Gastric Bypass.... yes or no???

bluesky, BSN, RN · Oct 25, 2005

You know after my third GP patient, I had a long conversation with the residents on my (then) unit about GP... I work surgical ICU.

Well the resident stated that about 30% of GP's return to the ER within the first week but that the vast majority are due to dehydration (apparently they are supposed to drink 30 cc/hr for the first couple of days and many just skip a few hours when they sleep). He said that only a few get the serious complications that we've seen... septic, ruptured anastomosis, etc.

That said, it is still the only procedure of that sort that presents to SICU on a regular basis.

Daytonite, BSN, RN · Oct 25, 2005

I know a number of people who have had this done. They all say it is worth it. One is an in-law of one of my brothers. The guy was 400+ pounds had developed diabetes and started having chest pain. Three years ago he had an open Rue-N-Y at St. Vincent's in Cleveland, Ohio. He has lost about 250 or so pounds and says he feels like a teenager. His diabetes and chest pain are gone. He went from being on 14 prescription meds to only 2. I am told that this is not an uncommon outcome. He had one complication about 3 weeks out of surgery which was handled in the surgeon's office--the opening where the duodenum is joined to the small intestine had closed up and so gastic secretions were building up. The 5 minute procedure in the surgeon's office solved the problem. He tells me he's lucky because he doesn't get dumping syndrome which means he can eat candy and drink soda without getting sick. My brother tells me that this guy eats constantly although it's always small amounts because what is left of his stomach can now hold about 6 oz. at a time. They'll all go to a restaurant and this guy will order a huge amount of food (old habits die hard), but can only eat an amount about the size of your fist and ends up giving the rest of the food away. I talked to him recently and he told me that he still has a protein shake every morning or else he just doesn't feel right the rest of the day. He also said, that, yes, he does snack all day long, but the amounts he eats are nothing like before the surgery.

Another relative of my brother, this time the mother of one of his daughter-in-laws, was a rolly-polly 5 foot lady who was a caterer, so she knew how to eat. She had a Rue-N-Y bypass three years ago and is down to 150 pounds. My neice-in-law has told me that she is careful what she eats because she can get dumping syndrome very easily. Two sips of Pepsi is all she can tolerate. If she eats too much or eats something that is too sugary she will be in the bathroom throwing up. She is very happy with her outcome and had no post-op problems. She does, however, have to keep up with her vitamin replacements or she has problems with her hair falling out.

The nurse in my doctor's office had a bypass about 2 years ago. I've watched over the last 2 years as the weight just melted off her. She had a rough go of it for about the first 4 months after the surgery. She had trouble keeping anything down. She said it took the first 4 months of trying different protein drinks before she was able to find one that she could finally tolerate (Resource). She had tried protein drinks before the surgery too and had picked one that she liked--after surgery, however, she got sick on it. She looks great and says she feels wonderful and would have done it again even after the first 4 months of hell that she went through. She doubles up on her daily vitamin replacements or her hair falls out. (This, I understand, is a common problem because the duodenum is where vitamins are primarily absorbed into the body and it is not in use after a bypass.

And, finally, my sister who weighs 350 lbs has been exploring having this surgery done. I went with her to the office of the surgeon she has chosen. I liked him very much--he has a very droll sense of humor! Anyway, one of the things that he stressed is that this surgery (Rue-N-Y) is not a cure for the obesity. It is only a tool to help lose and maintain a lower weight. One and a half to two years after surgery, he says that patients have lost the maximum that they are going to lose. I would assume that by that time, people have figured out what they can and can't tolerate to eat and, as I said above, old habits die hard. Dumping syndrome is an expected complication of this surgery and it the tool that helps the person control their eating. As the doc said, after the surgery you can have one or two M&Ms, but not the whole bag. He encouraged her to go to a monthly informational meeting he and his partners have on this surgery and we were shocked at the huge number of morbidly obese people attending the meeting! There were several patients there to talk about their experiences with the surgery and they showed an actual video tape of the endoscopic procedure that was really interesting. My sister was encouraged by the surgeon to investigate this procedure and get as much information about it as she could. They recommended that she go to www.obesityhelp.com. I've been to the website and there is a weath of knowledge there with clear explanations of the various types of bypasses. I don't much care for their forums, but it may be because it is lay persons talking about their experiences. They all seem intent on one thing--getting to eat solid food again after their surgeries, yet none of the posts I read were people who were even following their surgeon's eating instructions! In the surgeon's office, however, we were told that the Rue-N-Y is the most effective and safe and that there are problems with all the others. The surgery is reversible. My sister was particularly interested in the new banding procedure where the band has an inflatable cuff that can be adjusted. The surgeon told her that there had already been problems with the cuff sliding out of place or just breaking down and not working properly. The hold up now is getting pre-approval by the insurance company. Without the insurance the doctor's fee alone is $7,000. Some insurance companies agree to cover this surgery and others won't. The doctor's office staff is working on this with my sister. She has had cardiac and pulmonary evaluations and testing, does the psych evaluation next week and is waiting for a surgery date. Before surgery she has to attend a couple of classes with a dietition to go over the liquid protein diet she will need to be on after the surgery. She's already been sampling different protein drinks in preparation for after surgery. I don't think this is going to be a walk in the park, however.

Good luck with your own search for information on this. As we started researching this we have run across more and more people who have had it done and have very successful weight loss with it. Not one person that we've spoken to has regretted their decision to do this.

