Doctor suggested gastric bypass--freaking out!
colorfulmosaic
Posts: 9 Member
Hi guys,
I love reading your posts and have learned tons from them. I was hoping for some advice on my current situation. I was anorexic all through high school and early college. Midway through college, I developed bipolar disorder, and med-induced cravings caused weight gain to 235lbs at a height of 5'5". To be clear, I'm not blaming the meds for my problem, as I didn't have to give in to the cravings, and I certainly could have been more active. However, with the help of a nutritionist, therapist, and MFP, I was finally feeling as though I was back on track. I've lost a little over 30lbs in the past 6 months, and am now 5'5" and 203lbs. I make sure to eat at a calorie deficit and aim for 10,000-20,000 steps daily. To be honest, I feel pretty darn good because for the first time in years, I'm neither binging nor starving myself, and I'm living an active life.
Here's the thing. I've been pretty tired lately and my PCP ordered a sleep study. I met with the doctor (pulmonologist) yesterday, and he said my tests showed that I have positional sleep apnea (breathing interruption when sleeping on my back, but not when sleeping on my side or stomach). He said that since I have a BMI over 30 and near 35, plus one weight-related comorbidity, I would be a perfect candidate for gastric bypass surgery. He offered to refer me to a bariatric surgeon to get the process started.
I am reeling in shock from this. I am acutely aware that I'm too fat, but I've been losing on my own, albeit not rapidly. I didn't think things were bad enough that such a drastic option would be necessary. I have normal blood pressure, a normal A1C, and a good lipid panel. The only weight-related complication I have is the sleep apnea, and that can be controlled by wearing a device to keep me from sleeping on my back. I know you guys can't offer medical advice, but do you think it's unreasonable of me to want to keep doing this on my own rather than via surgery? I'm terrified of the surgery and don't want to live the rest of my life without being able to indulge here and there. I actually enjoy exercise and feel my appetite is under control--I mean, I'm eating at a deficit and losing weight--so I don't see why I can't continue on this path given that there are no signs that I'm in imminent danger. I asked the pulmonologist that very question, and he said the gastric bypass is better for maintaining the weight loss long term and he would strongly recommend that option. Personally, I feel like I need to keep battling my personal demons through therapy, etc, and that if I do that, I will be able to reach a healthy weight and maintain there.
Sorry for the long post--I'm just really scared. I didn't think I was at such a bad point that surgery would be recommended. What do you guys think? Any feedback would be appreciated!
I love reading your posts and have learned tons from them. I was hoping for some advice on my current situation. I was anorexic all through high school and early college. Midway through college, I developed bipolar disorder, and med-induced cravings caused weight gain to 235lbs at a height of 5'5". To be clear, I'm not blaming the meds for my problem, as I didn't have to give in to the cravings, and I certainly could have been more active. However, with the help of a nutritionist, therapist, and MFP, I was finally feeling as though I was back on track. I've lost a little over 30lbs in the past 6 months, and am now 5'5" and 203lbs. I make sure to eat at a calorie deficit and aim for 10,000-20,000 steps daily. To be honest, I feel pretty darn good because for the first time in years, I'm neither binging nor starving myself, and I'm living an active life.
Here's the thing. I've been pretty tired lately and my PCP ordered a sleep study. I met with the doctor (pulmonologist) yesterday, and he said my tests showed that I have positional sleep apnea (breathing interruption when sleeping on my back, but not when sleeping on my side or stomach). He said that since I have a BMI over 30 and near 35, plus one weight-related comorbidity, I would be a perfect candidate for gastric bypass surgery. He offered to refer me to a bariatric surgeon to get the process started.
I am reeling in shock from this. I am acutely aware that I'm too fat, but I've been losing on my own, albeit not rapidly. I didn't think things were bad enough that such a drastic option would be necessary. I have normal blood pressure, a normal A1C, and a good lipid panel. The only weight-related complication I have is the sleep apnea, and that can be controlled by wearing a device to keep me from sleeping on my back. I know you guys can't offer medical advice, but do you think it's unreasonable of me to want to keep doing this on my own rather than via surgery? I'm terrified of the surgery and don't want to live the rest of my life without being able to indulge here and there. I actually enjoy exercise and feel my appetite is under control--I mean, I'm eating at a deficit and losing weight--so I don't see why I can't continue on this path given that there are no signs that I'm in imminent danger. I asked the pulmonologist that very question, and he said the gastric bypass is better for maintaining the weight loss long term and he would strongly recommend that option. Personally, I feel like I need to keep battling my personal demons through therapy, etc, and that if I do that, I will be able to reach a healthy weight and maintain there.
Sorry for the long post--I'm just really scared. I didn't think I was at such a bad point that surgery would be recommended. What do you guys think? Any feedback would be appreciated!
