Q's and Concern..please respond ESPECIALLY if you had surgery @ DUKE

This was a perplexing conversation.  I thought it would be interesting to write it like a play. Characters: Nancy (my dietician/step-mother), Keith (my husband/silent partner) and Myself. Setting: in the car on the way home from my brother's graduation in Cullowhee Background info:  I'm trying to get my step-mother's professional opinion on whether or not I should "go for it"  and try to get gastric bypass surgery. Kelly: I'm sure Dad had told you that I am interested in having gastric bypass surgery, what's your take on it. Silence Nancy: Yes, he told me about it Kelly: So, what do you think? Do you have any patients that have had the surgery?  All Wendy (my sister) and Dad want to talk about are the ones that fail.  People that have had the surgery, lose tremendous amounts of weight and gain all of their weight back Nancy: The patients I see are the ones BEFORE the surgery. You know you have to lose a certain percentage of your weight before you have the surgery.  The only patient I've had after the surgery was one that didn't work. Kelly: Did she gain all of her weight back? Nancy:  No, she never lost.   Kelly: What do you mean "She never lost?" That makes absolutely no sense, if she followed the dietary guidelines Nancy: The doctors can't explain it and I can't explain it.   Kelly: How's her metabolism?  I had mine checked  (Thyroid) and they said mine was a 2 or something and said that was just fine Nancy: Her metabolism is fine. She had the surgery and it didn't work.  No one can explain why.  You have to be ready for that to happen. Kelly: Well, I've been trying to lose weight off and on since I went for the transplant evaluation and they told me I had to lose 40 pounds to get on the list.  Instead, I've gained 40 pounds.  I know I would stick to a diet if I made the commitment to get the surgery.  It's a totally new lifestyle. Nancy: Well, I think you should know that it doesn't always work. So here are my questions: 1. Does Duke require that you lose a certain amount of weight before the surgery?  The whole point of having surgery is because I am not able to do it on my own.  If I could do it on my own, I would. During my last attempt to lose, I went on what I would call a "salad diet" where I only ate one Wendy's Chicken BLT salad (no croutons) with 1 packet of ranch dressing a day @ 6:00 pm and gained 10 pounds in one week.  This makes me afraid to diet anymore because I am ballooning out so much during them. 2. How does dialysis affect weight loss post-surgery?  There's a warning on the paperwork you sign when you're first starting that weight gain is a side effect of dialysis. I'm on dialysis and am gaining weight..... 3. How does Lyrica affect weight loss post-surgery? There's a warning on the Lyrica commercial that weight gain is a side effect of Lyrica.  I'm on Lyrica and I am gaining weight.... 4.  What's the percentage of times where the surgery just doesn't work and there's no medical reason why? I'm currently in a wheelchair and have on real way of exercising until I lose some weight and can walk again.  All this dieting before surgery is making me worry!!  Please help!! Kelly :}

Kelly -

OMG!!!! What a load of $#!+ ... You can't have this surgery and not lose weight. Call the office tomorrow and ask the experts. I don't know where, who, etc... but that is nonsense.

I'm going to PM you my contact info. Give me a call.

Barb

P.S. In general, Duke doesn't require you to lose wieght before you have the surgery. I don't know about the side effects of Lyrica ...call your prescribing MD or pharm; I'm sure that they can tell you. I'm sure that Duke will talk with you about Dialysis and it's impact on WLS patients ... surely, there have been others.

Hi Again Kelly,   I agaree with Barb . That is just total nonsence ,saying the surgery sometimes dosent work..... think about it , there is no you would not loose weight. at least for the first year and one could lose a lot in a year!LOL.... Maybe she ment it dosent work because SOME people gain their weight back? or maybe the person your step-mother  talked to had some other weight loss surgery that is not as permament, like lap-band?....Do you think your family is just worried you are going to get your hopes up and then find out you cant have the surgery for some reason?...I to think you should call Duke tomorrow and ask if one of the nurses could call you back , if no one can talk to your then...tell them your situation with being on dialysis, your water limits, ect. ...there are some exercisies you can do in a wheel chair, I would guess they are mostly upper body but  my daugther -in -law is a PT. I will see if she will sugest some next time I talk to her. I would think you might could get some PT through your insurance after the surgery sence you wheelchair bound. She has talked to me about working with patients that have had WLS. She workes with her patients in the pool, that might be something you could do?........by the way I enjoyed talking with you the other night, we are leaving out for TN tomorrow....GOOD LUCK and try not to worry...~Mary~

