Help!! I am new and getting my consult tomorrow...

Hi Everyone,
Tomorrow I am meeting with a surgeon in Huntington Station, Long Island and I am in desperate need of help.

I am interested in the surgery but many people who I discuss this with have a preconceived notion that I do not need this surgery and that it will change my whole way of life in a bad way.. I am 28 5'1 and 260 pounds. I believe that it might help me since I have gone so far out of control.


What suggestions do you have for me and what helpful questions should I ask?

I thought I would ask:
what is his success rate?
Mortality rate?
How long will I be off from work?


other than that I kind of draw a blank....

I would appreciate any and all help!

thanks so much-
D

Which surgery will be best for me & why?

Do you want the Lapband, VSG, RNY or DS? 

I started with the Lapband, had complications after 2 years and needed a revision to RNY (Gastric bypass).  Do you have any medical condiations such as diabetes or high blood pressure?  You doctor would be able to tell you which surgery is best to make you healthy as well as thinner.

Good luck to you and let us kow what the doctor tells you...

D:
Hello, welcome!

Can you share how long you have been researching WLS and what procedure in particular you are considering?

You are correct to think there is so much more than a few questions! You also brought up the topic of naysayers so I will address both things!

(Hope you have a few minutes to read!)



This is the long and short of it...RESEARCH RESEARCH RESEARCH! All surgeries have risks, all have benefits which one will be best fit for you and what risks are you willing to take and what potential outcomes are you looking for makes your decision oersonal!

Know that all surgeries have risks and benefits. Making an informed and educted decision is recommended for each of us individually.

We all have biases, we all have opinions and we are all right for ourselves; judging choices of others is not helpful. Sharing our experiences, strength and hope can be helpful IMHO. You will hear success with any surgry and you will hear failure as well. You will hear about revisions from any tool. NONE are magic or perfect!

I am pro WLS, whatever that means to an individual. I am glad we have choices! I originally researched the lapband after that I decided for me I wanted lap Gastric Bypass. Happy with my choice 6 yrs out....I can say I now beleive that BPD/DS would be my choice based on what I now know; but in 2002 I didnt have that choice with insurance or local surgeons.

You can spin statistics anyway you want...I can share reasons that the lap band seems great or why it seems a horrible choice...I can do the same for any surgery....GBP, Sleeve, DS, MGBP etc......

For instance one article stated Lapband and RNY at 5 yrs had both 50% excess wt loss, sure because that study did not include lapband failures, remembering that 30% of those with bands get them removed (complications, failure etc) when that is factored in RNY at 3 yr was 73% excess wt loss and bands were 37% big difference (different spin see!)...want articles I have them just email me off list [email protected]

Longer one has a band higher complicaation rates go, so early on seem low vs bypass later on exceeds greatly!

BPD/DS I feel is the surgery of choice for super morbidly obese, it has record of greatest excess wt loss over time...I agree a person with BMI over 50 the stats I have seen show that (band or proximal bypass) are not enough to impact comorbidities, 30-50% excess wt loss when one is 200# or more overwt is not worth risk, the Sleeve as step one and then BPD/DS as step 2 seems the way to go for many..Lap Bypass seems to not get Super Morbidly obese (BMI > 50) close to normal BMI either....it is not meant to.....

Sleeve and band may give same excess wt loss but sleeve changes internal hormonal mileu having greater impact it seems on metabolic issues like diabetes, appetite suppression. Bands are contraindicated with autoimmune disease like Lupus, Gastric sleeve is of choice fo those with Chrones disease over other malabsorbtive surgeries.....


What is surgeon recommending how high is your BMI, what is your age, comorbidities, what are your eating issues (sweet eater?) these all factor into a decision for you...
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Be educated be informed, remember all sites, articles and personal replies (mine included) come with disclaimer of some bias! You'd NEVER convince me to get a band EVER I have seen too many issues with close friends and those in my support groups I facilitate (erosions, slips, perforating stomach, port flips, infected ports, disconnected tubing... faiures on failures, defeating the tool getting revision to bypass more and more) but that is me...You probably wouldn't convinve me to get a proximal lap bypass again either due to the issues of stretched stomas, wt regain etc....but hindsight is 20/20! The BPD/DS is not perfect it is for the HIGLY motivated and compliant person due to nutritional issues for life that are needed to be monitored (not that RNY isnt either but seems distal bypass or DS more so).... Again my choices may differ greatly form others!

LOOK AT ALL YOUR CHOICES (what insurance will pay and what the surgeons around you do!)
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Here is a good short article as well........

Is Weight Loss Surgery Right for You?
Jennifer Parr

The choice to have weight loss surgery (WLS) is a major, life-changing decision. And for some, a decision made all too quickly. If you're considering WLS, slow down and examine closely the reality of WLS. You'll find that people who are committed to changing their lives will succeed, but those who think surgery is the easy way out could ultimately fail and/or have severe complications from surgery.
Find a reputable bariatric surgeon. Do some research to find out who is the best surgeon available in your area. Meet the surgeon and ask him or her as many questions as possible about the different types of WLS surgery available and what would be best for you. Also, talk about your current eating habits and learn what behaviors you will have to change following surgery. Learn what to expect from the procedure, what complications could happen, and how to recognize the warning signs.
Attend a local support group. Do this even before you make your decision about WLS. The support group members will answer your questions and offer information that you didn't even know to ask for! By having an established support network, you will be better prepared for the emotional roller coaster that could lie ahead, and have support already in place in case the "ride" gets a little scary.
Learn about your post-WLS nutritional needs. Find out what your surgeon recommends regarding the protein, vitamins, and supplements you will need following surgery. It's not a bad idea to sample protein drinks to get a sense of what you like, but buy individual samples instead of bulk amounts, because your tastes may change after surgery. Also, buy all the recommended vitamins and supplements prior to surgery. Some of the vitamins and minerals your surgeon may recommend include multivitamins, calcium citrate, B12, iron, and biotin. Check with your doctor for the exact amount to take and for recommended brands (not all brands of vitamins and minerals are as effective for WLS patients). Early on, chewable or liquid vitamins and minerals work best. You can also use a pill splitter/crusher. Larger pills can get stuck as they try to exit your new stomach, usually referred to as a pouch.
Plan to follow your doctor's instructions. Many doctors require a certain amount of weight loss before surgery. Following your surgeons instructions is essential to your recovery. People who do not follow instructions are more at risk for complications. Following the plan your doctor sets out for you after surgery will give you a much better chance of having long-term success.
WLS is a major decision. So, ask questions, get support, and make the right decision for you. Everybody is different. Find out as much as you can about the surgery beforehand, and make sure you fully understand the changes you will face afterwards. Then sit back, strap yourself in, and enjoy the ride of a lifetime. Remember, it won't be easy, but getting your health back is the thrilling reward for your effort! http://www.nawls.com/public/84.cfm?sd=2
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Breaking the News: The Who, When, and Why of Telling Others About Your Surgery
By: Terri Elofson Bly, Psy.D
Category: Weight Loss Surgery

