Echoing the above posters, plus, there are unpublished side effects. An Ex's mom got the surgery a while back, and while she did lose weight and get her diabetes back under control (mostly), there were some pretty harsh consequences for that.
I think you have to divide the question of whether or not to do this into two questions. One, are you, right now, capable of healing up well enough to undergo surgery? About 20% of patients whose diabetes/weight/preexisting conditions cause complications will have to have repeat surgery, compared to about 10% of overall bariatric patients, so are you able to heal up before infection sets in or might you require a second surgery? Will your surgeries be covered under your insurance? Will there be adequate aftercare? And so on. Basically, does your doctor think you are sound enough to undergo this?
Two, and this is one only you can answer, can you buckle down to the absolutely iron discipline that's going to be required of you? Will you be able to food-nazi yourself without exception, for the rest of your life? This is something you have to really think about - not in contrast to your present situation, like "oh i can do it because it will be better than living this way now" but "I can do this because I must, and I will!" - and decide if you can do it. If you can, then ok, but if you struggle even a little bit, remember the consequences of any slip-ups will be magnified hundredfold. Can you handle never eating anything with a high GI index ever again? (dumping syndrome is not pleasant, and your diabetes will make it more probable that you'll get it often, so be careful) Can you live with no soda ever again, not even a sip? Carbonation will become your mortal enemy. The lifestyle change is pretty extreme, so be prepared for that.
Side question - will you have any sort of emotional support during this process? I don't mean like "i've got a few friends" but more like will there be intensive emotional support and therapy made available to you? there's a study in the journal of bariatric medicine (feb 09, I think, 09 sometime) claiming that patients who undergo remedial emotional therapy actually have better success rates than those who do not, and not just because they have to build a whole new relationship with food, but because it turns out that often people in your life freak out when you change rapidly, and so emotional support you thought you could count on evaporates (with every medical condition, it seems, it happened to me too when I was ill), and it's good to have a counselor you know you can go to when that happens. And that doesn't count the people who will unintentionally try to sabotage you.. "piece of cake? just a tiny bite?" etc. Are the people who are close to you willing to change with you? Because living in the same place with the same habits can break even the most iron will - your close compatriots will have to learn to eat the foods you can eat for as long as it takes for you to get healthy - no ice cream sandwiches on their plate and two bites of chicken on yours, you know? They're going to have to get the same nutritional training that you are, in order to help you make this work, (and if they're unwilling to help, boot them to the curb in short order), so make sure you've got that lined up before you go under the knife. And to be sure you have every resource available to you, doublecheck if your insurance will cover at least a weekly session with a nutritionist, physical therapist, and counselor of some sort.
Also, are you prepared for leaving your life on hold for a while? You may have to be hospitalized for weeks, or even more. Your job becomes healing and changing. This might be an easy or hard question to answer, but again, only you can answer it.
Will your doctor give you the rundown of options as to which kind of procedure you can have? Roux-en-y and Biliopancreatic diversion are the common procedures for people in your position, the former being easier on the person but you may be excluded if you're too big, and the latter having more extreme consequences and more danger but also is the only option for some people due to how their weight is arranged. Lap band and stapling might not be good options for you, as weight loss is slower and less overall. But make sure your surgical team goes over the risks and benefits of each one with you - do not go into this blind, basically.
There are medical professionals who believe that any sort of gastroplasty will cause malabsorption syndrome (and to be fair, about half of patients will experience at least some anemia, calcium and b-vitamin deficiency, and others) and so you have to balance the thought that you will essentially accepting a different set of medical problems over time, and that you may well have to accept a shortened lifespan because of them.. but then again that's a quality of life issue - not to mince words here, but you essentially have a shortened lifespan already, so at least you'll be mobile and have more chance of being able to help yourself get healthy again. Again, only you can answer the question "will the consequences be worth it?".
