Gastric bypass yields disappointing weight loss and many complications

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(Editor's note) Amanda Frank is an intelligent educated person who researched carefully before she undertook having a gastric bypass.  Extremely level headed, she was not influenced by TV ads or the like.  It was simple fact of when she sought information before surgery from the proper sources, she was given, at best, incomplete or misleading information. After surgery, she was totally compliant with the instructions from her surgeon who is a high visibility provider, member of ASMBS etc.  The following is her story in her own words.  She is willing to talk to those who wish to contact her and also, her advice for those investigating the gastric bypass. 

NOTE: How is Amanda doing now?  Updates at the end of this article!

By Amanda Frank

I finally understand that I am not alone. I am not the “one person” who fails to lose weight after Gastric Bypass Surgery. I am not the exception but the average and I am brave enough to speak up. I had a Roux en Y Gastric Bypass with Fobi pouch on Aug. 29th, 2000 by Dr. Goodman Win (*not the real surgeon’s name). At this writing, it is still in place.

Complications: I was hospitalized in November, 3 months after my surgery with fever of unknown origin, pain and highly elevated liver function tests. The doctors called Dr. Win and he talked to them a while about what I was hospitalized with he insisted that it was not related to the surgery. I finally found out that it was gall stones even though he took it out 3 months before. The pain was significant prior to and while hospitalized. The medication, Prevacid helped 1000% and I was finally out of pain. I have been on it since the hospitalization and was ultimately diagnosed with an ulcer in unattached stomach some months later. (*the part of the stomach which has been bypassed. This is a common complication)

I also came up with "slight" anemia almost immediately after surgery. This showed up in consecutive blood tests over several months. I had to press the doctor's office for a solution and I now take 5-6 times the daily allowance of iron a day in a very complicated, somewhat hard to find and expensive formula to keep my serum blood levels up close to normal levels. I also show that my blood protein is not high enough most of the time. These are a result of the malabsorptive aspect of the surgery and are permanent.

So, how did I get there from here?

My story is an odyssey of fact and fiction.

I was born as the third of five children where one of my parents was overweight and the other was not. Statistics will tell you that the child of parents like this has a 40% chance of being overweight and exactly two of us were over 200 pounds. Ironically, with my mother being a twin, I and my next youngest sister (only 19 months younger) were treated like twins most of the time and we both shared being overweight.

The only time prior to Weight Loss surgery that I was in the hospital is when I contracted Malaria after I had visited Haiti several years prior to surgery and it was this which the doctors believe which activated the type 2 diabetes in me. I was checked every 3 months like clockwork and no flicker of high blood sugar, nothing. But within a couple of months of getting Malaria, I was diagnosed with diabetes. I went from a fasting blood sugar of 55-65 to 350-400 in a very short time period. Unusual by any doctor’s standards. My sister had “a touch of diabetes” while I had never had any.

I was diagnosed as a type 2 diabetic within days of my sister at separate doctors’ offices. I was 34 at the time and she was about to turn 33. The only bright spot of such a terrible diagnosis was that I had 19 months more time without the diagnosis. Since my mother was also a type 2 diabetic, we were knew it would happen sooner or later.

I was devastated. Most people will think, “what is the big deal?” I knew that a diabetic will not die from the disease but you can lose your eyesight, kidney function, feeling, circulation, limbs and more before finally dying from one of the “complications” of the disease. I had barely begun to live and I felt I was being handed a death sentence. While there are things that can help keep away these complications from the disease, people get them sooner or later no matter how “controlled” it is. I now thought I had a good idea how the rest of my life would play out.

One day, a new friend took the risk of our friendship and told me about Gastric Bypass Surgery. Her roommate had it done and sang its praises. I was told how it would change my life; I would lose weight and keep it off. Just like every diet I had ever been on. She told me that Dr. Win had done the surgery, and he had the procedure done on a close friend and now was “helping” others out and his office was here in town.

A few days later, I was in my endocrinologist’s office for a diabetes check-up. I asked her and got a referral for Dr. Win. I called the office and was told my first step was to come to an “informational seminar”. I tried to ask questions but got few answers. I crowded into a small waiting area with 30 or 40 other severely obese people and their friends or partners or spouses or children or parents with them. I saw a PowerPoint presentation and listened to what amounted to a sales pitch for the surgery. The one thing I remember was listening to an MD say that diets don’t work. The reason I am overweight is not because of a bad diet or eating candy or whatever but that it was a medical condition for which doctors and the healthcare industry are doing nothing about. I thought I would die being told by every health care professional I have ever seen that I was the one at fault and I just needed to stop eating so damn much. For anyone in the medical community to acknowledge that they aren’t doing enough to treat obesity, gosh, I thought I was dreaming or in heaven!

