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Surgeon: Dr. Daniel Herron, New York, NY
Surgery date: December 8, 2000
Pre-op weight/BMI: 283.5/47.2

by Vickie H.:

Goal:

• I would like to stop taking 7 or 8 different medications a day to control my co-morbidity's.
• I would like to eat like a normal person without feeling guilt.
• I would like to be able to ride Roller Coasters with my children. To hike, camp, ride a bike and partake in other physical activities without hurting physically.
• I want to see my grandchildren, or at least have as much chance of seeing them as any other normal weight person.
• I would like to be free of the stigma of first impressions based on my weight.

Rationale for Surgery:
Until recently I was able to maintain quality of life; In the last year that has changed. I can see that soon I will no longer be able to volunteer for any physical tasks. I used to go hiking, now I make an excuse to stay in camp. I used to go out in front of my house and play ball and other games with my kids, now I tell them Mama's feet hurt too much. I cannot keep up with others when we are walking together without getting breathless. I am starting to look for excuses to avoid parties, I can't stand that long. I used to take the stairs, now I use the elevator. I used to play in the pool now I sit on the sidelines. I travel extensively for my job, the newer planes have narrower seats and I come home with bruises on my hips from them. My weight has been stable for sometime, so the changes that I am seeing are from the toll that weight takes on my body. I am small boned and now my hips hurt, my knees pop and hurt, I have heel spurs that flare up. If nothing changes how long until I have to have joint surgery. I am on blood pressure medicine, but still my ankles are starting to swell. How long until I have a heart attack or a stroke. In my job I teach classes all day, what will I do when my physical condition deteriorates?

The Roots of my Weight Problem
I was born in 1956, a normal size baby, 6 lb.10 oz. 19 ½" long at birth. As a child, I was not thin but not fat either. I blended in well and no notice was taken of my weight either direction. Just prior to puberty I gained weight, to the point that I was overweight. My mother who was morbidly obese (as was my Grandmother) immediately took me to the doctor, who said it was just a normal pre-pubescent weight gain and would melt off once my menses started. It didn't. I am not sure what my weight was, but by ninth grade I was wearing a size 14 and felt fat. (I laugh at that now) Two years later, in 1972 I was wearing a size 16, was 5'7" and weighed 165. At that weight I felt fat, uncomfortable with my size in comparison to my peers, with their slim legs and flat tummies.

That is when I fell into the dieting trap. I would diet and lose weight, stop and gain the weight back plus more. I tried a diet where I was injected with a hormone made from the urine of pregnant women, I fasted, I lived on 300 calories of Liquid Protein a day, I tried Weight Watchers, you name it I tried it; It worked ( it always worked) and then I gave up and failed. (Gained) After all the yo-yoing around I had dieted up to a stable weight of 240.

During this teenager to young adult time I did have an emotionally demanding life, and plenty of troubled times. I guess you could say more than most, but less than some. However, I have never felt that any of that was a trigger for weight gain. I know when the weight started to come on, puberty. I know what exacerbated it, dieting!

Unfortunately other people insisted that they knew more about me than I did, they told me I was an emotional eater, they said I ate too much and me? What did I do I bought into it. I believed that I didn't have enough control, enough will power, I thought if only I was different, or had had an easier life, I wouldn't be fat. Needless to say, I had very little self-esteem.

When It Started To Turn Around
In my mid-twenties I got a job in an engineering office and was given a chance to train as a drafter. Several clerks took the exam for the drafter class, but I was the only one who passed. I graduated third in my class and went to work as a Drafter. While I was feeling good about myself at work, things on the home front were deteriorating. I hadn't been dieting and the weight I was stable at was unacceptable to my husband. I was in a carpool with a couple of men and we had become social friends as well, I talked about my marital troubles in the carpool and they found it ludicrous that should diet just because/for my husband. For the first time in my life someone thought I was worthwhile. With their support I refused to allow my husband to browbeat me and in the end my husband divorced me.

