The Results of the Bariatric Surgery Seminar

It has begun. I am on the road toward bariatric surgery, which will assist me in reducing or eliminating many of the complications that I have incurred as a result of my weight: diabetes, sleep apnea, high blood pressure, and cholesterol. I’m tired of watching my body and health deteriorate because of my life-long problems with food. Despite the fact that I have tried to lose weight since I was a child, those attempts have resulted in short-term weight loss and long-term weight gain every time. I feel hungry and I shamefully feel powerless against the pangs to gorge.

On Saturday the surgeon held a bariatric surgery seminar, which is the first step in the process. He presented the information on both the gastric bypass surgery (called Roux-en-Y) and the lap band surgery. Both, according to Christopher Edwards, M.D. are good surgeries with excellent results. The lap band, however, is quickly becoming the surgery of choice because of the lower rate of complications and the ability to adjust the restriction of food. I am going to summarize my understanding of the information presented at the seminar to give a better understanding of why I am choosing one procedure over the other.

ROUX-EN-Y VERSUS LAP BAND

ROUX-EN-Y (Gastric Bypass)
Weight Loss: Slightly Higher and faster
Complications: More
Risks: Higher
Procedure: Laparoscopic but more invasive
Hospital Stay: Day or Two
Deficiency: Calcium, B12 and Protein
Adjustable/Reversible: No
Dumping: Yes
Pros: Higher weight gain and more long-term studies.
Cons: There are more complications, side effects and it is not reversible or adjustable. With gastric bypass, you can stretch out the egg-sized pouch and then you taken in more calories than you should. This is common after several years so the patient must be diligent in sticking to the strict dietary requirements or the weight may come back.

LAP BAND
Weight Loss: Slightly Less (55-62 percent) and slower
Complications: Less
Risks: Lower
Procedure: Laparoscopic and less invasive
Hospital Stay: Outpatient
Deficiency: Protein. Must take a multi-vitamin
Adjustable/Reversible: Yes
Dumping: No
Pros: It is reversible and adjustable. The surgery is less invasive and there are fewer side effects and complications. The egg-shaped pouch tends not to get stretched because with lap band, when you eat too much, then your body tends to vomit it back up rather than overstretching the pouch. Your stomach and intestines are not surgically altered for life.
Cons: There is slightly less weight loss associated with the band. Too much vomiting can cause band slippage requiring a surgical procedure.



DIETARY REQUIREMENTS
Calories Per Day (up to six months): 600 calories per day
Calories Per day (6 months-life): 1,000-1,500 calories per day
There are strict dietary requirements in the weeks and months after the surgery. I don’t know those details, but I will be presenting them when I find out. I do know that the diet consists of higher intakes of protein.

HOW DOES LAP BAND WORK?

A silicone band is placed around the top of the stomach, creating two stomach pouches. The pouch at the top is about the size of an egg and the opening into the larger pouch is about the size of a dime. When the person eats, the food sits in the pouch. This does two things. First, it fills the pouch and then the pouch sends signals to the brain that the stomach is completely full. Patients report that they feel full. The second thing this does is allows the food to sit in the small pouch and trickle into the larger portion of the stomach. By doing so, a person’s feelings of being full last longer. The rest of the body digests and works as it always has. There is no poor absorption of vitamins and nutrients (as with gastric bypass). There is just a restriction of food.

The band itself, when around the stomach, does not restrict food. The lap band has a cord attached to a port. The port is located under the skin on your left side. The surgeon sticks a needle into the skin and port and fills it with saline. This blows up a balloon on the inside of the band and causes the restriction. This can be adjusted as needed throughout the patient’s life.



IF YOU STILL EAT LESS, WHY DON’T YOU JUST DIET AND EXERCISE?
That is a good question and one that I have asked myself. Why do I need surgery? Why don’t I just hire a personal trainer and eat more healthy foods and smaller amounts. That is the natural way. I can’t argue with that logic. I can just tell you that I have tried that with no long-term success. My hunger eventually overtakes me and I am right back where I was, or worse, I end up heavier.

The way the lap band works is to trick your body into feeling full on only a small amount of food. True, a person will lose some weight by eating less, but as the question above states, it is more than that. The surgery does not fix a sedentary lifestyle nor does it replace proper nutrition and exercise. The surgery is not it. The entire process requires a change of thought and attitude – of lifestyle – in order to achieve real success. That is the hard part and it involves will power and determination just like a typical diet. The difference is that the person feels full after lap band surgery and does not have to deal with always feeling hungry.



