Weight loss surgery at an older age?

Hi, @loriskt - That is unfortunate you could not continue with semaglutide (Wegovy or Ozempic) due to nausea and other gastro issues. My doctor just switched me from semaglutide (Wegovy) to tirzepatide (Zepbound) for that exact reason.

I'd like to tag a few Connect members who may have thoughts about having weight loss surgery at an older age and while having other health issues @alsims463 @roch @grandmar @klch @fredheiden. Hoping they will share some of their experiences.

With your chronic fatigue syndrome, loriskt, what activity/exercise works and does not work for you at this time?

Hi
I had WLS when I was in my 50s. At that time, there were no 'safe' drugs to take. I was pre-diabetic, high blood pressure, had sleep apnea and need 2 new knees because of all the weight I was carrying around.
When I hit the 30 lb. mark, many of the issues were starting to resolve itself. By the time I hit the 90 lbs. off, all of the issues resolved.
I started to exercise on a daily basis. I have no doubt it helped to keep the weight down and the issues at bay.
As I mentioned previously, until I lost my husband almost 3 years ago, I kept the weight off all but around 5-7 lbs. I gained quite a bit when he died because all I could eat and keep down was comfort foods.
With my doctor's approval, I started with Wegovy but did not feel great on it. He changed me to Ozempic. Again, I didn't feel great, but it did not last long. He moved the dosage up very slowly. My appetite is usually minimal, and I usually can't finish my meals. As a result, I've asked him not to move up my dosage because I do not want my appetite to totally disappear.
I'd be happy to answer any questions regarding WLS or the shots.

Thank you for your reply. So far, I have such extreme fatigue that just taking a shower wipes me out. I have PEM (post-exertional malaise), which is a worsening of symptoms after physical or mental exertion. I've been trying to figure out if the fatigue is more from CLL or CFS, although figuring out what to do about it is almost impossible. My doctor has worked with me to try adderall and ritalin and other possible remedies, but nothing works. I have to find answers because I can't accept sitting in my chair just waiting! I have been diagnosed with Long Covid, also.

I started out with Mounjaro and then went to Ozempic because of the gastro issues. Even at very low dosages I had problems and after three months of misery I gave up. I think it is because of all my other "ailments" - CFS, IBS, fibromyalgia, GERD. I really did eat less on Ozempic and experienced NOT wanting to snack all the time. I started to lose a few pounds, but I just couldn't get over the nausea and constipation. My oncologist told me that she doesn't have any concerns about weight loss surgery in regards to the leukemia I have, so that's good. I do think that some of my problems could be alleviated or even resolved, like you experienced, after losing pounds. Surgery just sounds rather scary; it's a big step, and I have to find a way to keep the weight off afterwards. Maybe if I get the surgery, I'll try Ozempic again, or possibly Zepbound. Thank you for your help.

I've had issues with constipation and nausea, too. I take fiber and the
nausea disapates in a few days. After surgery, I didn't need anything to
help with weight. I guess I needed it now because my stomach stretched.
BTW... I also have fibro, GERD and I've had IBS. I've had lung cancer and
melanoma.
I also had constipation after WLS. As part of my program, I had to take
fiber every day.
Are we having fun yet??

I'm laughing at the "Are we having fun yet?". My husband and I ask ourselves that all that time, and complain about how we were supposed to be having fun now! You said you had WLS in your 50's - if you are comfortable with it, how old are you now? Sounds like you've experienced a lot of the ailments I have, except a different kind of cancer. I sent a message to my doctor telling her I want to pursue bariatric surgery. After the surgery, how long did it take before you started losing weight? Did you have problems with loose skin? I picture dragging around a flap of skin from my belly, which is where I carry a lot of fat. Being no spring chicken, in fact having skin more like a plucked chicken, I imagine it won't just tighten right up!

I also had the surgery in my 50s and I'm now 72. I was very pleased with the weight loss and how it helped resolve my knee arthritis pain and sleep apnea. It also helped me move a lot more easily -- I had no idea how nice it would feel to be able to easily cross my legs! I really don't see age as a barrier to the surgery at all. There are various forms of the surgery, and I would encourage you to think through your priorities (side effects, reversal potential, likely weight loss, etc) before you make a final choice.

Having said that, I went in with constipation issues, and came out with constipation issues. Also, dumping syndrome is real. In my case (everyone's experience is different), I went through a LOT of trial and error to learn what did and did not trigger my nausea, which in my case varies day to day -- I usually have trouble with soft grain products like bread (toast is fine) or pancakes, sometimes have issues with cruciferous vegetables, sometimes have issues with other vegetables, never have issues with any form of protein or fruit. Went on a FODMAP elimination diet for a while, but no, that isn't it. Also, it isn't gluten. It's just strange. However, I would do the surgery again in a heartbeat -- it was worth it.

And yes, at this age, our skin does not bounce back. So everything sags. Whether you go for plastic surgery is up to you, of course, but if you lose substantial weight at this age using any mechanism, sagging surface layers are going to be an issue. And the sagging in the belly in particular can be pretty spectacular if you lose enough weight. Also, the skin on my thighs wrinkles when I move.

One of the problems with the new GLP-1RA drugs is that there is no prep and no follow-up -- they just throw you in the deep end. In contrast, I had to do a LOT of prep before the surgery, and there was a lot of helpful follow-up. When you get hooked up with a surgeon, ask about all of that. (And ask at what point you can cancel without running into insurance problems -- that is, when is a commitment locked in.)

I know nothing about chronic fatigue syndrome. I suspect you'll want to be working with a physical therapist who specializes in people who are coping with this issue, since exercise is a critical part of not losing debilitating amounts of muscle mass (so is prioritizing protein in your diet).

You may also find that you can eliminate some medications as you lose the weight, which may help. For example, I'm off statins, which turned out to have been triggering orthostatic hypotension. That wasn't a problem at my original weight, but by the end of the weight loss, it was.

Hi, @loriskt - That is rough that the post-exertional malaise (PEM) causes just taking a shower to wipe you out.

If you've not already checked out the Post-COVID Recovery & COVID-19 support group on Mayo Clinic Connect https://connect.mayoclinic.org/group/post-covid-recovery-covid-19/, you might find it useful.

I'd especially encourage you to take a look at these discussions on PEM:

- Post-exertional malaise
https://connect.mayoclinic.org/discussion/post-exertional-malaise/
- Managing post exertional malaise
https://connect.mayoclinic.org/discussion/managing-post-exertional-malaise/
Did your doctor mention what would be done if you had weight loss surgery and ended up with loose skin?

Thank you very much for all of this information. One of the many reasons I want to pursue WLS is because of how uncomfortable this weight is. I was thin all my life until I had a complete hysterectomy at the age of 40, and after that my weight just went up and up. I had never experienced not being able to reach my back to scratch, or like you said, easily cross your legs. The way clothes fit are so uncomfortable - so many things are different. I know there will be many changes afterwards, and I am anxious to get started, having made the decision to do it.

Thanks for the links - I will check them out. I haven't gotten started with my doctor yet. She had just asked me if I wanted to consider bariatric surgery. Now that I've decided to pursue it, she is out of the office for five weeks! But I'm hopefully seeing another PCP to get the referral, and I will definitely ask them about the loose skin issue.