XP: So undecided Band vs. VSG... So many concerns.

Ok, here's the quick and dirty of it:

I'm one month shy of 30 years old, female, 5'7'' and weigh about 250lbs, don't have children yet but plan on starting a family in the next 3-4 years. I've been on the fence about having weight loss surgery for years... know that I need help losing the weight but thus far have been unable to make a decision. Two years ago I started workup for WLS and did 6 months of nutritional education at the surgeon's office, after thinking hard and talking with surgeon decided that surgery wasn't for me.

Fast forward two years to now and I'm even heavier than I was then, and at this point am all done with pre-consultations and am ready to submit for insurance approval if I could just decide on a procedure. Surgeon suggests the VSG because of insulin resistance and hormonal benefits, but I also wonder if it's partly because they do 60% VSG and 40% other WLS combined, it's a research hospital and statistics are taken into account... though risks of band were brought up (erosion, slippage, potentially less weight loss than with VSG, etc.).

I guess I'm just wondering what people think-- I've talked with my best friend who's been banded and has lost all the weight she needed to... she's dead-set on the band, I've talked to a few MDs *****ally like the sleeve, and I've talked to some of my family and friends *****ally don't know much about either and who just want me to be healthy and comfortable inside my own body again.

As far as my lifestyle, I'm a volume eater for the most part, mostly at night when I'm at home, or on days off when I'm not being active and am mindlessly eating at home. At work (12+ hour shifts) I don't have time to take breaks except for my one lunch hour, and I don't have time to sip water/fluids throughout the day (barely time to go pee!), nor can I leave a bottle of water at any particular area in the work station (I work in healthcare and it's a violation of state health codes). So I worry with the VSG about not being able to get the proper hydration, though I'd hate to discount a good surgery and possibly the better choice for me just because of my work environment three or four days per week.

And then I think about the band, which would make it easy for me to stay hydrated, and I know that during pregnancy (sometime off in the future) you can have it unfilled for ease and comfort, but I worry about erosion and slippage, and about strictures that might develop where the band is compressing on the gastric pouch.

Sigh, I think I'm just nervous, and would appreciate any words of advice or suggestions people might have. I'm going to be emailing the nurse director of the program my surgical decision today so that she can submit for insurance approval this afternoon... I'd like to have surgery early in May when I have some planned time off from work, so that I don't use up all my sick time. I'm just so undecided and frustrated with myself over my indecision!

Thanks for listening and commenting,
Emily

Emily,

Good hydration is going to be essential no matter what kind of surgery you choose. Do you not have a locker or secure place where you stash your purse? Is there a break room with a fridge in it? I'm not allowed to have food or beverages in my work area, but I keep a water bottle in the fridge in the break room and take a swig from it every chance I get - which is sometimes literally on the fly, but better than nothing!

I love my band, so of course that's what I'd recommend for a volume eater (like me). It sounds like you've done plenty of research so I'll just mention two things about the band that often get lost in the pre-op shuffle:

1. The band doesn't automatically make you lose weight as soon as it's put in you. Until you get enough fill in your band (which can take several months), you'll probably feel like you don't have a band at all and any weight loss you achieve will be through dieting.

2. The band requires a lot of aftercare, for fills and unfills to keep your band optimally adjusted. Depending on your health insurance coverage, that can get to be expensive, and time-consuming. I don't know what your work schedule or your employer's policy is on absences, but you'll probably have to take some time off work to deal with the band aftercare.

Good luck!
Jean

Thanks for replying Jean, I really appreciate your advice.

I know that hydration is important for whichever surgery I choose, just as it's important for people who haven't had any type of weight loss surgery! :) I just wonder about my own personal feasibility for taking that swig of water... I work on a *very* fast paced inpatient unit in a hospital and though we do have a breakroom, and I have a locker, and there is even a fridge, I often don't have time to take a break and couldn't see myself pulling away for that really necessary swig since I don't get a chance to do it now... sometimes I find myself not eating or drinking anything until 3pm when I've arrived at work at 7am. That's just kind of the way it is on my unit... it's *really* busy. But I know that I come first (as do my basic physical needs of requiring a drink of water and having to take a pee break), and I know that I won't be on that unit forever, and I also know that I can try to carry a fanny pack with me to "hide" the water on my person for that quick sip here and there.

I think having the Band though on this aspect of hydration will be infinitely easier-- no need to worry about breaking health codes by hiding tha****er bottle or stealing away into the break room and not being available on the unit because I can drink larger amounts of water at any time other than before or after meals as compaired to the VSG, which will limit the quantity of water or anything else I put into my mouth... unless I'm misunderstanding? If Banded, the restriction on fluids is nothing 30-45 min prior to or after meals, same as VSG. But if there's no finite volume to my stomach with Banding as with VSG, then during non-mealtimes there's much greater opportunity (and volume) to consume the proper hydration for people having had Banding. Does that seem right?

What I do wonder though is should I be making my decision just based on hydration? It seems silly to me, and I feel like I'm rationalizing (which I'm good at!).

Maybe it's cold feet, maybe it's my fear of elective abdominal surgery with the chance of any complications peri- or post-operatively whatsoever, but I just feel so torn. I think I might know in my heart of hearts that VSG is right for me, but then why am I dragging my feet so?

Sigh.

But if there's no finite volume to my stomach with Banding as with VSG, then during non-mealtimes there's much greater opportunity (and volume) to consume the proper hydration for people having had Banding.

I'm not sure what you're saying...maybe you're overthinking this (I don't mean that as a criticism...it's just that I tend to do the same thing so I recognize the symptoms!).