Let’s cut to the chase. I jumped through their hoops. I met with the surgeon once before the surgery in an exam room. Everything else was handled by his staff which, I was to discover, were a couple of former patients and a few relatives. Many were new, untrained and we were their guinea pigs to learn on (and make mistakes on). I went to the information seminar on Memorial Day 2000 and had had the surgery by Labor Day 2000. From the start, I did as I was told. I walked, walked, walked in the hospital. I ate pureed food and followed the diet. I was about 3 weeks after surgery when I hit my first plateau. I think I had lost 12 pounds since the day of surgery. I was in for my “one month” checkup but it was 22 days after the day of surgery. I was frustrated but was told it was all okay. Just be patient…I was talking to people who had less to lose and who had it the same day or a couple of days later and they had lost almost twice the weight I had lost. But, I just kept on doing what I was told. A couple days later, they needed some people to help put a documentary together for a film crew in Dr. Win’s office. I volunteered and came in. I was selected to be the patient who was being followed through the office with the doctor. There was one scene where I was to be weighed. Now, I had been in the office 6 days before to have my checkup. I could 3 bites of food, maybe. I was weighed on the same scale I was on before and actually GAINED 2 pounds in 6 days of nearly no food! I was just at a month post-surgery with this wonderful tool! What a joke!

My post-op period was easy as far as eating. Throwing up was not an issue and I rarely vomit, even now. I am coming up at 3 years post-surgery as of this writing. I think it was almost a year before I first threw up after or while eating.

When I was about 3 months out, I had had a low-grade fever for several months. My primary doctor knows that I have low body temperature of 97.0 so 98.0 is a fever. Dr. Win and his office, no matter how many times I tried to tell him, refused to believe that there was anything wrong with me, especially since they do not consider 98.0 a fever and hardly consider 99.0 a fever. After more than 2.5 months of this, my fever hit 99.3 and stayed there. Too sick to continue to go back to the surgeon’s office, I hit emergency rooms after emergency rooms and finally was listened to when my fevers started to mimic the cycle of Malaria. They ran many tests on me. My blood work was all crazy. I gave the admitting doctor and the gastroenterologist who saw me in the hospital the number for Dr. Win to see who could figure out what was going on. My blood work pointed to an infection and my liver function tests were also high. I had sonograms and they were discussing biopsies on my liver as it looked like I was going into liver failure. In the mean time, I was not hooked up to an IV all day, just 30 minutes twice a day for antibiotics. I could get a shot of Demerol but not a Tylenol for the pain I was in. I was admitted a couple of days before Thanksgiving. I was one of about four patients on that floor of the hospital for Thanksgiving. Also, I was still on the all protein phase of my post-op diet. I was finally released after a week’s hospital stay when the antibiotics kicked in and my fever finally broke.

I had been in the hospital when my 3-month check up had arrived. I rescheduled it and went in with copies of all of the paperwork from the hospital. Dr. Win made light of it. He could give me no reason for it and dismissed it. I came back 3 months later and got the name of a gastroenterologist who he worked with, mainly the pre-ops who needed coverage in the hospital the surgery would be performed in should something happen. The best thing I ever did was to go to this man. He was completely different from Dr. Win and his staff. He was kind, sincere and the most professional doctor I have ever seen. We went through the preliminary stuff and were trying to make sure everything was okay, post-surgery. On one of my visits, he was reviewing the results of several tests, which indicated no real problems. He was about to leave when I asked him if I could ask him some questions. He came back into the room, closed the door, sat down in a chair and told me to go ahead. He waited a while because his behavior was so unlike any doctor I had ever seen in my life! It was from his answers to a number of “what is this” and “how does this look like since it can happen after the surgery” that I was finally able to put together what had happened when I was hospitalized a few months before.

Part of the pre-op information is the huge lists of possible complications from the surgery which included a gall bladder removal. One of the known things I was told that I could get gall stones after it was removed. I signed papers with this on it! When I got out of the hospital, I asked Dr. Win about it and he said it could not possibly be that because my gall bladder was gone. I asked this doctor and he named EVERY SYMPTOM I HAD BEEN HOSPITALIZED WITH! He reviewed my medical records from the hospital and confirmed that was what I had! So much for Dr. Win being the expert!

Okay, let me back up just a tad here. One of the things that happens as you go through the process going into surgery and after is that you are told time and time again that a regular doctor is not going to have any idea about what is normal and what is not after a gastric bypass. They tell you over and over and over again that anything which might be remotely related to the surgery, you need to call Dr. Win’s office and ask them because they are the experts! I signed paper after paper about gallstones after gall bladder removal and when Dr. Win was consulted, it didn’t cross his mind. When he was presented with the labs and doctor’s notes and test results from the hospital visit, he said it was not gall stones. When I gave the EXACT SAME PAPERS to the gastroenterologist, he confirmed that the surgery was responsible. I had this put on paper and gave it to Dr. Win on my next visit and he said it was not! I have papers from his office which list that this is a common issue after gall bladder removal. He was a general surgeon for many years and has taken out many gall bladders and gives you papers to sign about this and can not identify when this complication has occurred. Some expert!

