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"Should I have gastric bypass surgery if I have heart failure?"
Since I am what the medical profession calls morbidly obese and have congestive heart failure, my cardiologist has suggested that I have gastric by-pass surgery. He believes that if I lose the weight, I have a pretty good chance of living a close to normal life again. I went to the bariatric surgeon, and after reviewing the post-op diet, discovered that after the surgery, I could have only a liquid diet for six weeks, drinking from 84 - 120 ounces of fluid per day. According to my fluid restriction to keep the heart failure under control, I can only have 64 oz. per day. If I go over that limit, I have major fluid overload, which results in days of IV Lasix or hospitalization. Why would my doctor recommend this gastric bypass surgery if I have heart failure?
Deciding when and how to proceed with gastric bypass surgery is usually a fairly complex process, which is why it is important to thoroughly discuss this with physicians experienced with gastric bypass. This is because gastric bypass surgery is done for morbid obesity, which is a severe and disabling health problem associated with a wide variety of severe medical conditions. Heart disease is certainly high on the list of problems that significantly complicate gastric bypass surgery. However, your doctor likely recommended the surgery because clinical research has consistently shown two things: 1) People who are morbidly obese are extremely unsuccessful at losing weight without having a gastric bypass. 2) The only chance people with morbid obesity have to live a reasonably long and healthy life is to lose most of their excess body weight. For someone with heart failure, gastric bypass surgery should only be performed at a major medical center that performs a high volume of gastric bypass surgery. The physicians involved should also communicate with each other often and function as a team. You should advocate for this as a patient. It is very important because it is likely that if you have a general internist who specializes in obesity, a bariatric surgeon, a nutritionist, and your cardiologist all talking to each other and working together, then they will be able to create a plan that allows you to have gastric bypass surgery and still manage your heart failure appropriately. I can tell you from personal experience working in bariatric surgery that after gastric bypass surgery, fluid overload is generally not a problem. In fact, dehydration is actually the most common problem for patients who have had a gastric bypass, which is the opposite of fluid overload. Your diet after the gastric bypass will be very different from your current diet, and your fluid restriction and heart failure medication plan are likely to change significantly as well. Many large medical centers that do a lot of bariatric surgery have specialized bariatric diets for gastric bypass patients with severe heart failure, so you may want to check if your hospital offers this in case it is needed. Overall, gastric bypass surgery can significantly improve the life and health of any patient with morbid obesity, but it is not without risk and requires major diet and lifestyle change. Deciding if the benefit outweighs the risk of gastric bypass is a complex decision that should only be made with the guidance of a team of trusted physicians experienced with gastric bypass, who know you and your medical history very well.
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