KrisRNwannabe · Oct 25, 2005

Alicheal,

I am in your shoes right now. I am torn between having the surgery or not. I found a wonderful website called obesity.com In my opinion you need to talk to many people who have had the surgery not nurses who have taken care of them (no offense). There are many forums on the website i gave you where you can discuss the pros and cons of the surgery. It is a life changing experience. I am still weighing the options of what type of surgery I want. I know what it is like to diet like crazy and not lose anything. what it is like to watch people enjoy food and you don't know what to do. visit the website and they well help you!!

prmenrs, RN · Oct 25, 2005

excellent post by daytonite! i wanted that surgery, too, but my doc was very opposed to it--remembers the old bypass surgeries ~ 20+ years ago--almost if not all the people who had it died. problems w/malabsorption, all sorts of things.

he had me go on a fast-type diet (http://www.ihmonline.com). i had shakes, bars, and entrees as meal replacement. i said "no" a lot, esp @ work! i call it the diet from he**. i stayed on that part of the diet for 6 months, lost 80#s (of the 150 i want to lose), then transitioned to fruits and vegs, now starting to add soy protein (which i mostly hate). i will go on the fast part again in january. my goal right now is to practice maintanence--learn how to live w/o getting fat again.

they are very big on maintenance. still using meal replacements, fruits and veggies, exersize, keeping good records, actually running the #s to see where you are, planning for parties, dining out, etc....... not that you'll never enjoy another donut or pizza, but that you'll make sure you balance it out during the rest of the week.

the diet was like an intervention---"stop what you're [i'm] doing now, it is not working". for 6 months i did something totally different, now i can see how to do it better, and it doesn't seem so miserable. and w/o all the risks of surgery.

no matter how you do it, weight is a really tough issue. my sister wants to do the surgery, and is heading towards having it ~ christmas. my mother has given her a hard time because i've been successful @ this, but i've told her i'll support her w/her decision.

Tweety, BSN, RN · Oct 25, 2005

Funny, one of the links on this thread is for "gastric bypass lawyers". There you go. Have the surgery, if things go wrong, sue! j/k

What I really wanted to say is to prmenrs, your link isn't working.

prmenrs, RN · Oct 25, 2005

Ok, try this one:

http://www.hmrprogram.com/programs.html

It's better anyway. Thx, Tweety.

LoriAlabamaRN · Oct 26, 2005

This is scary...

http://www.cbsnews.com/stories/2005/01/21/earlyshow/contributors/melindamurphy/main668323.shtml

"A recent study by researchers at the University of Washington found that 1 in 50 people die within one month of having gastric bypass surgery, and that figure jumps nearly fivefold if the surgeon is inexperienced."

Yikes... I do NOT like those odds...

RENAISSANCE RN · Oct 26, 2005

Catsmeow · Oct 28, 2005

I overeat when I'm bored and cause I just love the tastes of certain foods...(potato chips) so something that has helped me lose weight (50 lbs) is realizing that after eating a certain amt of one particular thing, I'm actually not tasting it anymore. There was a TLC program that showed a little segment where people sat down and ate a TON of whatever food it was they really loved, and all that was asked was they pay attention to when they could no longer distinctly taste the food. I didn't need to do the experiment to see how just being aware of that little thing helps control overeating. I know this sounds terribly simplistic but it's helped me tremendously.

Fergfrog · Oct 28, 2005

Hi Alichael,

I am 45 and a student nurse. I had gastric bypass (RNY w/Fobi) 5 years ago. I weighed 240 going in and lost 100 lbs in the first 11 months. I still weigh 140 today and pretty much eat what and when I want, except that I will dump if I eat something that has a combination of too much sugar and fat in it. Sugar by itself does not affect me.

I have complete bloodwork done every 6 months and as long as I faithfully take my intrinsic iron and my calcium, it's always perfect.

For me, this surgery was the best thing I've ever done for myself. It saved my life (I had life-threatening, uncontrollable bp and now I have normal bp with no meds), and it saved my marriage. I firmly believe that if it had not been for this surgery, I would not be in nursing school today because I just did not have the self confidence when I was obese that I have now.

I realize not everyone has a great outcome and I've heard some real horror stories from others that have had gastric bypass. My personal opinion (and that's all it is) is that the skill and experience of the surgeon you choose is critically important.

Good Luck!

Lisa in TN

WickedRedRN, BSN, RN · Oct 28, 2005

Hi, I am 10 weeks post op from a RNY, and down 63 lbs. I had no complications after surgery, but have found a couple of foods that just dont agree with me any longer. I have a very structured program as far as what I can choose from to eat and I do not vary from that list. Big advise I have is research your chosen surgeon thouroughly before you commit to any surgery. Make sure you choose a program that provides you with extensive follow up care and dietary consultations. For me the support groups and availability of a dietician are invalueable, as well as the surgeons office is very receptive to calling or paging them if there is any kind of problem.

Keep in mind I thought well over a year and tried a medically monitored diet program before I went into this. I agree with the other poster who said only you can make this decision for yourself. It is a deeply personal decision and no one else can make or influence it for you.

Good luck with whatever you decide! Feel free to PM me if you have any other questions.

Bipley · Nov 6, 2005

...Simple things like snacking on celery dipped in salsa, ...

Mmmmmmmmmm... that sounds good! Bell pepper strips dipped in salsa sound good too.

This is making me hungry.