All of this was the beginning of the end for me and Dr. Win and WLS. I realized, as many eventually do, that you go to these seminars and information classes where they tell you that it is not your fault, this will make you like everyone else who has not messed up their metabolism so bad by being on one diet after another. You will be able to lose weight and not diet. And, you wake up and eventually realize that you are now expected to follow the most restrictive diet ever invented (short of anorexia) for the rest of your life. I am not exaggerating.

At the rate I was losing (slowly, maybe 2 pounds a week eating 3 times a day, an ounce or two at a time for a whole year), I was never going to get anywhere close to my goal weight. You are not ALLOWED as part of the post-op to even think about adding carbs until you are within 20 pounds of what you should weigh for your height! So, because I am not anywhere close to goal weight, if I were to go back to Dr. Win’s office, I will be told to eliminate all of the carbs from my diet.

Because I can not do that, I am not being compliant with the post-op regimen and I am the only one to blame for my weight gain. I know this because that is what I was told day after day, week after week for months as I struggled to get my weight to anywhere close to normal. If I go to “support meetings” they chant this. If I go to the office for a check-up, all of the pre-op hopefuls are there thinking I am pre-op also. Since I am not a poster child for the surgery, I am more embarrassed and even less social that I was before the surgery. I am ashamed at having it and that I am still fat, very fat.

They wonder why post-ops don’t come around, it is not because we are too busy. It is because the weight came back just like every diet I have ever been on. And I am still to blame. If you don’t believe me, take my hand and let’s go to Dr. Win’s office and see what they tell you. I know. I have and that is what they tell me. Amanda, if you would only never eat a carb again…if you would only exercise like we tell you…If you would only quit drinking when you eat…if you would only stop drinking diet soda…if you would only eat more…no, you need to eat less…you need to eat 4 ounces at 6 months out…you are eating too much, Amanda, we didn’t tell you to do that!!!

Okay, you want to know stats? Here goes. My official pre-op weight was 373 pounds. I had reached a higher weight before that of over 400 pounds but lost some of it also. Because I was a diabetic and my blood sugar had become unstable, I gained a lot of weight very quickly in the 8-9 months before surgery. I had been in the low 330’s (pounds) when my average blood sugar tests went up sharply. This made the doctors and I work to bring it under control. By doing that, you will gain weight quickly and it will become very difficult to lose the weight again as it was for me.

The lowest I ever got was about 240 before gaining back and I am at about 300 or so. I am on the borderline with my diabetes coming back because of the weight gain. I have few problems either way.

I have not seen Dr. Win since my one year post-op. No follow-up here, huh? I got a rather directed form letter from the office to update my information which I did not return. The cover letter said that if it was not back by valentine’s day, 2002, they would call. I have not moved or changed my phone number since the surgery and I never received a call. Because of my experiences with the surgery and follow-up, I have not seen a doctor for over a year for any reason. My primary doctor left my insurance plan for a while and then came back a year later. I started with another doctor who was even less concerned about my post-op care after bypass than I was and have let it drop. Since I am not much smaller after surgery than before it and since my old doctor knows I had it, I am ashamed to go back to him. Also, my younger sister had surgery almost a year after mine and is in the year and a half post-op area and is still much thinner than I ever got but she was under the minimum weight when she had it and they fudged her pre-op weight so she would qualify (she had an extended illness which caused her to lose 45 pounds and she was about 190 when she had the operation).

With all of my un-poster child success with the surgery, I am sure that my surgeon counts me as a success. In my last visit to him, he did state that I will not make it to my goal weight (if not, then why measure success and when you can eat more normally by it???), but little to explain why I was not responding like the poster children. I had confronted him several times in several situations about my lack of weight loss. In public, the line I would get is that it is very individual and that he needed to see me in the office to “lay hands on me” and see what was going on. In his office, I felt like I was being herded along through the motions and the promised help to work out why I was not losing weight were empty. Not a blood test, not any labs, no tests, no x-rays, in fact, he never touched me at all! His staff asked the questions. They fed him some data and then he waved you off with a trite “there is nothing wrong with the surgery” and went off to the next patient. I confronted him after my sister’s surgery. I did at the support and information meetings and he always gave you a line. In private, if you were not PERFECT in what they wanted you to do, the nurse, the doctor, the psychologists and everyone would point to that. I know of no person who reported that they were in any way helpful to determine why weight loss had ceased nor help in getting it restarted. He had mentioned in one of the public sessions that my thyroid “might” not be working right but when asked about it in the office, no test was ordered and I was treated by him just like every other doctor has with the same trite comments and snide remarks and dismissed that anything medical was wrong with me. So much for my dream of no longer being blamed for being fat. I still am being blamed even by my bariatric surgeon.

