Bariatric Surgery-Need Advice

susannyc · Aug 15, 2009

Have you considered the duodenal switch? The cure tate for diabetes post DS is 98%. I had a DS in 2001, went from 304 lbs to 153. I wasn't diabetic, but I come from a diabetic family. My BP is now too low at times, my cholesterol is 95. The post op DS diet is high protein high fat, low carb. Think about it. PM me if you want. The web site is http://www.duodenalswitch.com

hellerd2003, RN · Aug 15, 2009

I had the RNY back in 2001 and would never recommend it. Anything that reroutes intestines/ messes up absorption of nutrients, etc. . . . I just cannot get behind that. Plus I've had numerous complications-- anemic, requiring IV iron (and I get scoped next week because I lose so much iron they think I'm bleeding somewhere); deficient in nearly every vitamin out there; hiatal hernia and GERD (not present prior to surgery); thinning hair; lethargy; nausea/ vomiting at least once a week . . . And you can still gain weight, so surgery isn't a PERMANENT fix unless you still do the darn diet and exercise rigamarole.

As for lap band-- the research is still fairly new, and some studies have shown an incidence of erosion of the outside of the stomach at the band application site. Also the thought of having a "tool" that you can inflate/ deflate when you need/ want to (going on a cruise? deflate the band! Wedding in a month? inflate the band!) is a bit crazy, and one needs to examine the psychology behind that "selling point" of the band.

Once again-- as crabby as it makes people (myself included!), weight loss is all about calories in

Good luck with your choice-- it's a difficult one.

Daytonite, BSN, RN · Aug 15, 2009

i think everyone "generally like a less invasive approach". i wanted something that i knew was going to be foolproof.

i had a silastic roux-n-y bypass in 2006 and am very happy. i weighed 387 pounds on the day of surgery and i am currently 168 pounds, approximately 20-30 of it is hanging skin. i am off my diabetes medication, was off my hypertension meds for 6 months, but had to be put back on them just recently and taken off my zocor because my cholesterol levels are normal. the 4 or 5 plastic surgeries to remove the skin cost $40,000+ and need to be spread out over 2 years. i lost approximately 10-12 pounds a month, not rapid weight loss like your husband erroneously thinks, and i am still losing weight. i watch what i eat and i have worked very hard to change my eating habits. i do a lot of low carb veggies and fish. i didn't do the weight loss drastically, but i did it gradually. i see lap band patients at our monthly support groups and a good many of them either aren't losing much or they have stopped losing--they figure out how to sabotage the lap band. our surgeon has told us that we have to be honest with ourselves. we have an eating problem + our bodies are extremely efficient at processing the food we do eat and turning it into fat. the surgery is going to put our eating and portion size under control for a while, but when you discover how how to override or sabotage yourself, and it is likely that you will, you are back to having the (over)eating problem. and you can't fool me. i was there. i know how you got to morbid obesity. i'm not being mean, but i was a fat kid and a fat adult who tried to get thin for 30 years. so far it has only been the permanent roux-n-y + better eating habits that has helped me. at 290 pounds i plateu'd because i was still eating the same junk, just smaller portions of it. i'd probably be gaining weigh if it wasn't for the permanency of the surgery. i have 2 candy bars and a bag of m&m sitting in my refrigerator! 3 years ago those would have been gone before they even got home in the car!

i originally wanted a lap band, but was told by another surgeon that the lap band could become dislodged, puncture the stomach and i would have to end up having a roux-n-y anyway. our surgeon comes to our support group meetings and often tells people that while the lap band works for people, many will consider having a roux-n-y bypass done as a permanent solution. you must be aware that bariatric surgery is elective. right now the lap band is the most commonly sought after of the surgeries for the very simple reason that it is reversible. people still want an out because they worry about their access to the food they love being taken away.

