October 04, 2005

• What I know about gastroplasty comes from some tv (some PBS documentary ages ago -- and my google-fu fails me at present because 'PBS' stands for something else, apparently), but from what I remember, it's not without risks. However, the greater risk is to not do anything. Being morbidly obese is a greater risk than the stapling, and attempting to change through diet and exercise isn't a safe option at this point. The surgery is a risk because it's a tremendous shock to the system -- the body is used to a certain volume of food and junk going through, and then it's basically forced into starvation mode. The surgery-shock is the big risk. Post-op is all about adjusting to new dietary restrictions, much like a diabetic would have to go through. Once that's all done, stomach-stapling turns out to be a real life-saver. It's just the part where it's done that involves the risk. Risk which is considerable, but still less than doing nothing. The testimonials from survivors expressed nothing but extreme gratitude. As for the travel, that's tricky. Carla doesn't want to see anyone, and is it allright to disregard that wish, and put Pat's needs ahead of Carla's wishes? Probably. No doubt, Carla is acting out of a motherly impulse to protect her kids, but perhaps out of embarrassment as well. I wouldn't worry about disregarding Carla's wishes on that basis -- you're all adults now. There's not too much that Pat can do, as it's largely in the hospital's hands now. So there's nothing wrong with a short trip, or a few short trips, rather than an extended visit which would jeopardize graduation. No-one wants graduation to be threatened. Dunno if that helps. Good luck!
• A good resource for information on bariatric surgery is obesityhelp.org. They have a very active community who can talk about their experiences, and it might be possible for Carla to make some connections to people in her area. The good news is that most people do very well if they are diligent with their post-op care. But there are still plenty of risks, and that site should be able to help you understand them.
• The risks of weight loss surgery are extremely high, the side effects are serious, and the lasting weight loss effects are debatable. In addition, many fat patients don't receive the medical care that they need because doctors blame everything on their weight. Before your fiancée's mom makes such a life endangering decision like WLS, I would advise that her daughter and sister make inquiries into the treatment that she has been receiving, and seek out a fat friendly doctor in her area that might give a second opinion. Here are some resources: Risks and side affects General Information Site Comparison of Risk and Benefit Article on lack of research on long term effects of WLS Hour long Science Friday show on WLS available as Mp3 CBS article on the risks Article on the need for intestinal transplant operations increasing due to bariatric surgeries Site by woman who had the surgery, and then had it reversed Anecdotal article about a chef who had the surgery Memorial to people who have died from WLS and its complications (from a pro-WLS site)
• Yeah -- a much better idea is to pay attention to all of those sources than me talking out of my ass.
• You also might want to check and see if she has symptoms of sleep apnea (most obese people do) and get her on CPAP therapy. An ENT doctor would be able to diagnose her and prescribe appropriate treatment. *my two cents*
• If she's morbidly obese and suffering health complications as a result of it, she sounds like a good canidate for the surgery. There are most definitely risks (especially since it sounds as if she's in poor health to begin with), but as long as she's with a good doctor, she should be ok (taking into account that every surgery comes with risks). That's the tough part, I guess. The surgery used to be something a few specialists did, but now it's increasingly common. If I were her, I'd want to know what kind of experience the doc has and what kind of support her mother will receive post-surgery. /not a doctor, but used to work in research relating to obesity, if that matters
• I agree with kimdog. Many obese people don't get good medical care because doctors are far too willing to blame everything on weight. This means that some treatable conditions go untreated and get worse, thus making it look as if the person's weight is to blame when it's not. I would follow kimdog's advice of finding a fat-friendly doc if you can (not easy, I know) and asking for their advice. I know a couple of people who have had the surgery, and their weight loss did not last. In their cases, they had a very risky and invasive surgery that did, essentially, nothing. (Granted, they didn't follow the exercise regimen prescribed by their docs, but in one case they were unable to do so,which could be the case here, and in another case they thought the surgery should be enough.) Also, there are issues of the plastic surgery that is often needed post-surgery to get rid of excess skin from the too-rapid weight loss, and that cost should be budgeted into the cost of the proceedure *before* any surgery has taken place. This is an important quality of life issue. Too often WLS is thought of as a magic bullet that will fix everything. It might fix the weight issue, especially in the short term, but the underlying health issues will still remain -- and on top of that your relative will now have to struggle to nutritionally support her body. If she does decide to have the surgery, make sure you shop around. There are lots of docs getting into this proceedure who have little or no actual training. Find a doc who has done lots of successful proceedures, and who does lots and lots of follow up care. You don't want a hack, and you don't want someone who'll simply drop your relative like a hot rock after the surgery is done. Living post-surgery is a huge, immediate lifestyle change, and trying to live that without medical support can lead to horrible complications and/or the failure for the proceedure to work. I guess what I'm saying is not to let the doc (or family and friends) pressure her into anything she doesn't want and/or hasn't researched thoroughly. This surgery is a big deal, and it's ok for her, and you and your fiancee, to treat it as such.
• I have no personal experience with WLS, my knowledge of it comes from reading things. The links kimdog posted seem like good things to read. I can tell you, though, that being unable to absorb nutrients properly (the end result of a successful WLS) is unpleasant at best. Which makes it far better than other possible outcomes, but it would be a serious change in lifestyle etc. Having to always be conscious of what you're eating and not eating is difficult, and even after that becomes a habit it's a further step to ensure that what you're eating actually gets you the nutrients you need. Vitamin supplements are never as useful as actually eating the food that you should be getting the vitamins from, but tend to be necessary. Mostly what I'm saying is try to make sure your fiancee's mother does a lot of research on this, and gets a few opinions from other doctors. It's a pretty serious operation, and not necessarily one that will solve problems.
• Thanks for all the kind replies. I've been meaning to provide an update, so here it is. After wavering back and forth many times, Pat surprised me with her decision to not drop out to stay with her mom. She did get the opportunity to visit her mom over the Christmas holiday. Her mom has done little to correct her situation including not making a decision about the surgery. Also, Pat noticed that her mom is simply unfit for travel. (She gets short of breath simply walking from the car to the front door.) Because of this (and because of other interpersonal family stresses) Pat and I have decided to not have her attend our wedding and instead have a separate small reception in Carla's home city. This is, of course, added stress, but considering the alternative of all the worries of having Carla out here (would we have to buy her 2 plane tickets, who is going to walk with her between gates, who is going to care for her out her during our day, who's going to see her off when we're on out honeymoon, will she even be ambulatory? etc) in addition to saving us the entire cost of including her mom (did I mention that Carla has no job and is on limited disability, with no savings?) we feel it's worth more to save Pat's sanity. The good news in all of this is that Pat did finish her penultimate quarter at university and is now enrolled in her final 3 classes. Once her degree is out of the way, she plans on working fulltime. I suspect that she may want to have an extended visit with her mother and try to convince her that she needs some serious professional help.
• I was thinking about you over the holidays, as I finally got a chance to ask my mom how she felt about her gastric bypass surgery, which she had a few years ago. She thinks it's the best thing she could have done for herself, has no regrets, and has only gained back 30 lbs (it's common to gain back 20-30 lbs). She's unable to overeat, and too much sugary food makes her feel dizzy (she's not diabetic). She looks much better. FWIW.