The surgeon’s office went through many, many changes in the months before and after my surgery. There was a pattern of the people answering the phones, giving information and medical advise to post-op patients were not able to accurately give any advise (more often than not, the information I got was dead wrong even out of the surgeon’s mouth). I called many times with life-threatening problems, with symptoms of serious complications which were not relayed to the surgeon. Time and time again. I sat in the exam room telling him what his staff had neglected to relay to him and while the implications were life-threatening, little was done and the pattern continued for months and years with no changes taking place. Also, he waved the potential liabilities aside and seemed to think that we were all “hysterical”. I heard many stories of the people who died that he did the surgery on and the message was that they just didn’t let him know that something was wrong. My opinion is that they did call the office and got the same kind of reaction I received over and over and over again (i.e. they basically wanted nothing to do with me).

One more scary post-op story. I was about 10 months after surgery. There was a change in my bowels. It went from what you would expect to looking almost exactly like how it went in. That is, it was undigested. I was weak. I was not losing weight and I was still eating protein only. I was getting sicker and sicker looking and no one listened. I was going to their aftercare groups two or three times a week. I was committed. I was trying hard and getting no results. No inches dropping. No weight dropping. Nothing was happening. I knew something was very wrong. I also knew that I would be ignored again since I had no fever and the change in bowels meant nothing to them. My suspicion was that the Y limb had closed off but no one would listen. The aftercare stuff was a lot of people who had the surgery and were doing good. Even they sensed something was wrong. But, even though they were employed by Dr. Win, they had no pull to change anything or to get any answers for me.

After a couple of weeks of this, it happened. Sooner or later, the unattached stomach will balloon up with all of the backed up digestive juices. It was easily palpable and you could almost see it no matter what position I was in. I called the office and I left a message for the nurse (you can not talk to the surgeon with any health, post-op issues. It always has to go through the nurse and if it is deemed serious enough, then it may be discussed with the surgeon. No guarantees on that!). The routine was to describe my symptoms and she would call you back based on triage. She called me back and we discussed my symptoms. Again, it was easily felt under my skin. I knew it was blocked. I explained this to her and she convinced herself that it was not that and I was scolded for scaring her so bad. I am totally serious. If the staples don’t hold, I will die from peritonitis within hours of it rupturing! My mom is an RN and I know more than the average person about stuff like this. So, the surgeon’s office dismisses me. I have an appointment for 5 or 6 days later with the surgeon. It is like ignoring a person with a hot appendix! I literally sat down and wrote out information in case I did not make it to my appointment to sue the B*******.

I came up with a plan B. Surgeon will not listen, let me try his preferred Gastroenterologist. I call him. He has not seen me in a couple of months, I have an appointment with him within a couple of hours. I don’t even have to lay down. He could see it and he came over and lightly touched it and confirmed that my limb was blocked and that something needed to be done ASAP. If I were ill (fever, lots of pain, anything and I was not), I would have had emergency surgery. The fact that I was not ill really, and he was up front with me, he was going to call Dr. Win and consult with him about this and call me as soon as they figured out what to do. He told me he had seen this happen in new post-ops but I was one of very few post-op he had ever seen longer than a couple of weeks after the surgery. Since nothing was leaking (yet), he had some time. He placed several calls to Dr. Win explaining what his findings were and needing to consult about what was going on. Do I need to tell you that it is almost 2 years later and he has still not heard from Dr. Win? I didn’t think so.

There is a couple of reasons I am here writing this. First, it was not my God-ordained time to leave this earth. Secondly, being believed and knowing that there was a doctor I could call should anything change and trust that he would take care of me, my gastroenterologist. And, I was fortunate that I woke up Saturday morning, used the bathroom and rolled over. There was a pop and a huge Woosh! I spent the next 3 hours drinking fluids by the gallon. But, for the first time in almost 3 months I finally had solid movements.

My appointment came up. We all remember September 11, 2001 and that was the day of my appointment with him. After the horrors of seeing the towers fall, it was all like walking around in a fog. But, I went through the process and the surgeon enters the exam room. By the way, Win seems to hate to see post-ops after the 3 months checkup. In fact, it was highly unusual for any post-op to see him as much as I did. Partly due to things which came up and partly insistence on my part but I believe that he doesn’t like to deal with us and his treatment of me shows this clearly. The process of a post-op visit, at that time, was an array of people and procedures and processes. You sign in at the front. You are brought in and weighed. They may photograph you if it is your anniversary. You are put in a queue to talk with their psychologists for 10 or 15 minutes. I believe somewhere you may have your temp and blood pressure taken. The weighing, pictures and these couple of items are done by people who often can not seem to do it right. You are asked if you want them to do your B-12 shot (extra charge you pay out of pocket, $10 a month—my insurance gives me 40 syringes and a 30 dose vial for about $15 and it lasts a year or so).

