Editor’s note: This is the third installment in an ongoing Next Avenue series about one Minnesota man’s lifelong struggle with obesity and what he’s learned since deciding to confront it through weight-loss surgery. Find earlier posts here.
I love a buffet. Really, really love a buffet.
Thanksgiving for more than 20 years of my life meant two things: warm weather in Tucson, Arizona and the Thanksgiving buffet at my parents’ country club.
Roast beef. Shrimp. Turkey. Ham. Sweet potatoes made sweeter and unhealthier with plenty of sugar and oodles of butter. Bread, rolls, croissants and desserts to die for (literally). All of this food surrounded opulent ice sculptures. It was over the top in many ways. And I so envied those who could be surrounded by so many choices and manage a healthy meal. Unfortunately, I was never successful.
Thanksgiving 2014 will feature a different kind of day and buffet:
- A protein shake for breakfast
- Participating in a 5K with the whole family, even the dog
- Traveling to my wife’s godmother’s for our Thanksgiving meal, where I will have four ounces of protein (turkey is an awesome bariatric food) and some vegetables. I’ll pass on the pre-meal, creamy Pink Squirrel cocktails and the — in the critical words of real foodies — “cloyingly sweet desserts.”
Still, some things won’t change. For instance, I won’t sample the carrot loaf, as I’m still unsure what carrot loaf is even after 20 years of carrot loaf.
Three months after my trip to Texas for a vertical sleeve gastrectomy, the new life that my nurse Deedee promised is taking shape. As I write this, I just finished jogging two miles in preparation for my first 5K and while my pace was still slow, it was twice as fast as the one mile I struggled to walk a week after surgery.
Selecting Which Type of Surgery
The idea that I would ever attempt a 5K seemed an impossible dream in May when I finally overcame my fear and attended a weight-loss surgery consultation at a local hospital.
In preparation, I investigated the four types of weight loss surgery. The amount of information was overwhelming, so I narrowed my search to three primary sources:
- The American Society for Metabolic and Bariatric Surgery (ASMBS)
- The Obesity Action Coalition
Sitting in the consulting surgeon’s exam room, I was asked which surgery I was contemplating. In my mind, the lap-band was relatively simple and the only one of the four choices that was reversible. Unfortunately, this surgeon was reluctant to offer it based on data on the lap-band, plus the fact that his surgical partner had stopped performing it entirely. Research is showing a lower long-term success rate with lap bands and a fairly high incidence of corrective surgeries for those who undergo this procedure. That said, it has worked and does work for some patients.
Ruling out the lap band left me with a choice between the gastric sleeve, the duodenal switch and the gastric bypass.
The science behind weight-loss surgery can be boiled down to two simple concepts: restricting the amount of food one can eat before feeling full or restricting the body’s ability to absorb calories. The lap band and gastric sleeve are restrictive surgeries that do not limit the body’s ability to absorb calories and nutrients. The gastric bypass and duodenal switch, by contrast, restrict food and limit the body’s ability to absorb nutrients.
The key distinction for me was that the gastric bypass and duodenal switch re-route the patient’s plumbing, either bypassing the stomach or re-routing the intestines.
Also, both boast high rates of remission (some say cure) for diabetes. The “cure” rate, however, is for those with Type 2 diabetes. My diabetes is Type 1, so the surgeon expressed limited hope that any of the surgeries would “cure” it. It was clear, however, that losing weight would help improve my ability to manage my diabetes.
I was strongly leaning toward the gastric sleeve, because it works without plumbing changes, so reported side effects are less. The downside was a lack of long-term research into its effectiveness due to its relatively recent rise to popularity. It is also fair to say that plenty of patients report that the removal of more than 75 percent of their stomachs causes side effects when they eat. However, it appears that the sleeve results in fewer severe side effects.
“The sleeve,” I finally said to the surgeon. He continued to thumb through my health history before looking up. “I agree.”
It was done. I was ready to begin the approval process for a vertical sleeve gastrectomy in Minneapolis. A huge weight was lifted. A decision I had procrastinated about making for seven years was in motion. A nurse came in and we scheduled meetings with a dietician and psychologist. There were plenty of steps, but surgery within six months was doable. I was on my way.
Until I wasn’t.
Finding Competitive Pricing
The phone rang. It was the nurse from the hospital. “Your insurance has an exclusion for bariatric surgery,” she said. Stunned, I was once again at a loss for words. I double-checked the policy. There it was in black and white: “Services Your Plan Does NOT Cover – Bariatric surgery.” I panicked. A decision I had avoided for seven years was unraveling around me. Fear was returning fast.
My first instinct, as a lawyer, was to appeal the denial. This surgery held the possibility of significant health benefits to me and tens to hundreds of thousands of dollars in health care spending to the insurance company and society. Given my associated health problems, approving this surgery was a no-brainer. But an appeal of an exclusion, I knew, was a long shot; I would have to prove that an obesity-related health problem I had was not being managed through other treatment. I could not make such a showing.
So I began to explore paying for the surgery out of pocket. My first choice, Hennepin County Medical Center, did not and would not even offer a self-pay option. Other bariatric surgery centers in Minnesota quoted me prices of $22,000 to $25,000.
Returning to Dr. Google, I soon learned that there were areas of the country and the world where bariatric surgery was more competitively priced. Mexico is a popular destination for medical tourists seeking bariatric surgery, for instance. But given my cardiac history and the look on my wife’s face when I broached the topic, Mexico was not an option for me.
I quickly learned that self-pay prices in, among other areas, Texas, Michigan and Nevada were much lower than here in Minnesota. Using Dr. Google, the reviews of surgeons on ObesityHelp and follow-ups with telephone calls and emails, I settled on Dr. David Kim in Colleyville, Texas. Kim’s price was just under $11,000, which, even when combined with airfare for three passengers and nine nights in a hotel, was about $10,000 less than surgery at home.
That’s how we came to spend nine sweaty nights in Texas in August, when every day the temperature climbed to over 100 degrees. We visited friends, watched a horse show, did some touristy things and managed to work in a vertical sleeve gastrectomy.
Ten grand is a lot of money, but given my limited choices and a real fear that I would back out unless I continued forward, it was the right choice for me.
I met Kim on a Friday, had the surgery on Monday, a follow-up appointment on Friday and flew home Saturday. The surgery went off without a hitch, and I have not had any serious complications. I have lost 85 pounds since my bariatric consultation in late May. So far, so good.
On this Thanksgiving, I’m thankful for the blessings and support of my family and friends and the opportunities this surgery has given me. I’m happy to skip the buffet.
Next: Bariatric surgery as a tool for victories on and off the scale.