Looking for info on PE during/after surgery, and other strange questions...

Hello all,

I'll start with this -- I'm in my early 40s, BMI of 50+ with most of the common issues: hypertension, type 2 diabetes, sleep apnea.

I've dropped by a few times in the past but have never gone down the full WLS route.  I am beginning to seriously consider it again.  I'll be discussing this with my primary care doctor next week.

Before I go further, you will need to understand that I am one of those people who will research and obsess over decisions out of some deep seated fear that I will make the wrong decision, or purchase the wrong 'thing.'

I am, probably excessively, worried that something bad will happen during/after WLS.  The scariest thing I can think of would be the risk of PE.  I've been doing a lot of Google research but I can't determine the following things:

• Why is PE such a concern during surgery?
• Am I just as likely to get a PE during a long flight?
  •    ...or sitting at my desk at work for 4 hours?
• Is there anything I can do preemptively, leading up to WLS, to diminish my risk of PE?
  •    ...other than losing weight before surgery and doing everything the surgeon says.
• Does anyone know a good source for PE info?  I haven't come across it yet.

The other thing I can't figure out -- I've seen figures quoted of mortality of 0.8-0.1% for VSG (my likely choice).  I read a study that mortality for total knee replacement was about 0.25%.  Part of this is because the knee patients were generally older, but is the risk really greater for the knee patients than the VSG patients, all other things being equal.

I need to have knee (meniscus) surgery and likely hernia surgery at some point, but for some reason, I feel like those surgeries are not treated with the same concern or gravity of WLS in general.  Are they all reasonably safe and for some reason they make a bigger deal out of WLS? 

I know that the place I'd go to get my surgery would/will cover all this and give me plenty of time to ask questions -- however, I also know that this forum is a great source of knowledge because of the collectives experiences -- and figured I'd ask.

Thanks!

joshua

I'll write for about 15 minutes...Then have to go somewhere.  I'm glad you are asking these questions.  Many who don't...Go through the process not thinking, are the ones who are not successful.  I remember the night before my surgery (RNY)...Waking up my wife and asking her if I was doing the right thing?  She said "you've thought about it, researched completely about it, prayed about it...Now get some sleep!!"  I didn't sleep at all the night before.  The surgery was on a Monday and I was worried the surgeon forgot the procedure over the weekend!!  Just how our minds work. 

Concerning the PE, it is just a safety precaution. If you had heart surgery they would put those things on you.  Any major surgery and you would have them on your legs.  That was one of the least of my worries.  I was worried about things like the catheter, complications from surgery, recovery time.  Your bariatric surgeon will go over most of this stuff with you.  But it most likely will be a PA in their office who you talk to.  The surgeon does the cutting, but they are very busy.  The questions go to your PCP and the PA in the surgeons office.  Yes, the surgeon will be there for the questions, but they can't spend hours with you for all the questions.  Also I would advise you to talk to the surgeon on which surgery would be best for you.  But let the surgeon do what they do best...The cutting.  There are a lot of things to consider with each surgery.  I would rather have a good surgeon (with a steady hand), who you may only see for 5 minutes before surgery and 10 minutes after, than one who has great bedside manners, but doesn't know what they are doing.  If your surgeon says it's a toss up, then I would choose the one you feel comfortable with.  If the surgeon feels one is better that another (and tells you the reasons)...Think long and hard on their input...This is their area of expertise.

Also since WLS has been around for many years now, your PCP can really give you good insight into which way to go.  Brian

PS  Dirty little secret...If you can wait on the hernia till after WLS, do it.  If it is the front of your belly, when you get the hernia repaired, you will get a FREE tummy tuck at the same time...You'll have a lot of loose skin there!!  They repair the hernia and pull the skin tight at the same time...

Thanks for the reply Brian!  Just the sort of stuff I was looking for.

I'm not un-concerned about recovery issues, complications, etc...from my reading the PE seems the 'scariest' as PE in general can be a very quick trip down a bad path.  I also understand that that isn't always the case.

