My Story

Monday, April 22, 2002

Dear Friends and Family;

I am writing to you to because John and I consider you a close friend or family member whom we love, and because we covet your prayers – now, as we have in years past. I am about to share some very personal information with you and ask you to join us as we come before the Lord, seeking His wisdom and provision. I want you to know that for many months now John and I have been seeking the Lord’s face in regard to these issues, and have made no decision lightly.

Now, after that mysterious beginning, let me start. As any of you will undoubtedly know, I have struggled with my weight since I was a girl. I perceived myself – from age 6 to be very much overweight. I often heard the comments of adults who remarked about my size – and believed myself to be gargantuan. And of course, I also heard unending comment from my peers – who also believed me to be fat. Those in my family will tell you that I started out very much “normal” – as this picture will show you. This is me with my Grandfather White, Christmas 1964 – almost 1 year old.

I could recount for you heart-rending tales of horrible things said to me about my weight, looks, etc. It took me many years to get to the place where I felt okay about being me. And I’m sad to say it was well out of high school. If only I’d been able to see myself with different eyes back then and realize that I wasn’t the “cow” that I was so often labeled. I just wasn’t fashion model proportioned. I’m happy to say that once I was happy with who I was before the Lord, I was able to begin to love myself and forgive any unkindness shown to me. It ceased to be a concern.

As most of you will know – I have lived a very active life. I’ve been so fortunate to travel a great deal of the United States and some in Mexico and Canada. I had the privilege of being in full-time ministry for a number of years. I also enjoyed sailing, water skiing, swimming, walking, and bike riding to name a few. One of my favorite things – even still – is riding roller coaster rides. Not far behind that – white water rafting! How I love the outdoors! I have such great memories of camping out under the stars in Central Washington with a bunch of teenagers and cooking over the fire, taking long walks through the beautiful meadows, and lying out at night watching shooting stars.

What most of you may not know at this point in time is how much my life has changed in the past few years. But before going into that more, I should say that my weight has gone up steadily since my late teens. I have tried Weight Watchers, over the counter diet drugs, vegetarianism, starvation; I worked with a registered dietician for 18 months at Kaiser, and tried virtually every other diet under the sun. In my mid-twenties I went to my primary care physician (who had been my doctor since I was 15 years old and I trust implicitly) and asked her about the Jenny Craig phenomenon. I had a friend who had lost a great deal of weight, and my own mother lost weight with that program. My doctor explained to me that she did not feel that this was the correct choice for me – that given my allergies (to medicines, environment, and foods) and her concerns about the end-result on heart and liver function, I should not proceed with this type of program. She urged me to follow a heart-healthy diet and to be more concerned about keeping my blood pressure and cholesterol in check, and to make sure that I continued to live an active lifestyle. So I did. A couple of years later, when the phen phen phenomenon hit, I again asked if it were something that I should pursue. Again, she felt that it was a poor choice, and urged me instead to eat a healthy diet and stay active. Again, I trusted her and followed her advice.

After John and I married we agreed that we’d like to have a baby, and began our quest to have one. Our first pregnancy – just a few weeks in length – ended in miscarriage. But shortly thereafter in June 1994 we learned that I was pregnant once again. I carried our baby Elizabeth until 23 weeks gestation, at which time she was born prematurely – weighing 1 pound 9 ounces, and was 12 inches long. She lived 4 minutes before returning to heaven. Since then we have experienced five more miscarriages, and of course, the birth of our son William – after 18 long weeks of bed rest. I am sure that the continual change and surge of hormones did nothing to improve my metabolism. My weight has gone up and down during these years. However, after William was born in February 1997 things did change. I actually lost 30 pounds when I was carrying William, and then after I lost even more weight. It was totally amazing. However, one of the things that I was aware of from the time he was born was the fact that “something” had happened to my back during that labor and subsequent c-section delivery. After William was born I found that simply walking through our home made my back feel as if it was on fire – it was searing pain – and at a given time I could hardly walk at all. It was then that I was referred to a chiropractor – who was able to manipulate my back and perform massage and apply heat packs. After several months of chiropractic care I was better – not quite where I had been before – but better, and this made all concerned happy. As time went on, though, my back would become more and more painful. It was a gradual thing. And with that pain came curtailed activity. It became very painful for me to walk any distance at all. And as a result, my weight began to climb again. It seemed ironic, really, because about the same time John and I vowed to give up nutra sweet (at my doctor’s urging) so we kicked our MAJOR Diet Coke habit. I thought – wow- we should lose weight now. Sadly, we learned to love regular coke and other sodas in its place.