That event turned my life around, I went to a marital counselor and moved to a group therapist. I worked through the bad things that had happened in my life and got ready to move on. Amazing, through all this my weight remained stable. Meanwhile a friend encouraged me to start running. It took a while but I worked up to a mile. Suddenly I had lost 10 pounds, without a diet. Then I started to go to a nutritional counseling group and went on an 1800 calorie, low fat, low sugar diet. As the weight started to come off my running increased. The weight loss would slow so I would lower my caloric intake. After about one year, I was eating 1200 calories a day, running 50 - 60 miles a week and weighed 140. During this timeframe my career blossomed and I married my running partner. I changed jobs and started to work long hours, my running suffered and I gained weight. Here I was happily married, with a great job, still dieting and gaining weight. I gave up the diet and the pounds rolled back on. Yeah, what a sin I started to eat normally! I was still running about 20 miles a week. My weight steadied at 230.

Then a few rough patches, I became depressed and cut back the exercise, I gained up to 250, of course I tried to diet a little during this time. Then my family doctor insisted that I lose weight. I went on NutraSystem, the loss was very slow, but I stuck it out.

Until, I got pregnant, NutraSystem wouldn't allow me to follow their meal plan while pregnant. Doesn't that make you wonder how healthy that diet was… Still pregnant, I gained back to 250 within 2 months and went on up to 260. Boy that doctor fussed at me a lot. But, after the initial gain, I only added a grand total of 10 additional pounds over 7 months. After the baby was born I dropped down to 240, then gained back up to 265. I held this weight for three years until my next pregnancy.

With pregnancy number two I gained a grand total of -5 pounds. That's right, just before I delivered I weighed 255. Post-Partium I weighed 235. Without any change in diet my weight went right back up to 270.

I Gave up Dieting, For Good
After gaining back my weight I decided to take a new approach. I would just accept myself for who I was and how my body wanted to be. I ate what I wanted when I wanted. I exercised as much as I could and enjoyed my kids. I gained steadily in self-confidence, my career was going great. I joined the an Alanon group, moved on the a therapy group for Adult Survivors of Alcoholic Parents. I reconciled with my father. My husband loved me, not the shell that I am in and I had two wonderful children. OK, so if everything was so great, why am I having WLS?

My Body Betrayed Me
About four years ago my ankles swelled up and my blood pressure went through the roof. Blood Pressure medication didn't seem to help. My PCP thought I might have congestive heart failure and sent me to a specialist. My heart was fine, the cardiologist put me on medication that had diuretics built in and I was fine. At this point they pushed me to diet and lose weight. I panicked at the thought, after all dieting was what had gotten me to where I was. I decided that I just needed a lifestyle change. I did a lot of research on the Internet and developed a healthy eating plan. I followed the USDA Food Pyramid and set the caloric value at about 1800 calories per day. My food plan included all things in moderation. It worked well (but then so did every other diet I ever followed.) Then my job started to include a lot of travel, I couldn't control how my food was cooked and often had limited options. The weight came back on and Guess What? So did a few more pounds! Now my stable weight was 280.

About a year ago I started to notice that things got harder, I got tired easier. Then, my heel spurs started and it hurt just to move. I'd do almost anything to get out of climbing the stairs in the house, never mind housework. It all really hit home in the spring of 2000. I cooked a nice Easter Dinner, for the family. After, I was exhausted I hurt. The next day I could hardly move, my daughter wanted me to go out an look at something with her and I told her "Mommy can't, she hurts too much!" About this time I heard on the news about Carnie Wilson, the RNY and thought about it, but surgery seemed too extreme. Yet the rest of the summer it sat back in the back of my mind, every time I couldn't do something because of my weight it would pop up and whisper, if you had surgery you could be riding that roller coaster, running with your daughter…

I Started to Research WLS
In late August of 2000 I started to research WLS. I started by searching on "Carnie Wilson" I found the medical site that had featured her surgery. I read messages on the board there that led me to the AMOS site. On the AMOS site, I started to search through all the links. I read the messages from people who had lost weight and I started to see that WLS was a valid solution for me. The only thing holding me back was dumping, I truly believe that I should be able to do anything in moderation. I was struggling with the idea of possibly never having a piece of cake again. Then I found Heidi's profile and her descriptions of the BPD/DS. A whole new world, opened up, suddenly there was a second option. I followed Heidi's links to the ASBS site and to Melanie's site for Duodenal Switch. From Melanie's site I found the discussion group. That is when my journey really began.

