Educate yourselves

Clearly the frequency of my blogging is slipping: I'm chalking it up to a combination of the usual vast amounts of work and my recent prioritizing of a developing book project/series of articles. The time has to be taken from somewhere, and so, sometimes, it's taken from blogging.

Which is still very important to me, I hasten to add: it's one of the principle ways I sift and sort through some of my daily experiences and ongoing concerns, as I've said before.  (It always amuses me when I read people's assertions that they blog for the sake of others. Er, no.  Blogging is always About Me, Me, Me, even if it's in service of what one might feel is a higher good.  That higher good is accorded its importance by the blogger, who feels compelled to write about it.  I'm not knocking it -- I'm just saying let's not flatter ourselves that we're this century's answer to Albert Schweitzer.)

However, the point of today's post is not altruism or the lack thereof; rather, it's to underscore the importance for those who are considering weight-loss surgery to consider all the options.  There are multiple forms of WLS out there, but sadly many WLS candidates as well as bariatric surgeons are unaware of the full spectrum of surgeries.  If you are considering taking the radical step of having your insides sliced and diced -- or even having foreign matter such as a band inserted into your guts -- for god's sake do the research. Read the medical literature.  Do not rely on a single surgeon's perspective, or your PCP's perspective, or even literature produced entirely by the bariatric community.  Read widely.  Make an informed choice. Take responsibility for that choice.  Don't rely on the anecdotal stories of a few people who have had the lap band, or the gastric bypass, or the vertical sleeve, or the DS. Don't rely exclusively on bloggers. Take their experiences into consideration, yes, but educate yourself through your own research.

I say this after going to a WLS support group last night at a local hospital where I was invited to speak because apparently it's soon going to be offering the duodenal switch as a WLS option, via the services of Pacific Laparoscopy's Dr. Rabkin (I'm not a patient of Dr. Rabkin, by the way). People wanted to know more about the procedure.  It was a well-attended meeting, a mixture of pre- and post-ops, and the vast majority of them had either had or were planning to have RNY gastric bypass, though I believe three had or were planning to get the lap-band.

I spoke and answered questions for about half an hour about my own experience with the DS, not with the intention to proselytize but rather to educate. Folks seemed genuinely nice and interested, but what was disheartening to me after the fact was the number of people who said to me in the course of the evening, "You know, I didn't know about the DS until [insert number of months here] after my [insert choice of WLS here]. I asked my [PCP/surgeon] about it then, and s/he'd never heard of it." 

(This shouldn't surprise me. My sister's own PCP, who's had gastric bypass himself, has never heard of the DS.) 

What's wrong with this picture?  Er, at least a couple of things: 

• The ignorance and lack of responsibility of the medical community (uh, is it really possible for a bariatric surgeon not to know about the existence of the available forms of WLS, even if s/he performs only one or two of them? And if it is, then I don't want that person operating on my innards, thanks!)

• The lack of concern evinced by most of the people at the support group when they realized they had made their choices without full knowledge of the range of options available to them (though I think this was, in part, because they're in the first flush of success with their chosen mode of WLS -- it's working for them right now, so there's no practical reason to feel concern)

Now, these were nice, intelligent folks at this meeting.  And I don't number myself among those who feel that their choice of surgery is the Only Correct Choice.  I believe the duodenal switch was the right choice for me, but I can completely understand choosing a different form of WLS and respect those who have and do.  The DS is definitely not for everyone.

No, what I don't get is a) making the selection of a particular form of WLS based on partial information available at the time, and b) not being distinctly uneasy about that fact later, when one discovers that one has done that, intentionally or inadvertently (of course, maybe some people were uneasy and just weren't expressing it)

I honestly find that horrifying -- but maybe that's partly because of my own personality make-up:  I'm a researcher by training, trade, and choice, and I'm also admittedly anal and a control-freak.  But the idea of leaving my education and the resulting choice of surgery in the hands of others and abdicating responsibility in that way (yes, I know that's a biased view, but that's how I see it) is just way beyond my power to understand.

Now, there were a few pre-ops who approached me, asked for more information, and I gave them my email address.  To each of them I said, "Look, just examine all the options, and then make your choice. Make the tool you choose work for you. That's all I ask."

(Note to the Rabkins: they need to get some literature and some speakers down to this hospital, pronto. Seems to me that'd be one of the first things they'd want to do ...)

Comments

[*S*]

Can I get an AMEN?! I so hear you about education and research. Now, granted, that is both our bent and avocation (although you're on your own with "anal", sister ;^) ), so it's natural that we have high expectations of ourselves in this area. But, man oh Manishewitz, I can't _imagine_ contemplating any surgical procedure without checking out every other option first. And books, that purport to present the straight dope on WLS, like the one I reviewed here: http://lessflabmorefab.blogspot.com/2007/10/it-aint-over-til-thin-lady-sings-how-to.html
but only present you with some of the options and almost NONE of the considerable risks, do all seekers a huge disservice.

*S*

[sparkly_jules]

And a double amen, here, too. I'll never forget a dialogue I had with a woman on e-Bay; I had bought some of her old clothes after she had RnY WLS--when I told her I decided I wanted the DS, she said, and I quote, "My doctor said the RnY is the best surgery."

Of course he did, your insurance company is going to pay him to do it. If he were an Edsel salesman, the Edsel would be the best car.

Doctors are human and infallible, medicine is an art, and not every medicine, surgery, procedure turns out the same for every person.

When I met with my surgeon and he asked if I had any questions I said, "they would require you to have a crystal ball." I wanted to know what my complications "would" be, not "could be"; I wanted to know how long I would be in the hospital, how high the pain would be, would I have a leak? And on and on. There is no way to predict those things just as there is no way to predict which surgery (or other medical process) is "best" for you, and to think your doctor knows best is naive.

I had no reply to the "best surgery" comment. I just thanked her for the skirt and blouse and moved on.

I am frequently amazed at my fellow human beings (and my own) stupidity.

Good post today.

Jules

[Deluzy]

I read your review of the book, *S* -- good job.

And Jules, I agree and disagree: I don't think there's a "best" form of WLS, per se, but I do think one can make an educated assessment of which form is best for a given individual -- and the person to do it is the person whose guts are going to be rearranged!

Only thing is, that individual had better inform him/herself, know him/herself well, and assess the likely risks and benefits head-on -- of *having* surgery and of *not having surgery.

And as you suggest, there are no guarantees -- just likelier outcomes than others.

[Dagny]

Having a WLS is such a personal decision, you MUST come to it on terms that make sense to you! I did and I urge other people to do so as well. I don't know how many times I've said, "This is what works FOR ME it might not be right FOR YOU...."

I felt good about every aspect of my decision going into it and it all worked out perfectly for me! That's what I would hope for everyone!

[sparkly_jules]

I guess I spent too much time working in the medical field (insurance (Blue Crotch); and hospitals St. Joseph of Orange, and San Pedro Peninsula) and listening to my mom's stories growing up (she was a medical transcriber), and which perhaps feeds in to my fear of surgery, childbirth, or anything excessively medical, because I know things can, and frequently do, go wrong or weird. So when I say not knowing what is "best," I mean in a crystal-ball sort of way. We can choose what is best for our lifestyle, body, psychology, etc., but until the surgery is actually over, we really don't know if it was "best." I didn't express that well in my last post. But to let someone else choose what is best for our body? Definitely ignorant and naive at best.

Happy Weekend,

Jules

[Deluzy]

Ah, got it, Jules. Yup, they can and do go wrong, and sometimes all the research and preparation in the world can't prevent that. I totally agree.