In the spring of 2000 I was so fortunate to be referred to a wonderful new PCP – her name is Marnie Foley, and from the time I met her I liked her very much. Of course, by this time, my own dear wonderful Dr. Madill, who had been my doctor for literal decades had decided to retire.

Some time in late 1999 I began to have problems with insomnia. As a matter of fact – it became severe. By spring of 2000 it was so bad that I would nod off at the drop of a hat. In fact, one day I followed John in his car to some errand or the other. I had a car full of children. We were slowing for a stoplight. I remember applying pressure to the brakes. Then I nodded off – I actually fell asleep. I actually rear-ended John! It was frightening – however I must confess that this was not the first time that I had nodded off behind the wheel. I had to fight to stay conscious all the time. During the summer months that year it was put to me that I might have sleep apnea, and I should probably follow it up with my doctor. In September I did, and I was referred for a sleep study. It was quite an experience – and what I would give now to have a picture of me then! I’m sure I looked something like the Borg Queen. It was wild – but also very revealing. It was learned that I have severe obstructive sleep apnea. When I fall asleep my airways close – and then I awaken with a start and rush of adrenaline – fighting for breath. I was immediately fitted for a CPAP (continuous positive air pressure) machine. I had tried a similar machine during my sleep study – and the lab technician confided in me that the CPAP didn’t help me much anyway – I continued to stop breathing even with the CPAP running. I tried, however, to use the machine – but largely without success. To this day, I continue to struggle to get enough sleep – being continually awakened from my sleep by the cessation of my breathing. It can be extremely frightening. It also brings on high blood pressure, and can also eventually bring on congestive heart failure.

In March of 2000 I also made another discovery – a lump in the back of my left wrist. It was tiny to begin with. But it continued to grow. And as it did, it pressed against the nerve bundle in my wrist, and brought on shooting pain, and eventual numbness of regions of my hand and arm. My doctor referred me for a nerve conduction study where I learned that I had several problems going on at the same time – there was some carpal tunnel syndrome in that wrist – but nothing glaringly horrible, I had some tendonitis in another portion of the wrist, and then I was beginning to experience permanent nerve damage from the pressure that the mass was exerting on that nerve bundle. I have up to 10% loss of function in portions of the hand, wrist, and arm. Dr. Foley referred me to an excellent hand surgeon who removed the mass November 20, 2000. It healed nicely, and the pain, tingling, and numbness that had been ever-present was gone.

February (2001) I had an appointment with Dr. Foley. When I arrived at the office the nurse took my blood pressure. It was astronomical – 184/118. Dr. Foley encouraged me to begin exercising right away if I preferred to stay off of blood pressure medication. She made an appointment for me to return in 2 weeks to be checked – and told me to get going with an exercise regimen. So I went back to the pool and began doing aqua aerobics 3 to 5 times a week. I loved it! I was so fortunate to have a friend who was able to join me for the same class and we had great fun.