To tell or not to tell, that is the question. Or at least, it's one of many important questions each person who is planning to have, or has already had, gastric bypass surgery must consider. Do you tell your family about the surgery? How about friends? Co-workers? And if so, when? Why is it important to tell anyone at all?
Last year, I conducted a study consisting of in-depth interviews with a number of men and women who had undergone gastric bypass surgery. One of the questions was, "How did others react when you told them about your plans to have the surgery?" I was surprised at how many of the participants replied something like this: "Well, they didn't react because I didn't tell them."
The decision to undergo gastric bypass surgery is a very personal one, and it is easy to argue that it is no one's business but your own. David, a married father of two, passionately defended his decision to keep quiet by arguing, "I certainly don't expect my female co-worker to announce to everyone that she is going to have a hysterectomy. Why should this be any different?" On the other hand, this surgery is quite different from a hysterectomy. First of all, it's much more noticeable; a change in one's uterus, no matter how dramatic, is easier to hide than a 10-pound-per-week weight loss. Furthermore, adjusting to the drastic nature of the surgery and the major lifestyle changes that follow can be difficult enough with a wide support network. Facing it alone can be overwhelming. Establishing a network of people who support you can serve as an invaluable resource during times of physical and emotional stress before, during, and after the surgery. The findings of the few research studies that have been conducted on this topic support what I have seen in my private practice: people who have a strong support system often have a more positive post-surgery experience than those who do not. That being said, there are often many obstacles that can make it difficult to confide in others about your plans for surgery, and no hard and fast rules exist that determine whom you should tell or when you should tell them. There are, however, some factors to keep in mind when determining when and how to form your own support system.
A patient I saw recently had not told anyone about his decision to have the surgery because he knew that his friends would have negative things to say about the surgery and he was not up to hearing it. He went on to explain that he was not feeling 100% certain about the decision himself, and he feared that hearing negative comments from others would lead him to change his mind. Perhaps you, like my patient, find yourself hesitating to tell anyone as you prepare yourself for the surgery, even keeping the information from close friends and family. If so, this may be time to engage in some self-reflection. What is keeping you from telling anyone? Are you embarrassed about having the surgery? Perhaps you still wrestle with fear or doubt about the decision, and are afraid to hear those doubts reflected in the faces and comments of those you tell. Asking yourself if perhaps your hesitation is because of your own fear, doubt, or shame is an important step in this process, and you may want to consider talking this over with a professional before having the surgery. Since most programs require a psychological assessment prior to surgery, you may want to take that opportunity to voice your concerns, as the psychologist may have some suggestions or resources for you - perhaps a few sessions of individual counseling - as you sort out your own feelings about the surgery. Becoming isolated from those who care about you the most is a high price to pay to avoid dealing with your own demons.
Another explanation patients often give for not telling close friends or family is that they do not want their loved ones to worry. One of the women in my study decided not to tell her elderly father, as she feared he would worry too much about her when he already had his own health concerns to deal with. Many patients are also painfully aware that the media focuses mainly on the horror stories, and they fear that those they tell will begin sending them clips of the latest surgery-related death, or lay awake at nights fearing for the worst. While this is certainly a possibility, it is also important to recognize that this is an opportunity to educate them about the realities of the surgery, to share your knowledge of the procedure with them, and answer any questions they may have about your decision. You might even want to invite them to attend an information session or support group with you. Many of the people I've spoken with said that once they took the opportunity to talk with their loved ones about the surgery, those individuals became much more supportive as the new information abated their fears.
Perhaps you are aware that some family members or close friends are adamantly against weight loss surgery, and you are concerned that telling them about your decision will cause rifts in these relationships. Weight loss surgery can evoke strong emotions, even from people who do not suffer from obesity. Rachel, a young college student, was extremely concerned about how her decision would impact her relationship with anti-surgery family members. "You know," she said, "just thinking about that huge disappointment that I thought others would feel...I had to decide whether or not I could live with that." Telling someone who is not supportive of the surgery certainly has the potential to create tension in the relationship. Not telling them, however, could also cause hurt feelings, as those close to you will likely find out anyway and will wonder why you kept such an important decision from them. It is important to ask yourself if, by not telling them, you are simply putting off the inevitable confrontation, in which case it is probably better to tell them sooner rather than later. Most individuals I've spoken to found that their family members reacted much better than they anticipated. Rachel's grandfather, whom she was sure was going to be angry, was quite proud of her for taking steps to improve her health, and they even bonded over their coinciding surgery experiences (he had recently had heart surgery). While it may take a few days or even weeks for your family to adjust to the idea of weight loss surgery, most will likely come around eventually and, if not exactly supportive of the surgery, will at least support you. Even when the conversation did not go as well as they had hoped, most people I have spoken to said they still felt empowered for having made the effort to explain their decision and stand up for what they believed was best for them, even if it meant disapproval from those they care about.
Most often, the reason people give me for not telling anyone about their decision is that they are embarrassed. David summed this up well: "It was humiliating to think that people would know that I was so fat that I had to have surgery. That I was unable to do anything about it myself." Obesity, for many people, provides many embarrassing moments. Consequently, these individuals are not usually seeking out new opportunities for humiliation. David was aware of his co-workers' tendency to gossip, and knew that if he told anyone at work, the news would spread quickly and he would soon become the center of attention - something he was decidedly uninterested in being. Some gastric bypass surgery patients experience their decision to have the procedure as an embarrassing admission of defeat. They cannot lose weight "on their own," and so they need the surgery to do it for them. Their perceived failure is something they prefer to keep to themselves, thank you very much. This rationale is pretty easy to understand, given the reality of the current cultural attitude toward weight loss surgery. I have spoken to many people about gastric bypass surgery, and am aware that nearly everyone, including those who have never struggled with obesity, seems to have an opinion about the procedure and its validity as a weight loss solution. Therefore, I also know that some people do in fact think of surgery as the easy way out, and do not hesitate to say so. For this reason, it certainly makes sense to assess your own comfort level with the wide range of possible responses when deciding whether to tell co-workers, casual acquaintances, or the check-out person at the grocery store.
The decision to tell or not to tell takes on new meaning once the surgery has been performed and the weight loss becomes noticeable. Everyone, including family, friends, co-workers, and the grocery store clerk, wants to know how you did it. Was it Weigh****chers®? South Beach®? Were you a contestant on "The Biggest Loser"? Or was it surgery? For some, admitting it was the latter feels like admitting that you did not really do it "on your own." While you know that losing the weight took a tremendous amount of courage, effort, and dedication, others may not see it that way. Ann, a soft-spoken teacher, says that when she tells people, they often respond with an "Oh," that she usually interprets as "Oh, so you didn't actually do it. Well, that's disappointing." David decided to tell his co-workers and other casual acquaintances that he lost the weight "just by doing the things you have to do to lose it." He added that he got so tired of explaining it to everyone, and dealing with all of the questions and opinions, that he simply stopped telling anyone that he had gastric bypass surgery. Rachel first decided to treat the inquiries as an opportunity to educate people about the surgery. But even she got tired of having to talk about it all of the time. "I want to be myself," she sighed, "and not just this woman who had gastric bypass surgery and lost a bunch of weight." The reality, unfortunately, is that in this weight-obsessed society people will want to know how you did it, may ask for updates for years afterwards, and will do so with varying levels of tact ("So, how much have you lost so far?" "Hey! Turn around so I can see how thin you are from behind!"). And unless you are comfortable turning heel and walking away with no response, you will probably need to come up with something. Your best bet might be to decide under what cir****tances you will tell the truth, and whether you will use something like David's approach in other situations. If you find yourself frustrated, tired, or embarrassed by the constant inquiries and comments about your weight loss, you might want to consider talking about it with a counselor, or seek support from those in the same boat, perhaps at a support group, with a friend who has had the surgery, or on an online message board for surgery patients.
It's a tricky business, balancing the need for support while respecting your own right to privacy. But the better prepared you are for handling the interpersonal aspects of weight loss surgery; the easier it will be to face them with pride and confidence.
Terri Elofson Bly, Psy.D conducts pre-surgery psychological assessments for several surgical weight loss programs in the Minneapolis-St. Paul area. She also speaks at weight loss support groups, for pre- and post-surgery patients. She is currently employed at Hoistad and Associates, a private practice in St. Paul. As part of her graduate studies, Dr. Bly received training at the Eastern Maine Medical Center's Surgical Weight Loss Program, a Center of Excellence in Bangor, ME.
WLS Lifestyles - www.wlslifestyles.com - Copyright 2006
http://www.wlslifestyles.com/printer-friendly.php?id=114

