You must meet all of the qualifications recommended by the National Institutes of Health: 
1) Your BMI is 40 or above
2) Your back pain is considered a co-morbidity
3) You have tried to lose weight conventionally and have not succeeded
4) You have done research so you understand the risks and benefits of the surgery.

Ask your family physician to refer you to a surgeon.  By the way, Dr. Hilario Juarez at St. Luke's Hospital in Phoenix does Lap RNY surgery.  I am not recommending him, but it is a place to start.  The surgeon takes care of submitting the paperwork for insurance.

Try not to be so down on yourself.  You have a medical condition that needs treatment.  Your insurance company should acknowledge this.

Weight loss surgery is very expensive.  Some people have paid for it themselves, but that is very risky if you end up having complications.  The cost varies greatly from about $8,000 to as high as $50,000.  Lap RNY surgery is the most expensive because of the equipment involved and the special training of the surgeon and the surgical staff.

I was in the hospital 5 days which is long for a lap surgery, but I had some minor complications.  Normally you are in the hospital 2 to 3 days if the surgery is done laparoscopically or 5 days if the surgery is done as an open incision.

Good luck and don't despair.

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Remember though that not all family physicians are as familiar as they should be with the latest techniques and successes of weight loss surgery.  If their experience is with the old "stomach stapling," then you will hear  stories about how people lost weight and then gained it back when the  staples came loose.  Or if their experience is with an old surgery such as the jejuno-ileal bypass, first done in 1954 from which many people died, you may hear horror stories about that.  Just remember that these surgeries are no longer performed.  The modern surgeries, especially the RNY which is what 70 percent of weight loss surgery patients have, has been endorsed by the National Institutes of Health, the American Heart Association and the American Diabetes Association.

If you are convinced that this is what you want, go to the appointment prepared.  Have some research information with you (you can start by copying some articles from this site).  If he or she has the opinion, "don't confuse me with facts, my mind is made up," then consider switching doctors.   If you are convinced from your research that this is the path that will finally allow you to change your life, don't let anyone stand in your way.

I know how this saved my life.  And the thought of an ill informed primary care physician stopping me was not something that I could have tolerated.   This whole process takes a lot of courage.  But there are many people out there who will help you through it.  You will find strength in places that you never imagined.  Don't despair and good luck!!

Answer 16
How successful is weight loss surgery?
Carolyn expressed concern that she would not succeed in losing her weight after weight loss surgery.   There are so many studies that have been done that document that those having surgery are so much more successful than those who diet.  It is estimated that 95 percent of all people who have dieted will regain the weight that they lost within three years and most will actually be heavier than when they started.  In contrast, the periodical Obesity Surgery in its April, 1997 issue, reported a 4-year study of proximal Roux-en-Y gastric bypass patients. The table below shows the average excess weight loss from this study.

          Years Post-Op       Percent Excess Weight Lost
                     1                              68.5%
                     2                              71.18%
                     3                              69.28%
                     4                              57.49%

What this table shows is that a 5'6" woman who weighs 260 pounds can expect to lose 83.5 pounds the first year following weight loss surgery. This is the average.  Some will lose more and some will lose less.  In my own case, I lost that amount of weight in just six months.  

How successful can you expect to be with weight loss surgery? You can expect to be infinitely more successful than with conventional dieting methods.  But remember that success should be measured in more than weight loss.  Rejoice in the first time that you can cross your legs, or fit comfortably in the bath tub with a little bit of room to spare.  Success is getting off of your blood pressure medication or walking your first mile without huffing and puffing.  Success is going to an amusement park and having the bar go down on a ride. Success is fitting in a lawn chair or not having to use an extension seat belt on an airplane.  Success is the first time that you can shop in a regular clothes department instead of the plus size department, or the first time that you can paint your toenails.   Success is the satisfaction that you have lost a tremendous amount of excess weight and you know that it will never come back.

Carolyn, I wish you the very best from your surgery.  There are steps that you can take to make yourself more successful. 

                         1) Eat protein first at any meal. 
                         2) Drink 64 ounces of water per day. 
                         3) Do not graze. 
                         4) Exercise 3 times per week.  

If you follow these four steps, you will succeed.  

Don't doubt yourself.  We have lived with failure for so long that it is natural, but have faith in yourself and have faith in the process.

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This is something to remember in general about weight loss surgery. Things often don't last forever, whether it be lactose intolerance, dumping, lack of hunger, massive weight loss, nausea, hair loss, etc.  Often these are conditions that continue only until our bodies adjust.

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Answer 10
Calcium Intake
It is very important to understand that calcium comes in several different forms and each form absorbs differently in the human digestive system.  Calcium carbonate is the most available and the least expensive of the calcium forms, but is the worst type to use because of your body's ability to absorb it.  Calcium carbonate requires gastric acid for absorption and if you have had RNY surgery, your pouch does not produce gastric acid.  People need a calcium intake of 500 to 1,000 mg per day so absorption is a major issue.

Many people take Viactivä calcium chews because they are yummy, do not cause dumping and contain vitamin D.  However, the form of calcium used in Viactivä is calcium carbonate.  Viactivä might be OK for people who have not had bypass surgery and have better absorption, but because of our reduced absorption ability, it is not what we should take.  In my early days post-op, Viactivä was my breakfast treat. I just loved those delicious little caramels! I no longer take Viactivä because I worry about my ability to absorb the calcium carbonate and the resulting greater chances of osteoporosis.

 The best forms of calcium to take are calcium citrate and calcium microcrystalline hydroxyapatite concentrate (MCHC).  These forms are optimally absorbed on an empty stomach and do not require gastric acid.  This is especially why those who have had bypass surgery, should take either of these forms of calcium.  I have been using a calcium citrate product that comes in a powder form and is easily mixed with a glass of water.  It includes magnesium in a 2:1 ratio or twice the amount of calcium as magnesium, as well as vitamin C and D to aid absorption. 

There are several antacid products on the market that claim to be a good source of calcium.  Many people take these products feeling secure that they are giving their bodies the nutrient that will allow them to avoid osteoporosis in the future.  Although these products are very good as antacids, I would not recommend them for the purpose of getting your daily calcium.  The form of calcium used in these products is calcium carbonate, which is formulated with antacid ingredients.  If your reason for taking this combination is for your calcium intake, you have a BIG problem.  As stated earlier, calcium carbonate needs gastric acid to be absorbed.  These products, by their very nature of being antacids, prevent absorption.  Since we have absolutely no gastric juices in our stomach pouch, antacids, as a calcium supplement, are useless for bypass patients.  Calcium also needs vitamin D to aid absorption, which is not present in antacid formulations.

Do not take calcium that contains bone meal, dolomite, or oyster shells because they may contain lead and other toxic substances. 

We tend to think that our bones are inert or dead material, but they are not.  Bone tissue is living and growing material that reacts to what we eat and how well we absorb what we eat.

When we were heavier, bone density was not as much of a problem.  Nature provides that as you get larger, your bone density increases to support your weight.  Now that we are getting to be a normal size post operatively, our bones become less dense and osteoporosis becomes more of a concern. 

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