Questions from a Confused Newbie

Hi Everyone, I posted this in the regular area, before I knew there was a Michigan board. I think it's nicer to talk to people in my area. So hello Michiganders! I've just starting seriously considering WLS. I've been in touch with the Cori Centers and am waiting for some information. (I know some of you don't seem to like the cori centers...they said my insurance co. said I need to get a letter of support from my current doc) I'm scared, worried and confused. It seems the more I read, the more confused I get. Lap, DS or Roux-Y? Am I up to all the hard work afterwards? Will I live thru the surgery? Is all the throwing up, dumping, just sipping small amounts of water and all the other horrible things I've read about worth it? Yes, I have a lot to lose, and no, I've never been successful at losing enough of it, but, gosh, this seems so drastic. I've been told that all this worrying is normal, but it makes me wonder if I should go ahead with it. Anyway, here are a few questions: *******1. What makes a high-risk patient? I'm assuming your current health, etc. plays a role, but if someone has a lot to lose, does that, in itself, make it more risky? I'm lucky and am pretty healthy so far, but I'm 300++ lbs. (boy, that's hard to say out loud), have bad arthritis in knees, am on blood pressure and thryroid medicine. *******2. How is it determined if you have open or laproscopic? If you have a lot to lose and have a big belly, can you still have laproscopic? *******3. How many of you went to multiple doctors before WLS and how does insurance handle that, or do you just pay each one separately yourself? ***And if you get approved thru a clinic, and then you change clinics, does your insurance approval transfer with you? *******4. If you have a lot to lose, does the doctor generally want you to lose weight before surgery? *******5. Did anyone find out they had sleep apnea and not know it? *******6. The Lap Band seems less drastic. But has anyone who has/had a lot of lose, have great success with lapband surgery? Or do you just get to a point and not lose anymore? And maybe my insurance co. wouldn't approve that anyway....don't know, have BC/BS. *******7. Is there an approximate time frame from making your first appointment to surgery, or is it just different for everyone? *******8. What kind of tests are done pre-surgery? *******9. Does almost everyone lose hair and does it always grow back? *******10. I read someone mentions wrinkles? Does your face get wrinkley? I'm over 50, and not wrinkled yet. (I know, I care about my face, but have let my body go) *******11. And just because I'm wondering.....does your shoe size get smaller? Sorry to bombard you with questions, but I have a zillion of them. I can hardly think of anything else but this surgery now. One minute I'm sure this is what I want to do, the next I'm scared to death of it, and say "No way!" But is you'd be kind enough to respond, it will help me on this journey that I've begun. Thanks.

Patty: A lot of your questions can be answered by reading others profiles. I pretty much kept constant track as I progressed through the process and I found reading others journeys helped me in mine. Now, I will try to answer what I can on you questions. There are lots of things that make you high risk. Yes, the weight in and of itself can make you high risk, but with the weight, most people are dealing with high blood pressure, sleep apnea, circulation problems, edema, and like you, really bad knee arthritis. Pretty much your weight and what your doctor prefers determines how you have your surgery (open vs Lap). My doctor has done close to, or over 2,000 lap surgeries and that is what I wanted. My mother had a couple of abdomenal surgeries and had hernias and then scar tissue that caused her to have two feet of intestine removed because it adhered to the intestines and then twisted. For that reason I did not want open surgery, but you may decide differently. If you are very large, it could be that you wouldn't be able to have it lap. and that is determined by your doctor and whatever weight you can lose prior to surgery. I did my homework on checking on doctors before I went into the one I decided on or orientation. If you get approved for surgery, I think you would be approved where ever you go. However, each doctor may require you to go through their program (behaviorist, exercise person, internal medical doctor, etc..) Best to pick the one you want so that you don't get into trouble and have to pay for repeat testing. It is always best to lose as much weight as you can before surgery. It makes it easier on you body and healing, it prepares you for life after surgery, and some doctors require it to show that you are really ready for the changes about to come. If you need to have co-morbidities for approval, they probably will test for sleep apnea. I had a little case of it, but not worth having the C-PAP machine at night while I slept. Good indications of sleep apnea is being tired even after a full night's sleep, horrible headaches that never seem to go away, etc... I no longer snore or have those headaches and get a great night's sleep after losing 112 lbs. I can't give you advice on Lap Band. There are some that swear by it, but for me, RNY was the way to make the necessary permanent change in my life. Also, my insurance would not approve it unless I was a severe medical risk. It would only approve the surgical option. Absolutely everyone is different. My orientation person told me it averages 3-6 weeks, well, my insurance required three months of the surgeon's diet, exercise, and behavior modification program so even though I started the process in July of 2004, I didn't have surgery until April 2005. Try not to focus on how long it will take, it will happen at the right time for you! Use that time to get as healthy as you can before surgery. I was really healthy prior to surgery and my doctor said I had done so well on the program that he only had me in surgery for 45 minutes (he averages 1-1/2 hrs per patient) and I was only in recover for 30 minutes. I had a EKG, and all the regular tests the internal medical doctor does. I had edema in my ankles and she found that, for instance. Then I had the sleep test, but that took some time to get into an appointment slot. Depending you the tests, but more dependent on your insurance and how quickly they approve it how soon you'd have surgery. Right before surgery (1 week) I had to have blood tests and general check up to see that things hadn't changed. They also did an EKG the day in the hospital right before surgery. The hair thing is not a big deal and happens even with other surgeries, not just gastric bypass. My mom lost a lot of hair from knee replacement surgery! Now, having said that, I did start losing some hair at about 3-4 months out and it pretty well stopped by the 6 month. It was noticeable in the shower drain, but I didn't go bald. I made sure I kept my protein up and that helps you in healing and with the hair loss. One of the girls found that mixing some Ovaltine with Enfimil with iron stopped her hair loss. While it may get thin, you won't go bald. If it's too bad for you, there are always inexpensive wigs for the short time this happens. I have all kinds of new growth all over my head right now at nearly 1 year out. I lost hair when I was on chemo. in the 80's (handfuls) and this was NOTHING compared to that. Well, you don't have the fat in your face puffing up the skin so, yeah, you might see more wrinkles. I'm 48 and I notice a few more wrinkles but my whole life is so much better now, who cares? Use moisturizer! Don't worry about it and you won't have the worry-lines to show for it! YES the shoe size gets smaller. I am falling out of my dress shoes from last year. I went from an 8-1/2 shoe to a 7-1/2 actually. But the best part was going from a tight 24 in clothing to a size 8 pants and small tops. Once you get the talk with the surgeon you will feel better. Make a list of your questions and take them with you. The orientation and this board and the introduction on OH helped me know what I was in for. If it isn't for you, you will know that, too! Hope that helps Pam from Paw Paw (Down 112 lbs. and at my goal)