However, while I enjoyed the aqua aerobics immensely, I was continuing to have debilitating back pain. When William turned 4 years old, I turned to John and said, “This has to change. My back is killing me – I can’t walk through the grocery store any more, it kills me to walk through church, I can hardly even make it to the mail box and back. I’ve got to speak to my doctor.” I spoke candidly to Dr. Foley about the fact that I was completely dissatisfied with the fact that my mobility was so severely limited by the back pain, and of course, the fact that I was now at my lifetime highest weight. She encouraged me to continue with my exercise, and she also referred me for physical therapy, feeling that it would teach me some strengthening exercises and that would help some healing to begin to take place. I had every intention of doing both right away, but somehow got distracted. I did, of course, continue on with the aqua aerobics – and was successful in lowering my blood pressure enough to hold off on beginning any medication to regulate it. But it wasn’t until April that I got around to arranging my first physical therapy appointment. When I went to physical therapy I was instructed how to do a number of exercises. I mentioned to the therapist a number of times that some of the things that he was having me do was causing some pretty significant pain in my knees. He told me not to worry about my knees – we were working on my back right now – and just to tough it out. After 6 weeks of physical therapy – I could hardly walk for my intense knee pain. My back was none the better, either. At one appointment the therapist actually threw my back out – after my repeated warnings that it would kill my back. It was significant enough that I wasn’t able to drive and John had to leave work to come and pick me up and drive me home. After a week and no resolution of the pain to my back and knees I returned to Dr. Foley and reported. She at once told me not to return to the physical therapist, and urged me to take Advil for the pain, and apply ice for any swelling.

It was during this time that a sermon was preached at church that had to do with healing. One of my favorite subjects – since I so wholeheartedly believe that God can and will heal according to His good pleasure. I know from personal experience that not only can He, but certainly – He does still heal today. It occurred to me in the car on the way home that I hadn’t asked God for healing for my back pain, the issues related to my weight, etc. And then, for the first time I sincerely prayed and asked God to bring physical healing to my life.

At the end of April I saw my OB/GYN for my yearly exam. She has been my doctor since William was born, and she has always been very supportive of me – yet honest with me as well. After my exam she sat down and talked with me as sincerely and earnestly as anyone ever has. She said, “Dina – I am really concerned for your life. Your weight has continued to escalate – even though you eat a healthy diet and exercise. And to be honest with you – even if you dieted and had great results – you could not lose the kind of weight necessary to head off the kinds of health problems that will be yours if you do not lose this weight. You need a drastic solution or you will lose your life. I want to encourage you to seriously research weight loss surgery, and once you have done that, please approach your primary care physician and ask what her opinion is. Frankly, I fear that your life will be severely shortened if something doesn’t happen soon.” To be honest, I’d never really heard about weight loss surgery – well, maybe in the back of my mind I’d heard horror stories about stomach stapling and people dying torturous deaths. But it was so remote and unclear in my memory, I determined to go home and begin hitting the Internet to research. John and I spent hours and hours researching. We learned that the stomach stapling of old was a trend long past. There were now Bariatric Surgeons world-side performing a number of surgeries that had been refined long-since – giving the morbidly obese a new chance at life. We learned that there are 3 main surgeries being done: The newly FDA-approved AGB (adjustable gastric band), the Roux-en-y (which is most popular and widely-known surgery), and the BPD/DS (biliopancreatic diversion/duodenal switch). There are a number of factors to consider when deciding which surgery is the right one for you, but a helpful tool is a BMI (body mass index) calculator. Here’s a chart that may be helpful:

Normal

Inferior to 24.9

Overweight

Between 25 and 26.9

Mild Obesity

Between 27 and 29.9

Moderate Obesity

Between 30 and 34.9

Severe Obesity

Between 35 and 39.9

Morbid Obesity

Between 40 and 49.9

Superobesity

Between 50 and 59.9

Super/Superobesity

Over 60

Standards Committee: American Society of Obesity Surgery; Obes. Surg. Dec.1997; 7:523

My BMI at that time was 61.8 – putting me in the super/superobesity range. Another determining factor is what a person’s co-morbidities are. The National Institute of Health (www.nih.gov) lists the following as potential co-morbidities (although there are many more) for the morbidly obese:

  • Asthma
  • Degenerative Arthritis
  • Depression
  • Diabetes
  • Heart Failure
  • Hyperlipidemia, Hypercholesterosis
  • Hypertension
  • Infertility
  • Pseudotumor Cerebri
  • Skin Infections, Etc.
  • Sleep Apnea
  • Thrombophlebitis, Pulmonary Embolism
  • Venous Stasis Ulcer

