Not to be Morbid, but how do they die?

[Deidrababe]

I have lost friends from complications due to weight loss surgery, but none directly from the actual SURGERY - Some I knew what happened and some I don't.

Many people I have met over the years at NAAFA events and other Size Positive gatherings have died too, but I didn't know them very well, just to say Hi, etc....and I never found out HOW they died.

I know this is morbid, but how do MOST people who die from weight loss surgery die? Infections? Blood Clots? On the Table? Other?

Please know that I know this is a sensative topic and talking about death is hard, I'm very curious, but I don't mean to offend or upset anyone.

Hugs,

Deidra

[LillyBBBW]

Top of the list: Doctor error. Bad doctors who don't know what they're doing at hospitals who merely added WLS to their list of surgeries because WLS is a cash cow now. Infection I hear is second on the list. I think third in line is that people who are not prepared to eat the new way they are supposed to and overdo it, causing damage at the surgical site.

I heard one time from a source I can't recall that some patients commit suicide, which is not counted as a complication from the surgery but should. People who are bi polar or have a history of depression sometimes undergo intense changes to their bodies that can magnify their symptoms during recovery. From what I understand no one knows the actual numbers but there are a signifigant amount of people who take their own life after this surgery that goes unreported.

[Tracyarts]

Well, there is a death risk for ANY kind of surgery for ANY size person, and the bigger you get and the more comorbidities you have, the more at risk for dying during surgery you are. (I had to sign all those release papers when I had my non WLS abdominal surgery a couple months ago.) Anasthesia risk, bleed-outs, strokes, heart failure, etc...

And a big problem is infections from leaking bowels. If the bowel is nicked or otherwise damaged and leaks into the abdominal cavity it means rampant infection. And they are working with the digestive tract during WLS.

Internal bleeding is a potentially fatal problem post surgery. As is infection from sources other than bowel leakage. (Infection at incision site, secondary infection picked up from poor sanitary practices). My mom nearly died following her hysterectomy. She came through surgery fine. She nearly died from a staph infection she picked up and took home from the hospital. Infection can spread like wildfire in fatty tissue (think cellulitus) and that can be a major problem post-surgery.

In some patients, incisions do not close and can become wounds. Sometimes infected wounds that result in tissue necrosis. Which can spread to the bloodstream and kill you. (This was a potential risk I faced being diabetic and having major surgery.)

Blood clots can be a major problem in ANY person post-surgery, and large people seem to be particularly at risk. They had special leg-things on me, massaging my legs from the moment I was taken into my room after my surgery, and they hauled my butt up out of bed the next morning to walk and sit to help prevent blood clots. Even with a ten inch incision down my abdomen, I had to get up and walk within 24 hours of coming off the table to help prevent clots.

Some people develop pneumonia after surgery. I had congestion after my surgery and had to use a lung exerciser and force myself to cough even though it hurt like hell.

ANY surgery is risky for any person, but the more comorbidities you have the the more potential for complications you have, the more risky it becomes.

MOST, (not all), people who have WLS are not the healthiest large people around. They are either at the end of their rope and in a state of decaying health and mobility, or they have not made a long-term commitment to healthy eating and regular exercise and stuck with it. Some WLS patients are extremely fitness conscious and healthy, but most are not. Mental health counts too. A lot of WLS patients are in a very low place before surgery. Either due to despair over lost mobility, health problems, and chronic pain, or angst from their inability to get their overeating issues under control, or with hyped up fear over their potential long term obesity comorbidities.

Your overall physical and emotional health helps determine your outcome from ANY surgery. Stress makes it harder to heal and surpresses the immune system.

And then there are long-term complications. Malnutrition issues, issues caused by chronic vomiting, etc... In many cases, the patients' health was already shot to hell due to diabetes, heart disease, chronic infection issues, breathing problems, etc... and it's hard to tell whether their poor health finally caught up with them or whether the stress of the surgery sped up their eventual demise. Maybe they were already dying from their comorbidites and the surgery only bought them a small amount of time or even sped their decline along a little?

