What do you wish?

I am brand new into this process, and I have been doing a ton of research. I have also been looking to make connections with people who have been through the procedure, or intend to go through it. Anyhow, my questions are...

• What do you wish you would have known before surgery that you didn't know until after?
• Is there anything you would change about your preparation?
• What made you opt for VSG over alternative surgeries? Are you happy with what you chose?

Thank you all!

• I wish I had read more about the hormonal/emotional roller coaster. I wish I would have become more involved on OH pre-op so I that I would seen some of the repeated posts like "Help! I can't get in all my protein!" and "I'm 3 weeks out and not losing!". I had a lot of anxiety post op about if I was "doing things right" that could have been avoided if I had read more. Also; for some reason I either missed or it was never told me to me that I can no longer safely take NSAIDs. That's not really a big deal, but for some reason that seemed like the biggest shocker post op. I haven't actually had need for them anyway, but still!
• The program I went through was pretty good at prepping me. My insurance didn't require 6 months of supervised nutrition, so I it pretty easy in that regard too. It was 4 months from my info session to my surgery. Because my BMI was 36.2 at my info session, I couldn't lose weight and therefore didn't change a lot about my eating habits prior to surgery. I'm sure it would have benefited me to do so, but I'm one of those people who functions well with hard goals and deadlines, so I was able to "flip the switch" when the pre-op diet started (9 days pre-surgery).
• I opted for VSG because I didn't have any history of GERD/Heartburn and I was scared of the RNY's intestinal changes. I was, frankly, scared of dumping and feeling like I could never eat sugar again. That was very much a pre-op point of view. I like that the VSG isn't a malabsorptive procedure, and although we have to take vitamins for life and monitor our levels, the risk of deficiencies is less. Looking from a post op point of view though, I am no longer scared of RNY and I know that would have been totally fine too.

Thank you so much for taking the time to reply!

I was not aware that the no NSAID applied to the VSG! I did know that it applies to RNY, so I was a little shocked to hear that. I have been told and read about the weight loss being as much mental as it is physical, but I'm not sure how to prepare, or even if I can really prepare (if that makes sense). Also, it looks like I need to uncover more about the hormonal changes. I have PCOS, so I'm hoping for some hormonal changes, but I need to be more aware if what to expect there. :-)

As for VSG vs RNY, do you feel that you made the best choice for you; or would you go back and opt for RNY if you could?

At this point, I can't complain at all about my choice. I was to goal at 6 1/2 months and I feel awesome. I've had no complications at all. Some folks do have GERD post VSG and the only true "cure" for that is a revision to RNY. I have been fortunate and have not seen that.

NSAIDs with VSG are a risk/benefit analysis you and your medical team have to make.

The biggest risk with NSAIDs are uclers that can perforate and cause serious complications and even death.

With an RNY, part of the stomach that is no longer connected to the digestive system is left in the body. The residual stomach can still develop ulcers, but because it isn't connected to anything, the symptoms may not even show up until the ulcer is very far along. I believe there's also some issues with the pouch, but since I had the VSG I'm not as versed with the RNY. I do know that my team said with the RNY, there's no way any benefit would be worth the risk.

With the VSG, you can still develop the ulcers. You can get a bit of protection with PPIs. The main difference is that you're likely to see the symptoms of the ulcer developing early on, and can get it treated.

I have an auto-immune disorder and have to retain the option to take NSAIDs and steroids (which can have a similar risk profile to NSAIDs due to some overlapping biochemical features) so my team said I needed to have a VSG. In my specific health situation, the benefits outweigh the risks.

Incidentally, I also had a history of some mild reflux and my surgeon and I discussed it and decided to take a small chance on the VSG bringing it back. But that it was most likely the reflux was a byproduct of obesity, and so far (knock on wood) we made the right call. No reflux since surgery.

In short, which surgery and whether or not NSAIDs can be taken (and how soon) is something you have to decide WITH your medical team. It's all HIGHLY individual to your medical history and profile.

To be honest not a lot surprised me after surgery. Not to say that I was never surprised...or somethings after surgery you wonder if this is normal or not...but I expected a bit of the unknown too after surgery.

From the posts I've read on this very forum, it seems like it varies a bit with the process with insurance and what not.

I'm from Ontario, and our health care system is public, so we have to go through a very long process. It can vary where you live in the province, but I was told from the time you have orientation to surgery is a year to a year an a half. Sometimes less than a year (11 months for me). We had to work with social workers, dietitians, doctors, before we got approved to see a surgeon. Although at times, I grrred this process and I wanted it to go faster, in the end I'm glad for it as well.

It's a very big decision, and I think the process I had to take, gave me the best knowledge of the surgery (I researched it to death prior to my orientation).

Also joining this very website, open up my eyes to alot of things. The pre-op phase, and the post op it does vary for everyone, but reading people's experiences, asking questions, doing your research, I think prepared me as best I could be.

