Passed my tests ... but the surgeon is worried about me having WLS due to my age.

Passed all my tests and went to see the surgeon for what I thought was an operation date, but he wanted me to take more time to think this through.

He's concerned about my age...71 at 5'8" and 405 lbs, a blood disorder (low platelets I'm on Imuran), two clotting situations after operations in the past (I'm on coumadin), and a hernia.  He said my risk-benefit for the operation does not look good...and may face a 10% chance of not getting off the table...or healing complications after the operation. 

He asked me to take a month to think it over and to start Optifast during that time as if in prep for the operation.  I'm down to 380 today, 25 lbs loss in a month, and my BMI is probably below 60 now.  In addition, I kinda like Optifast.  The dietitian says it's completely safe, even though it's about 950 calories a day.  It does seem to work, at least for now.  Maybe if I could get down to 280 I'd be happier with myself...that's another 100 lbs...and might take about 6 months if my current loss pattern continues on Optifast.  My will power is great...we had a big family dinner last weekend...turkey, gravy, potato, dessert, etc. and I just had my Optifast.  The smell of the food did get to me, but I was strong.

I asked if the VSG might be better for me than RNY and he said 'no' due to a higher possibility of leaks and slow healing at my age.  He has one patient who was 600 lbs and is now down to 200 but still in hospital after 6 months as his body won't heal..at least to date.

Can I have the honor of your thoughts on this?  It's a huge decision for me.  I'm not the average WLS age of 35-55 and perhaps it's not the right think for me.  I know I'm a lot older than you guys but maybe you can offer some good advice for my case.  I'm pretty sure the surgeon would do the operation if I said it's a go.

 Hi Adman,

At 49 and 285ish when i started my trip I am in no position to advise you. It sounds like your surgeon is an up-front kind of guy and wants you to make an informed decision. Have you tried other diets in the past where you lost significant weight and gained it all back or is this optifast diet your first? I was shocked when I started my preop diet at how fast the weight came off and how much I lost in a short period of time with little effort... it was my first major lifestyle change and I could have bagged the operation... I am so glad now that I went through with it because at goal I want to trash my diet but my pouch is there to remind my of my trip and how far I have come. It helps keep me in check, I would not still have the willpower to resist the food without my pouch talking to me.

Wishing you luck,  Brian

Hi Brian .. thanks for the reply.  Over the years, I have tried dozens of diets with some success but weakened on them and went back the other way, adding even more weight. 

Before I tried the Optifast, I thought there would be no way I thought it could curb my hunger pains...but it has.  I suppose it's not realistic for me to think that long term Optifast is the answer I've been looking for...other than surgery.  I would love to feel comfortable going to the beach in a bathing suit, or swimming, or being able to climb stairs or take long walks in Rome or anywhere without getting out of breath. 

But do I want to risk the 10% chance I'll die on the operating table, or have serious complications, as the surgeon warned.  At 71 I'm at an age when some of my friends are dying of natural causes and nobody knows how long we have on earth...so I've got to deal with that emotion before this Thursday when I see the surgeon again.

I have a pouch...actually more than that as it's a pannus apron hanging almost to my knees.  The plastics surgeon said I'd have to lose 100+ lbs before he'd feel comfortable operating on it.  But it won't go away on its own even if I lose the weight...so I'd certainly have a constant memory talking to me after losing the weight. 

Maybe I should post this on the 'general' board to get more input, but thought man to man would be good.  Thanks again.

 Oh!  By "pouch" we generally mean the small remnant of your stomach after you have the surgery... It is a reminder because if you overeat it hurts!

Wishing you luck in making the decision that is right for you.

I was somewhat younger at time of surgery, 55, but apparently according to what I was told, the medical profession as a whole takes a strong look at anyone 60+ with WLS. I don't think it is automatically ruled out, but certainly the risk assessment approach is a valid one.

It's been my belief, although through hearsay, that Coumadin and surgery are not a good combination. And that makes sense to me. Coumadin causes strong changes to your ability to clot, and let's be realistic that's not something you would want to face in an operation.

From this vantage point, I'd agree with Brian. You need to listen to the doctor's concerns. My guess would be that even if you were to press the issue, he would refuse to do the surgery. And, sometimes we need that sort of analytical advice.

Good luck in your decision and with your health.

Thanks Ken ... The surgeon did say that I would have to stop all coumadin and imuran and prednisone two weeks before surgery date, so I assume he's looked at that situation.