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When you're looking for a Bariatric surgeon/points to ponder:
http://www.amylhwilliams.com/questionsforsurgeon.html good link also

1) Check out info on this site: http://www.nydoctorprofile.com/ (*search under his name & look for any malpractice suits, payouts etc. You can ask about that). There must be a site for each state look up Doctor Profile + your state and google for a site!

2) Is he board-certified by the American Board of Surgery?
www.absurgery.org
American College of Surgeons?
http://web3.facs.org/acsdir/public/Detail.cfm?CHKDGTS=00299031800

3) Is he a member of the American Society of Bariatric Surgeons? http://www.asbs.org/html/about/membersearch2.html

4) What is the mortality rate (is the number of deaths) of the surgeon, the success rate (those losing > 50% of their excess wt at 5 yrs out)? Complication rates (wound infections, hernias, strictures, leaks, reoperation etc)? Average length of time in hospital.

5) The surgeon you find should be well experienced in the area of weight loss surgery (BARIATRICS). It's clear that the more experienced the surgeon, the lower the risk of mortality. Ideally, you would prefer to find a surgeon who has performed at least 100 of these procedures. (I say over 500!). I also recommend a surgeon who dedicates his practice to WLS, not one who does a case a week....

6) What you are looking for doesn't stop with numbers and statistics -- you will also need a multidisciplinary team one that includes: Surgeon, nutritionist, exercise physiologists, psychological support & support groups, that can be utilized pre- and post-operatively.

7) Look for a center or hospital that offers educational seminars to those who are just beginning the process so you can learn more about the actual procedure, the benefits, and the risks.

8) Is the hospital a Bariatric Center of Excellence? MOST insurances won't pay unless it is (I wouldn't go if it weren't!!!)
http://www.asbs.org/html/about/coe.html or http://www.surgicalreview.org/locate.aspx
http://www.facs.org/viewing/cqi/bscn/fullapproval.html

9) The preparation, both physical and mental, comes next, and is as crucial to the entire process as the actual procedure. Look to a surgeon that requires clearance from (what is indicated w/ your particular medical status) various doctors (psych/endocrine/hemotology/pulmonary/cardiology/nutrition etc). No this is not @ hoops this is making sure your health status is optimized before surgery. Preop smoking cessation, preop wt loss..etc.

10) What procedures does he do? Open or Lap? What is his follow up plan? Recovery time?

Education is a tremendously important part of the preoperative process & there is no question that there are major risks associated with the operation. However, those risks can be minimized by having a thorough preoperative workup so there aren't surprises during the procedure, and by making sure the surgeon is experienced and qualified. This is a courageous step for people to take, and it's not just about weight changing -- it's about life changing. SO take your time, find the right surgeon/surgical program for you for your life and your health and success long-term! WLS is a decision many of us make, but should not be made impulsively (*the average time one thinks about and has WLS is 2 yrs!) as we as MO people can feel quite desperate and see this as a last resort and can sometimes go with whoever is telling us they will perform, that may not be in our best interest!
EDUCATION IS KEY, AS IS A COMMITMENT & dedication to a healthy diet and exercise regimen, continual follow-up with doctors to monitor progress, and commitment to a new life.

Ask him all these questions or any others think of or you think of, if HE isn't right, find someone who is! After all you're putting your life in his hands and needing someone to care for you for life!!! Be an educated consumer of your own health! HUGS!
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Choosing Your Bariatric Surgeon
Robert Brolin, M.D.

The past several years have witnessed tremendous growth in bariatric surgery. There are more surgical procedures performed and every day there are new surgeons entering the field. There have also been "growing pains" including a higher number of complications and the increased cost of more operations borne by the insurance carriers.