To my knowledge, all WLS patients are told not to drink while eating or for 30-60 minutes afterwards. There is no finite stomach volume in any WLS patient's stomach...our stomachs all empty into the small intestine. The upper stomach pouch of band patients empties into the lower stomach pouch via a small stoma, and unless there is food stuck in the stoma (which we all try to avoid), lilquids can freely pass through the stoma at any time, even when there is food in the upper stomach. In VSG patients, liquids and foods pass out of the stomach via the pyloric valve, which may be a larger outlet than the banded patient\s stoma, but I don't know that a VSG patient can drink a larger volume of liquid and have it drain out significantly faster than a band patient.

Except as a new post-op, when I was told to drink no more than 1 ounce every 15 minutes, I've never had any restriction on my liquid intake (other than the none with meals or 30 min. afterwards). The only times I've had trouble drinking liquids were when my band was adjusted too tightly and when my band had slipped. Otherwise I can guzzle as much water as I want without any problem.

If you feel in your heart of hearts that VSG is right for you, maybe you should just go with your "gut"?

Jean

Wow, Emily....your situation sounds so much like my own....  I am SCHEDULED for lap band FRIDAY, and up until last night, I was second-guessing my decision.  I now believe that the lap band is the right choice for me.  I devoted my entire weekend to reading on this site--if you haven't already, you really need too.  There is so much to learn here!   Although lap band will be a slower weight loss, I appreciate the fact that is IS reversible.  With the sleeve--there's no turning back...ever.  Worst case scenario--if I have complications, the band can always be removed from my body.  Good luck to you!

If I were you, I'd reach out to Tetrarose.  She is also a very busy nurse that has been successful with her band.  She may see your post and respond, but if not, PM her.  She can speak specifically to your questions. 

For me, the band has been great.  But no matter what surgery you have you are going to have to figure out how to get 3 meals in a day.  That's the very minimum!  Part or our WL issues often stem from not eating breakfast or other scheduled meals and then we do all of our eating at night after work.  This is not the way to lose weight.  One of the major changes I made once banded is that I eat breakfast every day and I KNOW it's made a huge difference. 

Try to start thinking about how you CAN live healthier in your current work environment.  If you keep thinking about what you CAN'T do it's going to be hard to lose weight no matter what tool you have.  We've all made major changes in our routines and lifestyles in general to adopt a healthier lifestyle.  You CAN do it!

Best~
Lisa O.

I am an ex-bandster.  I have promised myself that I will not bash the band; it didn't work for me and that's that.  I will, however, caution any wanting the band and will tell my story.  The only thing that I can honestly say to you is...how much time do you actually have to eat?  Although you have to eat slowly and take small bites with the VSG as well as the band, there is a much lower possibility of getting anything stuck.  I just know that when I was stressed or hurried, my band would clamp up on me, and I could get nothing down.  It might be something to think about.
Also, with the band, there are some that can gulp water, me included, but many cannot.  Especially when you get more restriction, water takes longer getting down.
And I agree with you, you should not base your decision on hydration.  You have to have it no matter what.  Think about aftercare, how your body reacts to stressors, etc. 
I gave up on the band because I couldn't get protein down unless I was so loose that I had very little restriction.  It doesn't appear to be the issue with the VSG. 
I haven't had my VSG, so I am really just speaking from band experience.  Make your decision based on many factors.
Jenn

Thanks for commenting, everyone. It really helps to know that there is all of this support out there!

I started eating breakfast every morning before work or on my way there (at 6:30am), and in order to make sure I get my protein in I've actually left living a vegan lifestyle for the time being... this was very sad as I'd been vegan for over 10 years and felt it was a really big part of me. But part of the *biggest* part of me was all of the carbs I was eating, which is part of the reason I've gotten to be so overweight.

Lately I've been learning to put me first, and my body and health come before my moral beliefs-- so high-protein, fat-free dairy it was, and so far so good.

So between a very early breakfast, a scheduled lunch break and dinner at night I definitely eat three meals a day, I think it's just getting my body and mind used to what kind of meals I will be (should have been all this time) eating during those times. I'm concentrating on higher protein, really low carb and fat, high fiber (which has never been an issue from all the veggies I eat).

I guess I'm just frightened. I appreciate all of your posts and feedback-- it really helps!

I am not a proponent of the band anymore after having one for 3 years. I never got good restriction always either too tight or too loose. You can't eat and run or drink and run with the band or you WILL have problems so actually the VSG would be far better for that. Ask yourself this, if you get stuck (and you will!) how will you do your job while spittting mucous for an hour or having your food come back up unexpectedly. My surgeons office is urging people to go for the sleeve because it is so much easier to deal with, little to no after care, much better weight loss and ability to eat with far less problems. Myself I would never urge anyone to get a band when they can get a sleeve instead.

I was scheduled for a band, but changed my mind to the VSG.  I haven't had either (my info should be submitted for approval this week), so I can't speak from experience, but I will say that the high rate of complications with the band played a role in changing my mind. 

Having been laid off in 2009, I can't help but be reminded that my insurance, while stellar now, may not always be there.  What would I do if I lost my insurance and ran into a problem with my band? 

I know a lot of people like the idea of not permanently altering their bodies, but I'd rather have a permanently smaller stomach that works the same as it always has (it just holds less than it once could) than to have the maintenance, problems with getting stuck/sliming and risk of complication with the band. 

That said, if you can't have a water bottle that you put down at work... what about a CamelBak?  You're not putting it down anywhere and it's always with you; could that work?