Am I being overly sensitive?

Hi! I'm new to this forum and was hoping for some advice. I weigh 406 pounds. I went in for my first consultation on April 15th, and was told to lose 20 pounds(I weighed 419 pounds then). I had almost everything done because my records were transferred from a previous attempt to get WSL at another hospital the year prior(insurance issues), so they gave me a surgery date for June 4th. Today I had an appointment with the surgeon and had lost 13 pounds. I was fine with him postponing it because it was a lot of pressure for me to lose that much weight in a short period of time, and my primary doctor was VERY uncomfortable with it. But he started accusing me of not wanting this bad enough and not working hard to enough to get the surgery. And that other people could have been given my surgery date who want it more badly than me. Then he started showing me patients he had previously who did a better job than I did. One had lost 47 pounds in 6 months. I was only 6 weeks out. He also said he would have asked me to lose 40 or 50 pounds but he didn't "want to say anything".  Umm, ok? It made me feel very uncomfortable. I know I didn't hit the mark, but I tried very hard and I saw my 13 pounds lost in 6 weeks as an accomplishment. Now he's asking me to lose an additional 15 pounds by June 24th. Am I being sensitive or was he being a tiny bit unprofessional? Or both? Another thing: I decided I wanted the sleeve and he was really, really pressuring me to get the bypass. Any feedback or constructive criticism would be greatly appreciated! Thank you!

Personally, I believe that weight loss requirements before surgery are stupid, there is no liver shrinking in that short space of a time ...

However, in real life, we often just have to "play the game" - the insurance companies game, the surgeons' game, the psychs' game - however much we think it is stupid.

This will all be worth it in the end!   I understand him wanting you to have a surgery with a malabsorption component - with a high BMI (I presume yours is over 50) I would be looking at a virgin DS and neither a VSG nor an RNY.   It might be worth using the extra time to reseach it - there is a DS surgery forum on here and there are several places for you to find DS facts on different sites!

Thanks for your response! Yeah that's the reason he gave me. Yet I know for a fact he's worked on patients larger than me. I'm only 25 so I'm not sure if the DS is an option I'm willing to consider, plus he doesn't even perform them. But I'm still considering the RNY. I keep hearing contradicting info about the sleeve. Some say it's less malabsorptive. My surgeon says it's not. I've heard you lose the same amount of weight after a while. He says no. I'm so confused.

Bearing in mind that you ARE so young, as long as you can be compliant with your vits and labs, the DS would give you the best long term result.   The stats for VSG and RNY are not good after 5 years and regain is statistically less with the DS at that point.  Those of us who lose and maintain well at 5 and 10 years plus are unfortunately the minority and not the majority.   Think about your long term and make the right decision now - revision is way more difficult than a virgin surgery.

Anyway, as I say, research all 3 surgeries and see how you feel afterwards - this is a lifelong journey and to be able to start it at 25 is a gift many of us didn't get ...

As the saying goes, "Go with your gut."  Heh.

If you're feeling uncomfortable with your surgeon and he's pressuring you into something you're not looking for, maybe it's time for a second opinion.  My starting weight was 419 pounds.  My surgeon gave me the option of the RNY or the VSG.  I opted for the VSG and he did not try to convince me that I was making the wrong choice.  He said that you will initially lose more weight with the RNY, but over a two year period the weight loss for both RNY and VSG are basically the same.

I don't think you're being too sensitive at all.  Like Kim said, you might want to research the DS and consider that as another alternative.  Unless you have underlying medical issues that would make either the VSG or DS impossible, they should be options for you.  Some surgeons are more comfortable performing the RNY and tend to pu****

Can I ask who your surgeon is?  If you're not comfortable sharing, it's okay.