You are taken to a room. After a while, a person comes in, often the most senior nurse, to elicit responses to explain away any problems you are having. It is your fault because no one, I don’t care who you are, what your background is, how motivated you want to change, you can not follow the “doctor prescribed post-op care” 100%. They will ALWAYS find an explanation for why you are not losing weight or why it is not very fast or whatever keeps you from being happy or satisfied about having the bypass. I had nearly a dozen of these after surgery and that is what the result always was.

Finally, Win comes in. I am in a chair at the foot of the exam tables. This was his new office, bigger exam rooms (about 4 times the size of my manager’s office at work) and so he was over 12 feet away from me. He comes in and the nurse gives the low down. I try to interject and tell him it is a problem but, believe me, he is not listening and doesn’t care. Why? After she is done. I try to explain what is going on. He keeps interrupting me and says over and over like a broken record that there is nothing wrong with me. I am not lying and I am not joking. Also, he is still across the room from me. Over 12 feet away, has not even bothered to get up out of the chair to examine me. Instead, he repeats over and over that I am not having any problems and there is nothing wrong with the surgery. I interrupted him and told him that I was dismissed by the nurse who was standing at that moment in the room and scolded. I explained that I was given an immediate appointment with the other doctor who CONFIRMED what I had told the nurse. Dr. Win’s response, he is still sitting in a chair, across the room from me is that “he must me mistaken”. He has not come within spitting distance of me. He has not examined me and will not take the expert medical opinion of a doctor he sent me to as I really have this problem. Nope, I was imagining it and the other expert who felt the massive fluid buildup was mistaken. The doctor who actually touched me was wrong and he could tell this from over 12 feet away and did not have to touch me at all! I called his office at least 3 or 4 times that it was imperative that he discuss my condition with this other doctor before my appointment. Does he? Nope!

That was the end of my relationship with him and that office except for one quick visit. He sent me for a test. It had to be scheduled a particular way and had to be done with the radiologist at the hospital. It is a special scheduling issue and has to be handled and coordinated with multiple departments and resources. It was detailed on the orders I was given to take to the hospital and when I was called with the appointment date, I tried to verify it. Does it surprise you that it was not done right? I didn’t think so. It was also scheduled that as soon as the test was done, I needed to take the X-rays to an appointment at Dr. Win’s office. I got there and gave them the paperwork and the radiologist was not available for my procedure. He fit me in but it was a difficult procedure and all but the disregard for other doctor’s hours, opinions or schedules by Dr. Win should clearly show the quality of his expertise and complete lack thereof. Just in case you are interested, they numbed my abdomen, stuck a needle in the unattached stomach and filled it with contrast and took Xrays. I went to my appointment with Dr. Win. He had expanded his practice to include several other doctors and had several others who were learning under his “expert guidance”. The nurse took the Xrays and left the room. I waited over 30 minutes while he did whatever. He came in and said exactly the same thing as he did before, there is nothing wrong with me. He started to show me the Xray and was explaining it in their lingo to the apprentice surgeon who was there that day. I was listening and he realized I actually understood what he was saying so he got me out of there so he could continue to comment on my lack of compliance since surgery, etc in peace.

What I Have Learned to be the Truth about WLS

• Do not fall for anyone who tells you that it is too new to have long term result statistics. It is bull. I found as I questioned things after my procedure, they know more that they will tell you about it all.

• Doctors do this because most insurance companies will not cover it and cash is better than the cut the insurance companies pay the doctors. This is a lucrative field as all weight loss anything is. It plays on the hopes of all obese people and that ideal we should all be thin and can be. You can not.

• There is nothing magical about this and this “tool” people like to call it is hardly a good one. It literally allows you to become anorexic and when you continue it (I really wanted to), they will scold you for not eating enough and will tell you over and over again that you are eating too little and causing more harm to your body. You stop and then, you are eating too much! You can not win and the help they offer is no help at all.

• It is not my fault that I am overweight and this surgery only shows you that it is not. No amount of bypass helps. No amount of restriction is healthy. Eating normal after this surgery will still cause you to gain weight. I can not eat a whole lean cuisine after surgery and I am still gaining weight. It is not simply calories.

