A BIG DECISION - A LONG POST

In the weeks prior to our high school reunion, I was e-mailing back and forth with my good friend.  I was talking her into coming to the event (she has been my date for all the previous reunions) plus it is pretty much the only time I get to set eyes on her.

 Suddenly the topic changed and she asked me if I had ever considered weight loss surgery.  I told her I had gone pretty deep into the pre-op planning about 8 years ago before we lost our coverage - why?  Well, turns out she would like to help me pay for it.  It was one of those "life turns on a dime" moments.  I said I would look into it and we would talk.

Turns out my insurance company not only doesn't cover it - they won't cover anything at all related to it, ever.  They were very emphatic!  Wow.  I got the feeling they had put me on a watch list just by inquiring!

So then I looked into the options.

Eight years ago I had planned on  the Duodenal Switch which is a reduction of the size of the stomach itself and then a re-routing of the intestines which creates a "malabsorption" effect.  It is considered the riskiest, most complicated surgery but the life long weight loss, maintenance and reduction of other weight related problems is the best. It is the only surgery which allows, over time, for me to eat somewhat normally, drink alcohol and take Nsaids. Considering my arthritis - I need that! There is a significant vitamin regimen and certain foods will likely cause distress - like refined carbs and sugar. But apparently it is different from person to person.

They also offer the "Sleeve" which is just the reduction of the stomach size but leaving the pyloric valve, which some of the other surgeries, like the popular Roux en Y, removes.  The new popular one is the Lap Band which is an inflatable band positioned at a spot around the upper stomach.  It can be inflated or deflated to alter the size of the pouch for food to be digested and slipped through into the rest of the stomach.  It is the easiest and least expensive surgery but there are lots of issues with the way you can eat and what you can eat and it requires frequent adjustments (ongoing costs).  There also seem to be a lot of ways to circumvent its effectiveness - not that I would set out to do that...

Anyway, I researched and went on weight loss forums and blogs and learned more than I wanted to know about the different types and how they have affected people and I came back around to the DS.  The DS costs between $30,000. - $40,000. Hard to pin down  (and why the range?), but that is the way our health care works in this country.

My friend and I talked and the amount of money she is offering is not going to cover my surgery of choice.

More research, and the answer has been found. They call it "Medical Tourism."  Going out of the country for medical care which is priced much higher here. 

I am communicating with two surgeons in Mexico and the cost for the same surgery plus a longer hospital stay is  $11,000 and $13,000.  Both are highly rated, very experienced surgeons working out of hospitals.  I have communicated with a dozen of their previous patients and read, probably 50 testimonials and blogs and other writings about them. Can't find anything bad about them - no complaints; more than I can say about some of the US surgeons and hospitals.

Plus, by circumventing all the BS that the US docs do (which runs up the costs) I can get a surgery date in weeks instead of 6-12+ months.

I also discovered a number of post-op people who have taken to YouTube to chronicle their experiences.  YouTube seems to attract a certain kind of person, at least on this subject.  Let's just say they like to hear themselves talk.  There are glimmers of good info, but for the most part - not so much.

However, the benefit of YouTube is the visual. For the topic which concerns most of us very large women it is:  what happens after the weight is lost?  What remains?  Answer:  Lots of skin.  The women brave enough to show it prove that it is not pretty.  In fact, it gave me great pause.  The likelihood of being able to afford plastic surgery is slim to none. 

That shut me down for a couple of days.  No - in truth, I went on a bit of a binge.  After all, when stressed - eat.  How crazy is that?

And yes, I know that having this surgery will mean big changes to that particular issue of mine.  I have given a great deal of thought to it and also read a lot about it.  I know that there are people like Carney Wilson who managed to circumvent the surgery and gain weight back and I don't want to be one of those people.  This is my opportunity to make the changes that need to be made.  Like one guy said on a forum: "I went into surgery a fat guy and I came out as a skinny guy.  I decided to live that way the rest of my life." 

The surgeon required a low carb, low fat diet for at least the week or so before surgery.  I had pasta for dinner tonight and that is going to be the last time for a long time.  Maybe forever.  It will be worth it.

GEE, THANKS FOR THE HELPFUL NEW STUDY

The folks that are getting everyone confused about what medical tests they should or shouldn't have and how ofter are making recommendations about weight loss.  They suggest that doctors:

should screen all adult patients for obesity during office visits and either refer obese patients to comprehensive weight-management programs or offer them one, says the U.S. Preventive Services Task Force in new recommendations announced Monday.

Wow.  Ground breaking.  And do these folks actually believe that weight is not under discussion already during these visits?  Do they think obese people have not already looked into and probably tried some of these programs?

They go on to say:

studies show that comprehensive programs can lead to a loss of about 6% of obese patients' starting weight, or roughly 9 to 15 pounds, the panel says. That amount of weight loss may reduce their risk factors for heart disease, the panel says in its recommendations, published online in the Annals of Internal Medicine.  If you're obese and you "lose 5% of your weight, you're doing your body a favor."

Really?  If I lose 15 of the 140 pounds I should lose then my weight loss program is a grand success? 

They say:

After reviewing 58 weight-loss studies, the task force found that there is adequate scientific evidence to show that moderate to high-intensity comprehensive behavioral weight-loss programs with 12 to 26 sessions in the first year can help people lose weight.

The best programs often include both group and individual sessions and focus on setting weight-loss goals, improving diet and physical activity, and helping patients monitor food intake and exercise.

"These types of programs really focus on changing your lifestyle," Grossman says. Physicians can refer patients to registered dietitians, exercise physiologists, personal trainers and others who direct weight-loss programs, he says. "Some commercial and non-profit weight-management programs offer many of these features."

Is my very expensive insurance going to help pay for these programs, trainers and dieticians?  No.  Didn't think so. 

I know that my weight issues are laregly psychological and some people, maybe a lot of people, just don't understand the rules of healthy eating and living.  Some people I have seen on TV shows appear to never eat a vegetable, don't have a clue how to eat a balanced diet and never exercise - so I know these guidelines have an audience.

But in reality, all the fat people I know and most of the skinny ones, have been there done that with the diets and diet programs.  Instead of pointing out the obvious, how about getting insurance companies who are blaming their high costs on obesity to kick in some coverage for gyms and pay per session weight management programs?