1 The bigger you are, the older you are and the more inactive you have been are all key factors. Risks come in the form of but not limited to: Death, Pneumonia, DVT(Blood clot), infestion, and seroma. 2 you and your Dr. decide. I went open. 3 I narrowed it down to three Dr.s fro 33 and all were in the same office. 4 Most want you to lose before the surgery. The less you weigh at surgery time the better. You also prove that you are motivated. 5 I had it and knew it going in. 6 I know people who have had lap band and are now having an RNY revision. 7 I was three weeks from signing papers to cut. 8 Hpylori, BP, Chest Xrays, Blood work and a psych. 9 some do and some don't I did and it came came back thicker. 10 The whiter you are the wrinklier you may get. I am a swarthy olive skinned arab so I tightened up pretty good. 11 My arches came back so my feet went from 11.5 to 10.5. I also grew a half and inch. You questions are valid and quite to the point. kp

*******1. What makes a high-risk patient? I'm assuming your current health, etc. plays a role, but if someone has a lot to lose, does that, in itself, make it more risky? I'm lucky and am pretty healthy so far, but I'm 300++ lbs. (boy, that's hard to say out loud), have bad arthritis in knees, am on blood pressure and thryroid medicine. i weighed 408 and was not considered a high risk patient. there are many things that go into that consideration and it's best left to your doctor but i do know things such as heart and vascular condition, blood pressure, meds, previous history etc play a big role. as well as weight. *******2. How is it determined if you have open or laproscopic? If you have a lot to lose and have a big belly, can you still have laproscopic? mostly i find it's determined by two factors, how experienced your doctor is with laproscopic, what type of surgery you get (mini pouch = open) and your girth. (the tools have to reach) *******3. How many of you went to multiple doctors before WLS and how does insurance handle that, or do you just pay each one separately yourself? ***And if you get approved thru a clinic, and then you change clinics, does your insurance approval transfer with you? i went to a few, consultations were free of charge, an aborted surgery (due to surgeon's inabilities) was covered as "exploratory" and my medicare surgery was willing to pay for up to 3 attempts. *******4. If you have a lot to lose, does the doctor generally want you to lose weight before surgery? in many cases they want you to lose weight but it seems as if different doctors have different reasoning behind it, one it lessens the risks greatly, two they might need it to shrink your liver so it's not in the way or to make sure you fit with the equipment and then some doctors do it to make sure you are capable of complying. I'm sure there are other reasons as well. I';ve also heard of many people who were not required to lose at all. *******5. Did anyone find out they had sleep apnea and not know it? can't help there as i was diagnosed with apnea in '97 and didn't have surgery till '05 *******6. The Lap Band seems less drastic. But has anyone who has/had a lot of lose, have great success with lapband surgery? Or do you just get to a point and not lose anymore? And maybe my insurance co. wouldn't approve that anyway....don't know, have BC/BS. i was told that the long term results of lap band were equal to RNY but i didn't research it so i don't know if it's true. i wanted RNY. *******7. Is there an approximate time frame from making your first appointment to surgery, or is it just different for everyone? different for everyone. based on surgeon's schedule i would think and your own personal wishes. *******8. What kind of tests are done pre-surgery? i had EKG's, colonoscopy and endoscopy, full bloodwork ups including H. Pylori, chest x-rays+mri of abdomen and psych evaluation. *******9. Does almost everyone lose hair and does it always grow back? no, from what i'm told most men don't lose hair and most people who lose it get it back. i'm balding anyhow so i can't tell. *******10. I read someone mentions wrinkles? Does your face get wrinkley? I'm over 50, and not wrinkled yet. (I know, I care about my face, but have let my body go) i guess that depends on the person, the people i've seen pay lots of attention to protein intake, vitamins and excercise did not wrinkle. and one lost over 400lbs! *******11. And just because I'm wondering.....does your shoe size get smaller? mine certainly did. i'm back to a 10and a half from an 11 and a half.

