I am posting this because I wanted to get something off of my mind, and I thought you all would be the best people to tell. It is kind of a detailed story, so please bare with me.

So, I had my pre-Lap Band final visit on Monday (2/7). Everything was going great, and then the fellow came in. The fellow is the Surgeon's fellow-a Dr. who helps out. I thought it was funny he was a fellow, and a fellow!!!

He came into the room and said, "We have a problem, a big problem." Keep in mind, my surgery is this Thursday, and there have been no problems so far. So, I was a little startled. He said that since I have gained weight (6 lbs) since I first came into the clinic-that they couldn't do the surgery unless I lost 6 lbs by my surgery date.

Here is a little background. I came into their office the first time in August 2004 and I weighed 310. My surgery was supposed to be in November, but got rescheduled because of a cyst I had. Then, it was rescheduled for December. Incidentially, I began to have second thoughts, and rescheduled the surgery again after I had fully decided I wanted to do it. Alas, we arrive at my surgery date-Feb.10th.

So, I am all excited, and then the doctor tells me this. I think it isn't fair at all. It has been since August that I gained 6 lbs. and there is a 5lb limit. So I am over just by one, and he still insists I lose 6! I felt it was so unfair that I just broke down crying in the office. Also, look how long it has been since my first appointment there.

He also told me that I must have issues , and must not be serious about losing weight since I gained 6 lbs. He didn't only have bad news, but the way in which he delivered it was rather cruel. How do they train these fellows on bedside manner, anyway! Geeze!

So...now I am not evey eating Jello, or broth (I have been on a 10 day clear liquid fast before surgery.) I have just started the California juice diet thing-you know-up to 10 lbs in 2 days. Hope it works. Not eating, drinking only the juice fast stuff, diet soda, and Water. Hope I can manage 6 lbs in 2 days....

Please pray for me, or send me good vibes. :nervous

Joan

Joan, can you talk with your regular surgeon about this? Best of luck to you!

Holy Cow!!! I gained something like 12 or 13lbs in the months before surgery, but I lost it while on my 10 day pre-op liquid diet, so I don't even count it.

Some drs feel it is safer to perform surgery if you have lost weight, it's supposed to shrink your liver. If you are only 1 pound over your drs limit, then you will probably be just fine. It sounds to me like this 'fellow' is putting a scare tactic on you. Were it me, I would just show up for surgery whether I lost that 6 lbs or not. Nobody weighed me when I got to the hospital! However, if you are really concerned about it, I suggest you call your dr and speak to HIM about it and not talk to the 'fellow'. Honestly, the nerve of these people!!!

Have you said anything about this to your surgeon? I would not have let him talk to me this way. There is no difference in your weight gain before surgery and most surgeons don't even ask for a pre-surgery diet. I would look for a new surgeon if that is possible in your area. It's not like you are having Liposuction...you are having a surgery that is supposed to help you with this problem as it is! I would telk to your surgeon before yo do anything rash with your eating habits. If you don't have enough strength to get through the surgery because of your diet before the surgery then that could hurt you more than help. I would ask another doc in your area about this before I went through with it. There is no doubt you could lose 6 pounds in one week. But doing that is not healthy!! Please take care of yourself and don't put your surgery in the hands of someone who doesn't know what they are doing!!

Kim

joanie: This gets my dander up. Give me your surgeons number and I will set him straight.

Joanie, please don't do anything dangerous like try to drop a lot of fluids and risk getting dehydrated.

What a jack @$$ know if you ask me how rude.. opps I cursed sorry

But what gives him the right to talk to you like that..

I would definetly call your real surgeon not the wanna be..

Don't do anything drastic with your self because you want to be in the best physical form for your surgery and being dehydrated or lacking in other areas will make you sick.. Please contact the SURGEON and get his view on 1 extra pound..

Best wishes that everthing works out

joanie: This gets my dander up. Give me your surgeons number and I will set him straight.

Chanting..... "Go Penni.....Go Penni......Go Penni!" :Bunny

Print this rant out and give it to him. And if he isn't any wiser afterwards, I will call him myself and set him straight.

http://lapbandtalk.com/showthread.php?t=4750

Morbid Obesity is a DISEASE. It has been recognized as a disease since 1985(!!!!) by the National Institutes of Health (NIH).

