Thursday, July 25, 2013

Bariatric Surgery - Orientation

A few weeks ago I went to an orientation about Bariatric Surgery which is the first of many steps I'll have to do to get the surgery.  I was a little annoyed I had to go - I mean, I can just do my own research right?  Well, yes...and no. 

The orientation was being done by the primary clinic - a bariatric clinic - that specializes in this type of surgery and really doesn't do much else.  The information I got there was more than just a lecture about types of surgery and requirements - it was also a question-and-answer session talking to people from the clinic, almost half of which have been through the procedure themselves so they were able to speak from experience which was fantastic.  

The lecture and slideshow part was presented by one of the surgeons who has done thousands of these operations over the years, so he had heard most of the questions before.  The before-and-after slides of people who had dramatically lost weight were all people he had personally operated on in the last three years.  

Upon entering the conference room where it was being held, I experienced a first - almost everyone in the room was fat to some degree and the only "thin" people were clearly there to support a fat friend or family member. Since this was a group of people wanting to learn about surgery to lose weight, this is sort of a "duh" realization, but it was still...well...nice to know that for once I was in the majority and no one in that room would judge me for being fat because they were too and we were all trying to get help for it.  It was a great feeling knowing that for once in my life I was going to be in a room with strangers who were not going to judge me just because I was fat.  There was no negative vibe, no second glances, dirty glares, or shocked stares.  In a way there was a feeling of acceptance - we were fat, we all knew that, and we wanted to get help losing weight through surgery because nothing else seemed to work. 

Also, I knew the chairs they provided would be sturdy.  That was actually the best part, I think, sitting through two hours and not worrying about a slight shift making the chair break. You have no idea how nerve-wracking that can be. 

So, on to the information - for those who are curious about it for themselves or friends, family, etc. 

There were the usual charts and graphs about how bad it is to be fat for your overall health and that obesity leads to a lot of other health problems, including diabetes, sleep apnea, joint pain, and more.  I have all three of those so not a surprise.  However, they also listed mental-illness as a symptom of obesity and I take issue with that.  The speaker did clarify that no one was sure if obesity caused all of those things or if they lead to obesity but there was definitely a correlation.  I do agree there are a lot of obese people with mental illness so there is some correlation between the two, but I think it has to do more with having trouble maintaining a regular schedule and a healthy lifestyle when you're mentally ill.  In other words, in my personal opinion, being fat doesn't make you crazy, but being crazy can make you fat through sheer personal neglect. 

Anyway, so the speaker talked about the three types of bariatric surgery they perform at the clinic, explain what the procedure was and what impact it would have in the long term, sides effects, etc. 

**What I am about to say is mostly from memory, my notes, and from how I understood it through my sometimes foggy little lens. For more information start with the wiki entry on bariatric surgery and go from there.**

The first kind is Gastric By-pass.  

Basically he explained that they make a small pouch about the size of a shot glass at the top of your stomach, then cut your small intestines in a specific place and stitch it to the pouch so it would by-pass most of your stomach and a part of the small intestines.  Sounds a bit weird and slightly Frankensteinish to me, but it's the type they do the most (1000+ per year) and it's a lot easier to maintain afterwards then the others, ie less risks or side-effects.  It also has the highest success rate at their clinic in terms of people being able to keep the pounds off and stick to all rules you need to follow.  And this is the kind that helps you lose weight dramatically - 50 or more lbs in the first year, possibly even a 100lbs. 

The big problem is that it cuts out a part of the small intestines which absorbs certain vitamins like B-12, which means you have to take vitamin supplements for the rest of your life.  Not really a big deal, considering I am already taking other meds for life so what's a few vitamin pills added to that?  I already have the pill regime down so that's not really a big deal. 

The second kind is Adjustable Gastric Band.

Basically they put a band around the top part of your stomach and tighten it to control how much you can eat at one time.  It's less invasive and is much easier to reverse than gastric bypass.  However it's less effective and the weight does not come off as dramatically as with the bypass.  

But it's less scary and doesn't involve Frankensteining my intestines by cutting and splicing them onto other internal organs.  It's just a band clenching to make your stomach think it's smaller.  Sounds safer and better, right?

Well, apparently it requires more follow-up appointments with your doctor, stricter rules on the diet, and a lot more attention and follow-through then the by-pass, and considering I have trouble brushing my teeth on a regular basis, having to be closely monitored and more strict doesn't really sound like it would work for me.  