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Replies
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I would suggest getting a second opinion from another doctor, and also explain your current life style change to that doctor.
Does your current DR know that you are currently losing weight?
my two cents would be to continue to lose weight the regular way without the need for surgery; however, I have no knowledge of your current situation or what the risks are if you do not have surgery.0 -
I think that with your history of anorexia the suggestion from your doctor was completely inappropriate. You are not at a life threatening point, you have made significant progress and you are doing it in a healthy way. I think you should keep doing what you are doing and ignore the suggestion.
ETA: If they only suggested surgery and not a CPAP machine please consider another doctor.0 -
Get a second opinion, you are heading in the right direction all on your own. My guess is that the doctor is used to people looking for a quick fix and without your history. If it were me I would want to try to lose the extra weight on my own and manage the sleep apnea without the surgery first.0
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I find it odd that they would recommend gastric bypass when you are currently 53 pounds overweight (according to the BMI scale). You are doing a great job losing on your own, just keep doing what you are doing and if you are concerned about it then get a second opinion. Don't let his recommendation stress you out.0
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Thanks so much guys! I was very shocked, as my PCP was thrilled at my progress on my own and never mentioned any imminent risk of death or heart disease, so I didn't expect this from the pulmonologist. I know I could have lost more in this time span, but I was trying to look at things positively and focus on the fact that I am losing (albeit slowly) and am feeling great. As for why the doctor didn't recommend a CPAP machine, I think it's because he said a positional device would keep me off my back, which is the only position where I had interrupted breathing, and the CPAP machine would be too drastic since it's noisy and uncomfortable, and I'm fine when I'm not on my back. I found it ironic that he considered the CPAP drastic and not the surgery, but I'm not the doctor...
It was just really hard, as a former anorexic, to hear that I'm at the point where weight loss surgery would be recommended. Honestly, most of my overeating came from not being able to manage cravings, and I don't see how the surgery will really help that--I mean, the cravings will still be there, right? Plus, selfishly, I'd like to be able to eat a Snickers bar once in awhile without "dumping". I will definitely take your advice to get a second opinion. Thanks again guys!!0 -
I should also mention that I have celiac disease and am concerned about messing with my GI tract any more than necessary, and I'm also not thrilled about the idea of a future where I need more food restrictions than just the gluten...0
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I agree with everyone else. find another dr and keep losing weight on your own. you are losing and not severely obese,just find a dr that deals with breathing issues and sleep apnea and see if you can get a cpap machine. to me at your weight there is no need for weight loss surgery. if you can lose it on your own then keep going.if you know you can lose the weight without surgery then do that instead. good luck with everything. and congrats on losing weight as well.0
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To be clear, your primary physician didn't recommend the surgery, the doctor responsible for reviewing your sleep study results did?0
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I'm a little confused as I thought the normal recommendation for gastric bypass was class III obesity (BMI 40+) or class II (BMI 35-40) with a weight related complication.
Anyway, both categories are considered morbidly obese. Being labeled as that when my BMI was around 37 (I'm male and a smidge taller than you) was one of the motivators for me to lose weight. My PCP never mentioned WLS.
You are about 20 lbs away from an overweight BMI. I'm not a doctor, but I really question this recommendation. I recommend you get a second opinion.0 -
colorfulmosaic wrote: »
Then might I suggest you, as a courtesy, mention the suggestion to your PCP and then subsequently ignore it, unless your PCP thinks it's worth considering...and I'd be very, very surprised if they did.0 -
wow so the pulmonologist suggested it? I would find another one then. that was wrong of them to suggest it. I would contact my pcp and let them know what they suggested and let him/her know that you are losing weight on your own and you dont want to do the surgery. see what your pcp says.0
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I agree, you aren't THAT overweight and you are doing the right things to continue loosing weight and being healthy. I'm also 5'5, my starting weight was 197. I'm now at 137. Healthy eating and exercise work and you've proved that, i'm really surprised at that doctor.0
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I am 5'3" and weighed 237 in March, I was treating with medication, anxiety, depression, high blood pressure, and high cholesterol. I had been using a CPAP for almost a year. I then had an elevated A1C. My physician did not suggest bypass surgery but we agreed that I needed to make some changes. I began monitoring my carb intake and walking immediately. Shortly there after I began counting calories. By July I was walking five miles a day and losing an average of 2 pounds a week, my A1C was back to normal, my blood pressure medication was lowered by half. I have continued to lose weight, and have added strength/weight training. I have been able to discontinue my cholesterol medication completely, while keeping my A1C and blood pressure in normal ranges. Emotionally, I have never felt better. The CPAP, eating at a deficit, and increasing your exercise combined, can result in a greater or equal total fat loss than a gastric bypass in 6-9 months, with addition health benefits. With only the diagnosis of sleep apnea, you have time to try diet and exercise for a few months, before consenting to surgery.0
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Thanks guys--I will put in a call to my PCP as you suggested. It was a definite wake-up call to see "morbid obesity" as one of my diagnoses, but I'm willing to put in the work if it means avoiding a lifetime of dietary restrictions...plus, the complications really scare me!0
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I second the second opinion opinion! Perhaps a weight-loss specialist (non-surgical)? I suspect the GP & sleep clinic doctors see a lot of overweight and obese people who swear they'll lose weight . . . then don't. Or who backslide and re-gain weight they've lost. That isn't you now, and it needn't be you in future.