Tracy

[Miss Vickie]

Besides the ones mentioned, bowel obstruction is also a possibility. Now, bowel obstructions can happen from any abdominal surgery, but they seem to be more common in WLS patients. The problem with them is that they can happen months - or years - out from the surgery, after the time when most patients feel "the coast is clear". Any time a WLS patient has any kind of abdominal pain, it's worth a trip to their doctor. It could be just the flu. Or it could be something much more dire.

Most of the immediate postop risks can be reduced with careful consideration by the doctor. Heparin given in the hospital reduces blood clots, as does using epidural pain management. Diagnosing and treating sleep apnea prior to surgery reduces the risk of breathing problems from the surgery. Getting diabetes under control reduces the risk of infection. A leak test while still in the OR can allow treatment earlier, reducing that risk.

Obviously, there are still risks, and people do still die. :( But I'm not convinced that the risks are that much higher for some of us who are already at great health risk. What was my risk of heart disease with a family history of early death from heart attack and my own uncontrolled cholesterol and hypertension? What is the risk to my liver from the high amounts of Lipitor it was taking to barely keep my cholesterol under control. For the people who are healthy at high weights, the risk may be greater; but for those of us who weren't, it's trading the immediate risk of surgery for the long term risk of dying of diabetes or heart disease.

I think it's important to pick your doc based, among other things, their complication rate. My doc has a very low complication rate, and part of that is because he does the surgery open. Sure I don't like my scar, but I'd definitely trade the "pretty" for what I feel is "safer". And like I've said before, I'm very very lucky. I'm sure for some people, the risk was definitely not worth it. That's what makes it such an individual decision, I suppose.

[LillyBBBW]

Besides the ones mentioned, bowel obstruction is also a possibility. Now, bowel obstructions can happen from any abdominal surgery, but they seem to be more common in WLS patients. The problem with them is that they can happen months - or years - out from the surgery, after the time when most patients feel "the coast is clear". Any time a WLS patient has any kind of abdominal pain, it's worth a trip to their doctor. It could be just the flu. Or it could be something much more dire.

Most of the immediate postop risks can be reduced with careful consideration by the doctor. Heparin given in the hospital reduces blood clots, as does using epidural pain management. Diagnosing and treating sleep apnea prior to surgery reduces the risk of breathing problems from the surgery. Getting diabetes under control reduces the risk of infection. A leak test while still in the OR can allow treatment earlier, reducing that risk.

Obviously, there are still risks, and people do still die. :( But I'm not convinced that the risks are that much higher for some of us who are already at great health risk. What was my risk of heart disease with a family history of early death from heart attack and my own uncontrolled cholesterol and hypertension? What is the risk to my liver from the high amounts of Lipitor it was taking to barely keep my cholesterol under control. For the people who are healthy at high weights, the risk may be greater; but for those of us who weren't, it's trading the immediate risk of surgery for the long term risk of dying of diabetes or heart disease.

I think it's important to pick your doc based, among other things, their complication rate. My doc has a very low complication rate, and part of that is because he does the surgery open. Sure I don't like my scar, but I'd definitely trade the "pretty" for what I feel is "safer". And like I've said before, I'm very very lucky. I'm sure for some people, the risk was definitely not worth it. That's what makes it such an individual decision, I suppose.

I agree. If the choices are, "Be sick and die," or, "Take a daring risk to save your own life and possibly die anyway," I'd choose the latter.

[Amazon Kelli]

I agree. If the choices are, "Be sick and die," or, "Take a daring risk to save your own life and possibly die anyway," I'd choose the latter.
I've heard only of one case of someone dying near me. It was because he drank after his surgery. He was an alcoholic I guess. >..Too bad.:(

[Deidrababe]

I had surgery to remove my left kidney 4 1/2 years ago when I got Cancer...I was TERRIFIED of all the possible complications due to my size. I was so happy when I had NONE. I was supposed to be in the hospital for 12 days and was out in 6!

Surgery sucks no matter what and I know that no matter how,why, where or who opens you up, there is always risk, but since I always hear about people dying from WLS, I wonder what actually causes the deaths.

Thanks so much for all the input so far!