I started off in the Ontario Forum, as the RNY is pushed. You don't get a choice between the RNY and VSG. Now, I realize most if not all on this particular forum will say you can't use NSAIDS with a VSG, and I would never go against whatever your doctor/surgeon says, but up here VSGs are done mainly due to people who can't get off NSAIDS for medical reasons, or if for other medical reasons the VSG is safer.

I always wanted the VSG from the start. I didn't want my intestines rearranged, nor did I want the malabsorption factor that RNY provides you. I wanted normal digestion.

As I went through the process, I did get more comfortable with having the RNY, but medical conditions made VSG the only option. Which, yes I was very happy with, because in the end I wanted the VSG.

I don't think I would change anything about how I prepared.

Some of the things that did surprise me...kinda... was the first month after surgery and what they call hormone dumping. I knew and read about the experiences of some, but until you go through it, nothing can prepare you for it, its just something you will most likely go through.

I admit the first month was hard emotionally, but it got better. I wasn't able to eat soft food until 28 days after surgery. Felt a lot better once I could eat some forms of solid food again. It kept better from there on in.

Also, I had heard for some people how drinking water after surgery can be painful for awhile, and could only sip small amounts of water. I had no issues with drinking water. No pain, I could even take normal sips after a couple days. The only thing is that, even with that I had trouble getting my water in for a few months. I would just feel water logged all the time, making it hard to get it in, because i wouldn't feel like drinking. I have no issues with that now.

I'm surprised I still get dizzy when I get up from a sit down or lay down position (not always), but even at 5 months post op, I was told this can be normal in the first year (orthastatic hypertension).

I was told after surgery you will have this moment of what did I do (buyers remorse). And I did, the day after surgery. That wasn't the surprise, the surprise is that that one fleeting moment of buyer's remorse, was just that, fleeting and have had zero regrets since then! I do think the vast majority do not have any regrets, but I hear some that do. Its not just a moment, its much more long term. I feel bad for people that feel that way. I know some people may get serious complications and perhaps thats part of it, but for me best thing I ever did.

Ok, I have written a novel here lol Hopefully I've answered your questions, if you have any more, please feel free to ask.

Best of luck to you!

Thank you so very much for the information!! I apologize that it took me a while to get back to you. Starting school again and my head is spinning haha.

So, with the lengthy amount of time that you had pre-op, do you feel that it was beneficial in helping you mentally prepare for the process? By process, I don't mean just the surgery; I mean the healing, the life changes, and the actual weight loss as well.

With the NSAIDs, I had heard RNY makes it so you can't take them at all, but I've heard both ways on VSG. I will definitely have to ask my surgeon about that. Speaking of, do you have anything you would advise me to talk with my surgeon about, or ask him? Something that I might be overlooking, or that he might not cover in general overview?

My boyfriend (also obese) and I are set to go to a free seminar with our surgeon (his requirement before being able to schedule an appointment) on September 13. I'm so incredibly excited for that!

Originally the ASMBS said that VSGers could take NSAIDs but this recommendation has been revised in recent years to say that VSGers shouldn't use NSAIDs.

I would recommend asking your surgeon how he defines success and what percentage of his patients are successful. I'd also want to know long-term success rates - i.e., how many of his patients are successful at 5 years.

(Although, honestly, this would just be from curiosity. I believe, at this point, that 100% of success is determined by the patient. The surgeon can give you the tool, but the patient is the one who has to use it.)

No worries we all get busy in life. Sometimes I'm only on once a week on the forum...summer busy time lol

Regarding the NSAIDs, yes RNY patients cannot take them. VSG, as the US may have different guidelines than up here in Canada, as of now, generally speaking we are allowed to use NSAIDs if we have the VSG; however it does seem more than not from what I hear on this forum, most seem to be told no by their surgeon in the US. That would be a question I would ask your surgeon.

I would be asking the surgeon what he/she expects weight loss wise from you (although at the end of the day, you are in charge of how successful you can be). What size bougie he/she uses, any questions you may have about capacity. Should have a very clear understanding of the post op diet, so any questions you might have about that. Any questions you may have about the hospital stay, and the procedure that your unclear about. Write down questions, because believe me I always forgot something, if I leave it to memory lol

As for your question regarding the long process and mentally preparing me, yes, I believe that was beneficial for me. I've heard from people, whether its in the states, or people up here in canada that self pay, that you can get the surgery done within 2 months or less sometimes.

For me, unless its something you've thought about for years, and researched...I can't imagine just being like I want to have WLS surgery and I'm going to pay for it and have it done in possibly six to eight weeks. I'm not saying people can't be successful that self pay, I just feel for myself, that mentally this is a major life decision!