Speaking as someone with sleep apnea (obstructive, not positional), I know that some people have compliance problems with treatment devices, and the doctors see that, too. (My insurance company made me prove, via intra-device monitoring, that I use my CPAP before they'd pay for it. I know you may have a different treatment, but I suspect the compliance problem still occurs a good bit.)
So, maybe your doctors are skeptics, based on what they see. Not surprising. You needn't be typical, though - you can be extraordinary. Right now, you're proving that. Check in with another doctor with a different view of the world.
I don't encourage people to refuse treatments that are *strongly* recommended by their doctors, about which they've gotten second (or subsequent) opinions supporting their chosen direction. But I've personally refused treatments (statins; and vitrectomy, an eye surgery, for a couple of specific examples). I did this only after extensive careful, science-based research/reflection, by pushing back assertively but politely on the very doctors who recommended those treatments in the first place. It won't happen in all cases, but they were willing to support/treat me when they saw how determined I was. I don't know whether they would've reversed that support eventually, but they didn't need to: I did what I told them I'd do.0 -
daniwilford wrote: »I am 5'3" and weighed 237 in March, I was treating with medication, anxiety, depression, high blood pressure, and high cholesterol. I had been using a CPAP for almost a year. I then had an elevated A1C. My physician did not suggest bypass surgery but we agreed that I needed to make some changes. I began monitoring my carb intake and walking immediately. Shortly there after I began counting calories. By July I was walking five miles a day and losing an average of 2 pounds a week, my A1C was back to normal, my blood pressure medication was lowered by half. I have continued to lose weight, and have added strength/weight training. I have been able to discontinue my cholesterol medication completely, while keeping my A1C and blood pressure in normal ranges. Emotionally, I have never felt better. The CPAP, eating at a deficit, and increasing your exercise combined, can result in a greater or equal total fat loss than a gastric bypass in 6-9 months, with addition health benefits. With only the diagnosis of sleep apnea, you have time to try diet and exercise for a few months, before consenting to surgery.
Congrats on all of the progress--you are a real inspiration to me!
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I second the second opinion opinion! Perhaps a weight-loss specialist (non-surgical)? I suspect the GP & sleep clinic doctors see a lot of overweight and obese people who swear they'll lose weight . . . then don't. Or who backslide and re-gain weight they've lost. That isn't you now, and it needn't be you in future.
Speaking as someone with sleep apnea (obstructive, not positional), I know that some people have compliance problems with treatment devices, and the doctors see that, too. (My insurance company made me prove, via intra-device monitoring, that I use my CPAP before they'd pay for it. I know you may have a different treatment, but I suspect the compliance problem still occurs a good bit.)
So, maybe your doctors are skeptics, based on what they see. Not surprising. You needn't be typical, though - you can be extraordinary. Right now, you're proving that. Check in with another doctor with a different view of the world.
I don't encourage people to refuse treatments that are *strongly* recommended by their doctors, about which they've gotten second (or subsequent) opinions supporting their chosen direction. But I've personally refused treatments (statins; and vitrectomy, an eye surgery, for a couple of specific examples). I did this only after extensive careful, science-based research/reflection, by pushing back assertively but politely on the very doctors who recommended those treatments in the first place. It won't happen in all cases, but they were willing to support/treat me when they saw how determined I was. I don't know whether they would've reversed that support eventually, but they didn't need to: I did what I told them I'd do.
Thanks so much for this! I think you're onto something with the doctors seeing people who promise to lose weight and never do. I think this sleep clinic sees a lot of large patients, as the toilet seat in the bathroom is like 5 times larger than your normal toilet seat and some of the chairs in the waiting room are huge. I will strive to be extraordinary, as you said
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From your post, it sounds like he was simply stating that you would be a candidate for WLS. Having suffered from apnea due to excessive weight, my pulmonologist suggested the same. I was already exploring the lap-band, so I took his suggestion and filed it away. The apnea and the BMI over 30 are comorbidities which would allow most insurances to cover the expense of the WLS (it is extremely expensive - mine ran over $30,000 including all the discounts the bariatric surgeon had with the hospital)
I had lost 70 pounds on my prior to my surgery - the bariatric surgeon even asked me if it was something I really wanted to do 3 days before my scheduled surgery.
