meds, take them religiously, whatever it takes to get you in a good place physically and mentally.

So far, this surgery has been amazing. I feel fabulous and for once, I have hope of meeting my goals, or at least getting damned close. Good luck!

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Wow, amazing feedback so far everyone. Thank you. I know surgery can never be risk free. I've been under before so I know I won't have issues with that, but it's all the other possible issues.

It's nice hearing from all of you, especially knowing you had a lot of the same "high risk factors" as I do. I'm feeling a lot better about proceeding. Part of me still wants to call it off. But I don't want my decision made based upon fear.

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Just now, ZackAttack1 said:

Wow, amazing feedback so far everyone. Thank you. I know surgery can never be risk free. I've been under before so I know I won't have issues with that, but it's all the other possible issues.

It's nice hearing from all of you, especially knowing you had a lot of the same "high risk factors" as I do. I'm feeling a lot better about proceeding. Part of me still wants to call it off. But I don't want my decision made based upon fear.

I suspect that your surgeon was using some form of trying to scare you straight. But lets also be honest, those risk factors are the exact reasons you were approved for surgery! A successful weight loss surgery will see your BMI go down, and your sleep apnea and blood pressure would be reduced. It's a bit like telling someone, "I am about to do surgery on your heart to repair a defect, but the defect makes the surgery risky." Thanks, Dr. Sherlock.

I would try to schedule a follow up visit and pin him down on the risks he foresees -- you understand that you have risk factors, but how would those risk factors play out in practice? Does he think you are going to bleed out on the table? Does he think you are going to have a stroke? Right now, your mind is imagining all of the terrible things that could happen -- make him get specific. And if he talks about something specific, like the risk of stroke, then ask him, "What can I do, both before and after the surgery, that would meaningfully reduce that risk?"

If he was just trying to get you to see that the surgery isn't risk-free and won't be all rainbows and sunshine during the recovery, then feel free to realize that your doctor is an arrogant, but well-meaning, jerk, and not let him keep you from the surgery.

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4 minutes ago, Splenda said:

I suspect that your surgeon was using some form of trying to scare you straight. But lets also be honest, those risk factors are the exact reasons you were approved for surgery! A successful weight loss surgery will see your BMI go down, and your sleep apnea and blood pressure would be reduced. It's a bit like telling someone, "I am about to do surgery on your heart to repair a defect, but the defect makes the surgery risky." Thanks, Dr. Sherlock.

I would try to schedule a follow up visit and pin him down on the risks he foresees -- you understand that you have risk factors, but how would those risk factors play out in practice? Does he think you are going to bleed out on the table? Does he think you are going to have a stroke? Right now, your mind is imagining all of the terrible things that could happen -- make him get specific. And if he talks about something specific, like the risk of stroke, then ask him, "What can I do, both before and after the surgery, that would meaningfully reduce that risk?"

If he was just trying to get you to see that the surgery isn't risk-free and won't be all rainbows and sunshine during the recovery, then feel free to realize that your doctor is an arrogant, but well-meaning, jerk, and not let him keep you from the surgery.

He's the head of surgery at my hospital, and I was actually warned ahead of time by his PA that he is very blunt and honest, but that he is a damn good surgeon.

I did ask him what I could do to reduce the risk factors, and he said it was really too late. The most I could do was continue to lose as much as possible before surgery. I think at my current rate of loss, plus the all liquid diet for the week prior, I could lose a bunch before surgery. He told me the biggest concern is the blood clots. Obviously that is on me to walk a lot and do my injections--which I plan to do.

I can try to speak with him again, but knowing his attitude I'm not sure he would offer me much more. He was blunt, went over the risks, and that if I took the bell curve of all the risks, me being in a high risk category would automatically shift me over to the right. He said he couldn't get more into it because he doesn't see people as "risky" as me very often.

He's been doing this a long time. I trust his expertise. But hearing he's lost people is just incredibly scary.

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Posted (edited)

If I were you I would continually remind myself that WLS is a relatively very safe procedure that you get to go into as a planned procedure. Think of all the possible risks and complications that will come with all the procedures and surgeries you will most likely need and have no choice but to do if you do nothing about your weight.

Edited by ShoppGirl

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I might get a second opinion. Other people might not see you as such a high risk, and you might be more comfortable with one of those surgeons. But, the more weight you lose before surgery, the lower risk you'll be - with any surgeon. But I agree with what everyone else here says. If you go forward, follow the instructions both pre- and post-op closely. And being at the weight you are now makes everything more risky - for example, say you were in a car accident, you'd be much more at risk of serious complications due to your weight (and fat bias in health care just makes that worse!). And, the other sorts of conditions that make you high risk for surgery might be just around the corner if you keep at your current weight.

It's not really feasible to lose all of the weight you need without surgery, but you could see if you could get to like 350 before surgery, and get your BP controlled.