your other surgery is the vertical sleeve. http://www.obesityhelp.com/forums/vsg/cmsid,8874/mode,content/a,cms/. it is similar to a roux-n-y bypass. and i see the advantage over the roux-n-y bypass--you get to keep your pyloric valve. the major question i would have is how do they guarantee that the sutures (or staples) are going to remain intact? what happens if they should come loose? that is a long incision. they had problems before with the staples coming apart with the older gastric stapling procedure. however, i have not heard my surgeon talking about this procedure. i am going to my monthly support group today and i will ask about it.

we have many people come to our support group who are contemplating surgery and this is what we tell them about food because many are afraid to ask these questions, but it is the food questions we were the most concerned about too: i can eat anything including all the different fast foods. i've gone to every fast food place to make sure i can eat it all. what is different is that i can only eat small or normal portions. are you ok with that? instead of 6 tacos and 2 burritos i can only eat 1 taco and feel full. the fullness feels the same as it did when i ate a huge turkey dinner on thanksgiving. feeling full feels full--no difference. i can eat a candy bar and it tastes just the same and just as great. i do have to watch it with high sugar foods like milk shakes or coke because the sugar goes right into my blood stream (i have no pyloric valve) and i will get hyperglycemic very rapidly along with all the signs and symptoms--if i eat too much of these (especially ice cream) i will get dumping syndrome and diarrhea several hours later. i am a cheap dinner date because i just cannot eat all the food served in a meal at a restaurant so i have to plan what i will eat carefully to enjoy all parts of the meal. it is my head that gets upset that i can't "clean" the plate.

don't be fooled into thinking that bariatric surgery is a cure for obesity. it isn't. it is only a tool to help you in keeping your weight under control. you will still need to work at maintaining a normal weight. i see people who have gained 20, 50, 100 pounds with roux-n-y surgery. you can gain back weight with any of these surgeries by grazing--constant eating throughout the day on things that are high carb like chips and snacks as well as eating several meals. so, the surgery is only part of your commitment. you also have to attend support group meetings and pay attention to what you are eating. i attend weight watchers. as i mentioned, i am very attuned to what i eat now. there is no way i am going back to what i was before.

you and any others interested in information on surgery and the experience of others should check out this website: http://www.obesityhelp.com/

Silverdragon102, BSN · Aug 15, 2009

I think the surgeon is right and allowing you to do your research in what is best for you but he should also be able to make some recommendations. I had RNY in the UK done in 05 and lost over 100lbs and the best things I ever did. I researched it like mad and also found a great UK wls website where people discussed the good and the bad. People really have to remember what ever they decide WLS wise it is a tool and you still have to work at it, this is regardless on band, DS and RNY (sleeve isn't a big thing in the UK although there are some that have had it done) I knew band wasn't for me as it takes on general a few fills before restriction kicks in and people feel the benefit. Some also don't realise this but with proper research things will become clearer but finding a great support website does help (I know the UK website covers all surgery and even supports family and friends)

Baloney Amputation, BSN, LPN, RN · Aug 15, 2009

I talked to a couple of patients that say they wished that they'd have gotten the sleeve instead of the banding, because they generally didn't lose much weight. 6 nurses on my unit have got sleeve and are very satisfied...and to be honest, the weight that they have lost is totally amazing. I generally like a less invasive approach, but I'd really love that weight loss. I'd like to know everyone's thoughts on this, because this is probably one of the most important decisions I've ever made about my body, next to having kids.

Neither of these methods mess with your absorption, right? (I'm asking because I'm not sure.) If they don't mess with your absorption, I'm thinking that the speed and amount of weight coming off is going to be wholly dependent on your caloric intake rather than the method of internal restriction, so whichever method you choose is irrelevant in that respect.

SueBeeRN · Aug 15, 2009

I had the sleeve done at the end of May and am ABSOLUTELY happy with my decision. I've lost 55 lbs so far!! I researched both the sleeve and lap-band in depth, and found the sleeve to be the better choice for me.