• It is true when they state that medical science does not address the issue of obesity as a medical condition. I have always maintained that type 2 diabetes is not caused by this fat on my gut. Why? Simple, remove it like a cancer and see if I am still a diabetic. Guess what? They will not approve it. If they will remove a cancer because it infects the body, then remove the fat from my belly and see if my medical problems go away. They won’t. Why? Because you can not diet and keep it off (efficient metabolism), they never have to address that there is another medical reason for it. Everything is caused by carrying too much weight. There are people who are not overweight and have the same problem but we TREAT THEM DIFFERENTLY. Because you are fat, that HAS to be the problem and since they know it can not be solved, they can continue to shame and degrade you and not treat your illness. We don’t let them do that to the mentally ill but we allow them to tell us that we have to overcome this disease, this illness. Only with the obese. Can anyone tell me that if this fat in my belly is causing so many illnesses in my body, why not liposuction it out, cut it out like a cancer? A cancer patient is sick while the cancer is in the body. The doctors and surgeons cut it out, scrape it out, do everything they can to destroy it. My fat is even more deadly to me and my health than cancer is. WHY WILL THEY NOT DO THE SAME TO GET THE FAT OUT OF MY BODY?????

• My surgeon has fought obesity himself. He should know more about all of this and how it effects me and help me with it. He didn’t. I trusted that he was more understanding than a thin doctor and he was not. Most groupies of the surgeons are people who had it when they first started doing the procedure. If their practice is growing, if it is expanding, HEED THIS WARNING: they have gotten better at manufacturing a product (the surgery) and have streamlined getting you from thinking to the table. After that, you are on your own and proceed at your own RISK! My surgeon has one of the largest aftercare program in the country. They invented much of what you see in other parts of the country (if what they say it true and it seems like it is). We have two meetings. The pre-ops and new post-ops are literally a rah!-rah! Show for the surgeon. It is the same information said over and over and over. Any problems are squelched because it would turn people away from having the surgery. They talk a good talk in these meetings. DO NOT BELIEVE THEM! If anyone HINTS of an issue or problem, the surgeon will tell them to come in so they can discuss it one on one. This is a joke and a lie. No help at that one on one is given.

• I got my surgery before they started charging EVERYONE an “aftercare” fee. But, let’s talk $$$$:

1. Informational seminars are free. These are PR for the doctor and they know it! It helps weed out the people. But, it will sound so good. Many of the surgeons are real smooth talkers. The more they have done, the better the pitch the smoother they get. You will hear what you want. Their purpose is to sell you on the surgery. They spin it that way. While they talk about the down side, most of it is a spin to get you to have the surgery.

2. We had to go to a 4 hour meeting with the nurse for a lecture on what is going to happen to you. Graphic but still not very realistic. The H&P is assembly lined. This is the start of the paperwork.

3. Next, it starts costing. I was required to have a Psych evaluation. What did they learn about me and why did I need to pay $300 to see THEIR SPECIALLY TRAINED PSYCHOLOGISTS to approve us. Yes, this is what we were told. I was not allowed to have this done by anyone covered by my insurance plan. I had a 1PM appointment. The Psychologist was not even there! I got all of my paperwork done in 20 minutes. I am sure that most people take almost an entire hour and they arrive a little late. I arrived 10 minutes early and sat around (no magazines, nothing) until they got in from lunch at about 2PM. Mainly, they reviewed my answers to a couple of forms I filled out and asked me to parrot back what was going to be done to me. At the time, there were 3 psychologists in an office in another part of town. Now, they share space with the surgeon, their fees are the better part of the $900 aftercare fee (not covered by insurance) and there are even more of them. Last count, I believe there was 9 or 10 of them. I asked them about therapy since they supposedly were such experts in the psychological issues of this surgery. NONE of them see patients for on-going therapy. All they do all day is collect $900 in cash from the 3 evals they do all day, every day. I could live well on that! Nice job, huh????

4. I put this in another item although it is a continuation of the previous one. As the growth of the office continued, I saw people entering the process and how the process changed. For instance, people were told in the evaluation that they had “control issues” because they were not able to give up all control, post-op, to Win’s staff. If I had heard this from one or two people, that would be one thing. Dr. Win, himself, was doing about 1000 surgeries a year and had completed over 2000 at the time of mine. With the expansion of his practice into Puerto Rico (I believe) and 3 offices in our state, there are now 4 or 5 surgeons out of the home office plus the ones in the other places. I get this from patient after patient after patient. They have to be in therapy and Dr. Win is requiring that you do exactly what they tell you for the first year post op or they will not do surgery on you. There is something wrong here! When they started this, the psychologists were not doing normal therapy, only psych evals for surgery. SCARY! But, who has the real control issues? Think Cult! It is disturbingly similar.