My co-morbidities are:

  • Acid Reflux
  • Asthma
  • Degenerative Joint Disease (back)
  • Type II Diabetes
  • Grade 3 to 4 Deterioration of the knee (bilateral)
  • Hyptertension
  • Noctural Stress Incontinence
  • Skin Infections
  • Severe Obstructive Sleep Apnea

On May 8th, 2001 I met again with Dr. Foley – and I shared with her Dr. Darm’s concerns for me and her feeling that weight loss surgery (WLS) was what I needed. Going in I was a little concerned that she would react very negatively to this. One of the reasons that I like her so much is the fact that she is so conservative in her approach to medicine. But at the same time, she is also very pro-active. The other reason I wondered is because she probably weighs 95 pounds dripping wet – and this post-partum with 5 pounds to lose. I simply didn’t think she could relate. I was grossly wrong, however. She wholeheartedly supported my pursuit of WLS – and in fact confirmed that she believed if I continued on the path I am at currently – even with a sensible diet and an aggressive exercise program – I might have 5 years left to live. She was glad to research local surgeons performing the various weight loss surgeries, and assured me she would place a referral as soon possible. Within a week I had received that referral, and I called to schedule an appointment with Dr. Emma Patterson – the surgeon that Dr. Foley had found in her research.

Upon reaching Dr. Patterson’s office, however, I learned that it wouldn’t be as easy as making an appointment with the surgeon. I was told to leave my name and address, and I would receive information in return mail. Several days later I received a large packet and learned that I would have to recount my life history for this office. My information would be reviewed, and then, if they felt I was a candidate, I would be notified by return mail that I could then make an appointment. So – that very day I filled out all of the information and mailed it back before 5:00 p.m. A number of days later, I received notification that I was a candidate for the program, and I could proceed by calling to make an appointment with Dr. Patterson, and then I should also make appointments with an independent internist for a physical and blood draws, a psychiatrist for a psychiatric evaluation, and a dietician for analysis of my diet and explanation of what changes WLS would bring about. So I called to make my appointment. Keep in mind that this is the 3rd week of May. The soonest I could see Dr. Patterson would be September 25th, 2001. I was disappointed, but took the appointment. So I started scheduling the other appointments.

In early June I received in the mail a notification from our Insurance (Regence BC/BS, HMO Oregon) that my appointment with Dr. Foley on May 8th would not be covered. I of course phoned the insurance company and learned that because of the diagnostic code used, I was ineligible for coverage for that appointment. They urged me to phone Dr. Foley to learn what code she’d used and to ask if there were another she could use so that the visit would be covered. Suffice it to say that I learned that Dr. Foley was on vacation, no one wanted anything to do with breaching physician/patient confidentiality and reveal that code to me – even though I was the patient!, and I made approximately 30 phone calls before I finally reached someone who could help. The lady I reached was in the coding department of the clinic that I see my physician at. I gave her the details, and asked if there wasn’t some way – seeing that I was the patient and the payment for this visit was on the line – that I could learn what that code was. She agreed that it was reasonable that I be given the information and she did the appropriate research. The code used was for morbid obesity. I had been diagnosed as morbidly obese – and my insurance was saying that I wasn’t allowed to be that, or be treated for it. The coding lady agreed that was precisely what they were saying, and wished me luck. So I phoned the insurance company once again, and it was confirmed that indeed, I was not allowed to be morbidly obese, or be treated for it. In fact, I learned that they would not cover any thing related to morbid obesity at all – they had an air-tight written exclusion. So – needless to say, weight loss surgery would not be covered either. And I had just learned from someone on one of the e-groups that I was on that self-paying in the U.S. generally starts at $35,000 and goes up from there – I’ve heard of someone even having a $120,000 bill. I was depressed.

Amazingly just a few days later John learned that his insurance was being changed at work. There had been so many complaints about the service with BC/BS that they were changing to ODS Health Plans – and they said our coverage should be just about identical. I wasn’t sure what that meant, but I did hit a web site to research if anyone else with their coverage had ever been successful in getting coverage for WLS. I was encouraged to see several who had. So, the game plan was to wait until July 1st, have Dr. Foley re-write the various referrals, and start over again.

