Friday, September 12, 2008

WLS providers misrepresent - who loses?

Occasionally (ok not so occasionally) I listen to an interview with a weight loss surgery provider which misleads from start to finish. And this upsets me and I think it upsets the many providers out there who truly care about their patients and try to follow up and make themselves available. It upsets everyone because it could give folks a very bad impression of providers in general. Folks tend to make decisions based on very limited contact. That is, _if_ their limited contact is a provider like the following one, it could lead to not only bad decisions but also a bad name for the industry.

I actually came across this provider whom I will call DR X, because one of his patients wrote to me and she is not a happy camper. She had a gastric bypass 3 years ago and has been ill ever since and worse yet, she hardly lost any weight from it. This provider who told her it was easily reversed and that he would be there for her, immediately dropped her with his last communication being several rude comments about how she had broken the "tool" and all her illness was her fault. She now is looking for a provider to give her a take-down so she can have some quality of life again and not be so ill.

I am not blaming the surgeon for her illness - it could be that her body just really objected to having her innards so drastically rearranged - many bodies do object to having the stomach cut in two pieces and most of it bypassed and the gut cut into three pieces and put back together in a very different manner than it came from the factory (despite the fact that the media hype tries to convince us that it's a total "walk in the park" and the "weight falls off" etc).

What I do fault the surgeon for, is not supporting her when she did become ill and also she told me that the surgeon really did not give her any detailed instructions on how to manage, what supplements to take, B12 shots and a myriad of other facts gastric bypass patients should be in possession of, before they take the big plunge. To be sick and without a provider who understands can be one of the loneliest positions one can be in and yet, I have met quite a few ill gastric bypass patients in this exact position.

In the radio program I listened to, this provider made the following comments:

When asked if a gastric bypass wasn't a really extreme solution, he answered that living with a BMI of 43 was much more extreme than having a gastric bypass.

I think picking that BMI was an unfortunate choice for him. I lived with a BMI of 44 for quite some time and found that it wasn't extreme at all and that even being in my 60's I was totally not ill or even mobility impaired as he suggests. He never dealt with the fact that the gastric bypass has a 2 in 100 risk of death within 30 days of surgery (report delivered to the College of surgeons in Oct 21, 2003.[Study title: The Impact of Bariatric Surgery on Patient Survival: A Population-Based Study]) and a 2-4 percent risk of dying within the first year plus a 20 percent reoperation rate and a 34 percent risk of gaining all or most of the weight back within 10 years. (Annals of Surgery. 244(5):734-740, November 2006. Christou, Nicolas V. MD, PhD; Look, Didier MD; MacLean, Lloyd D. MD, PhD) Now that's extreme!

But the comments were about to get better or more um..misleading...

He dismissed all the "bad stories" about gastric bypass comparing pregnancy to gastric bypass "everyone gives them the horror stories. People in general want to share your misery."

I don't have to comment about this one except the least this comment is, is highly insensitive to those folks for whom the WLS does not work or makes them ill. Of course, there is every evidence that this surgeon drops patients who are not happy campers so he may not really be concerned with anyone but those who are happy with the surgery.

And of course, pregnancy is a very natural condition whereas the gastric bypass is a very unnatural condition. That's kind of a no brainer.

Next comment....

He pointed out that all WLS patients had tried dieting and failed but then, made another unfortunate analogy. He stated that "you don't buy a car without taking walks, getting rides from friends, taking the bus and riding a bicycle"

In case Dr X didn't know, most people never try out bikes etc before buying cars - indeed, a large percentage of teens already have cars and use them to drive as short a distance as 1 mile to school which would be a walk for me! And actually, most ill patients have told me that they really didn't give dieting as hard a try as they gave WLS, so perhaps his analogy while unfortunate for proving his case, may have been more correct than he meant!

Finally to make his point which was obviously to go buy a bariatric surgery, hopefully from him he made the classic comment of all times. I quote him here:

"It isn't extreme. I'd much rather have bariatric surgery than being obese. I'd rather have AIDS than diabetes. I know that people don't die from AIDS in the USA anymore..."