I agree with the other posters - talk it over with your PCP0 -
My sister, who's in her 50's, is just short of a year with the lap band.
It's what you make of it - you do still have to watch what you eat. And it's surgery, risky, and isn't comfortable. She figures another 20 lbs off and she'll ditch her CPAP machine.
Go on sites with members who have done the surgery and see what they say, and/or go to some group therapy, if you have any nearby.
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I agree with you. Talk to PCP again. There is a lot of risk with surgery. Congrats with your success to date.0
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I view it as the Doctor, believing that she should lose the weight; as soon as possible & obviously the surgery would be quicker, than dieting; to restore her breathing but at her weight, I don't believe that a surgeon; would even work on her & especially since she is losing weight, on her own.0
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1) Always get a second opinion before taking a major medical step, like surgery to irreversibly alter your anatomy and vital functions of your body.
2) You are not required to take medical advice, whether it's a drug prescription or a surgery recommendation (barring institutionalization, court order, etc.).
3) The response "the gastric bypass is better for maintaining the weight loss long term and he would strongly recommend that option" seems pretty weak. Did you ask him for studies to support that conclusion? How do those studies account for differences in motivation -- do they actually randomly assign participants to weight-loss surgery and no weight-loss surgery? There are plenty of people who manage to regain weight even they lose it after weight-loss surgery.
4) Unless the pulmonologist has other residencies, training, or experience not reflected in that title, he's not an expert in nutrition, weight loss, weight-loss surgery, or success indicators for individuals pursuing a variety of different weight-loss strategies.
I'm an inch shorter than you, was about 10 lbs heavier than you are currently before I started on MFP, and had several borderline-high factors (blood pressure, blood glucose, and triglycerides, and low HDL), and my doctor, while advising me to lose weight and urging me to go to Weight Watchers, which I didn't feel was for me, and holding the threat of blood pressure medication over my head, never remotely hinted at surgery as a recommended path at those stats. I actually was over the class II obesity line (about 36 as I recall) at that point. (This was all two and a half years ago; I now hover right around the overweight/obesity class I borderline, and am more focused on maintaining than on losing more, since all my blood work and BP numbers have been fine at this weight, and I'm again able to squat and stand without holding on to something, tie my shoes without fat rolls getting in the way, etc. I also lift, walk/run, dance, and do yoga, among other things, but getting rid of the everyday-life impediments that had crept up almost without my noticing that was the real icing on the cake of improving my health stats.)
To me it sounds like you have very good reasons for not wanting the surgery, which like you I have always thought of as a desperate measure, when the risks of general surgical complications combined with the radical alteration of your digestive system are outweighed by the imminent risk of maintaining your current weight.
I think I tend to question doctors a lot more than the average patient does, and I can't imagine getting surgery for no better reason than that presented by this pulmonologist (he may be math-challenged, but your BMI is not "near 35" in comparison to 30 unless you consider 75 to be "near 100" on a 0 to 100 scale; it seems like any surgeon that would actually perform this surgery on you is bending the qualifying threshold just to generate more surgeries). Honestly, I would be tempted to ask him what his professional qualifications are for recommending this surgery, and what his financial connections are to the surgeon he wants to refer you to. After which he would probably kick me out of the office.0 -
I think your doctor may have a quantitative brain and a lack of tact. Here's the problem x and if a and b are both true then answer y can happen. Some patients are looking for the easy fix and maybe he had 20 in a row begging for the band. There may have been a series of events for the suggestion.
However, I agree its too aggressive of an answer especially with your measurements. If this is a first offense shake it off. If there have been a few subtle tactless suggestions on your health look for another doc.0 -
I'm sorry but I don't know why you were upset by this. He was simply suggesting it as an option and that he would help you to get it. Maybe hes had a few patients that have done well after the surgery. He wasn't saying you had to do it. If you don't want it then don't have it. It's as simple as that.0
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It sounds like you have things under control. Surgery is definitely a last resort. Don't you have to be a hundred lbs overweight to quality for it, anyway?0
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Nope, nope, nope! I was 213 pounds at 34, then I lost 73 pound in a year just by eating less and moving more. It's entirely unnecessary to do something so drastic.0
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There's something financial going on, I bet. I wouldn't go to him for your sleep issues now, either.0
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You can definitely lose weight on your own! I'm 5'6 and was 220lbs not long after my 2nd baby, and I got down to to 154lbs on my own. Gained again in my 3rd pregnancy and have lost most of it. Here in England they'd never suggest surgery unless your life was at risk!0
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Read this for my opinion... http://community.myfitnesspal.com/en/discussion/comment/33777376/#Comment_337773760
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