5. Note, aftercare fees for people who do not live in the area the surgeon practices in is just a way of generating income. BEWARE. Dr. Win’s office would not wave the fees for anyone! To do 1000 surgeries a year times $900 for aftercare, where do you think the MILLIONS of dollars from just this part are going? I estimate that there this one required fee times all of the doctors is 5 million dollars. Think about what anyone gets for that in REALITY. Do not give in to their spin on the money. What are you paying for??? I will answer this a little later.

6. I was required to give a nutritionist $45 for a nutrition class. Yes, a CLASS with 20 or 30 pre-op patients and it lasted 1.5 hours! The only reason mine was that long is that I asked questions because nothing she said was clear and it contradicted what the nurse told us. No hand-outs from her either. Canned speech and she read the pages we were given about nutrition at the nurse’s lecture. Hold on, who would not teach one little class a week and take home CASH (yes, both her and the psych eval required the money in cash, not check and not credit cards). Do the math. I would love to work 1.5 hours a week and make over $1000 each time.

7. Look at their “services”. They had a special masseur who came in one day a week. What was special, oh, it was special for gastric bypass patients, of course! I believe she charged about twice the area going rate. It was like $60 a half hour maybe. At the support meetings she would give you a couple minute shoulder massage for $10 or something. There was another person who offered hypnotherapy for gastric bypass patients to help you be successful. Sure, one session was $225. But, hey, she didn’t believe you should need more than 6 or 8 sessions…These people are still charging for their services.

8. I forgot one of the BIG ones! For $1000 the psychologist would visit you a couple of times in the hospital before and after surgery to talk to you and help relax you. I never saw them with anyone for more than 15 or 20 minutes and 3 or 4 visits max. I asked if they had paid for the extra and they had. I even got the fee in writing in case I changed my mind because this was a “special” price because they had done the pre-op evaluation.

9. I admit that things have drastically changed. There are more and more people in the office and more and more in the aftercare office. There is a paid exercise physiologist. I tried talking to her when she was new and I know more about it all than she does. There is a spiritual advisor, a Baptist minister but I do not think he is part of a local church. There are numerous patients employed in various functions. The meetings and all are not out of the goodness of their hearts, they are being PAID! There are holistic people on staff and people are required for various hypnosis and calming classes prior to surgery. My sister did them (it was new about the time she had hers) and the concept was to bring a walkman into surgery and to give the OR staff certain words to ground you as you are being put asleep and awakened after surgery. Guess what? They did NOT do it for her and most of the other patients said the same thing! Look at the B-12. They charge you enough money for one little shot which take 30 seconds to administer by a person whose job is paid by the surgeon and they are charging your and making lots of money on that. They have added dozens of “services” which are little more than another way to get more money out of you for a dream that they know you will never see.

10. Many surgeons have a health food store in their office to give you low carb choices. They also sell very expensive vitamins, books, potions and so forth. When I had surgery, the doctor, the nurse, the nutritionist and so on all prohibited the use of any low carb products. They stressed that you HAD to eat protein and the more natural the better for you new tummy. Now, they peddle it also. Over priced and go to any health food store. There is tons of money in this stuff.

11. They sponsored a cruise with seminars for post-ops and special blah, blah, blah. My cabin rate was $295 book value. I was charged $395 for the cruise, double occupancy. I had a warm tray of cheese in my cabin when I arrived. There is no refrigerator to save it and it was thrown away. The seminars were few and no real value for the added expense and most of it was same as the support meetings.

12. They put on an annual party. You know, fancy, and the tickets are EXPENSIVE. It is held at an area hotel. There is some food but, everyone is post-op so how much do you really need to spend on food? Silent auctions (large ticket items and they were no deal). I believe the tickets for one person was $60. The entertainment was Karioke. It was worse than a high school dance. But, they seem to think we are made of money.

Do you see why they need so much money in cash? They are exploiting you. Really, they are. Follow the cash. Do not give in to their sob stories that the insurance companies are the problem and they are these poor doctors who only want to help you but can’t. There is more money than they know what to do with.

Where do you think Dr. Win got the money to expand so quickly? This is an observation. When I had my surgery, it was a one-man show. The fees, while high, were not all given to Dr. Win’s practice. While I didn’t agree that these were helpful, I did it as an initiation fee. The new ones go into his pocket one way or another. Almost as soon as this high fee was added and no longer “grandfathered in” on existing patients, I could not keep up with the expansion. I went to EVERY support meeting. I went to many of the aftercare classes and meetings. I knew things before the average patient found them out and still, the growth has blown my mind! Literally, within a couple of month’s time, there were now 3, next month, 4 surgeons in the office, taking patients and doing surgeries. My sister, one year after my surgery, had hospital visits by two new surgeons on staff with Dr. Win! A third one was doing all post-op visits for people over 3 months out from surgery and he had just started there as a second doctor when I was about 6 months out. 6 months later, there are 3 or 4 surgeons cutting plus that same second doctor doing follow-up. I am talking an explosion here, not controlled growth. Part of my problems is exactly all of this. The bottom line is greed at the patients’ expense and patient care is sacrificed.