Hugs,

Deeds

[OriginalCyn]

"On the table": Most likely a strain on the heart (surgery is hard on EVERYONE, and if one is unhealthy and/or if ones system is already stressed, then one is more likely to die during any operation).

"Immediately, or Soon, Post-Op": Likely to be due to infections acquired during the surgery or in the hospital room. Did you see the Discovery Channel's coverage of the WLS done to a 600+ pound woman? It was *assumed* that she had a hernia. After doing her WLS, the surgeon practically reached his entire arm into her lower abdomen to "feel around" for the supposed hernia, and he could find none. (The hernia-like bulge was caused by something else, and the name of what it was has slipped my mind.) As usual, the hospital sent her home in only a day or two. She got massive infections all through her abdomen that necessitated several more hospital admissions, and stays of several months. My own local "best friend" also had severe, life-threatening problems immediately post-op. In her case, what happened was due to the hospitals' policy of sending patients home "ASAP", whether it's in their best interest or not. My friend nearly bled out and required over 20 units of blood when she returned to the hospital.

"Longer-Term Deaths": Lots of things could cause this, such as not following the diet, and creating problems for oneself by trying to eat too much, resulting in violent vomiting--with a danger of a potential rupture. More commonly, though, death is caused by some level of malnutrition, because the intestine has been shortened, and not enough *vital* nutrients may be being absorbed.

I am not a medical professional, so consider the above to be an "educated analysis" by an interested amateur. I'd welcome corrections to my assumptions from M.D.s and R.N.s.

[SocialbFly]

My friend Deb, who died, died after a different type of obstruction happened to her. The esophagus is a narrow tube that brings our food water etc down to the stomach. The hole that entered the esophagus was too narrow and didnt allow Deb to get food or water into her. She later died from what i heard was a blood clot related i am sure in part, due to dehydration related to not being able to drink enough because of the narrowing.

WLS has many risks, i have also heard that the malabsorption of the nutrients leads to long term problems. One of the girls i work with in ICU used to work at Barnes, and she said there were several people listed for liver transplants as a long term result of WLS. So, many people think the surgery is without issues, should carefully research it, and look into long term successes and failures and decide if this is what they want. It is not and never was a black white issue....

[LillyBBBW]

A high school chum of mine died last year, a slow agonizing death due to organ damage from malabsorbtion. It seems she was not able to absorb the amount of potassium she needed and by the time they figured it out the damage had been done. There was nothing they could do for her. A colleague of my mom's died a year after her surgery. They said it was due to WLS complications but for privacy reasons no one would specify. My good friend's sister in law died not from the surgery, but from a follow up surgery to remove excess stomach tissue. I agree that there are risks with any kind of surgery but WLS in particular seems a bit more shrouded in death than many of the others.

[Miss Vickie]

From Cyn:

"Immediately, or Soon, Post-Op": Likely to be due to infections acquired during the surgery or in the hospital room. Did you see the Discovery Channel's coverage of the WLS done to a 600+ pound woman? It was *assumed* that she had a hernia. After doing her WLS, the surgeon practically reached his entire arm into her lower abdomen to "feel around" for the supposed hernia, and he could find none. (The hernia-like bulge was caused by something else, and the name of what it was has slipped my mind.)

It was her pannus, or apron. For some reason (I'm guessing it has to do with the underlying structure of the connective tissue supporting her abdomen) hers bulged out unevenly. If they'd been able to get a CT scan on her, they'd probably have been able to see that it wasn't a hernia. It's weird, though, the assumptions that get made. In 1998 I had a gall bladder attack and it took several days to get me on the OR schedule, even though I spent all of those days unable to keep anything down. Everyone assumed it was my gall bladder but when they got in there, they saw that I had an umbilical hernia with a loop of bowel that had strangulated. No WONDER I couldn't keep anything down. I could have DIED while they were thinking "it's just a gall bladder attack". Jeez.

My own local "best friend" also had severe, life-threatening problems immediately post-op. In her case, what happened was due to the hospitals' policy of sending patients home "ASAP", whether it's in their best interest or not. My friend nearly bled out and required over 20 units of blood when she returned to the hospital.

