theantichick

Thanks! Good to hear from other PsA patients who saw improvement. Apparently there's a number of reasons for the improvement beyond the weight loss alone. Which has figured greatly into my decision to have the surgery. My mom thinks it's a bad choice, but she'll support me in my decision. My husband and daughter are 100% behind me, as are my group of chosen family. Now it's just all the insurance hoops for 3 months.

I get what you're saying. I guess extending the analogy, I'm trying to find out if I'm marrying a decent guy, or a psycho.

This is absolutely true. I have worked around enough doctors to get a feel for their competence from talking to them. My surgeon was teaching at a university medical center until she was hired away by the physician group my rheumatologist is in. I found a paper she co-authored that reinforced my opinion after speaking with her. And from what I've been able to find, the "rock stars" don't do most of the surgeries at their centers, they oversee young docs starting out. So even going to one of those clinics doesn't guarantee you anything. Not to slam the other guys, I'm sure they are also great. But this one is in the group with my rheumatologist, and is across the street from my office, so it's super convenient as well for appointments and support groups.

I saw the patches and thought that was cool, but wasn't sure how well they'd work.

This is good information. I have irritable bowel, so I have issues with this without adding even more causes. I'll be visiting a BB&B this weekend.

So I met with the surgeon today. She's not listed here, but she's newly in private practice and was with a university group before. I'll probably tell her office person to get her added here ASAP. I like her a lot. She hasn't been doing this as many years as some of the rock stars in the area, but she answered all of my questions without hesitation or ego, talked about the things that contribute to complications, and what she does to avoid them. I like her approach, and her experience is good, just not as long as some. She has a personable manner, something I'm not accustomed to in surgeons. She says I'm a good candidate, agreed with me that a sleeve was the best surgery to choose, and we discussed the expected impact (good) on my other health conditions. So now comes the insurance hoops. 3 month supervised diet program, cardiologist for stress test (I have a past heart issue that's resolved, but we'll make sure of course), get my psych to write a clearance, visit a nutritionist, etc. Cigna also requires another doctor to say I need it, but since my rheumatologist referred me and was very positive about it, I don't think that will be a problem. My blood pressure has been trending higher over the last 4-5 months, and it was high enough today that I'll need to visit my primary doc and probably get put on something so I don't get refused for anesthesia. As a past ER nurse, it wasn't a number high enough to worry me especially with weight loss coming this summer, but high enough to cause a problem with anesthesia clearance. My surgery will likely be late July or early August. Which works out well because it will be after my summer vacation trip (when I would NOT want to be on liquid or puree) and if it's timed right will fall between my grad school semesters as well. She also confirmed what everyone here has said in response to my concerns about life-long eating problems... she said after the first year or two, the eating patterns of her patients look like normal people who don't have eating or weight issues. She expects me to land somewhere in the 1,500 cal a day diet range, and not have to obsess about food more than anyone else who's working to be healthy. So I guess it's onward and upward. Or downward (weight-wise) if you want to look at it that way.

Thanks for the book recommendation. I'll definitely check it out.

My PCP won't be for it, luckily she isn't part of the decision. My rheumatologist perked up when I asked her if it would be a good idea, and she started telling me benefits to the surgery that I hadn't even heard of. She referred me to a surgeon who I meet with tomorrow. My PCP probably won't know until it's over, if I decide to go through with it. Funnily, my PCP is the one who's been on me about my weight forever, but she thinks Atkins or gluten free is the way to go. Not for me.

ER nurse here. No judgment, but I will advise that you tell your surgeon about your use. The cocaine in particular can create some serious complications with surgery, and it will make it all the more important that a cardiologist do a full screening on you pre-op. And the cardiologist needs to know about your use as well. There will be medical people who will judge, I wish I could say that doesn't happen. But you VERY MUCH need to be with a medical team that you trust, and who have all the facts. You also need their input about how soon is safe for some of these things. The alcohol, especially since it has to be processed by the stomach. You wouldn't want to put something that stressful in your stomach too soon or you'd risk a lot of complications. As for the effects post-sleeve, I'm still in the decision stage, so I can't help with that info. The people I know with either sleeve or bypass report that alcohol affects them much more and faster than before surgery, but they haven't shared about other substances.

