Deciding between RNY and DS

I posted this question in the general weight loss section, but someone suggested I post here instead.  I have to choose what type of surgery I want (my insurance is Kaiser).  While I know that the discussions with the surgeon still need to take place, I already know that Kaiser doesn't offer DS to everyone.  I want to be clear in my mind about what surgery is best for me, and press for DS if I really think it is the one for me.  I have already done a lot of research, and it seems like DS has the best long-term prognosis, however, I am still not sure.  Would any of you be willing to share your thoughts about why you decided on DS?  I would be so appreciative.

Here are some stats about me:

55 years old; 5' 7" tall, weight fluctuates between 275-280 (currently at 279). My BMI is 42. Successful at weight loss but not keeping it off and the inevitable regain-plus (and my metabolism is very sluggish now that I am in my mid-fifties).  I have very painful joint problems (my feet turn black and blue if I walk too much).  I have no other co-morbidities (I am fortunate). 

I received some good advice in the other forum, but thought I would stop by here as was suggested and learn from those who have had, or are contemplating having DS. :)  Thank you!

Hi Patrice!

I'm only 4 months out, so I can't give you any long term experience. But I can say that I am extremely happy with my DS! I am so fortunate that I came here to research WLS before meeting with surgeons, otherwise, I never would have even heard about the DS. (I had Kaiser about 3 years ago and went through their 6 month program. I was all set to get the Vertical Sleeve until I chickened out. Not once did I hear about the DS there! What a disservice!)

I have a YouTube channel (in my signature) where I posted videos throughout my recovery, if you're curious. Mostly, recovery wasn't too bad, but I did have a few bad days here and there where I felt miserable. By week 8, I felt completely back to normal.

I'm losing at a steady pace (about 3 pounds per week). My starting BMI was 48.3 and after losing 55 pounds, my BMI is now at 37.0. I'm just about halfway to my goal and it's only been 4 months!!! I can't get over how quickly this is going. I've always been able to lose weight, but like you, I've never been able to keep it off. The permanent malabsorption we get from the DS will help tremendously with maintenance.

Food-wise, it's been good for me. I cut out most carbs. I used to LOOOOOOOVE bread and pasta and all sorts of carbs. But I found that once I cut them out, I don't really crave them any longer. This diet of high-protein, low carb works for me. I plan to stay low carb until I hit goal and then I will reintroduce carbs, but only in moderation. (I'm staying away from carbs now so that I can make the most of my "honeymoon" period of fast weight loss which is supposed to last 12-18 months.) I know that I can stick to this eating plan for life. It's not a diet -- I won't have to count calories like people with the VSG have to do. And I don't have to worry about dumping or reactive hypoglycemia like some RNYers do because the DS retains your pyloric valve. 

But (and this is a big but!) you HAVE to be committed to the following: eating enough protein EVERY DAY (100 - 120 grams); getting your labs checked regularly (3 months, 6 months, 1 year, and then yearly after that); and you must take your vitamins. Currently, I take about 36 pills per day. (Don't let that scare you!! 10 of those are calcium, and 5 of those are iron. It takes a little organization, but it can be done. I take them in 6 batches about 2 - 4 hours apart. My 3 month lab checkup wasn't too bad, but there were a few things that were trending down, so I started taking a few more vitamins than I was previously. In about 2 months, I'll check my labs again and I will adjust my vitamin plan accordingly. Just because I take this many vitamins, doesn't mean you will have to. Everyone is different.

FYI - if you get the RNY, you will still have to take vitamins. Even though the calorie malabsoption from the RNY goes away in about 2 years, you will malabsorb nutrients for the rest of your life, just like with the DS.

Another thing to think about: some people say that you might get acid reflux with the DS or the VSG. I might be the exception, but my horrible acid reflux went away after surgery. Before surgery, I used to have acid reflux EVERY night. I had to sleep sitting up. It was so bad that it would get into my lungs. Dr. Keshishian repaired a hiatal hernia during my surgery and he left my stomach slightly larger than normal (but still small!) because of my previous history with acid reflux. I take one Pantoprazole per day and I am acid-free! I can sleep laying down! Hallelujah!!!!

Lots to think about, but I really do believe that the DS is the best choice. (I'm biased, of course!) Good luck with your research!

Hi and welcome, Patrice!

The DS has the best statistics of any bariatric surgery for percentage excess weight loss, for maintaining that weight loss, and for resolution of almost all comorbidites. It also allows for the most normal quaity of life in terms of eating a normal diet, no dumping, being able to drink liquids with meals, being able to take NSAIDs. Lots of advantages.