I'm so sorry to hear about your friend. You know, when my doc got my surgery approved, he asked for a seven day stay approval, which he got (even though my insurance company fought me tooth and nail for the surgery itself). At the time I was displeased because I wanted to go home right away; I ended up staying 3 days, which was earlier than his estimate of 4-5, because I was doing so well keeping liquids down. I never felt rushed, though. I guess I'm lucky; it sure does seem that they're sending people home way too early, and I see this in particular with the lap procedure, because it's perceived as "no big deal".

Socialbfly said: My friend Deb, who died, died after a different type of obstruction happened to her. The esophagus is a narrow tube that brings our food water etc down to the stomach. The hole that entered the esophagus was too narrow and didnt allow Deb to get food or water into her. She later died from what i heard was a blood clot related i am sure in part, due to dehydration related to not being able to drink enough because of the narrowing.

I'm sorry to hear about your friend, honey. :( I know you weren't totally copasetic about WLS before. This can't have helped, can it? So did she have a stricture? It kind of sounds like that maybe, and that's a fairly common complication because scar tissue can develop and close the hole at the bottom of the new stomach. It's easy to fix, though, if found early; they go in and use a balloon to stretch it out. Sometimes it regrows, and they have to do it several times. I can't count the number of times, though, that I see people on WLS sites asking if they should see their doctor because they're a few days or weeks out and can't keep "even water" down. Some even will let strictures and ulcers go untreated because they're losing weight quickly. It just makes me crazy -- this is not a game, folks.

I've definitely found that I get dehydrated easily. Or at least I feel its effects more quickly than I used to. I notice my lips getting dry, oddly enough. Then I know I'm behind on my water, although truthfully I'm fairly good about getting it in. Again, I'm so sorry about your friend. :( How very very sad.

WLS has many risks, i have also heard that the malabsorption of the nutrients leads to long term problems. One of the girls i work with in ICU used to work at Barnes, and she said there were several people listed for liver transplants as a long term result of WLS. So, many people think the surgery is without issues, should carefully research it, and look into long term successes and failures and decide if this is what they want. It is not and never was a black white issue....

The liver issus are HUGE (pun intended). Any time you lose a massive amount of weight, it's hard on the liver because it has to process all the junk that was stored in those fat cells. That's why they advise "posties" not to drink alcohol, particularly during the rapid weight loss period. I've noticed I'm WAY more sensitive to its effects; last night I had (literally) 2 oz with dinner, and when I went to get up I was so dizzy I could barely stand. I was always a lightweight alcohol-wise, but now I'm even moreso.

As I told my kids, WLS is a "big" surgery. If you think about what we're asking it to do -- allow enormous weight loss -- you can really appreciate just how complicated it is. The thing that concerns me about it is how differently it affects people; going into it you never really know how you're going to do. Some people end up anorexic. Some people hardly lose weight at all. It is really a crap shoot. I suppose all surgeries are a crap shoot to some extent, but I think because weight gain is such a complicated situation, the treatment for it cannot really be predicted all that easily. And when you add to it the fact that most of us who pursue it aren't the healthiest people on the planet (since most insurance companies won't cover it unless you have a BMI over 40 or x number of comorbiditise), that adds to the risk profile as well.

Every time I hear about someone having a hard time with the surgery, I realize how very lucky I am. I wouldn't say it's been a breeze, or without effort or side effects, but overall I'm very pleased with how well I'm doing. The complications are definitely there, however, and because of that I'd never recommned the surgery for anyone.

[missaf]

Some people die, too, because they're not emotionally ready to make such a life change. the surgery itself isn't the weight loss mechanism, it's a catalyst to help you change your mental lifestyle, too. Medically induced starvation meet psychological issues. People still over eat and can't stuff their emotions like they could before, they perforate the stomach and can kill themselves with septic infections.

I've seen people who are walking death after WLS because of the complications. They were happier and healthier fatter.

Malabsorption is the other issue. if you can't get enough nurtrients, you're going to drive your body into a state of weakness, that when you do get sick, your body is too weak to fight off infection.