I've read up on staple line leaks, strictures, infections, etc.  My mother had VSG in 2006 and they cut her liver and they didn't figure out that she was bleeding out until 3 days later.  Thankfully, they finally figured it out and fixed it.

The more I learn, the more I read and the more I know all helps to curb my anxieties concerning WLS.

joshua

You're welcome...Enjoy giving input.  Whoever writes it, always take it with a grain of salt.  One thing about the liver and WLS.  It really is important that you stick to the pre op diet...Losing the 10-20 pounds before surgery.  With both the VSG and RNY the surgeon has to work around the fat next to the liver.  The weight loss makes it easier for them to do it with less chance for complications (like your mom had).  Ask away on the questions.  Brian 

Hi Joshua- Oh Pulmonary Embolism, PE (?)  I suspect you have medical training because I was not sure what you were talking about and had to google PE :) 

I was the same way about the surgery, I researched, researched until I drove my wife and family nuts with research.  I had my RNY about  six months ago,  total weigh loss during the whole process 143 lbs. 

I have the type of insurance where I had to have life coaching six months prior to surgery so I felt like I had to wait a long time for surgery 6 months and had to jump through many insurance hoops to get approved.  

Making the decision to have RNY surgery in October 2015 was one of the best decisions I have every made in my life!   I think my surgeon would have made a good salesman. I went to one of those intro seminars and the surgeon spoke briefly for just a few minutes, but one of the things he said I will never forget.  He said that his patients report after the surgery when they start losing weight, they report they are no longer depressed!  That really struck a nerve with me because at 337 I was really depressed ( also at that time I had suffered with Chronic Back Pain for about 4 years).  Guess what ? since surgery i  no longer have chronic pain and my depression has lifted. I am just much happier now at 194. 

Sorry not trying to write a novel.  Before I had surgery I was concerned about what could go wrong also.  I was most concerned about my liver being too big and the surgeon would not be able to complete the surgery because I had fatty liver disease. The surgeon said in his many years he had only one or 2 cases where the liver was too big to complete the surgery.  They put those things that inflate on your legs right after surgery to prevent a pulmonary embolism. Also they get you out of bed right of way and start walking.  I just think in the hospital they work very hard to reduce the risk of pulmonary embolism by keeping you moving. of course that is just my opinion. Definitely research the type of surgery, originally I was set to have lap band and that would have been really stupid on my part. Good luck with your surgery and keep us posted! - 

Interesting, post disappeared.

Brian and OHD, thanks for your input.  Information and anecdotes like the ones you provide are helping me move forward.

For sometime, I was fixated on "what could go wrong?" which prevented me from moving forward (likely 5-6 years ago).  I now have a better understanding and ability to frame the dangers and risks associated with it.

Now, I am looking and cataloging the long term changes and impact the surgery would have.  Also, discussing with the wife because these changes will impact her as well.

I've done this exercise before and I've always recognized a terrible pattern.  These are the things that I think I'll 'lose' if I have the surgery:

• Not supposed to drink soda anymore (I actually gave it up about 2 years ago)
• Not supposed to have caffeine
• Not supposed to have candy
• Won't be able to go to buffets and stuff myself uncomfortable
• Won't be able to have food X in the quantities I want anymore
• Not supposed to eat a bunch of sugary things
• Not supposed to drink alcohol
• Won't be able to go out to our normal fancy dinners in location X: (Las Vegas, Napa, SF, etc...)