Kelly, For 4 years I studied the gastic bypass and talked to people. In all the hundreds of people I met, no one ever "NOT" lost. Some did gain it back, but by their very own admittance, they started eating the wrong things and fell back into old habbits.  with the RNY, in the beginning, your pouch can't hold more than 2-3 oz at a time (why we have to eat slow 3-40 min in the beginning). Once it heals and stretches some, it generally only holds 4-5oz.  The pouch doesn't break food down at all anymore like your stomach use to - with acids and such. You do that mostly by chew chew chew.  The pouch is nothing more than a funnel to your intestines. Which now are responsible for absorbing the few nutrients it will.  How that will affect dialysis I don't know. That's a doctor conversation.  But I can't see how someone just doesn't loose anything.  That doesn't sound right to me at all.  As for Duke. When I went to Duke I weighed 450+ lbs. They refused to do the surgery on me till I was 390.  They do not handle high weight patients (too high risk). I would have rather then told me the truth and just said we don't want the high risk patients, but alas.  So depending on your weight they may ask you to lose weight.  Also, because of where they do the incisions for the RNY - if there is not a lot of room - it's tight - they might has you to loose some weight, even if you are under 390, just to loosen up the area they need to work in. OH HEY! I have a video, an exercise video that I don't need anymore. When I was 467 I couldn't exersize on my legs because of damaging my joints.  But I'm getting to where I can and I don't need this video anymore.  The video is teaching you to exersize in a chair - and I was thinking you could use it while in the wheelchair.  For nothing else, to just feel good!! PM  me your mailing address and I would be happy to mail it to you!

OMG KELLY, Look at all the before and after pics in OH if that dosent show you that this surgery works then I dont know what will. Sounds to me you know in your heart you want and need this surgery. I know it would make you feel better to have family suporrt but sometimes we have to go through things on our own. Wont it be wonderful to have surgery and then make the ones who say it dosent work and to prove them wrong. People frustrate me sometimes by their lack of understanding. Thank you for sharing this with us. You are always welcomed here.                                                 Annie

Hi Kelly, Here's what I can add to your questions and the above... 1. Does Duke require that you lose a certain amount of weight before the surgery?  The whole point of having surgery is because I am not able to do it on my own.  If I could do it on my own, I would. During my last attempt to lose, I went on what I would call a "salad diet" where I only ate one Wendy's Chicken BLT salad (no croutons) with 1 packet of ranch dressing a day @ 6:00 pm and gained 10 pounds in one week.  This makes me afraid to diet anymore because I am ballooning out so much during them. I don't know about Duke.  Ask 10 folks about what was required before surgery and you'll get 10 different answers (if they go to 10 different docs).  As you research this and the main forums, you'll see a wide variety of answers to this question as well as what folks are told to do post-op in terms of diet progression, protein intake amounts, etc.  At Southern Surgical, my doc/NUT required me to go on LOW CARB (<40gm/.day) beginning 4 weeks pre-op.  That is for a very good reason.  Lowering those carbs actually cleanses your live, makes it shrink, and makes it easier for the surgeon to get to the parts he/she needs to in order to perform your surgery.  Even if not told to do this, it's a good idea.  First, because of this safety issue, secondly because it starts making you have some self-discipline (something we aren't all that great with), and lastly, because you WILL lose some weight, that much less you'll need to lose after surgery.  I ate well in those 4 weeks, but I also lost 11 lbs!  That headed me into surgery feeling really great about the surgery and myself and gave me a jump start.  I've read everything from that to liquid diets for a few days up to a month and everything in between, including NO pre-surgery diet changes.  It's all over the place.

2. How does dialysis affect weight loss post-surgery?  There's a warning on the paperwork you sign when you're first starting that weight gain is a side effect of dialysis. I'm on dialysis and am gaining weight..... I have no idea about this.

3. How does Lyrica affect weight loss post-surgery? There's a warning on the Lyrica commercial that weight gain is a side effect of Lyrica.  I'm on Lyrica and I am gaining weight....I have no idea about this.


4.  What's the percentage of times where the surgery just doesn't work and there's no medical reason why? Contrary to what some others have posted above, there IS a small percentage of folks who have the surgery and lose virtually no weight.  I dug around when I had my first stall (13 days) in the main forum and found quite a few posts about this.  Some folks go through the surgery, and only lose 25-30-40 lbs. total (both w/bypass AND lap band) and then their loss stops completely and never goes any further, even though they are doing everything right, all w/out medical explanation.  I asked my doc about that and it was confirmed, although it is rare.  I don't remember what search terms I was using to find those old posts, but there are in the main forum. I mostly just spent hours of time reading back through pages and pages of posts (because I don't really like the search feature of these forums).  If you want more answers about that, I suggest you pose this and your other questions in the main forum where you'll get a broader audience and more widespread responses.  I just feared with my stall that I was one of those statistics that would lose 40 lbs. or less and stop... but it passed after those 13 days... I have had yet another one since that lasted about 6 days... so when they happen, as everyone will tell you... it will pass and is just a short bump in the road.