gastric bypass/stomach stapling ?? - page 3

I have a good friend who is seriously considering having this surgery done. I have never taken care of pts who've had this procedure and don't know anyone who has. This really scares me because... Read More

  1. by   JPRosselle
    My surgeon's requirements were BMI of 40 or over. I was at 41, with approx 90 lbs to lose.
  2. by   Fgr8Out
    Just thought I'd add my 2 cents....

    I've cared for many gastric bypass patients... laparascopic and open... and run the gamut of problems, success and catastrophes. The few deaths we've seen have been from complications related to leaks, so now the patients are NPO until they've had a follow-up gastrograffin swallow/CT within the first 48 hours.

    Most of these patients have been at high risk for everything, which initially would make one think they are a poor surgical candidate (and in a way, they are), but this is the very reason they qualify for the procedure... without it, they have very little hope of any quality life in any case. To my way of thinking, it should be an option of last resort, but I'm seeing it performed more and more on persons who don't really meet the "morbidly obese" criteria.

    I've seen horrific incisional infections... remember folks, adipose tissue doesn't heal nearly as well as other types.... And while this is very definitely a reason for increased post-op hospitalization, I would consider it far more the norm to some degree.

    As for pre-operative counseling... I believe it's a MUST... and should probably begin months in advance. Too often, I see patients who are screaming to be fed (and request amounts of food nowhere NEAR what their newly created stomachs are designed to hold) and who don't seem to understand they just went through a major surgical procedure not only to aid in saving their life but also because, for them, diet and excercise weren't enough and they required something as drastic as surgery to intervene. I could understand the behavior if the surgery were performed as an emergency procedure, with no time to prepare a patient for the post-operative outcomes (such as an emergency ostomy, for example)... but this is an elective procedure and I would think the patient would be aware of the changes required in diet, the need for caution with the introduction of foods. But too often, the patients we've cared for have been real bears emotionally and behave as if nursing is purposefully withholding food and fluids to be vindictive, rather than because of the inherent risks if these items are started too soon in their recovery. Behavioral modifications and psychological counseling need to address this to a greater degree than what I've witnessed.

    Horror stories aside, I have seen many wonderful results from this procedure... and I do believe there is a population for whom it is of immense benefit. I'd simply like to see more standardized care for these patients and an increase in education for those who care for them post-op so we can mitigate the complications and aid in a better recovery period.

    Best wishes and prayers to those of you who will be having this procedure done.
    Last edit by Fgr8Out on May 27, '02
  3. by   mattsmom81
    OK, guys, I'm still in anesthesia fog...how do I figure my BMI??
  4. by   NannaNurse
    The BmI has to do with a combination of your height and weight. Mine is 40. I'm 5'4" and 226. My wonderful hubby thinks I look better than Cher......remember, love is blind.....he REALLY loves me:wink2:
    According to the 'chart at my Doctor's office', I SHOULD weight about 112 to 126, so that means I have over 100 lbs to loose. I have Fibromyalsia, Arthritis of the neck, lumbar, hips and knees. I've had 3 surgeries on my knees. Thank God I don't have HTN (actually have hypotension) or DM. I want to avoid that. I've tried every known diet and loose a few pounds, then gain it back plus more. I walk everyday with my Greyhound, walk about 50 miles.....haha.....at work, Don't eat sweets.....maybe once a month will have a scoop of Pistachio Ice Cream....and only eat red meat about once a week.
    I have contemplated this surgery for over a year, done lots of research and will be attending my first meeting next month. I know there are risks and pain involved.....I am willing to take that to get rid of the extra 'ME' I'm carrying around. I'm 42 and want to enjoy my life being more fit. I want to run with my granddaughters and feel less pain in my body!
  5. by   RN-PA
    I found this site about calculating BMI by doing a Google Search-- Hope it's helpful!

    http://www.nhlbisupport.com/bmi/bmicalc.htm
  6. by   nursejws
    Mattsmom81,

    Baylor has two of the best wls surgeons in town: Dr. Todd McCarty and Dr. Joseph Kuhn. Their program and support group is bar none! I've been to several surgeons in the area, and none of them have the program or support these two have at Baylor. There is only one other surgeon in town that comes close and comes recommended.