Excuse me? People don't die from AIDS anymore? What planet does he live on, I wonder. Has he ever seen a terminal aids patient? There is nothing quite so bad as that. Diabetes while not a walk in the park, is totally no comparison to Aids and I really wonder how a physician can make such a bad error without making it on purpose, hoping the public is extremely ignorant.

Physicians like this scare me because people believe them and can get very hurt by their misrepresentations.

In the course of the discussion, it turned out this surgeon, Dr X, had gained 70 lbs at one time in his life and had lost it by exercise and extreme eating. In other words, some of his judgmental attitudes definitely resemble the ex-smoker who is intolerant of everyone who has not yet given up smoking.

He is not the first surgeon I have encountered who is fat phobic - actually I have over heard remarks from a few WLS surgeons which are extremely disparaging (to say the least) about the patients who provide their bread and butter. One surgeon, for example (who is retired now) told the nurses to not pick up a bariatric patient if they fell. "Just leave them on the floor and call the paramedics and let them deal with it" he told the nurses, an attitude which annoyed even very slim nurses. He was the one who laughed when he said "Oh, if they overeat after surgery, it WILL come up!" I think the vomiting after gastric bypass isn't a laughing matter by any stretch of the imagination. Not withstanding his assumption that all fat people are that way from stuffing themselves which in my observation simply has no relationship to reality.

In the as yet unpublished Russell Williams studies, he asked several caterers who had catered NAAFA conventions where the average BMI is well over 40, how the amount of food consumed compared to those conventions attended by a cross section of the public, many at so called "normal weight". He found that 3 caterers said the fat folks had consumed about the same amount of food as the so called normal weight folks and the other three caterers said that the fat folks had consumed less food than the slimmer folks!

So we wonder does a surgeon's fat phobia spill over to his/her performance in the OR? One would hope not and frankly, I had never considered the possibility, until I watched a "Whipple procedure" which is done for pancreatic cancer and much less invasive than a gastric bypass. The surgeon refused to do it laparoscopically (he said it was too delicate and too much might be injured), he took 5 hours to do it, doing most of the anastomosis with sutures and not with staples and painstakingly, avoided injuring organs, causing a lot of bleeding and not connecting blood vessels. The Whipple procedure provides for cutting a section of the pancreas and a section of the duodenum, the first section of the small bowel which is a small percentage of the digestive tract which is cut and rearranged in a gastric bypass. So I really wondered how they can do a gastric bypass in 30-90 minutes when there is a lot more cutting involved? Is it because fat people considered disposable in our fat phobic society? I was shocked to say the least but in thinking about it, it's logical that fat phobia would carry over, at least in some cases, as does any bias.

If you are considering any of these procedures particularly the gastric bypass (RNY) or duodenal switch/bileopancreatic diversion (DS/BPD), take your time. Get your information from informed consent documents or from a gastroenterologist. Someone who does not stand to profit if you decide to go ahead with it. That's only common sense. Sadly, we often take a lot more time and care, buying a car than we do, buying a surgery.


MyUserNameReadIt said...

" I'd rather have AIDS than diabetes"



B/c my Father suffered GREATLY and terribly after having AIDS for well over 10-15 torturous years!!

And how am I supposed to feel about my poor 4 year old Daughter having Type 1 Diabetes?!?!

Well, he sure is comforting..

Aislinn D. said...

Saying that a Whipple is "much less invasive than a gastric bypass" is a bit misleading. It may look like it's not as big a deal because less stuff is being cut, but the fact that one of the things being removed is part of the pancreas is actually a huge difference. ("Don't mess with the pancreas" is a common surgeon motto, right up there with "a chance to cut is chance to cure.") Mortality for a Whipple is around 5% even in places that do a lot of them, and much higher somewhere less experienced.

Not that surgeons don't say horrible things about the fat patients that they're operating on, and not that I doubt it may subtly influence the quality of surgical care. Just saying that bad as WLS is, it's not as bad as a Whipple. And I'd rather be fat than have either one.