The number of surgeons in many regions...has more than quadrupled during the past five years. Patients are now able to choose a surgeon within a reasonable distance from their home. So what criteria should patients use to choose their surgeon?

Experience

Experience can be divided into several components including:

· The number of years in the field;
· The number of operations performed;
· The variety of operations performed;
· The participation and leadership in professional organizations representing the field.

The available data suggest that the complication rate (including mortality) is directly related to the number of bariatric operations performed by individual surgeons and the number performed at a given hospital or medical center.

Board Certification

Certification by the American Board of Surgery demonstrates that a surgeon has:

· Completed training in a program accredited by the American Board of Surgery;
· Passed both parts (written and oral) of examinations given by the Board to young surgeons after completion of their training;
· Recertification via another written examination is required every ten years for established surgeons in order to maintain an active certification status.

ASBS Membership

The American Society for Bariatric Surgery (ASBS) is the only professional society in the United States that is entirely focused on bariatric surgery. In this regard, the ASBS has proposed guidelines for credentialing both bariatric surgeons and hospitals regarding the special needs of severely obese patients. The ASBS also offers educational seminars and courses for both members and other interested parties at the annual meeting and throughout the year. I strongly believe that competent bariatric surgeons should regularly attend meetings of the ASBS in order to remain current within the field.

To attain regular membership in the ASBS (preferred), a surgeon must be Board certified and in good standing in the local community.

Note that Affiliate members are either inexperienced (less than 25 bariatric operations), not Board certified, or both.

Strong Commitment to Follow Up

The outcome of every bariatric surgical patient discharged following their operation is a question mark. This is because weight loss typically occurs for more than a year prior to stabilization. Any surgeon who doesn't follow his/her patients for a least that long will have no idea regarding the effectiveness of the operation performed. Moreover, longer follow up is necessary to know if patients are keeping their weight off. I feel that regular long-term follow up is essential for obtaining the best weight loss results. Nutritional counseling should be available at each office visit.

Hospital and Office Facilities

It is extremely important that hospitals boarding bariatric surgical patients are supportive toward all components of the program. Be sure to ask the following questions:

· Are the anesthesiologists comfortable in managing morbidly obese patients?
· Is the nursing staff comfortable and well educated with regard to the special needs of bariatric patients?
· Does the hospital have special facilities for large patients (i.e., wheelchairs, beds, gowns, lavatories, etc.?)
· Does the hospital openly endorse/promote their bariatric surgery program?
· Are intensive/critical care physicians and facilities adequate?

Likewise, in the surgeon's office be sure to ask:

· Is the office staff courteous and knowledgeable with regard to the needs of bariatric patients?
· Does the staff understand the insurance problems and nuances associated with third party payers?
· Does the office have special facilities for bariatric patients (i.e., exam tables, chairs, scale, etc.?)
This article is reprinted with permission from Beyond Change, a periodical with information regarding obesity and obesity surgery, available at www.beyondchange-obesity.com.
http://www.nawls.com/public/135.cfm
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The single BEST piece of advice I can offer being ~6+ yrs out is this to anyone:
***Disclaimer some may consider this a no-brainer, others a downer, some a new view, psychobabble, whatever thought it is just my opinion, so take it for what it is worth, and it is meant to be helpful/insightful and thought provoking at a time so many of us are caught up with the right vitamin to take, amount of water to drink, etc.. it is meant to challenge beyond those tasks to see the small stuff matters but that there is a larger and more global view as well to consider!!!***

Establish your mindset to accept that weight loss surgery is not a cure/quick fix for morbid obesity, it's a very effective/powerful/wonderful tool that can be used lifelong to combat the chronic/lifelong disease of morbid obesity that has NO *current* CURE (*So at 1 yr out when many say 100# gone forever I sometimes shudder, it is never gone forever it is gone for now but the work has just started at 1 yr out IMHO). The tool is flawed and can be defeated as well (emotional eating, grazing, drinking calories, eating/drinking together, alcohol use, high calorie dense foods, too many simple carbs, overfilling pouch, carbonation, no consistent exercise routine). Considered WLS as part of a life-long process & commitment to challenge your personal awareness/responsibility/consistency/accountability and that a life-long requirement to follow up with physicians, a regular exercise program, and healthy eating. Accept it will come w/ potential challenges & imperfections (risks, side-effects, complications, challenges such as plateaus, not meeting goal, regain, possible depression, grief over the loss/safety of food/obesity may of offered/invisibility it offered although may of been unwanted at the time/the new attention you get, possible anger or anxiety w/o comfort of food as it used to be/limits it may impose, effort it requires to be healthy etc.) that these frustrations are part of the process to make you healthier see them as challenges not difficulties, positive self talk helps!. Your mindset will be the most important tool for success, as all the challenges of traditional diets/exercise plans for health will be present after WLS as well *Yup so many say I will never diet again, well let me say diets don't work *because people go off them* correct but you will have to be mindful of food and pay attention to intake and exercise for life, so in a sense your dieting for life! Even after WLS.... The surgery won't make a person change, but the beauty is YOU HAVE COMPLETE control over those changes/choices needed after surgery for success, the choices are there and the best use of the mind/psychology will harness those. Surgery is such a drastic choice that so many are successful due to a recommitment to healthy living and choices that is one reason it works and we say it is a 'rebirth'.

Changing habits pre -wls is the mindset that will keep you going, the surgery is a piece, the easiest/smallest IMHO. *It is however the milestone/landmark we set to focuses on. But truly the afterlife is the most challenging, the ever evolving challenges from things like getting in enough liquids to food introduction to vitamin taking, new ways of eating/drinking, introduction of exercise consistently to battling with the scale obsessions & disappointments as well as all the wonderful WOW moments. Have the support system needed to create the healthiest environment as well, willpower fades, the tools robust effects fades as well as the honeymoon closes...Harness your enthusiasm and mind for 6 months doing all you can to influence (not only wt loss) but the healthy lifestyle you want to adopt for maintenance, that elusive animal no one has mastered pre-wls. Exercise can become more routine after 6 months as well. Again the mind is just as/more useful than the pouch...it is the operator of the tool! Stress inevitable, so see each issue/stressful time as an opportunity to use your new tool/mindset! (Like I say use things as excuses or opportunities because holidays come and go each year as do parties, office food/celebrations, hurt feelings, sadness, losses, etc)


I know this isn't one message it is a million crammed into one right! Anyone who knows me knows I am never brief, this is my PASSION (giving back), WLS saved me from myself. It isn't easy or fair, but accepting life is imperfect just as the world we live in, embracing that imperfection and controlling what I can has helped me get thru many issues. There is no perfection, I work on that daily. So what to do about all of this babble?