    This procedure is covered by insurance as long as you meet the insurance guidelines. Some are easier than others by far. Unfortunately, I don't have the easier one.

    I think the requirements used to be 100lbs overweight with a BMI of 40. I think they have since changed it to a BMI of 40 and above?
  7. by   mattsmom81
    Thank you so much JWS...I will check it out, and thanks for the hyperlink too RN-PA....I am off to investigate my BMI.
  8. by   RN-PA
    There is one surgeon at our hospital who performs Gastric Bypasses (GBP) and we nurses, unfortunately, don't look forward to getting his patients. He is almost universally disliked by the nurses anyway for how he treats them, but with these patients, many of them are getting the surgery done with little to no participation in support groups and so are unprepared to cope with many aspects of the post-op regime. So, he does the surgery and we're left with all his patients' unaddressed psychological needs and emotions.

    This surgeon uses continuous epidurals (fentanyl) for pain control for a couple of days and sends them to us with NG tubes and WITHOUT foley caths. Because epidurals can often cause urinary retention, we invariably must catheterize them after trying futilely (and PAINFULLY for the patient ) to get them to void on a fracture pan. Many complain about the uncomfortable "Big-Boy" beds (I think it's a brand name; kind of insulting, huh?), and last week, I had a GBP pt. in her early 20's who developed a PE one day post-op and had to be moved to our Cardiac unit for a few days. She was my patient the day she was transfered back to Med/Surg, and it was difficult getting therapeutic PT/PTT levels with her Heparin drip (2600 units/hr) and Coumadin. She often complained, was frequently crying one day when told by the doc she might have to stay a few more days, yelling at her parents, yelled whenever blood was drawn or a new IV was started, etc., and the amount of emotional support I had to give was very time-consuming and somewhat draining. It could've just been her age and immaturity, but she is just one example of many psychological problems we've encountered with the GBP patients. Many are non-compliant with post-op care (using incentive spirometer, turning in bed, ambulation, etc.) and are basically unprepared for post-op procedures. I can only hope they are able to deal with all the other changes when they get home... We don't hear much in the way of success or failure, but I sure would love to know how they do.

    I don't mean to insult anyone with a weight problem, because I struggle with my weight and often use food to "self-medicate"-- for comfort, for stress, etc., and many obese GBP patients we see haven't developed great coping skills or worked through their psychological issues before getting a Gastric Bypass. All this is to say that I find our surgeon's lack of attention to the emotional/psychological aspects of Gastric Bypass appalling and unconscionable as well as unethical. I'm thankful that some of the posters here have found good surgeons and support programs in their area, however, because there is a definite need for this surgery, and I commend your courage and motivation for this drastic but life-saving procedure.
    Last edit by RN-PA on May 28, '02
  9. by   Ted
    About 3 months ago, my wife had gastric-bypass surgery. She thoroughly researched the procedure(s) (there's more than one type, I guess) and decided it was what she needed to finally lose weight. To her it was a health issue. She's been on all sorts of diets, briefly took Redux, went to OA, went to Weight Watchers . . . in her mind, she "tried them all". Her family has a history of heart disease (father died from MI), has high cholesterol, her asthma was getting worse, and her back and her knees were aching. She wanted to feel healthier.

    Her procedure was not without its complications. During surgery, they nicked her liver which resulted in a liter's blood loss. (Finally, after 2 days post-op she received 2 units PRBS's which made her feel tons better!! But that's another story and another thread!) She developed a small wound infection which required that I pack her wound twice a day for about 2 months (it's all healed now!)

    The side effects of this procedure is a bit worrisome for me. Malnutrition is the major side-effect. Because of the by-pass, she'll always HAVE to take vitamin and other supplimental pills for the rest of her life. She's having some minor hair loss. And when she eats too much, it's uncomfortable.