I think his concern is more of lifestyle changes ... why do it when you probably don't have 30 years to benefit from WLS while people 35-55 do have that.

I think they were surprised that my pre-op tests were good..they assumed I would have been at least borderline diabetic or that my heart tests or blood pressure would show more risks. 

So I do think it is more an age problem for them - they did tell me that the limit was once 60 but that has been lifted...but that I'd be the oldest they've done it on.  It would have been nice for me to see that another guy (or woman) was my age when having it done.

The way I look at it, is that having failed with every past diet, WLS seems to be my only option to a better life and perhaps longer life.  At the same time, I don't want to voluntarily put my lifespan at too high a risk and I think 10% is pretty risky for me.  The only option that seems to be working is Optifast but how realistic is it to continue on it for a year...and then what would happen afterwards.

Thanks again.

 This is variable, are you like Dick Clark or are you like John Candid. What I mean is we don't all age at the same rate. No one knows your body like you do.

No one knows what your level of will to live is. You could be 18 years old and no will to live and be gone in a month or 98 years old and make it to 108.

I lost my father to cancer when he was 73. He was still sharp as a tack mentally at that time.

A second opinion from a different doctor wont hurt.

Have you had major surgery like this before? Let me tell you, it does hurt and it does take the wind out of you. Talk with your surgeon about what group of anesthesia doctors he uses and if they have any that are super experienced with elder patients.

I think that your at you age at your weight because most of your health is OK. 

God Speed to you.

Wow.. what a dilemma.  I can understand your hesitation AND your surgeon's reservation at performing this operation in your situation. This is MAJOR surgery and even younger healthier people often suffer complications post surgery.  It sounds like your surgeon's biggest fear is the clotting factor during the 3-4 hour operation but you still have to consider how quickly you'd heal after surgery, how your body will react to the vitamin deficient aspects, etc etc.
The flip side is that at 405 pounds you are destined for increased health complications. I have spoken to people who have been on a medically supervised Optifast diet for more than a year.
This is a completely healthy alternative that could reduce your weight significantly and provide you
with the added health benefits that weight loss offers.  It seems that you are not struggling with the Optifast.  I found the Optifast to be an easier "diet" solution. You really don't have to think about food.
You don't have to weigh and measure and feel constantly deprived. It's a mind game, but somehow it's easier.. You forget about food and just "eat" Optifast.  BUT like most diets it doesn't solve
the problem. You could loose a couple hundred pounds on Optifast but eventually you would have to start eating again. Like all weight loss programs you can get the weight off, but will you manage to keep it off.
Since you are asking for "opinions" I'll give you mine... I'd avoid the surgery. It's just too risky. You don't mention which WLS center you are going to. Will they supervise you on a Optifast diet instead, OR can they recommend a doctor who would be interested in helping you with this non surgical route (Ottawa does)  You should be able to significantly reduce your weight with Optifast and once some of the weight comes off , you can increase your mobility and hopefully enjoy a healthier life without the risks that surgery presents to a person your age and with your health conditions.. Just my 2 cents. Good luck with your decision
John

Thanks for your replies.  The surgeon turned me down...based on my age 71, and past clotting and platelet problems.  But I think it was more his thinking that it was too late in my life span to be forced by an operation to make such significant lifestyle changes.  I don't fault him for this and appreciate his objectivity. 

I don't know whether I'm relieved or upset.  The doctor's set up is for surgery patients only so I can't even call their diet or nursing people.  He has referred me to a 'weight loss doctor' that may let me continue with Optifast 900 and mix in a meal a day on 'food'...but I can't get in to seem him until early November.  The surgeon did sell me another month's worth of Optifast 900 to use in the interim but wants to talk to me after that period when I suspect won't sell me any more then.

I've gone from 405 to 373 since starting the Optifast 900 program on my own...a 32 lb loss in 6 weeks on Optifast is impressive.  And, that's even further down from my 450 when I started Nutrisystem and lost 45 lbs on it before hitting plateau.  a 77 lb loss.  So maybe I can do it without surgery.  Time will tell.

Update:  Surgeon said no...because of age and blood problems.  I'm on Optifast only...4 times a day.  Gone from 405 down to 355 from mid Sept. to the end of Nov.  Maybe it will work for me long term.  Feels good.  Not hungry.  Pants falling off...using suspenders.  Longer term, I'm down from 450 about 2 years ago when I went on Nutrisystem and lost the first 50 before getting bored wth it.