So Confused

Hi, I'm new here and have never posted.  I have an appointment with Dr. O'Brien in 2 weeks to discuss WLS.  From what I'm seeing on the message boards, I may not have the difficult time of approval that I thought I would.  (I have Wellmark BCBS)  Any tips along those lines would be appreciated. My BMI is 46 and I have several co-morbidities that make this surgery almost a must.  I have diabetes, uncontrolled, kidney disease, kidney stones, GERD, joint problems, PCOS and am starting to have some cardiac issues.  Yes, ladies and germs, I am a mess.  :D  My primary care physician has recommended WLS many times, and I've wanted to have it but I'm scared.  Mostly I'm scared that I'll have it and still won't be able to keep the weight off.  I like eating healthy and I love exercise (when I'm not so obese that it's nearly impossible and terribly embarrasing) but I have SUCH an appetite.  It seems like I want to eat 24/7, and I doubt that WLS will cure that. Reading the message boards has helped me in a lot of ways, but now I'm more confused than ever whether to have LapBand or Gastric Bypass (and if so, whether to have lap or open).  Any guidance would be greatly appreciated. Jean

I have Wellmark BCBS and had my WLS in Minnesota with Dr. Henry Buchwald at the University of Minnesota Fairview (he and the hospital are in network), which is a bariatric center of excellence.  Dr. Buchwald is a world renowned bariatric surgeon and researcher (he is one of the to 10 WLS in the world).  He does the gastric bypass, vertical banding and the duodenal switch.  After much research, I chose the duodenal switch (DS).  I know you're torn between the Lapband and Gastric Bypass, but have you considered the DS?  I also had a lot of co-morbids and of those my diabetes was the worst.  I had a hard time controlling it, and at one point my A1c was as high as 14 (YIKES!).  However, the DS cured my diabetes (before I even left the hospital and before I ever lost any of my weight).  My most recent A1c was 5.3 and I don't take any meds for diabetes.  That to me has been the biggest benefit. With the DS I eat a high protein (at least 100 grams per day), high fat diet.  I eat a lot of meat (mostly steak and chicken), cheese, nuts, and when I have room left over I also eat lower carb high fiber veggies.  Since I'm still in the rapid weightloss phase and not near goal I avoid  carbs as much as possible.  Once at goal, many DSers add carbs into their diet and since we have a normally functioning smaller stomach (the pyloric valve is preserved) we can eat an occasional dessert and not have to worry about dumping.  We DSers malabsorb 80% of the fat we eat, so we have to eat more fat than others.  Frankly, after years of dieting mentality it is weird to be able to eat real butter, full fat sour cream and cheese all while losing weight.  Weirder still that my cholesterol is low, but that is the beauty of malabsorption.  I have to take supplements everyday (being lax with that is not an option, but I'll take it since I no longer have to take diabetic meds or high blood pressure meds) and have to have labs drawn every 6 months the first year and every year after that (so I can know if I am low in any area and tweak my regimine). I invite you to check out the DS forum here on OH and learn more about this great procedure.  One thing I noticed from reading on the forum is how happy and successful everyone was with the DS, and what a normal quality of eating life people had.  The other thing I noticed is that people were with other WLS types were seeking revisions (for example, from the band to the gastric bypass  or from the band/bypass to the DS), but no one with the DS was ever looking for a revision.  You can also check out www.duodenalswitch.com for more information about the procedure. Regardless of what surgery you choose, I wish you the best in your fight to rid yourself of morbid obesity and all the related co-morbids.  Best wishes!