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9 minutes ago, ZackAttack1 said:

He's the head of surgery at my hospital, and I was actually warned ahead of time by his PA that he is very blunt and honest, but that he is a damn good surgeon.

I did ask him what I could do to reduce the risk factors, and he said it was really too late. The most I could do was continue to lose as much as possible before surgery. I think at my current rate of loss, plus the all liquid diet for the week prior, I could lose a bunch before surgery. He told me the biggest concern is the blood clots. Obviously that is on me to walk a lot and do my injections--which I plan to do.

I can try to speak with him again, but knowing his attitude I'm not sure he would offer me much more. He was blunt, went over the risks, and that if I took the bell curve of all the risks, me being in a high risk category would automatically shift me over to the right. He said he couldn't get more into it because he doesn't see people as "risky" as me very often.

He's been doing this a long time. I trust his expertise. But hearing he's lost people is just incredibly scary.

As soon as I could walk in the hospital, I did. It was baby steps while using my IV stand as a cane, but I did. And the nurses were very complimentary because they usually had to prod patients to do it. And I did my blood thinner injections.

If you do what you outlined -- keep losing weight, walk as soon and as much as you can, take the blood thinning injections -- you will have given yourself a great chance to avoid any complications.

And as a guy who knows what it feels like to be that big... post-surgery life is pretty amazing. I've never had this level of energy. It's great to go on a 3 mile walk and not have my knees throb and ache after. I've posted this before: weight loss surgery is a bet on yourself. It's a bet that you have more willpower and discipline than your physique currently reflects and that if you were truly given a second chance, you would succeed. Like any bet, it carries risks. But are you willing to take that bet.

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Hi, Zack, and welcome to the site.

My high weight was 277, so not as high as you. I hadn't really thought of myself as being a candidate for WLS, but when I mentioned to my voice doc that I wanted to get off the proton pump meds, he suggested I consider it. I had sleep apnea, high blood pressure, and reflux. My age (67) also put me at higher risk. Now I'm 180 and off the proton pump meds. Also off the blood pressure meds. And my weight is down to 180.

A guy I sing with had a gastric bypass before I knew him. He weighed 525. Now he's 280 and MUCH healthier. He told me he got down to 240 before settling in at 280. He says he can get down on the floor and play with his grand kids, which he would never been able to do at over 500 pounds. He's happy.

If I were you, I'd go for it. But monitor yourself carefully and take care of yourself. A few weeks after surgery I had some chest pains. It was a Friday night, so I went to an urgent care place. They hooked me up to the box and scanned me, and there were no problems. You should probably adopt the same attitude about symptoms that might be nothing.

Good luck!

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Thank you everyone so much for the feedback so far. So may things I hadn't thought about.

@Dave In Houstonthanks for the info. My hospital has a surgeon on call 24/7 so they said I could call anytime if anything didn't feel right. Would definitely take advantage of that.

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4 hours ago, ZackAttack1 said:

Hi everyone. Need some serious reassurance. I’ve gone through my full program. I have been approved for surgery (the sleeve). I met with my surgeon yesterday and he was very blunt.

I’m one of the highest risk people he’s willing to operate on. I hit 4 out of 5 factors that put me into a high risk. BMI, prehypertension, sleep apnea, and one other I don’t remember. The only one I’m not hitting is age. I will also need to take injections for 28 days of a blood thinner because my clotting risk is so high. He seriously freaked me out. He said while he was still comfortable operating, he was not confident there would be no issues and needed me to be aware that there are incredibly serious risks for someone like me.

I’m 35, 6’3”, CW is 497. I’ve lost nearly 50 pounds in the past few months and am continuing to lose on my current diet.

I’m having serious second thoughts. I need someone, anyone, who can help talk me through this. Maybe someone who also was considered high risk and went through with it?

Please and thank you!

My surgeon never said this to me. I was 390 pounds, 5'6", bmi 63. had hypertension and high blood pressure. I also have PCOS which makes weight loss EXTREMELY difficult to do and maintain. And never once did my surgeon say these things. I'm glad yours was honest with you, but I think there may have been a better way to go about it. Also, I didn't have to do any blood thinners before the surgery. I have to do them now post op (2x a day for 10 days) but he has everyone do it because he knows we all heal differently and may not be able to walk as much as we should and he wants to prevent clots. I think those of us with higher weight and bmi and also with multiple comorbidities have to be extra careful, but I don't think it's anything we should be afraid of with the surgery. Think of it this way.....how much worse will you and your health be if you DON'T have the surgery? Will you be able to get back to a healthy life and weight without it? IF not, then to me personally, the benefits outweigh the risks for the surgery. That's what ultimately made the decision for me. I wanted my life back, and I knew there was zero chance of it happening without the surgery.

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