Too chubby for surgery

[breakingwaves]

Well I have been thinking all day about my visit with the cardio doc today. I had anticpated some interesting words but not quite what he had to say. He had thought that my last echo while in the hospital was probably more pronounced because of hospital stress, he thought that the monitor results would be not much to talk about but the echo and the leaking was a little worse and the monitor said that my heart rate had slowed to 40 beats which he kept shaking his head and saying not good, not good. Blood presssure still very high.

So I asked the natural question, when do you forsee surgery. His reply was I was really overweight, no surprise there, I have been the same chubbo for the last twenty years, short and stout. Told me that he would not recommend a surgeon until I lost 50 pounds, I am currently at 245. told me if I didn't lose 2 pounds a week I would most likely die. Changed meds from calicum beta blocker to Altace, the ace inhibitor.

Not quite sure what to make of it, don't know if I should pursue a surgeon without him or what. Plan to of course start the diet right away but any adiditional advice would be appreciated.

 

[tobagotwo]

I think you said it yourself: "any additional advice would be appreciated." That means a second opinion, cardiologist or surgeon.

What he did was to try to make you feel that you would die, and it would be your own fault for being heavy. That was supposed to frighten and shame you into going on the diet he feels you need.

While he probably believes that the end justifies the means, it was a crude attempt at a carrot on a sitck. And you're no donkey.

I would take his advice, and work to get the weight down, as it will hamper your recovery, regardless of a willing surgeon. And in spite of the fact that he acted like an horse's behind. You want all the odds you can get on your side for OHS.

You may still want to get that second opinion, though, just in case.

Best wishes,

 

[Nancy]

It may be that you have to lose some weight, however, it might also be an idea to get a second and even a third opinion.

Unfortunately, many people with impaired heart function retain lots of fluid weight because their hearts aren't working correctly. This may or may not be the case with you. My husband has had twenty pounds of fluid from time to time when his heart was not working well, and he is normally a slender man.

Getting a second and even a third opinion will help to get a solid assessment of your situation regarding the risk of waiting versus the risk of going ahead in your present condition.

You also need to get an assessment of that slow heart rate.

At those numbers, my husband was passing out regularly, and had to have a pacemaker implanted. While passed out, I couldn't get a heartbeat. EMTs revived him. But it was scary.

I wish you all the best.

 

[breakingwaves]

Thanks Bob! I got the message of the weight issue loud and clear but I do think he could have put it into terms that would have sustained a better partnership and working relationship. It wasn't like I adding obese to my Christmas list or anything. My husband asked him, so is there any suggestions you might have to her losing this much weight and he said very loudly, not with that valve!

 

[breakingwaves]

Thank you Nancy, I was really disappointed, I went into today hoping for a future plan of action, instead I felt scolded like a child with their fingers caught in the cookie jar. I have been telling him and my general doc, about lots of swelling that has been happening, of course doesn't take away the fact that I need to lose weight.

You know he could have even done what you have just done, explained some of the risks, and told me of what some possible symptoms could be, heavens knows I mentioned to him that I am 3 hours on the road every day taking my kids to school and back, instead when I ask him what to do if I felt any symptoms, his advice was to stop and rest. Not always an easy thing to do when I find myself caring for the 8,9 and 11 year old by myself most times while my husband travels.

He kind of left me stunned that I had left my life and the well being of my family's future in his hands and he left me with just one option which he felt was of my own doing.

 

[Nancy]

Well, if you do have fluid retention because of your impaired heart function, if you get proper medication to help you get rid of it, it certainly will help get you started on the weight loss plan and will make you feel a whole lot better.

But those low heartbeats have to be addresed, especially when you are caring for children.

Hope you find some better answers soon.

 

[breakingwaves]

Nancy

Nancy

I forgot to mention, the man is not a slim trim guy himself in fact I would venture to say that some treats have passed his way too, so I guess he can be glad that his ticker is working as it should.

 

[breakingwaves]

Nancy

Nancy

I agree, I am looking for some solutions so we can get on with our life, and truthfully, I didn't have a clue about what was low or high, just that he kept saying this is bad, this is bad. I am looking forward to seeing my regular family physician because he tends to interpret what the tests and the Cardio guys have to say.