The reasons are:

- I would not like to have to go back and forth to the doctors office every few months for fills, etc. With the sleeve, you only go to the doctor when it's time for checkups and such- no 'maintenance' to be done.

-I like the freedom to be able to eat what I want - only in MUCH smaller amounts. It seemed like with the band, there were a lot of restrictions on different types of foods. There also seemed to be a lot of 'rules' with the band (ie: chewing, size of bites, etc).

-Last, there seemed to be more reports of complications with the band. Don't get me wrong, the sleeve has complications- but there seemed to be much less incidences.

Most of my research was done at www.obesityhelp.com. The only 'warning' I have is that a lot of insurance companies still consider the sleeve experimental- so it's harder to get approved. I ended up being self-pay and am waiting for insurance to reimburse me.

I hope that helps... feel free to PM me if you have any questions.

MedSurgeMess · Aug 15, 2009

I'm lucky that my insurance will pay 100% of this (already checked after the nurses on my unit stated such), regardless of the route I choose, and I'm qualified. While I like minimally invasive, I'm not so hip with foreign body and the risks with that. Thanks SueBeeRN, I'm going to check out the website. I'm really leaning toward sleeve right now, whereas I was leaning toward banding last night before I went to bed....Keep the ideas coming.

RN1982 · Aug 15, 2009

I had my RNY via laproscopy, my abdomen has 5 small incisions which are all healed not. I could have went back to work within two weeks after having surgery, but I stayed off of work for a month.

Long Term Care Columnist / Guide · Aug 15, 2009

It's fascinating to read all of your experiences with the different types of WLS. I'd been researching them and considering the idea for years, and in fact started the process last fall when I hit 357 pounds and realized that I was just going to keep gaining if something didn't happen for me, and soon.

But thanks to the fact that my health insurance company has yet to join the 21st century in this regard, I came to the regretful conclusion that I was just going to have to take total responsibility for undoing 30 years of bad eating habits. I was out of options: since I don't have forty grand laying around to pay for the operation myself, and since my family members tend to die from lifestyle-related diseases in their 50s and 60s, the whole matter took on an air of urgency as I approached 50 myself.

Now, ten months later and 53 pounds lighter, I'm almost glad I've had to do this "the hard way". I'd been hesitant to have WLS because of patients I've cared for over the years who suffered from malnutrition, malabsorption, pain, infections, adhesions, intractable N/V, and other problems from the gastric bypass. I've ALWAYS been afraid of having my 'innards' altered anyway because I've had ulcers, GERD, and irritable bowel syndrome, and I need another GI problem like a hole in the head.

Weight loss really is 10% physical and 90% mental. You just have to make up your mind that NOTHING is more important than regaining your health and reclaiming your life, and that's with or without surgery. You have to change what you're eating and how much of it you're eating. You have to change your ideas about movement and seek out ways to be more active, even if it's just climbing the stairs in your house a couple extra times a day.

Now, I have lost only a modest amount of weight in relation to my size (I was a tight size 32, and now a 26 hangs on me), and compared with my friend who had the lap-band in January and has already dropped more than 80 pounds, I'm lagging far behind. But I'm not racing with anyone, and I'm not even dieting...........I have treats when I want them, there are no 'forbidden' foods. Yet I've finally succeeded in putting food exactly where it belongs in my life: something I use for FUEL, and the better quality fuel I take in, the higher my energy levels. My tastes have actually changed; I now prefer, and even crave, fruit and veggies and fish. I've lost my jones for greasy foods and can only eat small amounts of fatty sweets before getting a squeamish, squirmy feeling in my belly.

Though I'm still morbidly obese, I've lost enough weight now that I can play and roughhouse with my young grandsons, something I'd never had the energy to do in the four years my oldest has been on the planet. It's so funny, they're not yet used to this Gramma who chases them around the yard and rolls down the grassy hill with them, but they love it, and so do I---I'd long forgotten what it was to be able to play. The other night, we were outside rolling on the grass and slaying the Tree Monsters with big sticks for almost two hours; afterwards, I was tired, but felt positively young again, even though 50-year-old bones are probably not meant to be jostled from repeated contacts with uneven ground at considerable speeds!