I don't know where you are - if you are in SoCal Kaiser, they actually have a bariatric surgeon at Harbor City who does the DS for patients who know enough to demand it. His name is Dr. Belzberg. If you are in NorCal, you will need to request authorization for the DS outside Kaiser when you have your consultation with Kaiser's bariatric surgeon, get a denial, and then start the appeals process. it sounds daunting, but it can be done, there are people who can help you, and many people win their appeals when they get to the DMHC (dept. of managed health care) level.

You can find a lot of great info about the ds at dsfacts.com. Keep on asking questions before you make your decision, and that's the bottom line, it should be YOUR decision and not that of your insurance company. The DS is a standard of care bariatric surgery and has been done in the USA since 1988. It has been proven safe (risk of surgical complication almost exactly the same as gastric bypass) and effective. It does require committment to taking certain vitamins and supplements, and to eating plenty of protein, for the rest of your life, but if you make that committment, the chance of nutritional deficiency is very low (Kaiser says otherwise, but the studies do not support Kaiser's position).

Larra

Hi Larra - that really does help.  It sure sounds like DS is superior to RNY for all those reasons you mention.  I will need to make up my mind here pretty soon!  This really helps.  Thank you. 

Listen to what they said and do what's best for you!

I am more than 10 years out and there is nothing out there better than the DS.  Someday there will be but not today.  I had my surgery around the same time as a bunch of my co-workers.  More than 10 years later they have all gained their weight back and still dump and throw up even though the weightloss benefits of their RNY/bands are long gone.  As far as I've seen the benefits of everything else are temporary but the DS lasts.  Just like you and almost everyone else here, I could lose but was never successful keeping it off.  And I couldn't live on a starvation diet for life.  The DS lets me eat like a normal person and look like a normal person.  I wish I was skinny but I look better than many women my age.

I am 58 and I can work a very active job.  I can run swim, hike, and do almost anything.  I hate to think of where I would be today if I had not had surgery.  I can eat anything and you would never know I had WLS unless I told you.  My biggest regret is that I didn't have surgery when I was about 10!

Hi Patty; that sounds just like me.  I can be very active too (or was).  Anyway, DS sounds like the best option.  I have to make up my mind very soon.  I don't like the dumping.  And I would be incredibly depressed to gain back all my weight and still have it.  On the other hand, if I can utilize whatever tool I decide on well, I can keep it off.  I have to get my mind around the entire thing and make my decision.  Kaiser is sure to reject the DS option and I will have to appeal (if I choose that route).  I need to decide long term what's best, and the DS sounds like it wins there too.  Thank you for your help.  Congrats on keeping your weight off 10 years out!  That's fantastic!

I liked the fact that it gave me the best chance losing the most and maintaining the biggest loss.  The ability to take NSAIDs was also another one, plus being able to eat high fat unlike with the RNY.  Dumpinjg scared me - if you've not seen it check out a few videos of people dumping on youtube - it really does look like they're suffering big time.

DSfacts.com has a whole page on RNY and DS comparison.  I've extracted the part re the Excess Weight Lost below.

RNY

EWL% at 1-2 years    48%-85%
EWL% at 3-6 years    53%-77%
EWL% at 7-10 years  25%-68%

DS

EWL% at 1-2 years     65%-83%
EWL% at 3-6 years     62%-81%
EWL% at 7-10 years   60%-80%

http://www.dsfacts.com/Comparison-of-DS-and-RNY.html#.UqiYNv RdX10

Hi Huneypie.  I am scared of dumping too.  I did check out those people on YouTube after you said that, and they do look miserable.  Eeks.  Thank you for the statistics - that helps to show that to Kaiser.  Oh my gosh, I have to decide soon.  I also have to fight Kaiser to get the DS.  I'll have to look into the process.  I've heard it may involve an appeal.  The other option is to get the Sleeve and then convert later .... we shall see.  I'd rather just get it over with.  I am convinced that DS is superior to RNY.  And there's the NSAIDs that I really need.  Congrats on your results though!  Amazing! 

Be careful with going the 2 part route as some insurers have a single WLS policy.  2 parters tend to lose more slowly than people that get the DS in one step - you don't want to miss getting to goal if there's a more effective option.  Plus why go through 2 surgeries.

BTW I just sent you a PM - I know not everyone gets alerts to their PMs.