gastric bypass surgery

[Hegemony]

I particularly appreciate what Latico has to say.

Kay, what you might do is to get the food plan that you would be on if you had the surgery, and try it for six months. If you lose weight during that time and decide that merely staying on the food plan is sufficient, that will be a helpful non-invasive way forward. If you loathe the food plan and can't abide it, that will also be useful information, and suggest that the surgery is not for you.

I know that some people think, "Well, staying on the food plan is too hard normally, but after I have the surgery, I'll be forced to be on it, so that will make it easier." The problem is though that you're not actually forced to be on it; it's just that the weight-loss surgery will not be a permanent solution without sticking to the food plan. The surgery reduces the size of your stomach, but people can and do extend their stomachs again through eating off the food plan. So thwarting the whole thing is sadly entirely possible.

As for the number of people who become alcoholics after the surgery, I'm not persuaded that it's because they metabolize alcohol differently. After all, if they found themselves having trouble with alcohol, they could cut down or eliminate their drinking. My understanding is that they were using compulsive eating to handle emotions, and when that is no longer available, they move to compulsive drinking. So one would want to be very sure that one has a support system for handling emotions.

[kaysixteen]

Hmmm... it seems obvious that there is a great deal more to learn about this type of surgery, and whether it would be appropriate for me, than I currently do know.   That I can understand.   What seems also, somehow, to be the case,  is that my doctor, a graduate of his med school's class of 1981, did not seem to say anything like this stuff when I mentioned the idea to him, and I am wondering whether he knows these things, and if not, whom else to go to to get such data, objective and clear-headed?

[mamselle]

A second opinion from an enterologist who specializes in the upper GI tract might be a place to start.

Time from degree isn't always a measure of capacity for a comprehensive work-up; most settings require CPE (continuing professional education, or however they're labeled now) credits, so they should be reading the JAMS, NEJAMS, etc.,  regularly and doing coursework to stay up-to-date for licensing, if nothing else.

That said, I still haven't heard any differential rule-outs based on looking at the issues through the other end of the kaleidoscope: what if the obesity is secondary to a pituitary or other related disease process?

Those possibilities should have been addressed at some point along the way, and continued to be options until something proves them impossible or almost absolutely unlikely.

It's important never to let the presenting issue take the lead in considerations of causality, because treating the symptom as the root disease won't lead to a resolution, just a merry-go-round of more symptoms.

You can end up playing Whack-a-mole with the symptoms while the root cause goes unchecked.

That may not be happening here, and it may have already been considered, in which case, fine, keep addressing the obesity as the main issue.

But if other options haven't been considered, they should be, and that's another reason to get a second opinion--but be diplomatic, you may still need your original MD on your side, too, and some people throw hissy fits over second opinions.

M.

[Hegemony]

Surgeons are typically most concerned with the actual procedure and its aftercare, rather than with the larger picture. For the medical stuff, I'd seek out a professional who looks at the bigger picture and has experience with people who've had the procedure done — perhaps a GP, perhaps a specialist. And I'd also seek out a therapist who specializes in psychological issues around this kind of thing, since seems clear that the psychological aspects of adhering to the eating plan and to developing other coping mechanisms are often the missing link in aftercare. Interview a number of therapists — say, 3-5 — as the field has its incompetents just like all other fields. Make sure you get someone with experience in this particular area.