Get a good journal, start writing today all the reasons you are COMMITTED to this change, what your expectations are (hopefully realistic for wt loss 50-80% of excess not an ideal body wt) and that the goals are not wt related alone, the functional ones how you can integrate into life easier, (clothes fitting, less medical co morbidities or risk of, less meds, less pain (physical/emotional) the benchmarks you are setting, take measurements and photos each month along w/ weights to document the journey. the mind is powerful but may be challenging to change so the photos/measurements help when the HUNKAMETAL doesn't register a loss. We are much more than a number on a scale, free from the numbers and see how much you are more than that as a person, your abilities etc....The journey is full of hills and valleys, some bumps and many more pleasures to see, it can be an awesome ADVENTURE!

The letter you may write/journal entry today may save you from backsliding at your first plateau or at 1 yr out, a recommitment to those thoughts, and how you have grown over time. These are the things I recommend. I think everyone else has you covered w/ the 'physical items you need'. These are the ever-elusive psychological things you need LOL!
OK if you have read this far thanks for hearing me out! I wish you well.
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Bariatric Surgery: A "Tool" in the Treatment of the Disease of Obesity
How much weight do you estimate that you lost in your life from diets or anti-obesity drugs? More importantly, how much weight do you estimate you have regained following weight loss programs? Did the weight stay off for less than a year? For two years? Is there anyone who suffered from morbid obesity who was able to maintain their weight loss for more than five years?
Long-term studies have found that approximately 2/3 of people who lose weight on a diet program will regain all of their weight within 2 years. Approximately 99% of individuals will regain all of their weight by 5 years post-diet.
With diet drugs, weight loss is generally around 5% to 10%, which represents a weight loss of only 10 to 20 pounds for someone who is 100 pounds overweight. Weight regain is unusually rapid when the drug is discontinued. And, long-term studies have shown that, even if the anti-obesity medication is continued, weight gain occurs over time.
Weight loss success for the morbidly obese is even more difficult. Most individuals who are morbidly obese not only regain all of their weight loss following conventional therapies (diet, exercise, behavioral modification, or anti-obesity drugs) but, generally, gain even more.
Why are conventional therapies not successful in treating obesity long-term? Conventional therapies fail because obesity is a disease - a progressive and life-threatening disease -not unlike cancer.
Once an individual has the disease of obesity, it progresses rapidly, affecting all body functions, often with fatal consequences. And, similar to cancer, obesity stubbornly responds to treatment. Even when the disease appears to be arrested, the reprise is generally temporary; the disease often returning with vengeance, causing even greater fat tissue proliferation and weight gain.
Studies have found that most individuals who are morbidly obese are not eating thousands upon thousands of calories each day. In fact, several studies have found that the individual with morbid obesity eats fewer calories more than someone who is normal weight but, even so, continues to gain substantial amounts of weight. Why?
The morbidly obese are essentially trapped in a series of fat-promoting biological cycles that cause a greater proportion of calories consumed to be stored as fat. What are some of these fat-promoting cycles responsible for the progression of the disease of obesity?
For one, obesity causes hormone changes, such as an increase in insulin, defects in sex hormone production, low growth hormone, and elevated cortisol. These hormone changes increase fat storage and/or prevent the breakdown of fat, thereby, causing even more weight gain and obesity.
The disease of obesity also alters activities of various enzymes that control fat metabolism, causing less fat to be burned for energy and more to be taken up into fat cells and stored, increasing fat cell size and total body weight. Furthermore, serious obesity (as well as childhood obesity) may not only increase fat cell size but also increase fat cell number. An increase in fat cell number, according to several reports, significantly reduces an individual's chance for successful and sustained weight loss.
Weight gain further enhances the spread of fat tissue by altering the production or actions of several important regulators of eating behavior. By altering these regulators, the disease of obesity may cause an increase in appetite, food cravings, or reduced satiety (feelings of fullness). These defects, in turn, are likely to promote further weight gain and progression of the disease.
To make matters worse, obesity causes numerous health problems that may reduce an individual's desire for physical activity, lowering the numbers of calories the body burns for fuel and increasing those stored as fat. And, ironically, obesity-associated health problems, including diabetes, hypertension, depression, and arthritis are often treated with medications that cause further weight gain.
Bariatric surgery helps to 'break' many of these obesity-promoting cycles, improving the need for medication, normalizing hormones and some of the weight-promoting eating behavior regulators, increasing physical activity and calories burned, improving metabolism, and resolving disease and the need for medications that can cause weight gain. The interruption of these vicious weight gain cycles with bariatric surgery, coupled with the restriction that the surgery imposes on nutrient intake, induces massive weight reduction.
With gastric bypass, as well as the biliopancreatic diversion and duodenal switch, weight loss is rapid and substantial. Excess weight loss one year after surgery is generally 70% or more. Studies have found that 5 years after gastric bypass surgery most individuals will have maintained 48 to 74% of their excess weight loss. One study found that even 14 years after surgery, average excess weight loss for over 600 gastric bypass patients exceeded 50%.
Bariatric surgery, therefore, is effective in inducing massive weight loss in individuals suffering from the disease of morbid obesity and in helping to maintain much of the weight loss for years and years. Still, the surgery is not a 'cure' for the disease of obesity.
Although it is extremely rare for an individual to ever regain all of their weight loss following surgery, some weight regain generally occurs. As discussed above, an individual may lose 70% or more of their excess weight loss with gastric bypass surgery and maintain a 50% or more weight reduction long-term. Although such a high degree of weight maintenance is considered exceedingly successful for the disease of morbid obesity, some weight regain does occur, evidence that the disease is not arrested.
Longitudinal studies of large groups of gastric bypass patients have shown that around the second post-surgical year there is generally a weight regain of approximately 5% to 10%. This increase in body weight tends to happen about the same time that many individuals complain of a 'reawakening' of some of the symptoms of the disease, such as an increase in appetite, food cravings, and a loss of satiety.
How, then, can an individual maintain all their weight loss after surgery? For continued maximal weight loss success, the bariatric patient must realize that their surgery is not a 'cure' for obesity but rather a 'tool' that can assist in keeping the disease 'suppressed'. The surgical 'tool' is effective in inducing and helping to maintain weight loss by substantially reducing total calorie intake. And, as mentioned earlier, the surgical 'tool' breaks those obesity-promoting biological cycles that contribute to the progression of the disease and prevent the afflicted individual from gaining control over their body weight.
The pioneers of obesity surgery recognized years ago that the surgery was not a 'cure' for obesity but rather a highly effective 'tool' that assists in halting the progression of the disease. These individuals worked diligently to see that the morbidly obese patient would have every opportunity for life-long weight loss success. Through their efforts, the National Institute of Health, the National Heart, Lung and Blood Institute, the American College of Surgeons, as well as the national and international societies representing bariatric surgery, all recommend that patients who have bariatric surgery be followed by a multidisciplinary team of obesity healthcare professionals.
The multidisciplinary team of professionals aids the bariatric surgical patient in making lifestyle changes that, with the assistance of the surgical 'tool', helps to keep their disease under control. The multidisciplinary team generally includes (in addition to the surgeon and clinical staff) a nutritionist or dietitian with knowledge of the specific nutrient needs of the bariatric patient, a mental healthcare professional who understands obesity and the psychosocial consequences of the disease, and an exercise physiologist or trainer who can prescribe physical activities that help to promote maximal weight loss success and long-term weight loss maintenance.
There are now several studies reporting the effectiveness of the multidisciplinary approach to the surgical treatment of obesity. The early findings of these studies clearly show that individuals who participate in such programs have greater weight loss success and long-term weight loss maintenance than do those who do not take advantage of the multidisciplinary program.