This is going to be a long rant… I mean, post.

The longer I thought about doctors who make a patient lose weight before weightloss surgery as “proof” of their commitment to a healthier lifestyle, the angrier I got. I am FURIOUS. I am INCENSED. These surgeons are making their livings “treating” obesity, and THEY DON’T EVEN KNOW ENOUGH ABOUT OBESITY TO CALL IT A DISEASE. THEY DON’T KNOW ENOUGH ABOUT OBESITY TO REALIZE THAT IN 1991, THE NIH CONCLUDED IN ITS CONSENSUS CONFERENCE THAT DIETS, EXERCISE PROGRAMS, APPETITE SUPPRESSANTS AND BEHAVIOR MODIFCATIONS ARE NOT EFFECTIVE THERAPIES. YES, I am YELLING.

Because if they DID, they would NEVER tell a patient who desperately needed their help that they must lose weight FIRST – to PROVE they are serious about getting better!!!!

And to have this kind of attitude propagated on a weightloss SUPPORT board as acceptable under ANY kind of circumstances is absolutely reprehensible, and a symptom of just how well the prejudice against fat people is accepted. Not only is it tolerated, it is expected as our “just” punishment for being fat. Because after all, we are merely gluttons. The formula is so simple: too many calories in = too much fat. So diet and exercise. Too bad for you that you’re not one of the “normal” people who can regularly consume more calories than they need without getting fat – you are NOT a “normal” person, so you must just go hungry and exercise your butt off.

Guess what? The formula is NOT that simple. NO ONE really knows the complete explanation of why some people become MO and some people don’t. But not understanding “why” is NO excuse for discriminating against the MO, or continuing to blame the patient for their disease.

If a person could not swim, would it be acceptable for the lifeguard to say, “I could save you, but FIRST you must swim 20 feet to PROVE that you really want to be saved.”? Or better yet, “You can’t swim, so you should never have come into the Water in the first place. Why should I bother saving you? This is your fault.”

Except in the extreme cases of denying organ transplants to smokers and alcoholics, I have NEVER heard of denying treatment until the patient starts to get better on their own as an acceptable medical response. (I’m not saying I agree with the transplant thing, just that I have heard that a smoker who doesn’t quit wouldn’t be considered for a lung transplant, and an alcoholic that doesn’t quit wouldn’t be considered for a liver transplant. I don’t even know if that’s true – I’ve just heard it.)

Diabetics are not denied medication until they can prove they can get their blood sugar under control with a commitment to eliminating sugars from their diet and exercise.

Smokers are not denied the nicotine patch until they can prove that they can quit smoking for four weeks first.

A double-amputee is not denied their prosthetics to enable them to walk until they walk two blocks without the prosthetics, to PROVE that they really want to walk again FIRST. The prosthetics, after all, are just TOOLS – not “cures” for amputeeism.

People with high cholesterol are not denied medication until they are able to lower their cholesterol first, through diet and exercise.

If a depressed person goes to the doctor for treatment, and they meet the protocol, the doctor would NEVER say “Snap out of it first. Then I’ll give you the medication you need to maintain a non-depressed state.”

Anorexics are never told "JUST eat!!" Their condition is taken very seriously, and requires medical and psychological intervention.

I ask you all, then, WHY IS IT ACCEPTABLE TO REQUIRE A MO PERSON TO LOSE WEIGHT BEFORE TREATMENT?!?!?!? YES, we have to make lifestyle changes – but just like the amputee, we can’t do it without a TOOL. We have a DISEASE.

I feel that I have done the emotional work. I have completed a professional counseling program specifically for compulsive overeaters. I’ve been hypnotized. I’ve done every diet known to man, and some that I made up myself. How DARE ANYONE tell me that I am NOT serious about losing weight?!?!

I cried on the way into work this morning thinking about this. I am crying now. I will NOT accept punishment for this disease. I will NOT accept blame for this disease. I WILL accept the responsibility of doing something about it, however. But I cannot do it alone – because I am NOT “normal”, and I will ALWAYS need some sort of treatment to HELP me, until they find a cure. And I cannot stand by and let anyone forget that we are NOT here because of some moral failing, some character flaw, some personal weakness. We are here because we have a DISEASE. We need treatment, not judgment. If we were not serious about getting better, we would not be here.