It will probably take me another 2-3 years to shed the other 150 lbs. I want to lose, but I figure it took me 30 years to get like this so it's going to take more than a few months to undo the damage.

No matter what choices we make to lose the weight and regain our healthy lives, I wish everyone the best, and may your decision be the right one!!

kellyc034 · Aug 15, 2009

I had Lap RNY in 2002, so I can't really attest for the banding procedures. However, bariatric surgery was the best life decision I ever could have made. I am 5'3 and was 320 pounds the day of surgery. Now, 7 years later, I am 150 pounds, have a beautiful 4 1/2 year old daughter, work in a hospital as a PCT, and will graduate in May with my ADN. Never in a million years would I be where I am today if I didn't have surgery.

I found alot of info on obesityhelp.com when I was researching my decision.

Good luck to you in whatever you decide!

dianajh73 · Aug 15, 2009

There has been some great info here. Definitely check out the surgery pages on www.obesityhelp.com but understand that people are individuals so look for good statistical data rather than anecdotal.

My husband and I had roux-en-Y last year and do not regret the decision for a second. Our surgeon does RNY and banding, but they point out that the surgery is the same regardless, still laparoscopic, invasive procedure. It is UNTRUE that RNY is irreversable. The stomach is still there, it can be reconnected with minimal change (loss of small portion where the staples were, but that's it). I know someone who had a reversal d/t other problems that were attributed to the surgery but, unfortunately, were completely unrelated. Now he is gaining weight back and still dealing with issues, but stomach works just like it did before.

It is important to communicate with your surgeon. The horror stories I read mostly came down to bad surgeons who refused to listen to patients having legitimate problems. My husband had a stricture. Surgeon sent him for endoscopy, simple dilitation and not a single issue since. Had the surgeon not followed up and just figured he was doing something wrong it could have led to other issues which is the basis for a lot of the scary stories out there.

I was another that was not at all comfortable having plastic parts or going for frequent follow ups. The cure rate for diabetes is also impressive with RNY compared to band. DS is the best in this regard but it is permanent and drastic change in regards to malabsorption.

The best comparison chart I have seen is from http://www.lapsf.com/weight-loss-surgeries.html an organization that does all of the procedures. Only you can decide for you, but really consider what you want and how to get it.

Good Luck, it is an amazing journey. It is only a tool, as stated by others. I was 316 and now hover at 200 (16 months later). While I am still 20 pounds from goal this is less than I weighed in high school so pretty happy and few restrictions. Could totally gain weight again if I really put my mind to it, just so you know. you can eat around anything, it's all about changing your relationship with food and letting the tool work for you.

Take Care,

DJ

RN1982 · Aug 15, 2009

To Hellerd:

Yes, you still have to watch what you eat and exercise after RNY. The surgery is not a cure. You mentioned all your problems and make it seem like this happens to every RNY patient. I've not dumped, I'm not dehydrated, my labs are normal but I take my vitamins too. Just because you had a bad experience doesn't mean that everyone else will. I am completely satisfied with my decision to have RNY. My surgeon is great and I have him and the bariatric service on speed-dial if I have problems and I've not had one. I think it's also important to have a good aftercare program which the hospital where I had my surgery at does. I don't feel hungry though sometimes I do have some head hunger. I miss some of the bad foods I use to eat like the fast food but all in all I've had a great experience.

To those who are interested in gastric bypass or banding, Obesityhelp.com is a very informative site and don't think that after surgery you can't eat anything interesting, check out Theworldaccordingtoeggface.com for bariatric friendly recipes as well as bariatriceating.com. I just made protein ice cream for the first time with chocolate protein powder and PB2 and Lactose free milk and it was yummo...125 calories and 20 grams of protein for 1/2 cup.