I Made an Appointment with Dr Herron
I lurked on the duodenal switch group for a short time and started to realize that this surgery seemed as if it was made for me. I used the list of Surgeons from the Duodenal Switch site along with information from my insurance's website to locate Dr Herron and the Mt. Sinai Practice. I decided that I wanted the BPD/DS done Lap and called and made an appointment.

On Thursday the 12th of October 2000 I saw Dr. Herron, We started in his office where he explained the Gastric Bypass (RNY) and Biliopancreatic Bypass Surgeries. He feels I am a good candidate for either surgery. However, he favored the RNY for me. One, because of my low weight, Two because of my IBS, he is concerned that I will be one who has severe diarrhea and Three, because my GERD may not be completely cleared up, due to the fact that there is still acid production in the stomach.

He asked me to go back out and research the RNY with an open mind. He ended by approving me for surgery, I got a date - December 8th 2000. But, he didn't specify which surgery he will do, that is up to me…

BTW: Big SURPRISE, I don't measure 5'-7" any more. They measured me at 5'-5.5", I shrunk!!!

RNY Vs BPD/DS: My Take on the Subject
I went to two of the online support groups and posted messages asking for feedback about post-op experiences. After corresponding with many people, I had about 45 responses. I came up with the below conclusions:

(IMPORTANT PLEASE READ: I want to say that what I write next is just my opinion, based on the many responses that I got. It is critically important that each pre-op out there make this journey for him/herself, based on your own priorities and honest soul-searching. Research, Research, Research! Research some more. Then ask your own surgeon! )

The Surgeries: Both the RNY and the BPD/DS are effective in facilitating weight loss. The key is that they are an aid, not a silver bullet. It should be understood going in to either, that you will have to modify your diet forever.

RNY:
This surgery is the Gold Standard, by which other surgeries are measured. Based on my research, the dumping syndrome is desired by many, not a just a side effect.

• GERD - None of the people who responded who had GERD prior to RNY surgery had any problems after.
• IBS - I only had one or two responses to this question and the problem was helped by RNY surgery.
• Diarrhea - Several people responded who had diarrhea after RNY. None of them uncontrollable, mostly diet related.
• BM's - There is no trend here. Most people have slightly more than pre-op. They do tend to be more odorous, but less so than the DS. (Based on the RNY post-op patient's own opinion. I doubt that anyone has done a study.)

In my totally unprofessional/personal opinion, the RNY is an excellent surgery for anyone. Especially good for those people concerned with being unable to change/control their eating behaviors. The dumping syndrome (By the way a lot of people don't have ANY dumping) is a powerful tool that helps to revise bad eating habits. If you are worried about control of food issues then perhaps the RNY is the better surgery. The pouch is much smaller and hopefully you will dump until your behavior has been modified.

BPD/DS:
This is a newer surgery, not included in the medical consensus statements or recommendations, because it's new. This surgery is a more drastic surgery and has a slower recovery and higher complication rate.

• GERD - Many of the people that responded to me have total relief of their GERD with the DS. A few still need to take medication post-op. The difference seems to be if the GERD is weight related or functional.
• IBS - I had four responses to this question. One out of the four ended up with bad diarrhea post-op, the other three found that the surgery helped their IBS.
• Diarrhea - Many people experience diarrhea post-op with the DS. For most it clears up after about six weeks. The rest can control it by avoiding a high fat diet.
• BM's - Again there was no trend. Most people agreed that the odor was worse than pre-op, but controllable with Ozium, Devrom or diet modification. Some people actually have fewer BM's post-op.

In my totally unprofessional opinion the people who choose BPD/DS surgery need to be more motivated and committed to good maintenance post-op. My surgeon likened it to a turbocharged sports car. You have to take more care with its maintenance if you want it to stay running right. You have to choose good eating habits, as there is no enforcer. You will lose weight even if you choose to eat badly, but you run the risk of having problems with protein deficiencies and/or diarrhea.

