What will the surgeon say???

I have researched like crazy and I want WLS!

i have good insurance coverage. I have two appointments with surgeons to see which one I like better. I meet the medical criteria. What I don't know is which surgery is right for me.

i had an endoscopy last month and I have Barret's esophagus from GERD. I was leaning toward the gastric sleeve but have read that reflux can continue to be a problem with the sleeve. I also have a hiatal hernia that needs to be repaired.

So maybe I'm a better fit for bypass, but I take psychiatric meds for  bipolar that are extended release so may not be absorbed after bypass.

I guess I'm scared that reflux is going to rule out the sleeve and medication absorption is going to rule out bypass. Where does that leave me?

Two weeks until I see the surgeon so I thought I'd ask you all what you think.

Write down every question and concern you have and ask, ask away. Do not leave either doctor with out getting all your questions answered. That is what they are there for and this is the only way you will get the true answers. 

With Barret's esophagus, I would not even consider VSG. Esophageal cancer is no joke, and that's where you could end up.  No, it's not a sure thing. But it's too big a chance to risk.

I've seen too many people revise from VSG to RNY because of this sort of issue. Do the surgery once, and be done.

^^^^^ what Grim said - VSG is an absolute no for you ...   RNY is possible with just an alteration to your prescription - you are not the first on mental health drugs and won't be the last ...

While the GERD can definitely lead to cancer, it's also vital to consider the bipolar disorder which can also be just as disastrous in its own way.  When untreated or undertreated, many mental illnesses can be on par with having cancer in terms of lifetime outcomes for health.  It's definitely something I would consult physicians for because it's a very complex situation.  However, I'd absolutely talk to a physician specifically familiar with bipolar disorder, as the mood stabilizers often used are not as frequently prescribed by PCPs.  There may be alternatives if you go RNY that might work well.  

XR versions of medications tend to be better in terms of convenience and mood stability, but a lot of folks do well with the non-XR versions that I see, too.  Sadly, the only way to know is to take them and see.  There are many people with bipolar disorder who have gotten the RNY, though, so there are definitely solutions for the conundrum. 

I fully agree with everything that has been said both about VSG and you bi-polar meds. My suggestion may seem a little odd though. If your WLS will not be a secret I would consult with my pharmacist as well as my surgeon and prescriber of the bi-polar meds about the absorption of said meds. I have found they know far more about how the meds are absorbed and other med facts than the prescribers do. After all that is their profession and they don't have to know so much about so many things as your Dr does so they often stay far more informed and up to date than your Dr can. Having two family members that take these drugs I understand their importance in your life. Good luck.

Yes!  Absolutely for the pharmacist!  It's not an odd suggestion at all!  

What I forgot to say is that I have a psychiatrist who manages my meds. He has suggested WLS in the past and I'm seeing him the day before I see the surgeon to get his input. Two of the meds I take are available as an oral disintegrating tablet. The third, Effexor, and my besty, is ER. I'll talk to my psych doc about alternatives.

Thanks for the input. I will talk to my pharmacist. Great idea. And no, the surgery is not going to be a secret. I've decided to be upfront with whoever asks. 

RNY seems best because I've read that reflux is a non issue afterward. The psychiatric meds I think I can work around.

The other thing about psych meds is, they really aren't the sort of thing that you take the same med for life, like you would for cholesterol. To be successful, they always need changing, adjusting, dropping, adding, etc. Be sure to talk about that, as well.

Make sure insurance will cover the oral disintegrating tablets.  You may need to have the psychiatrist fill out a prior authorization form.  I ran into that issue, myself.  I wish I had thought to do it ahead of time.  While I had the VSG, I didn't want to mess with being unable to take pills even if for a while in case I got sick.

Effexor isn't easily replaceable, and it does work really well.  There used to be regular non-XR tablets that most would take multiple times daily, so that may be an option, too.  Not sure how hard they are on the tummy, though.

I did research for my degree on psychiatric medications post-WLS and this was one article I wound up citing.  There's sometimes a relapse in people regarding their mental illness, and there's usually reduced serum levels of the drugs after the RNY compared to before.  Sadly, there aren't as many studies about it as you might imagine.  However, knowing that going in gives you a huge advantage in case it happens. Good luck! :)