And then there's the real turn-off: it's adjustable and can be adjusted by you, meaning it involves a medical attachment that is basically a string that tightens the band when you pull on it and you have to be careful and be monitored when you pull it and how much, etc.  It might make me a feel a bit cyborgish which wouldn't bother me except for the fact that I worry about constantly fiddling with it as I am prone to do sometimes.  And that I live with three small children who like to climb around and on top of me.  Since I don't have a lap they basically sit on my stomach or my legs if I'm sitting down.  I can just imagine them finding the string or tab or whatever it is and trying to pull it, so...yeah, that's a "no" on that one. 

The third kind is Sleeve Gastrectomy.

The doctor basically described it as cutting off half of your stomach (or more) then stapling the remaining part closed. The stomach part they cut off is removed from the body and put into a bucket then disposed of (I kid you not, the guy actually said "we put it in a bucket").  That's sounds kind of extreme.  There are a lot of risks with this type of procedure including internal leakage, internal bleeding, ruptures, and other not-very-pleasant-sounding things.  

They very rarely do this kind of surgery and it's only in extreme cases where the others are not likely to work or can't be done for some reason.  It's also the only procedure that cannot be reversed.  The cartoon next to this actually shows what my reaction was as the doctor described what was involved in the sleeve surgery. 
 I think the only reason I would go for this is for the photo op of me holding a bucket containing half my stomach which is a disturbing image that I would still strangely want if I had this type of surgery.  Which I won't.  Because it's scary. Oh my dear lord, it makes me shudder just thinking about it.  (and I'm clearly bizarre and insane because I just decided that if I took of photo with my and my bucket-o-stomach I would have to put googly-eyes on it. Just because. Because I'm twisted.  Twisted like a pretzel.)

So, I've decided on the Gastric By-pass.  Considering that last year they performed 1000+ by-passes, far more than the 400+ lap bands and the less than 100 sleeves (that's in the last 5 years, not just 1) I think it's safer.  I would rather choose one that they have so much experience with and that is the most recommended type of surgery than one that involves hazards such as external strings and internal leakage.  

I'm very glad I went to the orientation.  I'm actually going to do this, and not just talk about it.  I found out my insurance will cover it as long as my doctor agrees that it's medically necessary and since she suggested it - and I'm 400lbs - I have no doubt that I'll qualify.  

Now I have to send in some forms and start the next steps which includes an exercise and nutrition class, getting a psychical evaluation from my doctor, and a psychological evaluation.  When the speaker mentioned that everyone had to get a psychological evaluation done after someone asked about the risks of depression after the procedure, I asked what would happen if you were already mentally ill.  He said I would still need to get the evaluation from my psychiatrist, so that should be pretty easy, as long as I'm declared mentally stable enough for the operation.

I have a lot of questions and thoughts and feelings on all of this which I will be bringing up in future posts.  I will now leave you with a picture of bucket that some day may (or more likely may not) contain a partial stomach.  But not mine.

All images I used were either drawn by me or are from Wikimedia Commons.


  1. Howdy! I guess you're probably not surprised that I'm reading this, but I thought I'd stop in and say hello anyway. :) After all, I too am bipolar and overweight, so I can sympathize to a certain extent. I am also extremely interested in my favorite Yibble being healthy and happy and around for many many more years, so that's another reason I'm reading.

    This was an interesting and informative post. And it makes me feel kind of horrified that my own dear mother suggested I look into getting the sleeve surgery. (Yes, she really did. And considering she's been on my case about my weight as long as I can remember, it's more exasperating than insulting.)

    I agree that obesity is unlikely to lead to mental illness, but I would not be at all surprised if certain types of mental illness lead to obesity. In the beginning stages of my bipolar diagnosis I physically never felt full, which makes it all kinds of difficult not to overeat. Not to mention all the various medications that actually contribute to weight gain.

    The mental image of a googly-eyed stomach bucket made me giggle, so clearly I'm as twisted as you are. :)

  2. Clearly I've only just now checked the comments section. I had no idea your diagnosis was bipolar! Last I heard it was Depression. When did you get the new diagnosis? Now I totally want to chit chat and geek out disorder. Some how the phrase "geek out" doesn't seem to work with mental illness....but maybe it should?

  3. I was diagnosed back in...uhh...late May. Here's the post I made about it at that point. I've been doing the med dance, but I think I'm doing pretty well on two prescriptions: one for mania and one for depression/anxiety. That said, I can still tell when I'm "up" and when I'm "down". I just have better control over things.