Weighty Matters

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Medical Necessities

on July 4, 2012

A dear friend has started the process to have weight loss surgery.  She’s chosen a surgeon and attended his seminar about different options, then met with his surgical coordinator.  Now she needs to schedule the many appointments with different specialists and have a number of examinations and tests.  These are all medically necessary to give an accurate picture of her overall health and clear her for the surgery.

About this time last year I first went to a weight loss seminar and then to the consultation with the surgeon.  Before I left that appointment, they gave me a letter for my primary care physician which listed all of those many tests.  I already knew by then that my health insurance plan wouldn’t cover the actual surgery, but when I looked at the required procedures, I crossed my fingers and hoped that they would at least be covered.  Thankfully, they were, probably because there wasn’t a single test that a doctor wouldn’t reasonably prescribe for someone who is super obese.

Over the next few months I was scanned, scoped, poked, prodded, tested, examined and asked the same questions about my personal and family health history over and over and over again.  In case you’re wondering, by the time the pre-surgical procedures were complete, I’d had:

  • Extensive blood tests — twice
  • A cardiologist exam, EKG, chest x-ray and echocardiogram
  • Pulmonology study and two overnight sleep tests
  • Upper and lower G.I. endoscopy
  • Psychiatric evaluation

Many bariatric patients also have to undergo a nuclear stress test.  I’d had two of them five years prior and neither time was fun.  When the cardiologist told he he didn’t see the need, I almost hugged him in the office and did a happy dance on the way out.

I share all this because, honestly, a lot of people don’t realize how involved the journey is before you even have the surgery.  I also know that most of us would skip as many of these tests as we could if the doctors and hospital would let us get away with it.  I sure would have and that would not have been in my best interest.  In fact, it would have been an enormous risk.  Not that risking my health was anything new to me.  Look how long I’d been obese, than morbidly obese, then beyond that — all the time knowing, but shutting out of my mind, that I was risking early death from heart attack, stroke, cancer or numerous other conditions.

Then we can factor in that many extremely overweight people avoid going to the doctor even for regular check ups.  I was better about that in recent years, but there were stretches of time before when I neglected to have even the most important, routine examinations.  I metaphorically buried my head in the sand and ignored common sense and rational thought.  Over the years, I hated going in for checkups or anything else, pretty much because I didn’t want to face the scale and the doctor and hear the lecture I knew I deserved.  Because of this, God only knows how long I had high blood pressure and Type II diabetes before I was actually diagnosed and put on medication a few years ago.  I’ve probably suffered sleep hypopnia for several years, too, but never got tested until last fall.

The worst experience of getting lectured by a doctor happened in 2007 when I had acute gall bladder problems.  Suffering great discomfort, I finally went to see the doctor.  After asking a few questions and examining me for five minutes, he concluded it was my gall bladder and wrote orders for further diagnostic tests I could have the next morning.  He was positive I’d need surgery and arranged everything so that I could have it after the tests.  He then launched into a lengthy scold of why I absolutely had to have weight loss surgery.  I was literally lying in pain on his examination table while he went on and on and on.  I just nodded and told him I’d think about it, but right then I was only thinking about getting through the night.

The following morning I went into the hospital where a scan confirmed that a sizeable gall stone had blocked a duct.  An hour later I was in surgery.  The following day when the doctor came in to write my discharge orders, he took the time to lecture me again about weight loss surgery.  In fact, he came thisclose to telling me I was stupid to put it off.

Looking back, I realize that, even though he’d done the surgery laparascopically with less invasion, I could have died just from the anasthesia because we really didn’t have a clear picture of my overall health.

So last fall, when I got the list of what I’d need to do before I would be cleared for the bariatric procedure, I didn’t really complain.  I’d come to see the medical necessity of learning everything we could about my condition inside and out.   When all was said and done, I was pretty happy with the results.  Hypertension, sleep hypopnia and high blood sugar aren’t great, but hot damn, the results could have been so much worse.