Thank you, thank you, thank you. Too much excellence in your response to quote it all, but this is exactly the kind of thing I was hoping for. I have read so much about the post-op diet, and it feels like everyone is living post-op on some 600-800 calories and never eating carbs. That didn't seem realistic long-long-term, so I was hoping I was perceiving things a bit off. I also love what you said about attentive vs. obsessive. If it weren't for the hormone changes with the surgery, and what that means not only for cravings and overeating, but also the direct impact on my auto-immune condition, I don't think I'd want to do the surgery. I want to get to a place exactly like you describe... a normal healthy diet where I don't have to obsess about food and exercise, but eat mostly right and go and do the things I want to do.

First, thank you all so much for the support and feedback! When I stopped to re-read it before I hit post, I was concerned that it was going to be perceived as surgery bashing and I'd get a ton of negative feedback. But this is really my main concern, the ongoing changes to my life, and what my life will look like 10 years from now. I'm a nurse, and underwent a massive knee reconstruction in 2008 which involved 4 months direct physical therapy and another 14 months rehab on my own at the gym. So I know the things to check on a physician, how to choose a physician, what kinds of complications are possible and what can be done to prevent some of them (not all, unfortunately, but life is a risk). The surgery itself and the post-op recovery don't scare me at all. The pre-op diet scares me more, because I know myself and that I'll really struggle through that part. I also know that losing the weight is not optional for me at this point. I have 155 lbs of "excess body weight" by the official surgeon's calculation. The weight I ideally want to lose is actually about 125 lbs. I have sleep apnea and an auto-immune arthritis (psoriatic), as well as high cholesterol and borderline high blood pressure. My rheumatologist says the surgery would immediately change some of the hormone production that directly drives the inflammation with the psoriatic arthritis. Not that it will cure it, but it can definitely help the meds work better. I am so out of shape that only a few minutes of walking tops out my training heart rate. My therapist is trying to get me to embrace the "health at every size" concept, but I am not healthy. Nowhere close. While I'd love to be able to shop in "normal" clothes stores, the aesthetics are really not that concerning for me. I want to be healthy again, period. I want to go dancing and get back in a belly dance troupe and be able to do anything I want to (within the limits of the auto immune condition). I also know that losing weight, whether with or without surgery, demands permanent lifestyle changes. Hence the work with the therapist. I've been on diets off and on for over 30 years. Obviously that hasn't worked. The best I've ever been able to maintain was a 35 lb loss for about 2 years. (I only had about 45 to lose at that point). Which was great, I don't want to belittle it. But bottom line, it wasn't long term. I gained it back, plus another 100. I just want to make the best decision, and timing matters now because of the treatment plan for the auto-immune. If I were looking at this clinically on behalf of a patient, I'd recommend the surgery. My head's there. I just know how important of a decision it is, and need to know it in my gut as well.

I'm on my 2nd Mirena. LOVELOVELOVE not having periods. It also reduced my migraines. I gained weight during the time I've had it, but I don't think it contributed. That said, everyone has a different experience.

Yeah, a few months ago they linked Benadryl and other antihistamines of that generation to dementia. I don't think they know, and with a 24 hour news cycle, stuff hits the news and it's not really news. One study doesn't have enough weight for me to pay attention to it.

Going back to belly dance. I don't like "exercise" but I love to dance. I'm so out of shape now my heart rate maxes out just walking for a few minutes. In the same vein, I want to drag my husband to swing dance lessons. Other than that, many of the same things other people have said - fit in "normal" chairs and airline seats, shop at "regular" clothes stores, less pain in joints.

My PCP has been harping on my weight for years, and generally advocating diet/lifestyle. Her latest kick started after I was diagnosed with an auto-immune disease, so now she's harping on going gluten free, and all my problems will go away. Yeah, bite me. I love her otherwise, and she and I have had some head butting over side effects to meds and stuff, and I finally have her trained to work with me instead of dictating to me what to do. Part of that was my becoming an RN. I can go head-to-head with any general practitioner with studies and peer reviewed journals. My Rheumatologist was actually the one that pushed me off the fence about the sleeve. We thought I had rheumatoid arthritis, but a couple of symptoms came to light this week that changed the diagnosis to psoriatic arthritis. She hasn't been harping on my weight, but had expressed some concern. I said 'what do you think about...' and she said "DO IT!!!" There's hormones and stuff from all the extra fat that have a direct impact on my auto-immune condition. Surgery won't cure it, but besides taking stress of joints from extra weight, the hormonal changes can make the meds work better. I'm not even discussing it with my PCP. She'll find out next time I go in for my annual or the next upper respiratory thing I need antibiotics for. Family practitioners/general practitioners simply cannot keep up with the sheer volume of medical information, just looking at peer reviewed journals. They'd have to read some 400 articles a month just to try and keep up. So most are woefully uninformed. Many times patients come in with more information than the docs. But they shouldn't be tacky about it if you give them information. If they are, move along.