I will honestly say, going through this process, especially the first bit, I had second thoughts. I knew physically I needed to do this, but its serious surgery, and life changing. Could I accept all this? As I went through the process, working with the dietitians, social workers, doctors, and joining this website and talking with people who had gone through it, or about too, gave me lost of insight and assurance I was making the right decision. The further I got through this process not only did I become more confident in my decision to do it, it also gave me time to mentally wrap my head around all these changes I would experience after surgery.

Don't get me wrong, I felt as prepared as I ever could be, I was very at peace with decision...I was more nervous the day of surgery about getting my pic line in then the surgery itself lol, but until you go through the surgery/recovery experience I don't think you can be 100 percent prepared. I don't think its about being 100 percent prepared, I think its about being prepared the best you can be. Could my process been a bit shorter for me, well yes lol, but I don't think I would have been prepared as I could be if, I went to my doctor and said I want WLS, and I get sent to the surgeon, and a couple months later, I'm having surgery. I gained a lot of information, education, from my bariatric center. So, at the end of the day, I'm very thankful for my process.

Any other questions please feel free, hopefully I've answered all the questions you ask.

Good luck!

Amanda

I missed this post when you made it since I was AFK.

Pre-op, I read everything here. I read the forums as far back as I could for both the VSG and the RNY. Due to that, I came up with this list of promises for myself and it served me very well. Maybe it'll be helpful to you as well! (Sorry for OH turning copy/pasted punctuation into question marks. No idea why it does this.)

WLS Promises

1. I will not panic if I stop losing weight for a few weeks. Instead, I will re-evaluate that my eating is on plan and wait until the stall has lasted 4 weeks before I start to panic.

2. I will not ask OH what I need to take to the hospital, I know these things. Chapstick and a pillow. And the pillow really just needs to be in the car for the trip home.

3. I will not lie when people ask me how I've lost the weight. I will either be honest and tell them "surgery, diet and exercise" or I will tell them "I'm not comfortable talking about this with you." These are the options, lying by omission is not one of them.

4. If I screw up, and I will screw up, I will forgive myself and return immediately to plan. It's okay to screw up, it's not okay to beat myself up for it or let it become the start of a downward spiral. It's also not okay to say "I'll return to plan tomorrow."

5. If I don't start losing sizes right away, I won't freak out. Chances are the clothes I wear now are too small and tight, and I just deal with it. It might take awhile for my current clothes to fit correctly and that will happen before I can get into smaller sizes. (This was true, I think I lost about 50 pounds before needing to buy new clothes.)

6. I will own my mistakes. They're mine and result of my own choices, no one is ever going to hold a gun to my head and make me eat crap, I control what goes into my own body.

7. I will not compare my weight loss to that of anyone else. I'm me.

8. I will do everything I can to find a therapist I can work with. This will help me out in the long run. (Therapy = awesome.)

9. I will be hyper aware of potential addiction transfer issues and especially aware of getting too caught up in numbers as I already know I am want to do.

10. Extra skin is a fact of life, get the **** over it. If I really hate the way my body looks, I can save my pennies and nickels for plastic surgery once I've maintained for a year or two. People will still have sex with me if I have weird skin, and lots of places sell compression gear. I will, however, have every issue with my skin documented. (This didn't happen as planned, but hey, life rarely does. People did still have sex with me even if I had weird skin.)

11. I will be kind to myself. I will keep getting to my monthly massages, I will keep engaged in my hobbies, and I will spend time with my friends.

12. I already know that being a "hero" about medication is stupid so I'll work on remembering that when the time comes. Pain keeps us from healing, it's not noble.

13. I will only weigh myself once a week. I will not let myself get obsessed with the scale. See #9. (LOL, this definitely didn't happen. I weigh daily, but I don't obsess thanks to TrendWeight.)

14. My stomach will probably gurgle after surgery, this is normal. Just don't go to silent Meeting anytime soon.

15. I will not worry if people don't comment on my weight loss. I will assume that they're being polite and not commenting on another person's body, which is what they should do. (I wish people didn't comment on my body.)

16. I will work to break the compulsions to "clean my plate" and to "not let food go to waste." Sure, there are starving kids in Africa, but throwing away food will not change the situation.

17. There is nothing to be done for hair loss, assuming that I'm eating on plan. It will happen, or it won't, but I will remember that it will grow back eventually. I will be a shavee with St. Baldricks six weeks post-op. (And I've kept my hair short ever since.)

18. I understand that my hormones will be all messed up after surgery. I will do my best to remove myself from the company of others instead of taking my hormonal changes out on them.

19. I won't weigh myself for the first two weeks post-op because I know that I'll gain weight from all of the fluids and swelling that surgery entail. I'll wait to weigh until I'm off liquids. (I made it one week...)

20. I will not panic if I don't feel restriction immediately post-op. Chances are restriction won't kick in fully until I'm eating dense proteins and that will take 4-6 weeks on my plan. (This, indeed, was the case. I never had any issue with liquids.)