It is so much better and healthier to not blind ourselves to our own reality.  Not investigating whether problems exist does not mean they won’t develop.  It’s enough of a risk to be overweight without ratcheting up that risk level by ignoring life-threatening problems.  I’d urge anyone who is obese, whether or not they’re contemplating weight loss surgery, to bite the bullet and go to the doctor.  Get an in depth assessment of your condition.  Find out if there’s something bad going on in your body and treat it.  Not matter what happens after, you’ll be better off in those moments.

By the way, now that I’m almost six months post-surgery, conditions are improving.  I haven’t taken Metformin since the surgery but my blood sugar has dropped around 50 points.  My blood pressure is consistently lower than it was even though the medication is the same.  I won’t be surprisd if the doctor has me try going off one of the two pills to see how I do.  I feel like my heart is strong, my breathing improved, and my body stronger than I ever guessed.  Best of all, it’s only going to continue to get better from here!



4 responses to “Medical Necessities

  1. hoperoth says:

    It makes me so happy to read your updates about how happy and healthy you are. 🙂

  2. Mary Stella says:

    Thanks so much, Mary and Skye. Even though the very process of writing about my experiences – present and past – helps me, it means a lot that you and everyone come here to read. You add to my journey with your presence and the comments very often provide insights for me to consider.

    I was really tired when I wrote this post last night and realize now that I probably should have mentioned the medical follow-up because that’s been really thorough too. I saw my surgeon a week after I was released from the hospital and then monthly for the next three months. Mid-way through, they required another full blood work up with extra vitamin panels. Thank goodness for my health insurance because the bill would otherwise have reached over $2000.00. (Even though my insurance plan didn’t cover the actual wls, it did pay for those pre-surgery evals and the post-op bloodwork.)

    Bloodwork is so important to track that everything inside is correctly functioning. Eating such small amounts could lead to vitamin deficiencies. Mine came back pretty good overall, but the doctor did ask me to add a B-complex vitamin to the other supplements I was already taking. (Multi-vitamin, Calcium with D, B-12.) I also take krill oil capsules for Omega 3 fatty acids since I don’t eat fish and couldn’t possibly chow down on enough walnuts. Omega 3s are good for your heart, skin, hair and, according to the optometrist I saw on Monday, eye dryness.

    Another thing that I learned is that we shouldn’t take our multi-vitamin and our Calcium at the same time. Something in one counteracts the other. So I take the calcium with me when I leave the house and take it 30 minutes later.

    Regarding the VSG, I’d never heard of it until I started my research last year. At the time I thought that the gastric bypass was my only choice since I didn’t think gastric banding would work for me. I was positive I’d find a way to eat around the band. I very recently learned of yet another procedure called the iband with gastic plication. In this choice, instead of cutting away 70% of the stomach and removing it (VSG) or stapling off 70% of the stomach and leaving the flap in while also rerouting part of your digestive system (gastric bypass), the surgeon folds up part of the stomach and sutures it closed which forms something similar to my sleeve, and then the patient also gets a band.


  3. Mary says:

    It’s a pleasure to soak up your happiness through your blog! But I’ll read even if you have a bad day.

    I agree with Skye.

    I’d never heard of the VSG until I read your blog. Curiosity made me research it, and I can see why you chose that WLS. Odd thing is, I realized my mom had what must have been essentially a VSG before I was born. She had ulcers and at the time partial gastrectomy was a treatment. Small world.


  4. Skye says:

    Wow, that’s an amazing amount of testing you have to go through before surgery. Sounds essential, though. I’m not sure if they go thru quite that level of testing for cardiac patients: my friend had to insist, against his doctor’s, his wife the doctor’s, and the insurance’s wishes for some tests that did indeed prove he needed bypass surgery in January. It’s been just six months since the surgery and, due to a several month long PT program after he got out of the hospital, he’s strong and healthy and able to do virtually anything. Very different from his surgery 30 years ago when his hear problem first occurred! But he didn’t go thru quite the range of tests as you did. Maybe that many just aren’t required.

    I’m so happy that you continue to do better, day after day. It’s a pleasure to soak up your happiness through your blog! But I’ll read even if you have a bad day.

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