What can you as the bariatric patient do to keep you disease under control? First, recognize obesity for what it is - a progressive and malignant disease. Second, know that your surgery is a 'tool', rather than a 'cure' for your disease that can enable you to lose massive amounts of body weight. Third, recognize that the surgical 'tool' can help you to keep your disease suppressed and enjoy long-term weight loss maintenance, provided you are willing to make lifestyle changes necessary for long-term weight loss success including: 1) regular physical activity, 2) good nutrition and appropriate vitamin/mineral supplementation, 3) assistance in improving emotional status, and 4) continued involvement in a bariatric support group and in your clinical program.
Cynthia Buffington, Ph.D.
Cynthia Buffington, Ph.D., is the Director of Research for The Obesity Wellness Center
http://www.beyondchange-obesity.com/obesityResearch/bariatricSurgATool.html
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How To Choose A Bariatric Surgeon
So you're considering bariatric surgery. You are not alone. Over 100,000 patients this year will undergo some type of bariatric procedure in the United States alone. Media attention is at an all time high. Patients are evaluating their bariatric surgical options now more than ever. The number of surgeons performing bariatric surgery continues to increase each year. The choices for obese patients have never been more plentiful, but some would say they have never been more difficult.
Bariatric surgery was once a club, if you will, of dedicated surgeons who had great interest in the treatment of the morbidly obese. Over the last ten years, bariatric surgery has developed into a society and more recently by necessity evolved into an industry. With more and more surgeons claiming their "bariatric expertise" every day, patients now have more choices regarding bariatric surgeons. How does the patient choose a bariatric surgeon? Here are some points for you to consider:
What are my surgeon's credentials regarding bariatric surgery?
This is one of the most basic questions you should ask yourself and your surgeon. In this day and time of new technology and innovative techniques, almost anyone can claim to be a bariatric surgeon. Each day I receive across my desk brochures soliciting my participation in a "weekend course" to learn about bariatric surgery. These are programs where interested surgeons attend to learn about the field of bariatric surgery and discuss pertinent issues with leaders in the field. Attendance at one of these courses does not imply that one has been trained in bariatric surgery. These courses should be utilized as opportunities for interested surgeons to investigate bariatric medicine and evaluate the level of commitment necessary to embark on such a specialty. So know how your surgeon became interested in bariatric surgery, and ask what proportion of his practice is involved with bariatric surgery. Is bariatric surgery 10%, 40%, or 90% of their practice? Proficiency in this field is initially hard to grasp, and difficult to maintain, therefore I feel a dedicated bariatric surgeon should devote at least 50% of his practice to bariatric surgery to be considered a specialist by his peers. Did my surgeon receive special training in bariatric surgery within his residency program? Did my surgeon complete a bariatric fellowship? Is my surgeon board eligible/board certified? Is my surgeon in good standing with the state medical board? All these questions are important, and should be asked early on. Being technically able to perform a gastric bypass or place a LapBand does not a bariatric surgeon make. As I will discuss later, practicing bariatric surgery is more than just learning a surgical technique. I know from my practice, the operation itself is less than 10% of the total package, and I will discuss this further later.
What is my surgeon's reputation in the medical community?
This will tell you a great deal about your surgeon, because one physician cannot do it all. Bariatric surgeons should work closely with other physicians in their community when caring for bariatric patients. What does your family doctor think of your bariatric surgeon? Your cardiologist? Does your neighbor or an acquaintance that is a physician feel that your choice of a bariatric surgeon is a good one? Any "inside information" from the medical community could be very helpful.
Are other patients satisfied with my surgeon?
Any Internet chat room can help you with this process, but beware. Not everyone who is obese is a candidate for bariatric surgery. Be on the lookout for a disgruntled patient who had a bad experience with a particular surgeon, and spends his or her free time trying to trash that surgeon, that surgeon's office, and staff. Pay most attention to the majority, not the exceptions. Attend a support group meeting and ask other patients their opinion of their surgeon.
What are my surgeon's complication and mortality rates?
This can be difficult information to obtain, but the best way is to ask. Any respectable bariatric surgeon will be honest and open with you regarding these issues. Remember, some bariatric patients are quite ill prior to surgery, in essence making them great candidates for bariatric surgery. With pre-existing co-morbidities comes increased risk. This is not however a license for higher complication rates or high mortality rates. The accepted mortality rate (chance that a patient will die within 30 days of surgery) is roughly 1%. The accepted morbidity rate (chance that a patient will experience a complication of some kind in the immediate post operative period) is roughly 15%. These complications include things like wound infections, incisional hernias, deep venous thrombosis, and post operative bleeding. If you never ask, you will never know.
What is my surgeon's office like?
This is a very important observation that all patients make. First, start with the waiting room. Are chairs there you can sit in comfortably? Do the chairs have arms? Is the waiting room cramped? Then look at the examination rooms. Are the examination tables large enough for large patients? Do they have scales for weighing patients in excess of 500 pounds? Is the staff friendly and courteous? Does my surgeon have a bariatric coordinator who can be contacted easily?
Is my surgeon offering an operation or a program?
Some bariatric surgeons pride themselves on the ability to operate, and measure the success of their patients by the immediate postoperative course. Once a patient recovers from their surgery, the bariatric surgeon may dismiss them to follow up with their family doctor. This leaves the patient with little follow up in the weeks, months and years to come from a surgical standpoint. Most dedicated bariatric surgeons spend the majority of their practice in bariatric surgery, educating their patients pre- and post-operatively. The vast majority of their operating time is spent performing bariatric surgery, not just adding a gastric bypass or LapBand on if there is a shortage of hernia repairs or gallbladder excisions. Truly dedicated bariatric surgeons see this specialty as demanding of their time and resources. Their program starts with education and evaluation prior to surgery, and leads to life long follow up after surgery. The more comprehensive a program, the longer the process from first consultation to operation. Beware of the surgeon who sees you in consultation one day, and offers you a bariatric procedure the next week. Not much of a program there if you ask me. The more involved your surgeon, the more satisfied you will be.
What does my surgeon expect of me before and after surgery?
This is tied into the operation vs. program question. My feeling about bariatric surgery is that the operation itself is approximately 10% of the entire package, but a very important 10%. Information sessions are a great way to learn about the options for bariatric patients, and some surgeons require prospective patients to attend a free information session prior to an office consultation. One should not see this as an "unnecessary step". This gives a patient, but most importantly a patient's family or loved ones a chance to learn about this exciting opportunity at no cost and in a non-threatening environment. What about post-op? Long-term follow up is necessary, and in most elite bariatric practices, mandatory. Are labs checked, weights assessed with each visit, support groups offered and encouraged? In my experience, the success of a post-op bariatric patient is dependent on four major points: completing a successful bariatric procedure, taking daily supplements for the rest of your life, adherence to an exercise regime with a strength training element, compliance with a strict post-operative diet, and commitment to long term follow up and support group participation. If one of these elements is missing, the post op patient's level of success will be limited.
Is the hospital specially equipped for the bariatric patient?
This assessment can begin in the admissions department. Don't be afraid to ask questions, because without questions, you will get no answers. Are the chairs large enough? Do they have special wheelchairs, stretchers, and hospital beds? What about reinforced toilets or extra large bedside commodes? Are the gowns large enough to fit? Is there specialized equipment in the operating room, specifically an operating room bed that can accommodate a person greater than 500 pounds? Is anesthesia specially trained to care for the bariatric patient?
Is my surgeon a member of the American Society of Bariatric Surgeons?
Last but not least, one if not the most important question you should ask of your bariatric surgeon. Involvement in this society is considered mandatory for the true bariatric specialist. Members evaluate current research, discuss new techniques, and set standards for the society to follow. If you had a bad heart, would you seek the consultation of a cardiologist who was not a member of the American Heart Association? I rest my case.
These are just some suggestions, and take them for what they are. Remember; choose a surgeon and a program where you feel comfortable, even if you have to drive an hour or two out of you way. It is your choice and you are the customer.
C. Kenneth Mitchell, JR., M.D., F.A.C.S.
http://www.beyondchange-obesity.com/medicalMatters/howToChooseASurgeon.html