Let's talk about a few of the consequences you don't hear about - when Ex-Mom got her vertical gastroplasty, she did lost about 120lbs in short order.. but she also lost some of her hair. It grew back just fine, but the body sheds hair when it loses weight rapidly, so be prepared to draw your eyebrows on for a while and get some hats maybe.
Chewing. I'm not saying you don't chew your food now, hehehe, but you're going to have to chew it about three times more thoroughly than you ever have, since mastication is going to become super important to your digestion. With Ex-Mom we all had to chew at the same speed as her for a meal, just to see how bad it was, and I have never been more bored of eating in my life! For real, it's super important to slow your eating speed waaaaaaay down, forever. So, yeah, there's that.
Aaaaand then there's the farting. Sorry to be crass, but omg it's unreal. I don't know why nobody mentions this part in the literature.. probably because it is so crass, I suppose, but when only partially digested food is deposited in the small intestine, the flora go craaaaazy and there is some serious gas that comes of that. It was pretty bad with Ex-Mom, too. You know when someone has a dog that's kinda old and scraggly but loving, and then it lays on your feet when you're watching tv and you forget about it? And then all of a sudden you're desperate to get outside because the dog totally cut the cheese and you'd give your left arm for some cyanide because it smells so bad? Like that. There's actually a company that makes charcoal filter pads for people who have had bariatric procedures, because it's that much of a problem for most patients. Be prepared for that.
I think what it does boil down to is a question of lesser evils - would you rather continue as you are now, or risk the procedure and the discomforts of life afterward? Would you prefer a new set of medical circumstances or the ones you know? Only you can decide that, but it sounds to me from what you've talked about before that you would really prefer to be mobile, and that being able to do more for yourself will lessen your depression (and rebuild your hippocampus, which will help your depression even more) so maybe this is the way for you to go?
Oh, and don't lose weight too rapidly afterwards - the gallstones can be debilitating.. moderation, moderation, and time.
You're a smart woman, I know you've thought about all this already probably. You'll make the right decision. Call me up if you need someone to bounce ideas off of. I have a whole stack of laffy-taffy jokes that I need to torture you with :)
I think you have to divide the question of whether or not to do this into two questions. One, are you, right now, capable of healing up well enough to undergo surgery? About 20% of patients whose diabetes/weight/preexisting conditions cause complications will have to have repeat surgery, compared to about 10% of overall bariatric patients, so are you able to heal up before infection sets in or might you require a second surgery? Will your surgeries be covered under your insurance? Will there be adequate aftercare? And so on. Basically, does your doctor think you are sound enough to undergo this?
Two, and this is one only you can answer, can you buckle down to the absolutely iron discipline that's going to be required of you? Will you be able to food-nazi yourself without exception, for the rest of your life? This is something you have to really think about - not in contrast to your present situation, like "oh i can do it because it will be better than living this way now" but "I can do this because I must, and I will!" - and decide if you can do it. If you can, then ok, but if you struggle even a little bit, remember the consequences of any slip-ups will be magnified hundredfold. Can you handle never eating anything with a high GI index ever again? (dumping syndrome is not pleasant, and your diabetes will make it more probable that you'll get it often, so be careful) Can you live with no soda ever again, not even a sip? Carbonation will become your mortal enemy. The lifestyle change is pretty extreme, so be prepared for that.
Side question - will you have any sort of emotional support during this process? I don't mean like "i've got a few friends" but more like will there be intensive emotional support and therapy made available to you? there's a study in the journal of bariatric medicine (feb 09, I think, 09 sometime) claiming that patients who undergo remedial emotional therapy actually have better success rates than those who do not, and not just because they have to build a whole new relationship with food, but because it turns out that often people in your life freak out when you change rapidly, and so emotional support you thought you could count on evaporates (with every medical condition, it seems, it happened to me too when I was ill), and it's good to have a counselor you know you can go to when that happens. And that doesn't count the people who will unintentionally try to sabotage you.. "piece of cake? just a tiny bite?" etc. Are the people who are close to you willing to change with you? Because living in the same place with the same habits can break even the most iron will - your close compatriots will have to learn to eat the foods you can eat for as long as it takes for you to get healthy - no ice cream sandwiches on their plate and two bites of chicken on yours, you know? They're going to have to get the same nutritional training that you are, in order to help you make this work, (and if they're unwilling to help, boot them to the curb in short order), so make sure you've got that lined up before you go under the knife. And to be sure you have every resource available to you, doublecheck if your insurance will cover at least a weekly session with a nutritionist, physical therapist, and counselor of some sort.