[OriginalCyn]

This, from a health newsletter that I receive regularly:

Gastric bypass may cause hypoglycemia

BOSTON, -- Boston scientists are warning physicians of a
hypoglycemic complication among gastric bypass surgery
patients. Collaborating researchers at Boston's Joslin
Diabetes Center, Beth Israel Deaconess Medical Center and
Brigham and Women's Hospital say physicians monitoring
such patients should be alert for a new, potentially
dangerous hypoglycemia complication that, while rare, may
require quick treatment. The study details the history of
three non-diabetic patients who suffered such severe hypo-
glycemia following meals that they became confused and
sometimes blacked out. Two cases resulted in automobile
collisions. The immediate cause of hypoglycemia was
exceptionally high levels of insulin following meals. All
three patients in the study failed to respond to medication,
and ultimately required partial or complete removal of their
pancreas -- the major source of insulin -- to prevent
dangerous declines in blood glucose. "Severe hypoglycemia
is a complication of gastric bypass surgery, and should be
considered if the patient has symptoms such as confusion,
lightheadedness, rapid heart rate, shaking, sweating,
excessive hunger, bad headaches in the morning or bad night-
mares," said Dr. Mary-Elizabeth Patti, an investigator in
Joslin's Research Section on Cellular and Molecular
Physiology. The research is published in the October issue
of the journal Diabetologia.

[Sandie_Zitkus]

And does anyone have any numbers about the number of post WLS patients who become alcoholics?????

I've heard it's very high - but I have no numbers.

[Miss Vickie]

Cyn, I've read that article. It's pretty scary. Yikes! Fortunately, I haven't had any drops in blood sugar; OTOH, I'm pretty careful not to eat simple (or even complex) carbs all alone. I try to have some sort of protein first, which will slow the absorption and breakdown of carbs (or so I'm told). What's scary about the patients mentioned in the article is that they weren't diabetic, and so weren't really expecting blood sugar swings. I'd be interested in knowing what their fasting insulin levels were prior to surgery; if they'd been running high levels, and then didn't have the sugar intake for the insulin to work on, maybe it could cause such a crash? (Just my crazy hypothesizing...)

Sandie, I don't know that any studies have been done, but sadly there are a number of people who switch addictions, to alcohol, cigarettes, etc. Alcohol is particularly scary in the WLS patient because our lives are already under stress from rapid weight loss. So, adding alcohol to the mix is a Very Bad Thing. We're cautioned against drinking any alcohol during the first few months, and then to only drink in moderation thereafter. But I think for some people, the need to anesthetize themselves is high, and if you can't do it with food, alcohol's the next best thing, especially because many of us post WLS don't require much to get rip roarin' drunk.

[LillyBBBW]

Cyn, I've read that article. It's pretty scary. Yikes! Fortunately, I haven't had any drops in blood sugar; OTOH, I'm pretty careful not to eat simple (or even complex) carbs all alone. I try to have some sort of protein first, which will slow the absorption and breakdown of carbs (or so I'm told). What's scary about the patients mentioned in the article is that they weren't diabetic, and so weren't really expecting blood sugar swings. I'd be interested in knowing what their fasting insulin levels were prior to surgery; if they'd been running high levels, and then didn't have the sugar intake for the insulin to work on, maybe it could cause such a crash? (Just my crazy hypothesizing...)

Sandie, I don't know that any studies have been done, but sadly there are a number of people who switch addictions, to alcohol, cigarettes, etc. Alcohol is particularly scary in the WLS patient because our lives are already under stress from rapid weight loss. So, adding alcohol to the mix is a Very Bad Thing. We're cautioned against drinking any alcohol during the first few months, and then to only drink in moderation thereafter. But I think for some people, the need to anesthetize themselves is high, and if you can't do it with food, alcohol's the next best thing, especially because many of us post WLS don't require much to get rip roarin' drunk.

I am convinced that scientists don't know nearly enough about metabolism as they let on. I exhibit signs of hypoglycemia through stages of my life. I will become shaky as a leaf, a little disoriented, winded, etc. if I haven't eaten in a while. I finally went to have a fasting test done where I had blood taken from me every hour. By noon it was visibly clear to the doctor that I was struggling and the symptoms were on in full force, yet my blood readings were normal. The doctor aborted the test and sent me to go get food.