 

[Karlynn]

It would have been nice if he'd made your weight-loss issue into a partnership for the two of you. "We're going to get your weight down, so we can fix your heart." I don't know of anyone who has gone on to lose weight after being made to feel shame about it.

Not to mention the fact that it's stressful to have heart issues and if you are like me, you head to the cupboard to de-stress. It's hard to break that habit.

My suggestion would be to not try and start any big weight loss plan until after the holidays. Then begin by setting attainable goals for yourself.

 

[JimL]

On the echo results: Was it a standard echo, or a TEE?

Even though I am and have always been tall and slim, I gained and lost twenty pounds within days around the time of surgery, all just fluid. Lasix is really wonderful stuff for shedding that extra water weight.

 

[Nan]

That was really not a helpful way to deal with a patient (you in this case).
(I was also overweight at surgery - size 16-18- not as brave as you to give my actual weight)

I think you should most definitely find another surgeon/cardio and get another opinion.

You want to be as healthy as you can be going into OHS....you have to be careful about what kind of diet you choose. Perhaps your PCP could refer you to a nutritionist? Or you might check out weight watchers, they have a pretty healthy plan.

Good for you for facing this heart problem and trying to find a solution.

And don't despair, take it one day a time, both with your heart and with your weight.

Good luck, I'll be looking for more posts from you!

 

[Marguerite53]

Hello.

Hello.

Hi. I'm sorry you had such an insensitive conversation with your doctor. My cardio is also very interested in me losing weight. I'm 5'8" and about 195. (long legged, sturdy boned, large breasted). She said a pound a week, and when, after 3 months, nothing much had changed on the scale, she asked me if she could help me in any way. I wasn't actually sure what she meant, so I just shrugged her off. Her best suggestion was the South Beach Diet since it was designed by a cardiologist and didn't have you doing weird things.

My general practitioner thinks she is being harsh. I have changed my diet choices and am walking about 10 miles a week. I know that I am improving my general health, at a slow pace, perhaps, much slower than the cardio would like, but at a pace where the change can become permanent. I loved the South Beach Diet book. Am I actually on the diet? No. But I have taken the non-sugar approach and am very good about avoiding bad carbs and sugars. What's amazing is how the body adapts. You really go from craving the carbs, to not realizing you want any. There are some great receipes and health rules and info in that book. Please get a copy.

Another diet book I read several years ago stated one thing quite well. When the author stopped different sized people on the street and asked them the same question, the thinnest, healthiest looking people always answered the same way. The question was, when do you eat? The heavier people describe many different scenarios often related to holidays, events, moods, seasonal likes, times of day, etc. The thinnest people consistently answered....I only eat when I'm hungry. The South Beach book has a very helpful section on hunger and eating habits.

It is hard to get invigorated about exercise when you feel tired all the time. It is frustrating to hear from everyone that if you'd just exercise you would feel so much better. I don't think, in our condition, it is actually true.

I do know that my legs are stronger (not that they were weak) and my stamina is improving with the walking. All I've done is find a very chatty friend who will walk 3-4 times a week with me around a nearby middle school track. The track is flat (there is no way I could be walking around my hilly neighborhood on a daily basis) and cushioned and easy. Perhaps you might think about dropping off your last child at school, parking, and going to the school track. Your children will support you. They will make sure you are wearing your walking shoes! They can be your biggest allies in this. Whatever you normally do after you take them (or get them off to school), put it off an hour and start walking.

I have 3 children also, 22, 20 and 17. If I were feeling like I'm feeling now, when they were 8,10 and 12, I would be crumpled into the fetal position sobbing most of my days. I honestly don't know how you women with young children are doing this. You have my complete and utmost respect.

I hope these ideas can be useful to you. It is tough with the holidays. Treats and gratification abound. At least, I was thinking, if you were to start a walking routine, (oh, gee, where are you, is it temperate enough??) then, well, at least it's a start.

I agree with others that a second cardio opinion, or a confirmation from a surgeon about the weight issue, is a totally reasonable idea.