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RETURN TO WORK........


Consider asking what is typical for your surgeon for your surgery/age/profession what does he recommend?

Consider asking what he allows for people some will not release people for safety reasons before a certain time period. For example as a psych RN working in a hospital I needed 4 wk minimum to meet my job demands safely to avoid hernia to self. (this was for a LAP RNY!)

Consider that you will most likely not be eating at 1 1/2 wks as most programs do liquids 14 days. How will you be able to manage near constant sipping at your job (can you do this now) to avoid dehydration?

Consider at 1 ½ weeks not even eating and learning on the job with all those pressures how to eat slow, chew well and what will be safe foods that do not make you nauseated/vomit or dump....

Consider perhaps taking more time than anticipated as going back early is not as challenging as needing to take more time and cover that short notice wise.

Consider possible complications that could arise, I am not suggesting making a total what if list, just a contingency plan for what if you need more time for some reason beyond your control, prepare others too. For example I had a complication needed second surgery at 4wk out, I had developed adhesions that cut off my intestinal tract and making a obstruction/stricture at Y connection, this meant 4 more weeks of recovery so I was out 8 weeks. Sometimes things happen despite the fact we planned one way. Just being aware can help this.

Consider the time that is imperative to take care of your needs which are most important, relearning to eat, drink, take meds/vitamins, exercise and fit in the new lifestyle. Getting off in a rush may only delay or hamper you taking full advantage of the honeymoon/rebirth. So many of us focus on rushing back to life and forget to acknowledge this is about us and needing to focus on ourselves for success and happiness long-term. We get one honeymoon...I hope we use it to our full benefit. The hardship IMHO is going back too soon not taking the time needed not just to heal but to develop the me time to be successful it starts NOW!

Consider some go back in 1-2 wk without issues, consider I have seen people out months as the fatigue, nausea, etc really is too impairing. It is the extreme not norm but our bodies are undergoing a major stress/trauma. The world will go on, life, jobs etc without us they will find a way. IF WE CAN NOT AFFORD IT then it may not be the time for surgery. There are no guarantees 10 days will be enough, or 4 weeks will be enough...

Consider that you probably are eligible for short-term disability, to augment your leave time.

Ultimately when you go back is influenced by many factors some you can influence and some you have no control over. Asking what is typical/expected can give you a good gauge and being open to needing more helps as well. I tell people the best time to have surgery may not be today it may be in a few months so consider that also.

