Weight Loss Surgery

[BeAGoat]

I'm 18 years post transplant and want/need to lose weight. I haven't been offered any of the weight loss drugs. However, I'm being encouraged to go the surgery route. My BMI is around 37 but I'm type 2 diabetic and have high blood pressure. I'm concerned for my kidney with all the diet restrictions attached to weight loss surgery. Has anyone had the surgery post transplant?

[Bassetmommer NKF Ambassador]

I was told I could not have the surgery because of complications with meds and transplant. Also that you have to take calcium and it can cause kidney stones. I think I was fed a line of bull.

[BeAGoat in reply to Bassetmommer]

That's why I'm doing as much research as possible. I have concerns about staying hydrated and the absorption of my tacrolimus and myfortic. I had a parathyroidsectomy which has me taking calcium. The bariatric surgeon was a transplant surgeon prior to specializing in bariatric.

[barbara55109]

If you are T2 diabetic you should be able to try the medications first. I am not a good candidate for bariatric surgery. I have had several abdominal surgeries and no large intestine. My terminal ileum, the end of my small intestine was also removed and a section of small bowl is gone too. Long term dehydration, tied to my colon removal 31 years ago, caused my CKD. I cannot absorb any of the vitamins that are usually made or absorbed in the colon. So no vitamin K for me. I need monthly B12 shots. Pills won't work when you don't have the sections of the digestive tract that absorb them. So, I'm filled with internal and external abdominal scars. I'm already malnourished. Given that bariatric surgery can also lead to malnutrition and gastric issues it just isn't a good option for me.

Both semaglutide and tirzepatide have shown weight loss results that compare very favorably, without the problems associated with bariatric surgery. The drugs have their own side effects, but luckily those haven't impacted me much. I was on semaglutide for a little over a year.

Because of my combination of health conditions my endo followed the prescribing protocols and it took several months to get to the top dose. I was able to go from 224 to 190. But then my weight started crawling back up.

Since the CKD diagnosis and my attempt to get on the kidney transplant wait list I go to the YMCA an average of 5 nights a week for 2-4 hours. I mostly ride recumbent bike and stepper. I have holes in my knee bones from IV prednisone so weight bearing exercise is very painful. Most days I eat once. I try to have a late lunch. I have severe dietary limitations due to my ileostomy. I have a parastomal hernia and easily get blockages. I need to avoid all veggies and fiber. Weight loss diets emphasize veggies and filling foods. It is impossible for me to meet all the medical diets I've been prescribed. They all disagree with each other. Low carb for T2, low protein for CKD, low fiber for ileostomy, low calorie for weight loss. My endo wanted me under 800 calories a day. So I eat once a day. I mostly eat turkey or chicken sandwiches. I am still malnourished, but there isn't anything I can do about it. Every dietician gives contradictory advice. They only know their specialty. Since a blockage can kill me I stick with a low fiber diet.

I switched to tirzepatide. I was on two types of insulin - because of my CKD. Prior to CKD my diabetes was totally in control with low doses of glipizide and metformin - but those drugs are contraindicated with CKD. So I had to go on insulin. I had frequent lows while on insulin and semaglutide, but I couldn't stop the insulin. My A1C was in the 5s. After hitting the max dose of tirzepatide I was able to stop my meal insulin. It was a miracle and I finally started dropping weight. I now hover around 175. Because of my unique system and dehydration issues my weight can vary by 5-10 pounds a day.

Genetic obesity, dietary limitations, a blockage prone, high output ileostomy, postmenopausal, insulin and physical limitations make losing weight very difficult for me. I've never been able to get down to 800 calories a day as recommended by doctors. Getting off on insulin was the key. I expect to be on the max dose of tirzepatide as long as my insurance continues to cover it.

For the last month I've weighed between 172-176. This is what I weighed at 17. I'm 61 now. I've NEVER been thin or even average. Stupid BMI charts still have me as obese, but at least I qualify for a kidney transplant.

I have had very few side effects on either semaglutide or tirzepatide. I have had occasional stomach cramps when I eat. I CAN'T get constipation, though if I ate high fiber I would have life threatening blockages. For me, the known bariatric side effects are much worse. Luckily I haven't been impacted by the world wide shortages. I am very fearful of losing access and gaining weight above the transplant limit.

If you are on insulin that make losing weight much more difficult. It makes most people gain weight. If you don't have an endo, I suggest you see one. They are much more knowledgeable about weight loss than GPs or nutrition people. Obesity is more often caused by metabolic issues, not calories in calories out. Endocrinologists understand the science.

[BeAGoat in reply to barbara55109]

Thank you for your very informative response. So far in two days I'm getting better information here than I've been able to obtain anywhere else. I have appointments with nephrology and endocrine in June and July so I will ask alot of questions.