NO ONE deserves to feel badly about themselves because they have a disease. NO ONE should be made to jump through hoops to prove they want to recover from their disease. MO is NOT A CHARACTER FLAW. This is NOT my opinion – this is medical FACT. It is up to US to know and understand this, and to eradicate the long-held beliefs that we have allowed to shame us for all of our lives. We must NEVER EVER allow anyone to get away with propagating beliefs that MO is anything but a disease that requires medical treatment.

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http://216.239.63.104/search?q=cache:OTJxKzuvN8QJ:www.shapeup.org/profcenter/diabesity/PoriesPres.ppt+is+morbid+obesity+a+disease%3F&hl=en

"The truth is that Morbid obesity is a disease, not a moral failing."

“Obesity is a chronic, lifelong, genetically-related, life-threatening disease with highly significant medical, psychological, social, physical, and economic co-morbidities.”

Statement on morbid obesity and its treatment. Obesity Surgery 1997 7:40-41

“In 1991, the National Institutes of Health concluded in its Consensus Conference that diets, exercise programs, appetite suppressants and behavior modifications are not effective therapies.”

Report of the Consensus Conference on Surgery of Morbid Obesity, National Institutes of Health, Washington, DC 1991

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http://www.rsapc1.com/morbid_obesity_surgery/

"Morbid obesity is the most common form of malnutrition in the United States and in the world today. It is considered after smoking to be the second leading preventable cause of death in the United States. It is a chronic disease which is very complex and has multiple etiologies."

"We lose over 300,000 patients a year to morbid obesity and morbid obesity related medical problems."

"There are social, psychosocial and economic consequences of morbid obesity that can be devastating. Unfortunately, the prejudice against the obese is very common in our society."

"Conservative management of morbid obesity that includes diet, behavioral modifications, exercise programs and the like have been found to be ineffective over the long term. A person who is morbidly obese who attempts conservative management, as mentioned above, either alone or in any combination, is not expected to be successful more than 5% of the time. Over 95% of patients who are morbidly obese and meet the criteria for morbid obesity will regain their weight and often overshoot their previous weight. Surgery for morbid obesity is the only method that has resulted in long-term maintenance of weight loss and the reduction of the comorbid diseases that are associated with morbid obesity. In particular, hypertension, dibetes mellitus, risks for coronary disease, osteoarthritis, gastroesophageal reflux disease and many others.

Morbid obesity is a chronic disease which is defined as a disruption of bodily function that develops slowly and persists for an extended period of time and often for life. It is multifactorial and includes genetic predisposition, environmental factors, social economic factors, cultural influences, hormonal influences and digestive abnormalities. In 1985 morbid obesity was recognized as a disease with associated comorbid diseases by the National Institute of Health. In 1991, surgical weight loss stated to be superior to nonsurgical weight loss methods and that only surgical intervention produced acceptable long-term results. In 1993 the National Institute of Health recognized the vertical banded gastroplasty and the gastric bypass procedure to be effective in significant reduction of excess body weight. The National Institute of Health recognizes morbid obesity as being an epidemic that can only be reduced significantly by surgical intervention for both morbid obesity and its associated comorbid problems."

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http://www.landauercosmeticsurgery.co.uk/obesity/

"OBESITY: A MEDICAL CONDITION

People who suffer from obesity are poorly misunderstood by those of the population who are not obese. There is a common attitude that overweight people are stupid and unable to control themselves. People who are obese are often the brunt of cruel jokes and thoughtless humour, even to the point of suffering abusive comments in public places.

We now know that the medical condition of morbid obesity is a complex disorder, and not simply due to over-eating. The vast majority of people living in the Western World eat more calories than they need but it is only a small proportion that relentlessly lay down every excess calorie in their fat stores. Most people have a mechanism, by which their body knows when their stores have been refilled, but there is an unfortunate group of people where this mechanism is defective, and when they eat it can be likened to filling up the bath with the overflow blocked off.

There are of course no fat people in starvation areas of the world, but this is because these are regions with chronic malnutrition and nobody there has access to even adequate calories.

People who are morbidly obese often find it difficult to believe that their problem is a medical disease and not simply due to overeating.