    She eats like a bird now. Five to six very small meals a day. (It's the recommended eating behavior with her type of by-pass.) However, follow-up blood work show that everythings o.k. CBC is fine. She's not nutritionally compromised. She's fine.

    And she's happy. After three months post-op, her energy levels are normal. And she's loosing weight. About 45 pounds to date. Her back and knees aren't bothering her. Her asthma, so far, doesn't seem as bothersome; if anything, her breathing is better; less winded.

    I still find it a bit strange to see her eat so little. I guess I've lost my eating partner of 17 years. I feel a little lonely because of this.(I'm still a little over weight and still love to eat . . . lots! But that's another story and another thread). These are my issues, though.

    I'm still getting used to how she feels when we hug. It's like hugging a new woman every few weeks. It is strange to me. There's less "wife" to hug.

    I need to admit one more thing, though. I almost feel like I'm committing adultery (sp?) when we . . . . . . . well you know. It's like making love to a different woman. . . . .

    When I tell her this, she laughs.

    She's obviously happy. I support her. It is a change . . . not without its risks. And it seems to be a postive change in the long run.

    Ted
  10. by   mattsmom81
    What a nice story Ted! Thanks for sharing with those of us who struggle with weight.

    Doesn't look like I qualify...my BMI came back at 32 and the literature states 35 MAY be considered if other risk factors are present...otherwise it's 40. <sigh>

    Oh well, guess I'll keep trying to diet, but it's tough when you hurt, can't excercise, and have 'fat family' genes.

    Guess there's always liposuction...LOL!
  11. by   Ted
    Amy, my wife, and I just got back from a "dinner date". Of course she didn't finish her dinner. Had to "doggie bag" the rest. She plans on at least having 2 to 3 meals with tonight's leftover.

    My wife is turning into a cheap date!! :chuckle

    Just had to share!

    Ted
  12. by   NurseDennie
    I've been thinking about this, sort of in general. I'd checked with my insurance co. and the only "treatment" they will cover for weight loss is the surgery. I was trying to see if I could get my daughter into a weight-loss program supervised by a doc with menu planning and exercise, etc. I can FIND them, but they're expensive!!

    Anyway, as I am *definitely* fighting a weight problem, and my previously-successful regieme is NOT working now, I have been interested in this. I have been afraid that I would sabotage the effects of the surgery by over-eating because of a psychological need. I like big bites, you know?

    Anyway, they say that you can only eat a couple of ounces at a time, and should have several meals a day. I've been doing that for a bit now, and sure enough the psychological part of it is the smallest problem for me right now. I'm HUNGRY!

    So Maybe that surgery would work for me!! I don't know - if the physical hunger was gone, perhaps then I'd be fantasizing about sweets and larger portions because of the psych component. I don't know.

    Love

    Dennie
  13. by   JPRosselle
    Dennie, I seldom feel hungry, but feel the need to eat, only because it has been a while since I ate last, etc. As I think I may have said before, if you do eat more than will "fit", you just throw up. Ted mentioned that his wife would be uncomfortable. I only feel uncomfortable just prior to losing my meal, snack, etc. Because I take insulin, I have to wait until I have eaten to take my insulin. Otherwise, I may loose my meal and then be in trouble. I can not tolerate oils, grease mostly just fried foods. I also have lots of doggie bags from going out to eat. We are instructed to chew 20 - 30 times per bite, because 1/5 th of the small intestine is removed during surgery. It gives less time to absorb the fat. I have started getting concerned about not eating enough so I am currently writing down everything I eat during a day to take to the surgeon appt. 6/6 will be 3 mo post-op for me and I will then get my blood chemistry checked. I have lost 61 lbs in 11 weeks, so I am concerned that "chemically" I am where I should be.

    There are different surgery procedures, so if you don't "qualify" for one, possibly another would work for you. I personally had the RNY - lap. I know this surgery is NOT for everyone, but for those that can have it, it can be a miracle. I was told that with my heart and lungs in the condition they were in, I didn't have long to live.

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