Wow, he's a douche. Some surgeons ask you to lose some weight first to help shrink the liver to make the surgery easier for them, but good surgeons can do the surgery just fine anyway. Also, some of us became overweight because we have very efficient metabolisms, so I was able to go down to about 800 calories a day, and not lose. My surgeon understood that, so when I gained a few ON THE PRESCRIBED LIQUID DIET, I was worried he'd think I cheated. I followed that stupid diet like my life depended on it (I thought it truly did) and he just said "wow you're efficient, no wonder you are this size". 

Regardless of all that, I'd feel very uncomfortable letting someone cut me open that treated me that way. I hear this too often. I would put money on it that if he gives you the RNY and you don't rock it, he will blame you. There are lots of fat hating dr's that need to move into another field. 

One last thing I'm going to throw in, not because I care what surgery anyone has, or that I have some unreasonable need for you to be my bobsey twin and get the same surgery as me, but I spent a long time researching surgeries, read studies and looked up all the scientific data I could find on the different surgeries.

You are quite heavy, and for you to have the best chance to get your excess weight off, and keep it off, you really need to look at the DS. Like RNY you will take vitamins for life, and that's not negotiable, but it has a better track record than RNY, and doesn't have some of the RNY drawbacks like dumping and reactive hypoglycemia, and you can take NSAIDs for pain with DS. Not with RNY. I highly recommend at least perusing some of the information that has been consolidated at DSfacts.com. 

I suspect your surgeon doesn't do the DS, but again, I'd be looking for a different surgeon anyway that treated me with respect. 

As a group, surgeons can be lacking in bedside manner. If he is a really good surgeon and this is the best fit for you, it's probably worth dealing with his personality and jump through his hoops. You don't have to take long walks on the beach with him.

Delay is not the worst thing. I had my surgery a few months later than I could have, because the timing worked out better for me.

It can be confusing, but figure out what is best for you, and try to get that done.

He is an asshat for sure but if he is a good cutter you can get your hand holding elsewhere. 

Play the game and drink some protein shakes so you can schedule your surgery.

Yes, he's being unprofessional. Consider consulting a different surgeon. There's an increasing body of evidence that high-BMI patients do better with a two-staged procedure that starts with a gastric sleeve and progresses to bypass if enough weight is not lost. This is a decision best made by your surgeon, but if your surgeon is a jerk, as appears to be the case, you might be better consulting a different and better surgeon who is up on the literature.

I had the sleeve at recommendation of my surgeon. The procedure was not covered by my insurance and I was denied. My surgeon and my PCP pow-wowed and both went back to the insurance company. My surgeon had a nice long talk with the medical director of the insurance company, explained the research that supported sleeve as a first procedure in a possible two-staged process for high-bmi patients. The medical director made the decision to cover the surgery, a procedure which the company DOES NOT COVER.

You need a good surgeon. That doesn't just mean competent in the OR, that means ALSO competent working with patients. Any surgeon who doesn't understand that hollering at us fat people is pretty ineffective needs to go into a different kind of surgery. I urge you, for your own mental health and happiness to reconsider continuing with this surgeon. If you have a good primary care doc and have a good relationship with him/her discuss your concerns and ask for a referral to a different provider. My very best to you. I think 13 pounds is SUPER. I managed to lose like...FIVE pounds and I didn't hear word ONE about it from anybody. 13 pounds is a lot of weight and that tells me that you are serious about embarking on a new life. I'm very sorry this surgeon doesn't want to make it a happy and comfortable one for you.

My very best to you and success in your journey.

Hi There,

   Unfortunately I have the mother of all "lose this amount before surgery".. " you have to show you are committed" .... "it makes the surgery easier"   stories!!!!     Send me a PM if you are interested..... I don't want to bore everyone else here to death with the whole story as it is a long one..... the bottom line is, don't fret!!! and NO.. you are not being overly sensitive.....  I was told by my first surgeon, "You have to lose 75 lbs before I even considered operating on you. You are enormous"...  Yes, that is a ver batim quote!!!  Anyhow, I am more than 100 heavier than you and I finally am getting surgery (in 5 days in fact).... You will be fine and this will all be in the past before you know it!!