By the time mid-June rolled around, I was finally beginning to feel as if my knees would possibly heal. They were still painful and I was still having great difficulty walking because of the knee pain, however, I finally felt as if there were some hope. On June 18th, 2001 shortly after John returned home from work, I stood up out of one of our kitchen chairs. In an instant my right knee just buckled and it felt that everything inside my knee had had a collision of the worst kind. The wind was sucked out of me and the pain was immediate, extreme, and I was completely unable to walk. Within minutes my knee was swollen to twice it’s normal size, and the swelling was continuing down my leg. Within 30 minutes I phoned my physician, and I was referred to the urgent care clinic. I was seen right away and an x-ray was taken. It was confirmed that there was no broken bone of any type, but the physician told me that she wouldn’t be surprised if I had a meniscus tear or some other sort of tear in there. She told me to follow up with my own physician in two days and gave me some pain medication and anti-inflammatory – telling me to keep the knee elevated above my heart and packed in ice. When I returned to see the doctor 2 days later things were not much improved. I actually saw a colleague of my own doctor – since Dr. Foley was on vacation – and this doctor informed me that even if there were something wrong with the inside of my knee, it was doubtful whether anyone would do anything about it anyway – given my weight. She told me that I would likely just have to deal with the pain the best I could – and sent me home with lots of samples of Vioxx. Needless to say, this was disheartening. I tried returning to aqua aerobics – but the pain was simply too unbearable. When Dr. Foley returned from vacation I told her my saga and she disagreed. She felt it was reasonable to refer me to an orthopedic surgeon for evaluation, and so she sent me to Dr. A. Brooke Benz, where I was evaluated.

At Dr. Benz’s office, I was evaluated by his associate John Voss (a PA). I went through a thorough exam and had quite a number of x-rays taken to evaluate. They were unable to determine from x-ray whether or not there was a meniscus tear, but were able to see that I have severe mal-alignment of the knees – due to my weight – and there is substantial damage done as a result. They referred me for aqua therapy for 6 weeks and told me to return for re-evaluation. So, I went to aqua therapy and did okay – but frankly, was experiencing substantial pain. On my return appointment I expressed my pain issues, and it was then that they agreed I needed an MRI. I was referred, and the next morning I went for the MRI. First of all, the place that did the MRI was in a building that was just recently completed in our area, and so of course, I’d never been in it. I parked in my handicap accessible space and once inside this very large building (that curves around 3 corners of a very large block) learned that the office that I had to visit was clear at the extreme end of the building. It is very difficult for me to walk any distance, so needless to say – I was in substantial pain by the time I got there. After filling out the multiple pages of information I was taken back to the MRI room. The tech had me climb on the table, positioned my knees (which was painful) and I mentioned that my lower back was very painful. She said it wouldn’t take too long, and could I tough it out? I said, of course I could. She then proceeded to advance me into the MRI machine. I had told them coming in what my weight was, but apparently they hadn’t paid much attention – because it soon became obvious that I didn’t fit into the MRI tube. She kept advancing and telling me to hold my breath – suck in – and hold my stomach down as hard as I could. We made it to my rib cage – where I had to gasp to get a breath. She asked if I thought I could stand it long enough to run the test image. I agreed that I’d do what I could. So, she left and began the test. A number of minutes she returned and told me that it was working, and could I stand it a little longer? I said yes. Well, 6 – 4 minute passes later I was done. I’ve never been so relieved in my life. She took me out of the tube, and then told me I could get up. The only problem was by that time, my lower back was in so much pain and so cramped up that I simply could not do it. It took assistance for me to be able to sit, and even more assistance to be able to stand. I was in so much pain that I had tears running down my face. I asked if there were any way that they could take me to my car with a wheelchair. She looked at me and said, “Oh – sorry, we don’t have any.” So, after waiting a while and trying to get a handle on the pain – I very slowly made my way back to my car. I cried the whole way. I finally made it back to my Mom’s house – where the kids had stayed during my appointment. My Mom kept the kids and sent me home to take pain meds and rest. It took several days to get over it. However, it only took 24 hours for Dr. Benz’s office to call and confirm that I had a severe medial meniscus tear and needed surgery as soon as it could be scheduled. The scheduler called and notified me that my surgery would be September 17th at St. Vincent’s Hospital. Several days later the scheduler called back – apparently my insurance would not cover at St. Vincent’s, so I had to change the date to the 20th of September at Tuality Hospital. This was August 17th, 2001.