MORBID OBESITY IN FAMILIES

The disorder of morbid obesity often runs in families. The chance of having morbid obesity is clearly increased if other people in your family have the condition. Studies of identical twins who were separated at birth and brought up separately show that if one twin becomes obese, then the other one is likely to become obese as well."

I agree with everyone. And I think that not only should you tell Dr. Horgan your concerns about the six-pound loss the "fellow" ordered, you should alert him to what this dude is telling patients. "I must have issues, and must not be serious about losing weight" -- is that anything for a patient to hear TWO DAYS BEFORE WEIGHT-LOSS SURGERY? Or ever? I wanna kick this guy's ass!

Donali,

I don't know what to say..... I'm speechless.... Really that was an incredible post. All I can do is thank you and I hope that people that are faced with an ignorant doctor that requires someone to lose weight before performing weight loss surgery to prove that they are "serious" about losing weight will print this off and give it to him/her.

Bravo!

Joanie, I got banded with 6 others, so we all shared stories. Some were told to lose weight prior to surgery, others weren't. I was supposed to maintain a low-fat diet, but I gained a couple pounds instead. I wanted answers, so I asked my surgeon why some people had to lose weight. Seems insane - if we could lose, we wouldn't need surgery, duh. The first thing was confessing that I pigged out that week instead of dieting. I was afraid he'd send me home, but he just said, "don't worry honey, this surgery is going to help you so you don't have to keep eating that way." He said gaining a few pounds isn't a problem with an experienced surgeon.

You're only around 300 pounds (where else can you hear "only 300" other than here?) That's not hugely obese compared to someone weighing 500 or 700 pounds, so your surgery shouldn't be extremely difficult. The enlarged liver can make it more difficult for the surgeon to get around during the surgery, but they should not put off your surgery. Tell your surgeon to stop being lazy and grab his toolbox!

Joo wanna I shoulda beat him up for joo?

GRRRRR!!! What burns me is how totally arbitrary this is, and how meaningless 6 lbs are when you're talking about someone who weighs over 300 already. I can lose (or gain) 6 lbs in a DAY!! Maybe you were pre-menstrual, who the hell knows?

That fellow is power-mad, and quite possibly out of line. I doubt very much a surgeon would cancel a procedure two days out because the patient was a few pounds heavier than some magic number. What if you had been 330 when you walked in there the first time? What the hell difference does it make?

Grrrr..... Call DeLarla, she'll break his knees for ya...

Hey Joan,

Sorry you had to deal with such ignorance. Hopefully it all gets straightened out and you get to keep this surgery date. Best wishes, Teresa

I just had the opportunity to chat with "the attending physician" who supervises fellows where I could have had my plastic surgery (free to me, long story.) I asked him to inform "junior" that if he continues assuming that he knows what patients want without bothering to ASK them, that private practice might prove to be a food stamp experience for him, as well. (In this case, he figured that when an MO patient is going in for PS, she must want to look like Calista Flockhart and, since she won't, she won't be satisfied with the surgery. My Beverly Hills plastic surgeon said, "Tell me what you're looking for." I said, "Rubenesque." He said, "We're on the same page. My insurance will pay and my surgery is in two days.)

Can you decline the services of the fellow, or is he a "given" with the coverage you have? I ask, because--and I don't want to scare you--but I wouldn't want a beginner doing my band. (And I'm not a total snob; I did have a beginner do my panniculectomy.) The band complication rate is tied directly to surgeon experience.

Anyone who would want you to make a scale move in short order--and basically, the only way you can do that in time is by dehydrating yourself--is not practicing common sense, let alone good medicine.

Best of luck...

Hey you all! You know what...I have tears in my eyes again. From reading all of the supportive posts you gave me. I could share this with no one else and get the same reaction as I have gotten from you. You all understand.

I agree with everything you all said. Why should we have to prove we are serious? I thought considering surgery was as serious as it gets! My husband asked me if he was a little man. I said, "Yes." ( I was wondering what he meant by that when I answered) And my husband said that he probably has a Napoleon complex. If that is true...maybe he is trying to show his power and control by being mean to fat people like me (who are bigger than he...) hehehehe

If obesity is a disease...is it fair to blame the patient?

I feel so much better now. I feel empowered, and I am so glad I happened upon this support site. Thanks to you all for your help, support, and encouragement. I am crying again because no one would understand like you...

Joan