Hi Patty, my name is Michelle I live in redford also. I had my surgery in January and I was 309 when I started the program at UofM. I was actaully the first surgery they did there for their program. As of today, I am down to 229 and I am 5'3". I don't think you are that high risk just because your 300+ lbs. My cousin also had the surgery and had a few of the same problems and 1 or 2 others and hers was laposcopy and is fine. I was blessed, I chose UofM and just stuck with them. My ins covered mostly everything. I just had to pay my deductible and made arrangments on that. With their program they just ask that you lose 15lbs and they give you a diet to follow and you also meet with the nutrionist pretty regularly. So you don't do it by yourself. I had to have a sleep study done before my surgery and I did have it but it was not that severe so I never got my prescription filled. and I don't need it now.The time frame on how long it takes depends on your insurance and what tests they want you to have. The only tests I had to have was the sleep study and bllod drawn. I think everyone is different and the doctors you go to will determine which ones you need. To avoid alot of hair lose make sure you take your vitamins and protein and 9 out of 10 times I am told it grows back. I have not had any problems with that yet. Your face I don't think would get wrinklely. For me, that is the first place I lost my wieght and you would never know it . I do want to tell you before you pick a doctor, do some investigating. You want to make sure they have a support group and that it is a good one. I am 32 and one of the youngest in my group but everyone is so open minded and I love them all. Hope I was of some help.

Hi Patty, I'll answer what I can. Here goes. *******1. What makes a high-risk patient? I'm assuming your current health, etc. plays a role, but if someone has a lot to lose, does that, in itself, make it more risky? I'm lucky and am pretty healthy so far, but I'm 300++ lbs. (boy, that's hard to say out loud), have bad arthritis in knees, am on blood pressure and thryroid medicine. The more co-morbisities you have the higher risk you will be. The heavier you are will also make you higher risk.(This will be determined by your DR.) *******2. How is it determined if you have open or laproscopic? If you have a lot to lose and have a big belly, can you still have laproscopic? In my case I chose open,because I have the micro-pouch & Dr.Wood only does this procedure open. This would also depend on the size of your middle,because the instruments have to be able to reach. *******3. How many of you went to multiple doctors before WLS and how does insurance handle that, or do you just pay each one separately yourself? ***And if you get approved thru a clinic, and then you change clinics, does your insurance approval transfer with you? This does not apply to me. I have had the same DR for 17 years *******4. If you have a lot to lose, does the doctor generally want you to lose weight before surgery? This also would be determined by your DR. I personally did not have to loose any weight before surgery. I was 309. *******5. Did anyone find out they had sleep apnea and not know it? I never had it. *******6. The Lap Band seems less drastic. But has anyone who has/had a lot of lose, have great success with lapband surgery? Or do you just get to a point and not lose anymore? And maybe my insurance co. wouldn't approve that anyway....don't know, have BC/BS. I don't have any personal experience w/ Lap-Band. I have the Wood-Sapala Micro pouch done open & I had no trouble getting approved. I have BC/BS PPO *******7. Is there an approximate time frame from making your first appointment to surgery, or is it just different for everyone? I started my journey in Feb 2005, 1st consult was April 2005 & surgery was June 2005. I did not have my first consult w/ DR until I was approved & all paper work was in order. After I met w/ DR. first time it was about 4 weeks until I got scheduled. *******8. What kind of tests are done pre-surgery? There is a blood test you have to take when you first start. I had to have EKG,Stress Test,blood work,chest x-ray. *******9. Does almost everyone lose hair and does it always grow back? I had none. My hairdresser acually says he thinks it's thicker after surgery. *******10. I read someone mentions wrinkles? Does your face get wrinkley? I'm over 50, and not wrinkled yet. (I know, I care about my face, but have let my body go) I have no wrinkles on my face,but I have quite a bit of loose skin on my butt , thighs & tummy. *******11. And just because I'm wondering.....does your shoe size get smaller? My shoe size went from 10w to 9 med I hope I answered answered what I could. WLS surgery is a very personal decsion. Once I made my choice & met DR Wood I never looked backed. I thank God everyday for the second chance he has given me. Good LUck on your journey. Linda 309/189/140

Thanks sooo much for all your responses. I really appreciate it! I'm going to attend a couple of seminars in the next couple of weeks. It's still a tough decision, but I'm doing all I can to try to come to the right answer for me. Thanks again. I'm sure I'll have more questions.....