I should back up a bit and say that during all of this time that I was dealing with the knee(s), I was also having my various appointments in order to satisfy Dr. Patterson’s requirements. All agreed that weight loss surgery was what I needed to pursue. We were so thrilled, as well, to find that our insurance was paying for all of these visits – leading us further to believe that they would pay for the surgery.

On August 21st I had the most interesting phone call. It was Sandy, from Dr. Patterson’s office. She’d just learned that there was a cancellation in the schedule, and Dr. Patterson could see me on the 28th, if I was interested in coming in earlier. Of course I was! John and I arrived at the surgical consult with Dr. Patterson and spent the next 2 hours going over all sorts of information with her assistant, and then eventually Dr. Patterson. I had done a tremendous amount of research and really believed that the BPD/DS was the right surgery for me. I knew from various on-line email groups, etc. that Dr. Patterson did the BPD/DS, the RNY, and the Lap Band (or AGB). When we finally saw her she informed me that I was too heavy to have the BPD/DS done, and the only surgery she would consent to performing on me was the Lap Band. I was so disappointed. I knew that people who had the Lap Band didn’t lose the weight like the other surgeries, and that the potential for complications was high. But she said if she did the Lap Band on me, then maybe I’d lose a certain percentage of my weight, and then be a candidate for another surgery later down the road. I found that incredibly discouraging, but I was willing to do anything by this point in time. So she put me on a pre-operative diet (high protein, low or no carb or fat) and told me if I gained a single pound I would be excluded from the program. I was notified that once all of my paperwork was in to her office, my case would be submitted to insurance for pre-approval for surgery. She told me that letters of medical necessity from my PCP, OB/GYN, and pulmonologist would be a real plus, and encouraged me to ask those doctors if they would write those letters for me. They were gracious enough to do that. By October 5th, they had everything together and submitted to insurance at 9:00 a.m. that morning. By 5:00 p.m. we had an answer – unequivocally – NO. Our insurance, we learned, has an airtight exclusion for the treatment of any weight-related condition. In other words, I could be dying of anorexia and they wouldn’t cover treatment, either.

Shortly thereafter I learned some things about Dr. Patterson and her practice that were disturbing. I began to question whether or not the Lap Band was the correct choice for me – and whether Dr. Patterson had been completely honest and up front with me – and wondered was it worth the risk to do, and so I began my research all over again. I read many medical papers on the outcomes of the various surgeries. I talked to hundreds of patients. I emailed scores of Bariatric surgeons and asked their opinion about the changes that Dr. Patterson was making and whether or not they agreed that the BPD/DS was too invasive a surgery for a person over a certain weight. During this time we also contacted Walter Lindstrom – an attorney who specializes in fighting insurance companies to get coverage for people to have weight loss surgery. He had had much experience with our insurance company and assured us that their exclusion for coverage was airtight, and a fight in court would be a loss of money that we could save for a self-pay surgery. We did also write a letter to John’s employer asking them if they would please change the insurance product that they purchased so that it would include coverage for weight loss surgery. They told us that they were not interested in doing so.

All of my renewed research and gained information from interviewing so many post-operative patients, surgeons, and their family members led me to an important conclusion. The Lap Band was not the right choice for me. I am highly prone to allergies – and because of this, chances are high that my body would reject the band and port that would be implanted in my body. The Lap Band also has the highest rate of reoperation due to complications. And – the Lap Band is the only weight loss surgery that does not “cure” diabetes, does not help bring an end to sleep apena, and has the lowest success rate for amount of weight lost.