I haven't had these symptoms in years and was only reminded of them when I read this post. But it would never occur to me to mention it to a doctor and the chances of anyone being able to detect it through a blood test would have been slim at best even if I had. So many people have a successful surgery, I'm glad that you are one of them. I just wish things could be better and doctors knew more so that people don't have to live like a cat in a room full of rocking chairs.

[Sandie_Zitkus]

Sandie, I don't know that any studies have been done, but sadly there are a number of people who switch addictions, to alcohol, cigarettes, etc. Alcohol is particularly scary in the WLS patient because our lives are already under stress from rapid weight loss. So, adding alcohol to the mix is a Very Bad Thing. We're cautioned against drinking any alcohol during the first few months, and then to only drink in moderation thereafter. But I think for some people, the need to anesthetize themselves is high, and if you can't do it with food, alcohol's the next best thing, especially because many of us post WLS don't require much to get rip roarin' drunk.

That's interesting Vickie - I have a friend who had WLS 5 years ago and drinks like a fish. I mean this woman can DRINK and does all the time. I gotta wonder what it is doing to her body. *sigh*

[RedHead]

Vickie I agree with everything that you have shared.

I had choices...they weren't great ones; but I had come to a place where I had been on antibiotics for over a year to keep me from losing my leg to cellulitis.

I shattered my left foot 15 years ago falling down the stairs...after numerous surgeries to correct the break, they finally ended up fusing my foot. Multiple surgical scars on my foot would not completely heal...I would have one area that always would have a scab...finally I got an infection. It was horrible, then I got it again, and again and again. My doctor feared that the only thing left was to amputate...I told him flat out the leg stays...I put it into writing.

I went into this WLS with my eye's wide open; I had already had 10 surgeries prior to my WLS. Each one carried a risk and was higher each time I went under.

What I found to be the largest and most prolific cause of death with this surgery was not any one single thing.

1. Surgeon takes on to high risk of patient
2. Patient doesn't follow after care directions
3. Patient doesn't follow pre-op care directions
4. Inexperienced Surgeon ****
5. Hospital staff that are unfamiliar with Bariatric Surgery and the things to look for.

It was almost always a combination of all of the above...of course there are exceptions, such as what we have heard about the friends who have died.

I only read about these online...I don't have anything but positive experiences to go by. My sister had the surgery, another one has the lap band, a friend had the rouxY surgery, and none of the women in my support group (well over 75) had complications as a direct result of the surgery. It was always as a result of previous issues that the doctor was aware of and working with.

[Dibaby35]

This is why again people need to be aware of all of the options out there. When I was doing my research a few years back it scared the hell out of me how many deaths and complications were associated with the bypass. I used to read all those obituaries too. I'm a single parent and at the time had a 2 year old at home and I couldn't deal with the 1 in 200 death rate at the time the bypass stats were producing (I believe its 1 in 500 now). Anyways, in the 6 months that I did my research I had only heard of one death from a banding and that was also doctor error. Of course it was still new in this country but I couldn't find any info in other countries about deaths either where the procedure had been done for years. My other issue was that I could not be out of work for 4-6 weeks. The band is not perfect but if more surgeons would do the procedure there would be far less horror stories. Yes I know u don't loose as fast with the band..but most bandsters catch up 3 years out and have less chance of regain (due to adjustability). Anyhoo thats my 2 cents.

If anyone is interested (i hope I'm not gonna get banned for this) go to this site..www.spotlighthealth.com. It has great support for all the WLS surgeries out there..and the best support for bandsters that I have found anywhere.

The weird thing now is that I'm so used to living with my band and relying on it too keep me in control, I can't even imagine not having it. Honestly I would panic if I had to loose it. It's a HUGE life changing event that u can never go back to the way you were (well u can have it removed but u shouldn't even think about it). It's not like a diet that u can just do for 6 months and then pitch when u get sick of it.

Well hope I helped someone.