LOL. I read this a while back, and thought it was terribly interesting. This is my favorite quote: Yes, we exhale lost fat. There it helps plants photosynthesize (if you're feeling noble) and contributes to global warming (if you're feeling guilty).

I'm a research fiend, and my docs know I want the nitty gritty details. Sent from my Nexus 5 using the BariatricPal App

I have people in my life who run the gamut. My sister had the surgery several years ago, and has been harping on me since that I just *HAVE* to have it. I was on the fence about it until an appointment with a specialist yesterday who said unequivocally, the surgery would have a direct positive impact on my health. Won't cure my situation, but will make it a lot more likely that the meds can work. My mother sees some of the complications my sis had (mostly related to the skin surgery later) and is worried about complications, and thinks I can do it by myself if I just work at it. Like I haven't' been for 30 years, Mom? One of my best friends is anti-surgery and argues against it with reasonable arguments, but doesn't go so far as to criticize me for the decision, and will support me in it. Most of my other close friends are super-supportive, some have already had bypass and are grateful for it, others probably need surgery but aren't in a place to really consider it yet. The one that surprised me is my boss who I talked to about it this morning. She's a very fit person, runs marathons and such. She's sorry I'm having to deal with this, but is super supportive of whatever I need to get healthier. Just telling her what my pulse rate was at the doc's office yesterday after walking less than 5 minutes was enough for her to realize how serious this has gotten for me. I'm a super open person, and will likely disclose to everyone. Bottom line is they aren't in my position. They don't know the months of research I've put in, or what advice my doctors have given me. They don't know all the pros and cons. They can judge all they want. Sometimes it will be hurtful, I know. But this won't be the first controversial decision I've made in some of their minds, and it won't be the last. They're welcome to their opinion, and if they make it too uncomfortable for me, they lose the benefit of my presence. I do wish people could be more supportive and understanding in general, though.

Hi, everyone, I've been on the fence about the surgery for a few months now, and a visit with my rheumatologist yesterday tipped the scales. I kept thinking "heck, if I followed the post-op diet, I'd lose weight and wouldn't need the surgery". But I'm 46, and I've been dieting some 30 years. Obviously, it doesn't work long-term for me. Back when I was 230-ish (I'm 5'9") I was able to take off 20 or 30 lbs and keep it off almost a year, but it always crept back on. The last truly successful time was when I was 200-ish and dropped to about 175 and maintained for a couple of years. But the last 5-6 years have been a huge struggle with going back to school (nursing school) while working full time after a divorce and numerous health issues with both me and my kiddo. I pushed over 300 for the first time this last fall. If I were still in the 230 range, I'd keep slugging away with diet/exercise. But as nurse and a research fiend, I've been looking at the research, studies, and statistics. While it's not impossible for someone with 130-ish lbs to lose and keep it off, the statistics are not even close to promising. And the last year has given me a diagnosis of psoriatic arthritis (was rheumatoid until yesterday, new symptoms clarified the diagnosis) which has made it very hard for me to exercise. Nursing school combined with inactivity due to pain caused the last 40-50 lb gain, which has resulted in my cardio conditioning to be completely awful. Walking less than 5 minutes yesterday from the cab to my doctor's office and back to the exam room saw my heart rate at 157 and I was winded. Something has to give. Like I said, I was on the fence until I mentioned the possibility to my rheumatologist. She is enthusiastically for the surgery in my case. Apparently fat cells secrete leptin (which I knew) that *directly* affects the disease activity for psoriatic arthritis (this I did not know). Most hormones involved in auto-immune disorders are estrogen-modulated, and fat cells secrete estrogen. While the surgery will not cure my arthritis, it can render the treatments much more effective on top of reducing the load on my joints through weight loss. That pushed me over, and I'm going to a seminar tonight to talk to the surgeon my rheumatologist recommends. I was worried about dealing with the auto-immune with surgery recovery, but my sis (who had the surgery a couple of years ago) put me on a facebook support group where a bunch of people with auto-immune talked to me about the benefits to their condition with the surgery, and I'm feeling much better about it. I'm sorry this is long-winded, but I saw the question in the post, and writing it all down helps me process. I'm not sure I'm ready for all of this, but I know it will help my health, and I guess the time is now.