Approved for Surgery - Wracked with Doubt

Hello all.  I'm going to preface this with some vital statistics and this apology: this post is WAY TOO LONG and I'm truly sorry for that!  Now the statistics.  I'm a 6'1", 51-year-old, male, who, when he first sought out a DS surgeon, weighed 497.5 pounds.  Very lovely!  Given this level of obesity, I was just approved for a DS by my insurer, Medica - took all of about 20 minutes from the time it was submitted by my surgeon for approval.  No question about my "qualifications" for the surgery.  The good news is that all of the pre-reqs are satisfied and the approval process is complete.  The bad news is that this just got VERY, VERY REAL, and it is FREAK-ING-ME-OUT!  So now I'm looking for a way out, even though I know that it's almost certainly a bad idea. 

The thing that is giving me the most pause is that since I first met with my surgeon on August 4, and was told to lose 40 lbs prior to my then tentative (now definite) surgery date of November 15, I have managed 78 lbs of loss - yep, in just under 10 weeks.  I did nothing more than reduce my daily food consumption to between 1500 and 2000 kcals, and reduced my salt way back (blood pressure was rockin' at 207/131 when I was first evaluated for surgery - it is now controlled with medication at 126/77).  But I'm still 6 weeks away from surgery, so I'm probably looking at about 100 lbs of total weight loss before surgery.  This begs the question: if I can get this amount of loss w/o surgery, why do it?  My current answer - and the one that I'm 99% sure I will end up with - is that I have had rapid weight loss before, but it was always followed with equal or greater weight gain.  Why, then, expect this to be different?  As Einstein put it, insanity is "doing the same thing over and over again and expecting different results." 

The only thing different about this particular weight loss episode is that I have managed it on very little exercise.  In the past, I have created very large caloric deficits by - rather manically - riding bike at very vigorous rates for very long periods of time.  That always led to my exhaustion after 70 to 100 pounds or so of weight loss.  That exhaustion then led me to grab as many bags of s**t carbs as I could get my hands on, and to voraciously consume them until all, and more, of the weight was back on and I could once again despair over my situation.  But I'm not exhausted now, because I haven't been doing what I did in the past, at least not with respect to exercise.

But here's the deal: I still know - or should know - or think - or have at least a nagging sense - that not doing the surgery is a bad idea.  I am fifty-one-years-old for God's sake!  If not now, when?!  But the fact remains that the surgery and all that comes after it scares me.  I just don't know if this is the right way to go. 

How did you all sort all of this out when, I assume, you went through these same or similar doubts/emotions?

Again, I will almost certainly resolve all of this in favor of the surgery, but it is really maddening for now.  Thanks for letting me vent on your time.  Any and all insights will be very much appreciated.

P.S. I did read the responses to KarinV’s post on essentially the same topic from a few days back.  They were helpful, thanks.  I am posting this in addition to it in part because I would like to know if the recent weight loss success component to my situation would sway anyone in deciding whether to do the surgery.  Thanks again.

I sorted it out easily: I weighed 400 pounds. I was all done fantasizing that, having gotten to this weight, there was a snowball's chance in hell of getting off AND KEEPING OFF enough weight to keep me alive and functional.

Be realistic, my friend. You weigh 500 pounds. If you lose 100 pounds, you'll weigh 400 pounds. There's really not much win going on there.

IF IF IF IF you lose 200 pounds, you'll still weigh 300 pounds and you will still be at risk for every comorbidity on the planet. And you have a less than 5% chance of keeping that stuff off, with diet and exercise only, for EVEN FIVE SHORT YEARS.

Only crazy people bet on odds like that.

The average maintained EWL five years out with the DS is around 80%. You have around 325 pounds of excess weight. 80% of that is 260 pounds.

For that, you'll have to eat critter every day for the rest of your life. No way around that. God made critter for us to eat. You'll have to take a couple handfuls of pills a day. I dunno about you, but that's three swallows tops for me (because I'm currently using a 3x daily calcium instead of 4x daily). OH THE SUFFERING lol.

You'll have to get your vein poked as often as every three months and once in a blue moon more often. If that's a problem, then just keep doing what you're doing, because it is not optional. If you get really lucky, you'll be able to get away for a while, down the road, with twice a year. But hey, as people get older, they get sicker and have to go to the doctor more often. Ask any aging person. So what?

For me, the DS constituted best possible betting odds. Done deal and I've never looked back.

All Excellent points, Elizabeth.  Thanks . . . and thanks for being direct.  I have to get past the head games that I've gotten so used to around this.  The odds are what they are and they are very bad with respect to getting this done on my own.  Again, thanks!

We really do play amazing head games on/with ourselves :-). It's a survival mechanism at oh, so many levels.

Look at the kind of discrimination and abuse we get every day from our environments. We survive it partly through denial....some version of, "It isn't really so" or "it isn't really that bad."

We mind game ourselves about our consumption. SOME people really do eat very carefully monitored and controlled diets and still stay fat. But it is very uncommon.

We are blind to our appearance. I have yet to meet anyone who could honestly see how big they were before their surgery. Our brains just adjust the images we see.