Also, are you prepared for leaving your life on hold for a while? You may have to be hospitalized for weeks, or even more. Your job becomes healing and changing. This might be an easy or hard question to answer, but again, only you can answer it.
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Will your doctor give you the rundown of options as to which kind of procedure you can have? Roux-en-y and Biliopancreatic diversion are the common procedures for people in your position, the former being easier on the person but you may be excluded if you're too big, and the latter having more extreme consequences and more danger but also is the only option for some people due to how their weight is arranged. Lap band and stapling might not be good options for you, as weight loss is slower and less overall. But make sure your surgical team goes over the risks and benefits of each one with you - do not go into this blind, basically.
There are medical professionals who believe that any sort of gastroplasty will cause malabsorption syndrome (and to be fair, about half of patients will experience at least some anemia, calcium and b-vitamin deficiency, and others) and so you have to balance the thought that you will essentially accepting a different set of medical problems over time, and that you may well have to accept a shortened lifespan because of them.. but then again that's a quality of life issue - not to mince words here, but you essentially have a shortened lifespan already, so at least you'll be mobile and have more chance of being able to help yourself get healthy again. Again, only you can answer the question "will the consequences be worth it?".
Let's talk about a few of the consequences you don't hear about - when Ex-Mom got her vertical gastroplasty, she did lost about 120lbs in short order.. but she also lost some of her hair. It grew back just fine, but the body sheds hair when it loses weight rapidly, so be prepared to draw your eyebrows on for a while and get some hats maybe.
Chewing. I'm not saying you don't chew your food now, hehehe, but you're going to have to chew it about three times more thoroughly than you ever have, since mastication is going to become super important to your digestion. With Ex-Mom we all had to chew at the same speed as her for a meal, just to see how bad it was, and I have never been more bored of eating in my life! For real, it's super important to slow your eating speed waaaaaaay down, forever. So, yeah, there's that.
Aaaaand then there's the farting. Sorry to be crass, but omg it's unreal. I don't know why nobody mentions this part in the literature.. probably because it is so crass, I suppose, but when only partially digested food is deposited in the small intestine, the flora go craaaaazy and there is some serious gas that comes of that. It was pretty bad with Ex-Mom, too. You know when someone has a dog that's kinda old and scraggly but loving, and then it lays on your feet when you're watching tv and you forget about it? And then all of a sudden you're desperate to get outside because the dog totally cut the cheese and you'd give your left arm for some cyanide because it smells so bad? Like that. There's actually a company that makes charcoal filter pads for people who have had bariatric procedures, because it's that much of a problem for most patients. Be prepared for that.
I think what it does boil down to is a question of lesser evils - would you rather continue as you are now, or risk the procedure and the discomforts of life afterward? Would you prefer a new set of medical circumstances or the ones you know? Only you can decide that, but it sounds to me from what you've talked about before that you would really prefer to be mobile, and that being able to do more for yourself will lessen your depression (and rebuild your hippocampus, which will help your depression even more) so maybe this is the way for you to go?
Oh, and don't lose weight too rapidly afterwards - the gallstones can be debilitating.. moderation, moderation, and time.
You're a smart woman, I know you've thought about all this already probably. You'll make the right decision. Call me up if you need someone to bounce ideas off of. I have a whole stack of laffy-taffy jokes that I need to torture you with :)
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I can say that I haven't had a gallbladder since I was 18, so at least gallstones are off the list...
Thank you; I have to go teach shortly, but I will probably call sometime tomorrow if that's okay. *hugs*
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