The surgery that is most often performed is the Roux-en Y (referred to by the WLS community as the RNY) – this surgery entails making a 1-ounce pouch by removing the lower portion of the stomach and the pyloric valve (the valve the regulates the release of digested food from your stomach to your intestine). A “stoma” is created by sewing the intestine to the bottom of the new pouch. While the results of the RNY are really great for some people – people who are heavier – or super morbidly obese, tend to end up still in the “obese” category. RNY patients also experience a syndrome called “dumping” that is caused when foods that are fatty or have a certain amount of sugar in them are consumed. Here’s a description that I felt gives good facts:

DUMPING SYMDROME: Dumping symdrome occurs when partially digested food rapidly enters the jejunum, and is quickly digested creating a concentrated mass. This concentrated mass pulls fluid into this concentrated mass (due to diffusion) from the intestinal capillaries out of the main blood stream. Results of this sudden fluid transfer will be diminshed blood volume from loss of fluid from the blood stream and stimulated peristalsis from the sudden increase in volume inside the intestines. END RESULT: Cold sweats, nausea, weakness,chills, cramps, low blood pressure, diarrhea, over all flu like symptoms that come on quick and may last 30 minutes or so.

Other discouraging statistics include: the number of people who end up with complications and reoperation, the number of people who learn to “out eat” their surgery and regain their weight, and the need to continue to “diet” with the surgery. I know MANY people who have had this surgery and are very happy with it. However, after my research, and speaking with my PCP, we agree it’s not the surgery for me.

So, the surgery that we have agreed is for me, is the BPD/DS, or “DS.” The DS is the most invasive of the surgeries. It is recommended for patients with a BMI of 50 or higher. The pyloric valve is kept intact, so no dumping syndrome. Weight loss is a great percentage – I know many who have had the DS who have lost 100% of their excess weight and kept it off for several years now. And because of the combined restrictive and malabsorptive qualities of the surgery, weight comes off faster. Most of the patients that I have spoken with who have had the DS and are my size lose their first 100 lbs the by six months after surgery, and are generally “at goal” by 18 months following surgery.

So, now that decision is made – the question is which surgeon? There is a web site that has a listing of the DS surgeons in the world, actually. (www.duodenalswitch.com) So I started emailing them and asking “how much” – because cost is going to be a significant factor for us – and whether or not this can actually happen before my health brings an end to my life. Pricing came in as low as $35,000 and as high as $120,000. John and I carefully analyzed our income, obligations, and budget and knew instantly – we just can’t afford that. About this same time I started running into people online who had gone to a clinic in Alcoy, Spain and a surgeon named Dr. Aniceto Baltasar. (http://www.drbaltasar.com/i_default.html)

 There were a number of things that were very impressive about Dr. Baltasar:

He has a very low “complication” rate with his patients.

  1. There is an exceptionally low “reoperation” rate with his patients.
  2. He is one of 3 top DS surgeons in the world – he has very impressive credentials, a large body of published work chronicling his work, and is reported to be one of the most “patient-friendly” surgeons there is – anywhere.
  3. Most U.S. surgeons spend between 4 and 8 hours doing the DS. Dr. Baltasar’s surgeries typically go no longer than 120 minutes. Of course, the less amount of time under anesthesia, the better.
  4. Most U.S. surgeons have waiting lists up to 1 year for surgical consults, and then often as long as 6 month wait between consult and surgery. If I had the money today, I could call Dr. Baltasar and have a surgery date within the next couple of weeks.
  5. Dr. Baltasar also removes the gallbladder and appendix at the time of surgery to avoid any of the more “common” abdominal surgeries as a post-op patient.
  6. And…it only costs $11,500 plus traveling expenses. (So all tolled, we think $15,000 will be enough.)