All I could ever focus on was the food.  That is sad that food is such an important aspect of my life.  I've started to come up with other things I could potentially lose:

• Will have to stop taking most of my prescription medication, as the issues should subside
• Won't get to drag my CPAP along everywhere I go (maybe)
• Won't get to pay double for clothes from the specialty store
• Won't get to remember to ask for a table or a booth table that moves at a restaurant
• Won't be able to crowd my neighbor on a plane
• Won't be able to easily break normal things by sitting/standing on them
• Won't get to wait while others go on rollercoasters
• Won't get to go to the multiple doctor's offices 15+ times/year
• Won't get to be winded doing normal things
• Won't sweat profusely doing mundane things

I'm also looking at what my long term prognosis is should I not get the surgery as I currently have:

• Hypertension (that is currently way out of control)
• Sleep Apnea
• Type 2 Diabetes
• A torn meniscus (I don't want to get operated on right now)
• Constantly tired
• Slightly enlarged heart (cardiologist said it was normal for someone my size)
• Hiatal Hernia (Possibly others?)
• Arthritis
• Neuropathy in my forearms/hands
• History of heart disease in my family
• ...and a few other odd conditions that I can't remember...

At any rate, I am seeing my PCP tomorrow and will talk with her.  Then, I will likely call the local outfit that is not only approved by my insurance, but appears to be very good.

Here is a good question -- my insurer required a six month medically supervised diet prior to surgery.  I have been on a supervised weight loss program for the past six years (not very effective, obviously).  In people's personal experience, will an insurer take a weight loss program from a PCP to satisfy the six month requirement.  I know it's possible that they will only start counting the six months once the clinic contacts them to start the program.  Ideally, if everything went my perfect way, I'd have the surgery in the next 3-4 months.  If I had to wait six months, it wouldn't be a huge deal, just would be more difficult around the house as we would have kids back in school.  We would have local help from family available to us as well.  The other reason is because of a change to my insurance, my WLS will cost about 5 times what it would have cost last year.  However, once I pay for the WLS, I could likely get my knee surgery the same year without any additional cost.  If I had them in separate years, I'd have to meet that deductible both years.  Would be nice to save a couple thousand dollars in the process.

Thanks again, and have a great day.

joshua

I'll touch on a few of your concerns...Not all.  Write back about the 2 or 3 major ones. 

I'll just share about me and RNY.  With the Sleeve you have different issues and freedoms...Both plus and minus with both surgeries. 

Food; I followed the guidelines for the first year to a tee.  I got down to goal weight in 6 months and 10 days...Day of surgery I was 282 (lightweight)...190 at goal.  The first 5 years I would have a spoonful of Wendy's Chili (with cheese) for breakfast...Along with other stuff like a protein shake.  So I didn't touch sugar for 1 year...No coffee for 1 year...No soft drinks for 1 year!  So I'm starting to feel pretty good about myself (vain/pride).  I start trying and testing different foods...See what works and what doesn't.  Do I dump...Do I semi dump?  I dumped 1 time (real bad) and it was enough for me to reinforce my not want to go down that path.  I stay good for about the second year.  After that I start testing my limits!!  Stupid stupid stupid!!  I start going back to things like tortilla chips, Pepsi, sugar, cakes, breads.  Over the years I slowly got back to about 235 pounds.  Then guess what??  I had a second heart attack.  My first one was 16 years ago.  That really woke me up and I made a recommitment to eat right.  I am one of those people in the middle...Not a great success nor a failure.  Over the years I have gone back to sugar, coffee, tea, anything...But some things don't sit well with my pouch, so I eat very little of certain things.  Some people can't with RNY...Their pouch won't let them.  Some people can't handle milk, sugar, beef post RNY.  It is sort of a test and see.  But on some of these things, that test and see can lead down the wrong path...Regain weight.  So I will have (just me...Everyone else is different) about 3 oz of coffee in the morning...With sugar, Splenda, Equal, and milk.  I'll eat dark chocolate from the freezer quite a bit.  I will work it off doing things like mowing lawns and riding my bike.  This afternoon I was on the roof pruning trees...It was hot too!! 