Let us know!

Marguerite

 

[Englander]

That was not fair at all. Very very cruel. Nish was a little chubby and his cardiologist did mention ways to loose the weight. which we tried and succeeded. A little bit of support from him would go a long way. I stress with one child and you have 3. I wish you all the best.
Love,
Bess

 

[Johnny Stephens]

Time to add a cardio to your shopping list

Time to add a cardio to your shopping list

Wow - I'm a pretty laid back guy, but several of your cardio's comments would caused my "redhead's temper" to surface. At the time of my surgery, I was substantially heavier than you. My cardio pointed out that I needed to lose weight (duh), and that anything I could do before surgery rolled around would help. My eventual surgeon alluded to my "body habitus" not being a problem with the surgery itself, but that it might cause some extra rehab effort and possible breathing workload post-surgery. (actual: rehab yes, breathing no)

I have switched doctors in the past for their insensitive, and frankly, ignorant references to my weight. My current GP is borderline in this area, but my cardio and surgeon are very compassionate.

I hope you get some more realistic answers and some medicos you can work with.

 

[breakingwaves]

Karylynn

Karylynn

I started keeping track today of food iintake, I am switching to the new meds the ace inhibitor and diuretic so I will ease into major calorie counting. I did have a healthy choice tv dinner for dinner which was actually pretty good, I was surprised, it said it was 280 calories. I also plan to do as he suggested not eat anything more this evening. Went to the grocery store to start stocking the fridge with healthy things, threw out all the leftover Thanksgiving stuff.
Most of my problem is not having much time to do meal preparation for me, with my husband away most of the time, I cook for the kids and grab something easy to eat, but now I will be more careful.

 

[breakingwaves]

JimL

JimL

He did put me on Hyrocholorothiazide, a thiazide diuetic. It was a regular echo, and I haven't gotten my copy yet, I am going to examine it carefully when I get it from my GP next week. He had expected the test to be not as pronounced as the recent one, I have had three echos in the last three months. He said, my heart aortic valve does not close completely, and instead of being able to compensate, it doesn't know what to do so it has to work harder. Didn't share the actual numbers with me.

 

[Nancy]

You have every right (by law) to ask for and receive copies of your medical records. They cannot refuse you (but they still might), however you have the HIPAA law on your side.

Get copies of your tests.

 

[breakingwaves]

nan

nan

I am a pretty easy going, really don't speak up much for myself kind of person. Takes me a while for the words to sink in, sometimes I wish anger would come faster than it does when things are not quite right, but today I got mad. You are right, he was, not much of a help anyway and ended up making me feel small and not too bright. My spouse has been in major denial and I drug him along to finally get the scoop, didn't help much that he made it sound like I had chosen this way of life and if I could lose 50 pounds in 6 months it would all go away. 2 pounds per week are the doctor's orders. what it did was make me very hestitant to call him if anything not feeling came around and I don't think that is a healthy way to feel. I am usually a very optmistic person, so I was feeling pretty down today.

I kind of feel about the weight admission like I do about doning on a gown at this point , if something ends up showing, its a little too late for me to be too modest, hehe! In a way its all hanging out!

 

[breakingwaves]

Marg

Marg

Lots of good advice! tomorrow is the day to start the new ace inhibitor and when it gets into my system and I have dealth with any side effects, I am going to start the walking in our local mall. I need to do some more Christmas shopping so I might be able to browse in the windows as I buzz by!
I have no idea what this is going to yield but I will be able to look any doc in the eye and say, this is what I have done, let us move on to a resolution. I am not the fittest person in the world but I have the soul of a hard working farm gal so I will give it my best shot.

I will choose to look on this in a positve way and say he wouldn't be the one I would choose for his bed side manner and don't think he will be the one I would choose to make the decision about the surgery but he did strike a chord!

 

[breakingwaves]

Englander

Englander

If he had taken the time to get to know me, he would have realized talking with me would have been more effective than talking at me. It seemed to me we are in the mist of choosing some life partners, not a way to make a happy marriage of doctor and patient! GGRR!