I have had the opportunity to email with Dr. Baltasar a number of times now. I have given him my health history, etc., and he has acknowledged that he will accept me as a patient whenever I am ready to go. I have discussed this at great length with my PCP – who has done her own research on the surgery and Dr. Baltasar. She agrees it is the right course to take – although she would much prefer I were closer by so that she could be involved in my immediate post-operative care – but gives me her blessing nonetheless. She feels the sooner I have this surgery, the better – my health will only continue to deteriorate with the lapse of time.

So after all of that info, I feel like I should “recap” so there’s a little more concise accounting:

  1. At present I am being treated for:

    1. Diabetes (I take 5 pills a day to try to keep it in line – because I am insulin resistant, however, dosages change frequently).
    2. Hyptertension (I take 2 pills daily for this).
    3. Severe obstructive sleep apnea: the long-term side effect of this being congestive heart failure. Unfortunately, my c-pap machine is not effective for this so I get small snippets of sleep each night – in the recliner. This condition is complicated by the fact that I have been asthmatic since a child.
    4. Acid reflux (1 medication for this).
    5. Degenerative joint disease. My mobility at present is such that I can walk short distances with a cane, but other than that I use the wheelchair. The doctor says I have less than a year left to walk. Unless I lose the weight – then I’ll likely have a 15 to 20 year remission on the DJD. Pain continues to be an issue, but pain medications must be used very sparingly because of the sleep apnea.
    6. Bilateral knee degeneration: the orthopedic surgeon says about 2 years left before bi-lateral knee replacement necessary. Unless I lose my weight.
    7. And the promise that my health will only continue to decline in other ways the longer I stay this heavy. Because of my weight I am at a higher risk for cancer, heart attack, stroke, etc.
  2. What will happen if I don’t have weight loss surgery? My health will continue to deteriorate and I will likely be dead within 5 years.
  3. What will happen if I do have weight loss surgery?

    1. My diabetes will go away. A recent article published by the American Diabetes Association states that weight loss surgery (specifically the RNY and BPD/DS) are nearly 100% guarantee of elimination of diabetes in the morbidly obese.
    2. My sleep apnea will go away.
    3. My hypertension will go away.
    4. My acid reflux will go away.
    5. My degenerative joint disease and knee degeneration will go into remission – pushing the need for surgical correction and loss of mobility back by potential decades.
    6. My health and life will be restored.
  4. We’ve decided to pursue the BPD/DS surgery, and have chosen Dr. Baltasar in Alcoy, Spain as the surgeon to do the surgery.
  5. We have to save $15,000.00 so I can have this surgery.
  6. It would be best if I had surgery soon since I am losing my ability to walk – and walking is a major component of healing in major abdominal surgeries – it speeds healing so significantly and helps to avoid potential blood clots. That, and the fact that the sooner I have surgery, the sooner the other health concerns stop advancing – and in fact – begin to retreat entirely.

One other thing that I would also ask you to pray about is the heredity factor that is involved with morbid obesity. This is very much a factor in my own case – my maternal grandfather and many generations back on his side of the family were morbidly obese. There are those on both sides of my family who are morbidly obese, actually. And we are beginning to see the signs of it in William – who at age 5 weighs 69 pounds – the same as his 9 ½ year old sister. He will be seeing an endochronologist May 16th because of suspicions of possible low thyroid and potential Type II diabetes. If his weight escalates at the rate that it has been he will be facing the same health concerns that I am. A frightening legacy to hand down.

So that’s the scoop. We come to you to join us to come before the throne of the Father to pray for provision of this surgery so that healing can take place – from these diseases, and for an end to the constant pain. Will you also be praying for John? My lack of mobility and physical limitations have left him with such a heavy burden. He awakens early each morning to do housework before he leaves the house at 6:00 a.m. for work. He returns home from work at about 5:30 p.m. only to have to prepare the evening meal and do more housework – there seem to be endless dishes, laundry, and bathrooms to be cleaned, and floors to be scrubbed. I am so humbled by his incredible servant heart and loving kindness to me. God has blessed me so richly with such an incredible husband.

Thank you for being there to share this with. You are a blessing to me.

Love,

Dina

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