RNY Vs BPD/DS: My Decision
I feel that I do not eat large portions now, typically when I go out to dinner I eat one half or less of the portion that I am served. I enjoy eating a variety of foods and cannot imagine forever, giving up desserts and chocolate. I do anticipate following a low fat / low sugar diet for two years or until I reach that dreamed of goal weight. But, once I am there it is very important to me that I return to what I think of as normal eating habits and that includes dessert and chocolate. I know that the BPD/DS will allow me to do this, albeit with a little diarrhea for my indulgence. I cannot be sure that the RNY will, as I may be one who has the dumping syndrome.

I realize that I may still have problems with my GERD because it is related to valve function not overweight. I have been taking the medicine a long time and I am OK with still taking it. As far as the IBS goes, well, it sounds as if problems with that may be my own fault for eating too much fat. I will be praying that I will not be the one who still struggles with uncontrollable diarrhea and orange ooze, maybe I will get lucky. If not then I am willing to live with my choice.

Pre-Op Testing - The Nutritional Consult, Psychological Exam and Endoscopy
Dr Herron requires three things be done before submitting the LOMN (Letter of Medical Necessity) to insurance. A nutritional consult with his staff nutritionist, a psychological consult with the Psychologist for their practice and an Endoscopy with a Gastroenterologist familiar with WLS.

I met with Nicole, Dr Herron's nutritionist, I didn't really feel good about how it went. I decided to be very honest on the questionnaire that she had me fill out. She told me she saw me as a much better candidate for RNY, because I like to eat sweets she was concerned that I would be at risk for protein deficiency. Now folks I'll admit I don't have very healthy eating habits right now, but come on, my weight has been stable for two years. Nicole acted as if because I admitted to eating "CANDY", that I eat tons of it and that she didn't think I could give it up… But she did approve me for surgery!

My meeting with Dr Drooker went better. I was very nervous, because many doctors, among others, have told me that I was wrong about my eating not being emotional and I didn't want to hear it again. Guess what! He didn't say that at all. He asked me a lot of interesting questions, which I answered and at the end he cleared me for surgery! The most interesting question was "You seem very comfortable with your weight, why do you suddenly want to lose weight?" The answer was easy, "For my heath."

I saw Dr. Saha for my Endoscopy. I drove myself up to Mt Sinai, without realizing I needed to take someone with me. Due to the fact that I would have to drive home they did the Endoscopy without any medication! It wasn't as bad as I thought it would be, no worse than the stricture dilations I used to have. He said that my strictures were gone, I said "the acid probably burned them away, LOL." I do have a fairly large Hiatal Hernia and he was amazed by the amount of Bile in my stomach. He saw a lot of irritation and he kept asking me how I stood the pain, and didn't I have nausea and diarrhea all the time. I said, "I Do have problems all the time, but I thought it was IBS." He wasn't surprised and told me that I will be amazed how much better I will feel once my bowels are rearranged. YES!!! He approved me for surgery. I suspect/hope that I may be one where the surgery will actually help my bowels. Wheeee!

My Battle with the Evil Aetna (Insurance)
Wasn't a battle at all. In fact it was so easy it was almost a disappointment. I have Aetna US Healthcare, Open Choice PPO. They have a reputation for refusing the BPD/DS and authorizing only the RNY.

I had prepared an extensive document for my visit with Dr Herron. It contained my Goals for Surgery, my diet and weight history, my family weight history, my medical history and a psychological assessment of myself by me. I had letters of recommendation from my PCP, Chiropractor, Cardiologist and Allergist. I called Darryl, Dr Herron's insurance specialist, and talked to him. I wanted to make sure, that this information was included in the submittal to Aetna and to tell him that, I wanted to get a copy of Dr Herron's LOMN, to add to my records. (I was preparing to fight.) He told me he would be submitting everything the next day. The next day when he called me I was astounded to find out that Aetna had approved me. Darryl said he was also surprised and that it had only taken four hours.

More to Follow
This brings you up to date on my WLS journey. I will add more to this saga as my journey continues.

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