Here are a few things that don't sit well with my pouch...I can eat them, but try and avoid a lot of them;  large amounts of coffee, soft serve ice cream.  pork (just 1 or 2 pieces...hard to digest), pasta, pancakes...Again I can eat these, but in very little amounts.  Deep fried foods, Chinese foods, deer, bear...All these things I can and have eaten...But they don't digest well in the small intestine. Almost like when you've had too much Chinese food...That feeling you get.  So if I go out I'll get a cup of chicken/beef vegetable soup and hot or cold tea (with a little Splenda and sugar).  I'll pick off my wife's plate a lot...We've gotten use to it.  I'll have 4-5 McDonald's French Fries...And take the rest home for later.  I know if I ate a whole bag of medium fries I would feel bad...So I choose not to.  Doggy bags become your friend.  I and everyone who has had surgery, has had to rethink how they eat.  Yes, Las Vegas and Hometown Buffett may not excite you...But being near normal weight totally makes up for it!!  Now I'll have a Pepsi...But 3-4oz in ice...Good bye Big Gulps!!  But you sort of knew that anyways...And I'll try and do the penance for my sins...Working off the bad food with work or exercise and eating the right foods during the rest of the day.  Brian

Brian,

Again, thanks for the input.  

You comments about what does and does not work echos a lot of what I have heard 1st (and 2nd) hand.

You also touched on what would be my biggest 'fear' post-surgery and post-recovery.  Getting down to X pounds and then going right back up.  Many of the people I know went back up and my heart bleeds for them.  I have a bad habit of suffering for others, it can be troublesome.  At any rate, my hope is that I come up with a way to live, eat and exercise so that I do not turn around and gain a significant portion of weight back.

Joshua

Hey man, welcome to the forum. It seems youve done a decent amount of research and I am very similar in the way you are (I look for many reviews, look for other options, look for better options, etc). I, like you, also have a love affair with food lol. Part of my favorite thing about traveling is trying new foods or restaurants that I've seen online or on TV even.

Fact of the matter is... things can happen. Things can happen with any surgery... To be completely transparent, my brother had Open RNY in 2001 and while in the hospital recovering he had a heart attack and died. Even with that, I looked into getting WLS in 2008. My father told me no chance in hell. Well, now 8 years later and plenty of yo-yo gains and losses, I'm back. This time, I'm paying for it (was in college previous time I looked into it). The thought of having the surgery still scares me... But I'm already on a road of devastation, but the outcomes with the surgery outweigh the potential risks. 

I had shoulder surgery in 2010 and I could have died from a clot then, too. My father has had multiple knee and back surgeries, same could have happened to him.

I'm in pretty good health despite my weight (I work out 4-5 days a week with weights, I like to think in my mind I'm a powerlifter). I dont do much cardio due to pressure it puts...

I've had similar discussions with my wife (todays our 2nd anniversary!) and she is on board with it. I took out a medical loan for the $10,600 and on May 12 I get to write my surgeon a check.

You're doing your due diligence. Do your research on operations. Do your research on surgeons. Do your research on hospitals. Look for surgeons that have a lot of surgeries under their belt. Center of excellence criteria... etc. Like someone else said, I'd rather have a skilled surgeon that is a jerk than one who is nice but no clue. 

At my info session I asked my surgeon in front of 40 other people how many people have died during or after operation in recovery. He told me two and asked why. I told him my brother died in 2001 from the surgery and he had no idea why I would be sitting in the room considering it. 

This forum is a great resource (I found it after googling my brother after he died, actually. He was a member). Ask as many questions as you can. The mens forum is great, but the general forum is more "busy" and gets more attention, just so you know

Welcome!

Chris

Chris,

Asking the surgeon about patient deaths is a great idea, but I don't know if its something I could do.  I'll have an opportunity tomorrow.

I am going to an informational seminar tomorrow with a local doctor recommended by my PCP -- "All the doctor's wives go to him" she said.  I am lucky that I have 3 Centers of Excellence within an easy distance (< 20 miles).  So I am on the doctor research part of the voyage.  

There seems to be a not-too-uncommon hokey pokey people play with WLS.  Consider it, stop considering it, consider it, shelve the idea again, etc.  Would be interesting to know how many people go through that, and then eventually go through the surgery.

Thanks,

joshua