Be well although I think 1.5 weeks may be cutting it WAYYY TOO close in many ways I feel more important it short changes you! Take all the time you can possibly to be well and safe. Some will go back no matter what, 4 weeks may be great and 2-3 average...where there is a will there is a way..even if it means waiting....
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NAYSAYERS......
It is common for friends/family members to respond to "OUR" choice
to have surgery in non-supportive ways. There are many reasons,
including jealousy, fear, concern etc; because what we do effects
those closest to us. They may be uncomfortable, frightened, unable to
adjust easily. All we can do is include them in our process so it may
be beneficial to us both, educating them but ultimately if they
adjust is their choice and beyond our control. We can assist in
asking clearly and directly for what we need (it is then their choice
to give it or not); ultimately this is our process and all we can do
is be self responsible (w/ or w/o their support) for our journey. We
can keep the lines of communication open, letting them know our
feelings, as well as appreciation when they can offer support. Best
case scenario is over time they can see we didn't take the 'easy way
out', can assist us in our success and believe in our ability to make
the tool work for a lifetime despite its limitations, and deal w/
their own feelings vs projecting them onto us if they are upset,
angry, fearful so not to sabotage our efforts. We do not need police
or critics, we need supporters/cheerleaders and empathetic
listeners who can truly be there for the good/bad/ugly. It is not a
competition but many friends/family can see it that way as quite
threatening indeed. We ultimately can surround ourselves w/ positive
energy and support or negative energy. It is a beautiful journey one
that can assist us in loss of wt but growth in self esteem and
personal growth to a healthier way of communicating in relationships,
it may involve leaving sabotaging and unhealthy relationships so we
can fully blossom, no longer being a victim of our cir****tances,
many times our self worth can keep us positive and enable us to choose
healthier coping and healthier choices in communication and
relationships. WLS can give us so much more than our physical health
if we work at it! Our significant relationships can thrive and
benefit as we get healthier, as we learn to love ourselves from the
inside we will have so much more love to give others, vs the old self
loathing and hate many had....As we work on the sabotaging
relationships and any efforts those around us make to instill us with
Fear (of abandonment/punishment), use of obligation or guilt to
revert to old habits, make us feel selfish for our own wellness/self
care. Learning to id these emotional blackmail techniques and ways to
use boundaries, communication, negotiation either from some self help
reading on the topics or therapy can be our best tool to deal w/ the
changes WLS may bring to our lives/relationships, challenging yes,
impossible no...Sometimes distance or leaving a relationship is our
only choice but better than regain due to sabotage, NOONE has any
intention at regaining wt after WLS, sadly it happens and all to
frequently relationship stressors can be a major trigger to old
emotional eating patterns, slowly they can resurface, after all we used
them for years, it is not so easy to change (for ourselves or others).

For me I try and listen to what they are really saying before I get
defensive, "I hear you are sad because or you seem angry because,"
Sometimes a simple acknowledgment (not agreement) is all anyone
needs/wants. Offer that and agree to disagree, or finally use the "I
feel, or I statements taking 'blame/judgment' out of the scenario
which can escalate a situation.

Be well! It is a glorious journey one we would love to have assistance
on, we can ask but sometimes we do not get, but we can get thru it!
Support can come in many forms, online, in person support groups,
places u may of never thought!

==================================
Preparing for Weight Loss Surgery

http://my.webmd.com/content/Article/101/106101.htm?printing=true
By Heather HatfieldWebMD Feature Reviewed By Michael Smith, MD
From psychological exams to support groups, weight loss surgery takes thorough mental and physical preparation, but most importantly, it takes commitment.
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Ø BOOKS:
Ø Weight Loss surgery: Finding the thin person hiding inside of you Third Edition By: Barbra Thompsons: http://www.wlscenter.com/ or at www.amazon.com ISBN: 1932205306
Ø Weight Loss Surgery for dummies http://www.dummies.com/WileyCDA/DummiesTitle/productCd-0764584472.html or http://www.amazon.com/Weight-Surgery-Dummies-Marina-Kurian/dp/0764584472 ISBN-10: 0764584472
Ø The doctor's guide to weight loss surgery How to make the decision that could save your life By: Dr. Louis Flancbaum ISBN: 0553382462 http://www.wlsguide.com/Foreword.html or www.amazon.com
Ø This is NOT Brain Surgery...But There IS a Magic Pill!
by Teri Kai Holtzclaw *I have in PDF file form email me if you want it.
Ø Become You by Teri Kai Holtzclaw ISBN: 0971260125 available at: http://www.obesityhelpstore.com/books.html
Ø The Success Habits of Weight Loss Surgery Patients By Colleen Cook $22.95 available at: http://www.bariatricsupportcenter.com/
Ø Exodus from Obesity; The Guide to Long-Term Success After Weight Loss Surgery. is $24.95. http://www.paulapeck.com/
Ø The Emotional First + Aid Kit--A Practical Guide to Life After Bariatric Surgery http://www.bariatrictimes.com/obesity-medical-books.cfm or amazon may have it cheaper $25 Author: Cynthia L. Alexander, PsyD
Ø Dying to Change: My Really Heavy Life Story, How Weight Loss Surgery Gave Me Hope for Living by Katie Jay & Small Bites: Daily Inspirations for Weight Loss Surgery Patients http://www.nawls.com/products/department4.cfm
Ø Gayle Andres's "Living a Lighter Lifestyle; A guide to successful wt loss and maintenance after WLS" *Not sure if still in print? Try amazon
Ø Dr. Simpson's books starting with WLS a lighter look at a heavy subject, getting to goal and staying there and losing the last 30#. http://theweightlossdr.com/store/index.php?cPath=21
Ø MAGAZINES:
Ø ObesityHelp Magazine $25/year 6 issues/yr publication http://www.obesityhelpmagazine.com
Ø Beyond Change newspaper is awesome! http://www.beyondchange-obesity.com/
Ø WLS lifestyles $24.95/year a quarterly magazine http://www.wlslifestyles.com
Sites for books etc. also:
http://www.obesityhelpstore.com/
http://www.bariatrictimes.com/ free articles online and old issues!
http://www.livingafterwls.com/Library.html
This link has tons of good articles
http://www.bariatriceating.com/bafhe.html
http://www.bariatricoperation.com/articles.htm
http://www.asbs.org/ look at links to right!

Some sites to sign up for free newsletters via email:
http://www.livingafterwls.com/Newsletters.html
http://www.bariatricsupportcenter.com
http://www.drsimpson.com/
http://bariatrictimes.com/subscribe/
http://www.believenewsletter.com/
http://www.wlscenter.com/
https://www..barimd.com/newsletter.php?practiceId=7
http://www.aboutmso.com/ep/sg-patientcorner.cfm
http://www.nawls.com/public/department65.cfm
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Gastric bypass is no quick fix

By Heather L. Connors

Take Care,
Jamie Ellis RN MS NPP
100cm proximal Lap RNY 10/9/02 Dr. Singh Albany, NY
320(preop)/163(lowest)/185(current)  5'9'' (lost 45# before surgery)
Plastics 6/9/04 & 11/11/2005  Dr. King www.albanyplasticsurgeons.com
http://www.obesityhelp.com/member/jamiecatlady5/
"Being happy doesn't mean everything's perfect, it just means you've decided to see beyond the imperfections!"