Many of us are in very deep denial about our degree of disability, regardless of whether or not we have actual illnesses to which we can point. If you, for example, were really in touch with the concept of what weighing, say, 350 pounds rather than 500 pounds would do for you in the longer term, you wouldn't be having these thoughts. I suspect, too, that you'll look back in a year or two and be stunned at how you were barely existing from day to day.

(And I hope when that day comes, you will celebrate how strong and brave you were to keep on marching in the face of such devastating burdens to bear.....NOT beat yourself up with hateful self talk about how awful you were.)

It takes a hell of a lot of energy, courage, stubbornness and grit to just keep on living when you're this big. I trust you will be just BLOWN AWAY by how different it gets.

Healing yourself from severe obesity takes time. It also is not a total healing of life. Fixing one thing--obesity--doesn't fix anything else in life. This is all but impossible to comprehend at the beginning, and way too many people never comprehend it.

So, just take on the ONE task (which is really many, many tasks) for now: Heal yourself from obesity. Use the tools that will really WORK. Going on diets ain't it.

Hi again Elizabeth.  The delusions I have maintained about my weight in order to keep going on a daily basis are truly amazing and truly disturbing.  I go back and forth on whether this can be considered a survival mechanism, though: it is and it isn't.  The fact that I am here is partly a result of the denial you astutely describe.  I understand how, at this very developed stage of obesity, the ability to deny the extent of my condition allows me to get through a day and earn a living (and that is certainly a survival mechanism), but what purpose did it serve on the way here?  I was definitely in deep denial about the problem throughout, but what purpose did it serve back when a realistic assessment of the situation had a chance of being corrected without such an extreame  intervention?  It's a paradox - at least to me.

Your comment about obese people's brains not allowing us to see ourselves as we actually are really stuck a chord.  I had a picture taken of me about 50 lbs into this initial weight loss process - the first picture I had allowed of myself in years.  For the first time in a very, very long time, I really looked at myself.  The image in my mind wasn't even close.  I was very sad, but it also made me very intent on getting to a more healthy place.

Thank you again for your insights, especially regarding taking the first steps first and remembering that is what this is - a first step toward a physically and emotionally balanced life - and certainly not the last step - and maybe not (most likely not?) the most difficult step.

the more reading you do here, the more you will realize this is the answer for losing the weight and keeping it off.
 
It is scarey and you will be nervous but if you just accept that as being normal you can deal with it that way.

If you are 51 and 400 pounds I think you know that losing it isn't the hard part. The DS gives you the best shot at a healthier normal life. Don't make the mistake of backing out but if you need to postpone it to think about it or learn more I did that for a year to be sure. It's a big decision and not one to be taken lightly but please decide not to go forward with it. It will probably be the best decision you ever made.

zuzpetals: stepping away for awhile is probably not a good idea for me.  The time is now or never, and never is a very bad option.  I feel a little foolish for having raised this now.  Seeing your and others' responses, the way ahead seems very clear, and it is to give myself the best chance at long-term weight loss.  That's through completing the DS.  Thanks very much for your time in responding.  It was very good of you.

Your post isn't too long. 

"So now I'm looking for a way out, even though I know that it's almost certainly a bad idea. "
This sentence would be correct if you left out the word "almost."

You have managed to lose a lot of weight in two months.  That's good.  The odds of that staying off are at about 3%.

You are doing well on this short term thing but is it now YOU?  If you were laid off from your job, flooded out of your home and your pet marmoset died tomorrow...how would you cope with that?  What would you do to assuage the feelings of loss?  How is that any different than what you have done all your life?

If you are convinced beyond a shadow of a doubt that you finally, once and for all, have a handle on this food thing and have decided to become a compulsive exerciser instead...maybe the surgery is NOT for you.  Otherwise, welcome aboard...and welcome to the pre-op jitters.  (Stand by for the post-op Buyer's Remorse.)

Sue

Thanks to you, too, Sue.  It's funny how this part of my life is the primary area where I abandon what is otherwise a fairly matter-of-fact approach to things.  You're exactly right, of course, that things always seem kind of bright and shiny when they are going well. "What's past is prologue," however.  The past in this case means that, left to my own devices, the current success will meet the same end as it always has.  I'll let you know how the "buyer's remorse" goes when I get there.

No, and hell no.

Good on you for getting - temporarily! - into better shape for surgery.  But please use your research skills to find, learn, understand and internalize the immutable FACT that many MANY clinical studies have PROVED that > 95% of morbidly obese people cannot - CANNOT - maintain significant weight loss long term.  And those that do are most likely settled into what is essentially eating disorders and maniacal exercise regimens.

You have to face facts.  FACTS.  You didn't get to nearly 500 lbs with a normal metabolism.  You're 51 - you CAN'T exercise your way out of this, and the temporary good results that you're getting from dietary restriction WILL NOT LAST.  Your body will outsmart you in the long run.

You are, right now, at this moment, likely to be in the BEST physical health to undergo surgery than you will ever be again.  If you pass on this opportunity, you will almost without a doubt regain, likely to an even higher weight, and face an increased chance of a stroke, heart attack, developing (if you don't already have it) diabetes - which will increase your surgical risk as well.  And you will be older.

To say nothing of the possibility of losing health insurance, or having your insurer delete bariatric surgery coverage in the next plan year.

The time is now.