ISSUES RESOLVED WITH BARIATRIC SURGERY
The following numbers from my surgeon’s presentation, are the numbers of people who report they no longer have issues with the condition.

• Type 2 Diabetes: 95%
• Hypertension: 92%
• Cardiac Function: 95%
• Sleep Apnea: 75%
• Stress Incontinence: 87%
• GERD 98%
• Cholesterol 97%

PSYCHOLOGICAL SIDE EFFECTS FROM BARIATRIC SURGERY
(This piece of information has come from Internet sources and from the presentation)
Bariatric surgery is not all good. There are issues that come up after these procedures. Psychological factors arise that people do not realize or are not ready for. Cases of divorce and suicide have occurred as a result of the surgery. Divorce can happen for several reasons. The patient may lose weight and start getting attention from interested parties that they are not used to. This can lead to adultery. If both spouses are overweight and only one gets the surgery, then there can be jealousy on the part of the one who is not losing weight. If a marriage was rocky to begin with, then the weight loss will not fix the martial problems and can increase them.

There have also been cases where people have been unable to deal with their new body. Their friends and family may treat them differently, they may get divorced and they may feel all alone, leading them to suicide. These issues cannot be dismissed out of hand, but must be considered carefully.

The surgeon stressed that family supports are the most important factor in this process. The surgery, he said, is very easy. The hard part comes afterwards and a person must be in a supportive family unit in order to see success and be healthy and happy afterwards. In my case, my wife and I have a remarkable, loving and trusting relationship. We are not cheaters, either one, and neither of us are jealous. I don’t think these will be issues for us, but they are things to consider.


FAMILY SUPPORT
Besides my wife and daughter, my parents are supportive of this decision. My friends and I have only talked briefly, but I think they too will be supportive. There is a difference between support and concern. My wife and parents are especially concerned about the surgery and the after affects. They are scared that I will die, have complications, or that everything will change. I know my wife is struggling (I write this with her permission) with the fact that I will be a new person. I will have a new body, a new degree, and a new job. She is scared that she will be with a completely new guy. She also worried that the new me will not like the old her. She is also slightly overweight and she worries that I will not be attracted to her any longer. It is a fair concern and I would expect anyone to be fearful. Change is very scary. My role in all of this is to reassure her that my physical change does not affect my emotional connection with her. She is my soul mate and I love her very much. She loves me fat or skinny and I love her fat or skinny.

My family will need outside support and they will need support from me. I will have to remember that this is a hard process for them as well and that I am not the only one struggling. And this will be a struggle. The surgeon made no bones about the fact that this is hard. The surgery does not make this easy. A quick Google search will tell you that. The surgery is the easy part. It is after the surgery that the work begins.



THE LAP BAND CHOICE
I am choosing the lap band for several reasons. The sense of feeling full on an amount the size of an egg is probably the most appealing to me. The fact that it is less invasive, adjustable and reversible appeals to me. Not that I want it reversed. I don’t. Let’s say a patient with the lap band, God forbid, gets cancer. The person will need to be able to get more nutrients during chemotherapy. During an office visit, the surgeon takes out saline so you can intake more food. It takes all of five minutes in the office. Same thing for a woman who has a lap band and then gets pregnant. The surgery is done under general anesthesia but it is outpatient surgery. Most people go home that day.



NOW WHAT?
There is a strict procedure and requirements to follow in order to be considered for bariatric surgery. Because of my weight and other issues I am eligible for the surgery. Now I must go through the process, which is as follows:

1. Attend the bariatric surgery seminar
2. Fill out the paperwork
3. Office visit with the surgeon
4. Office visit with the nurse coordinator
5. Nutritional evaluation
6. Behavioral therapy evaluation
7. Psychological evaluation
8. Rehab exercise evaluation
9. Submit request to the insurance company
10. Schedule surgery

DISCLAIMER
I am not a member of any medical field – not a doctor, nurse or anything else. The information presented here should not be used to for any kind of medical decision. It is presented here strictly to help my family and friends understand my decision and help give them an idea of what is going on, why I choose the lap band over the Roux-En-Y, and to help them make sense of what is going on with me. Always consult a physician and don’t quote me.