New Member w/ Severe Metabolic Problems, Will VSG Still Work?

Hi All,

I've spent the past week reading tons of posts on most of the forum boards and haven't read anything yet that sounds as severe as my issue. I'm wondering if any of you had similar problems and are now successful with your VSG. About me: I have a 51.8 BMI, 55 yr old woman. Approved for surgery, waiting for date. My surgeon and I met once and will meet again. She said for me to research VSG and bypass, she's fine with either for me.

I saw my father lose and gain 100 pounds until he had diabetes in his 60s, dying from it in his 80s. I am following the same pattern, although don't yet have diabetes/prediabetes. I've gained and lost 100 pounds 5 times since I was 20. I always thought I was doing something wrong. My mother has always been slim. I don't snack, am not into sweets, live alone, am not into cooking or food, etc. Ten years ago I was approved for bypass surgery and backed out because I thought I was weak, could do it myself. I saw a metabolic doctor and a therapist, lost 100 pounds on a high protein eating plan. The minute my body hit 200, I began to gain. At this point, I was out of grad school, commuted to work by kayak, and my job was docking boats over 17 acres, running, 10 hrs/day, 4 days week. Despite vigorous exercise, the weight came back on, I was eating exactly as I should, was not an emotional eater, etc. I was devastated when I ended up back at 300 pounds.

I moved to a city for a new job; the place is known as "Medicine City" because of its international reputation for medical research and hospitals. I saw 2 metabolic doctors who teamed up to help. After doing weeks of trial food plans, they told me to eliminate fruits and veggies, because I gained when I ate them. I ate high protein, high fat, and in a little over a year, I'd lost 100 pounds again. During that time, my soulmate died, my father died, and I was erroneously diagnosed with an inoperable brain tumor until a second MRI was ordered. I never wavered from the eating plan, I so, so desperately wanted to be at a healthy weight. When I hit 200, the doctors had a plan to "trick" my metabolism by doing one day shakes, one day water, one day eat protein, etc. Didn't work. In less than 2 years I was back at 300. In the end I was injecting Saxenda in my stomach every day, taking phentermine, topiramate, and metformin. I got down to 280 and came to a dead halt--for over a year--and gradually gained again to 300. Both doctors finally said I had such a severe case of metabolic issues, that I needed bariatric surgery to reset my body, because due to genetics and gut bacteria, etc., it wants to be 300 pounds.

I am so, so scared that the same is going to happen after my VSG surgery, but my surgeon assures me that it will not happen if I follow the correct eating. I want to try to avoid the bypass, because I already suffer from end-stage osteoarthritis in my left hip and am fearful of the malabsorption. Plus, honestly, I don't make much money and have no alternate source of income, and there's no way I could afford trips to the ER from complications, so I'd prefer the surgery that has the least complications.

I would love to hear from any of you who have had VSG and who had struggled with a body that shut down at a certain point. I'm hoping you made it past the old roadblock weight.

Thank you so much!

Welcome to OH!

Your doctor has assured you that if you follow the eating plan you will lose. This is a very good sign. There seems to be no medical contraindications so there is your green light.

I will I'll say this. This surgery is not a miracle worker. Much of your success will be based on your own effort. You could potentially not lose all of the weight, you can potentially gain weight, and rarely you can also have complications.

It's a very difficult decision I know. My opinion is, if your doctor has given the go ahead, and you have enough will power to lose 100lbs on your own like you state, you are a great candidate.

Best of luck in your decision making process.

An intestinal bypass of any sort, DS or RNY, has benefits and metabolic changes a sleeve simply does not to the same degree. I'd argue the majority of weight loss occurs to these drastic metabolic changes and not the caloric deficit that the surgeries create. It's basically a reboot to factory standards for your metabolism. A sleeve also has a strong metabolic effect, and in fact there are people who've lost hundreds of pounds and kept them off with a sleeve alone, however if you are resistant to Saxenda and stimulants and behavior is accounted for (no surgery can change consumption habits), it is more likely that you will not get as good of a result statistically.

I used to weigh 750+, have a thyroid that is basically non-functional, an eating disorder, lymphedema, lipedema, and am highly insulin resistant. I still have lost over half that weight (I really should add it up and haven't in a while...). How?

I lost the first 300 or so pounds following a ketogenic diet. I tried medical interventions that were pharmaceutical and they did nadir. I was also eating crap. I went back to therapy and then went for bariatric surgery and got a sleeve. I lost well for quite some time, but I hit the wall.

The problem is that intestinal bypasses permanently alter the metabolism in ways the sleeve does not. The VSG is absolutely a metabolic surgery, however the benefits last around 10-12 months. With the RNY and DS, the initial benefits last 18-24 months and both have malabsorption long after that. The DS is more extensive and so has more of an effect. I had to revise my surgery due to crippling GERD, and I have a longer RNY than most. My metabolic struggle with the sleeve vanished.

Oh don't get me wrong... I lost around 140 (? I forget) with the sleeve, but the RNY has worked much better. If I hadn't had dumb stupid GERD not responding to NSAIDs I'd have gotten a DS without reservation.

Many people get a DS and RNY with end-stage osteoarthritis. Hell, I've got it in my knee and three other joints. I also have the back of a 90 year old. I'd still have gotten a DS.

You can have complications with any surgery, though. It's more likely with a bypass for sure, but I've seen sleevers go to the hospital more than DS or RNY peeps on occasion. It happens. Compliance to aftercare decreases the likelihood, but we can't help random stuff either. I am nauseatingly compliant and had to go to the ER twice after my last surgery, once for gut stabbing pain which ended up being a giant seroma, and once for a severe post-op infection. Again, I am so compliant even my surgeon says I am too compliant sometimes, heh.

If you can commit to the vitamin regimens for malabsorption, I'd strongly consider the DS, or RNY if not. The sleeve can absolutely work for you, but be prepared that if you have already been resistant thus far that it may likely not. Again, if I could've gone DS I would have even with my arthritic issues and low income, too.

Boy you sound like I was. Active despite being obese and obese despite being active. The duodenal switch (DS) changed all of that for me. It is the most aggressive of surgeries and yields the highest results. The tradeoff is that you take a lot of vitamins to counteract what your body no longer has the time to absorb properly with food. We eat just like you do..high protein, high fat, low carb.

It has a sleeve stomach like the vsg and a more aggressive intestinal bypass than the RNY. You may need to consult another surgeon for it, because there are fewer than 100 in the world, but they are worth the trip to get it.