In conclusion, I have not had the problems others have had with my surgery. I have had some highly unusual ones, granted, but what they tell you and the reality of life after surgery is not easy, is not simple and is not the answer. The only reason I am not as large as I was when I had surgery is one thing, I can not eat anywhere close to what I used to and my body has adapted totally and it takes much less food to gain weight. As I spoke to people who gave the “higher than normal” weight losses, one thing stood out, they threw up almost all of what they ate. People who lose 60 pounds in the first month, lose 150 at 4 or 5 months post-op are often the ones with whom have the hardest time eating and keeping the food down and this is a problem which is rarely brought to light. For the person like me, who does not have that sort of stuff go on, results are ALWAYS disappointing. I have yet to run into anyone in person, in cyberspace or even as a friend of a friend of a friend who has had an easy recovery and is thin. The other dirty secret is that the ones who look so good, every one of them have had numerous reconstructive surgeries. Not one or two but DOZENS. I know one guy at my meetings who has had 5 or 6 surgeries to remove/reshape his belly. It still is not good, flat and still, the skin hangs. But, surgically remove that hanging skin and the surrounding fat, sure, I would be thin still. Without it, forget it! And since most of us have spent billions of dollars on weight loss things which failed and need the insurance to cover the procedure, cosmetic surgery is out of the question. Oh, did I tell you that shortly before I quit going to see Dr. Win, that the surgeons were taking more and more patients to do “proper” skin removals so they would be more pleased than the standard plastic surgeons tummy tuck???? Where does it end?

Update: 3-2005: I have now developed neuropathy due to the malabsorbtion of vitamins and I am in the process of considering (and probably doing) a takedown of the bypass at this time. Otherwise, I will have pain in my arms and legs, getting worse and worse until I will be in a wheelchair and eventually die because of this. It progresses as pain and numbness moving out of my feet to legs and hands and as the nerves continue to die, I will eventually get to the point where I can not walk any longer unless I reverse the surgery ASAP to stop the progression of the neuropathy from the bypassed part of my intestine.

Update 10-2006:

Finally, the media is reporting the REAL science that people do live longer being overweight and the "obesity" line is not as harmful as they have been scaring everyone with. But, always notice that while they tell you of study after study which is proving women are better being curvy than bones, they always drill back and tell you how "unhealthy" being overweight is.

I have said before here that I had weight loss surgery over 6 years ago. I just saw some article which was probably the most balanced article I have ever seen. One point that stood out was very simply that all of the supposed "obesity illnesses" are easy to control and you can live a very long life with diabetes or high blood pressure. But, the problems people have with weight loss surgery is not as easily fixed. One study found that close to 10% of the people who have the surgery are dead within the first year. The most hidden complication are the 20% of post-ops have neuropathy and, after more than 20 years (the RNY is older than that actually), they are still not sure of all of the effects.

I was not one of the "lucky" ones. My weight loss was average (I did not make it to "thin") at about 50% of my "excess weight". So, I went from about 350 to 250 and, 6 years out, I have regained about half of what I originally lost and am about 300 pounds. I was completely devastated at all of this. And, I often get private e-mails from people on one list or another telling me how to make my surgery "successful". I traded well-controlled diabetes for horrible nutritional deficiencies. I have had a broken foot since 1/1/06. My doctor wanted to avoid surgery. The bone is about half healed after more than 9 months. If I am to live, I have to have this reversed soon. As a result of "something" (the study had no information on what to do), I have painful neuropathy in one foot and numbness in the other foot and some other areas. Had I not had the surgery, I would not have developed diabetic neuropathy at this point in my life. In addition, my diabetes would have to be uncontrolled for 10-20 years or so to get it if I remember what my endocrinologist told me. Since it was so well-controlled, I would have been over my retirement age before it could have happened.

Back when I had my surgery, the surgeon reported that he had only 3 deaths in the over 13,000 he had performed. Interestingly, I personally knew 6 or 7 who died out of maybe 60-80 people I knew who had the surgery. And, in some age ranges, the death rate is staggering according to some studies.

Personally, I think that we have been given a load of garbage about weight, obesity and all the rest.

Update 2010: Amanda is seeking a doctor to do takedown surgery.  Her neuropathy has gotten to the point where she cannot work and she is also suffering a lot of pain from possible bowel obstructions.  Also, she has had malnutrition issues in the last year because she often cannot eat or if she does eat, it doesn't stay down.

Amanda Frank  is available for contact....

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