Uncomfortable with my surgeons advice

Hey folks! I'm new here and I don't really know where else to go with this. I apologize ahead of time and thank any who are patient enough to read through this.

I have basically agreed to something I'm completely uncomfortable with and I'm not sure what to do. I'm generally the type to follow my intuition and it's almost always a good thing. However, since his is something that has caused me a great deal of anxiety and fear for the last 5 years, I'm not entirely sure it's intuition only and maybe that fear creeping in with a different "voice". 

So to explain a bit might help.

This is attempt number 3  for me to follow through with a Bariatric procedure. The first time I was scared by the "voice" that told me I would have major complications and might even die. This was because I went into the seminar wanting a sleeve gastrectomy but was told my insurance would only cover a BPD or Roux En Y.  I walked out, bought a food scale, a new pair of walking shoes, a gym membership and started to reform my entire life. I weight 327 and within a year, I had lost 128 pounds with a low glycemic index diet/Ketogenic diet and exercise.

Got stuck for 2 years there so visited the Bariatric option once more. Was told the same thing so I walked away again.  

Here we are now. 3rd time is the charm. I have re-gained 40 pounds but the sleeve is now an option for me!!! I have completed all the requirements and the surgeon is telling me that the first week in April is what we are looking at. I just need to attend a Support meeting and provide that to them, then we are a go. Should be ecstatic, right?

Here's where I need some insight and advice.  I went in to my appointment knowing I was going for the Vertical Sleeve. Being a diabetic that was able to come off of all insulin and meds with my initial weight loss, he was impressed. We also talked about my recently noticing that,unfortunately, my glucose numbers have been Way too high again. Everything I eat, even protein and fats ONLY are still spiking my sugars. I don't want to go back on diabetes meds/insulin, so surgery is the only answer. My surgeon says that at 243 pounds, I barely meet the BMI requirements and he is only able to approve me for a surgery under a 'diabetes control' diagnosis. But to do so, I should let him perform the BPD INSTEAD OF THE SLEEVE.  He says it has a proven long term remission (20+ yrs) of diabetes while the sleeve is linked to only 5-7 years. When he put it that way, I figured OK...this is why I'm having such an extreme procedure done. To allow me to avoid the deadly complications that have ravaged the rest of my family. So, I said yes.

But now......I'm terrified!! I am hearing that intuition once again telling me that the complication from the intestinal diversion will cause me tremendous complications and I am ready to walk away once again. My current diet consists of virtually no carbs that do not come from vegetables or a small amount of fresh fruit. I have learned that high amounts of good MTC fats are amazingly healthy. My biggest downfall and weight gain came in the last 2 years from falling off the no carb wagon and overeating in general. I turned back to food after my Brother died in 2013 and just never got back on track. With a BPD, my body will not tolerate the fats I know are healthy and I cannot imagine the vitamin/calcium deficiencies that will come with this particular surgery because of the inability to consume evhealthy fats. This is why I wanted the Sleeve to begin with!!! No deficiencies and plenty of restrictions!!! 

I need advice/help with this issue. Anyone? Please help!! I'm scared to do what he suggests and scared to walk away for a 3rd time. I am not in control of my glucose and terrified he won't let me have the sleeve. What do I do?

thanks again for taking the time with me.

~K~

Don't do any surgery that you are not comfortable with. Go to another surgeon and get a second opinion. 

First, your doctor is recommending.  He can't make you get one procedure over the other, and I suspect he'll be happy to perform whichever one you choose...or you can find another doc who will.

Regarding diabetes, the duodenal switch (DS) has the best statistics for resolving diabetes, although it's not 100%.  I think the BPD is some sort of hybrid DS, but not a true DS.  You should clarify with your doc exactly what's being done.

The issue with all of the malabsorptive surgeries is that you have substantial lifetime supplementation of vitamins and minerals.  If you go to the DS forum and browse, you'll see many discussions about vitamins and what lack of supplementation will do to you.  And, yes, your innards will get rearranged.  If you're not comfortable with that, don't do it.  You have to live with whatever surgery you choose.  Just realize that the sleeve may not do as well putting your diabetes in remission than other surgeries, so you need to be prepared to accept that.

BPD-DS is just another name for the DS. The SADI or SIPS is a different version of the "real" DS.

Unfortunately Dr. Boyce's office refers to the DS and the BPD/DS. He was my surgeon. Excellent cutter, lousy vitamin advice. I am over 5 years out and have the DS from him.

Just FYI---the BPD was the precursor of the DS. The old BPD is rarely done anymore, and usually only in special cir****tances. It's basically a large-pouch RNY, but the pouch is cut horizontally instead of the usual upper-left-corner pouch. The remnant stomach and a portion of the upper small intestine is completely discarded. REALLY effective for weight loss, but has some distressing side effects.

It's terribly confusing, because when Dr. Hess developed the DS, eh called it the BPD/DS, to acknowledge the role the BPD played in its development. (And it DOES divert the bilio-pancreatic limb, just like the BPD.)

I'm 99.44% certain Dr. Boyce has no intention of doing a BPD. (*grin*)

Your body, your decision.  Some surgeons push certain surgeries because they're more comfortable performing them.

At this point, I think it would benefit you to seek a second opinion.  Ultimately you have to live with whatever surgery you get for the rest of your life, so it's best to be happy with the one you believe will work best for you.

My surgeon gave me the option of the RNY or the VSG.  I wasn't full blown diabetic and didn't have GERD.  I knew in my heart that the sleeve would work best for me.

I went in originally wanting the sleeve.  I felt it was less "drastic". My primary doc recommended I research RNY before deciding,  because of how it can help with type 2 diabetes.  My A1C was 10.7 right before my first seminar. My surgeon also thought that I'd benefit from RNY,  and I ended up with rny. 

No regrets,  my diabetes is in complete remission and my A1C has dropped 6 points.  I've had zero complications,  lost nearly 100lbs at 6.5 months since surgery and feel better than I have ever felt in my entire adult life. 

I'm not telling you to choose one surgery over the another,  but what I'm saying is that the complications from the surgery aren't guaranteed to happen.  

Spend some time on these boards.  Read about all the options,  ask questions,  etc. And get a second opinion from another surgeon.  

I think BDP is a form of DS and that you can eat fat but will only absorb about 20% of that fat.  That is just what I think.  Talk with the DS board for more accurate info in what you will be living with.

Surgeries that include intestinal division are most likely to take care of the diabetes.  I was worried about that and realized that I never felt how my intestines were connected before surgery and feel no difference after.

The sleeve is going to help you do the same thing you did without surgery.  Losing weight will be from eating less calories, but every calorie you eat will get absorbed.  You will almost certainly have Bounceback regain and the diabetes if it goes under control will very likely not be under control five years after the sleeve.

For every year that you wait for intestinal division surgery, your pancreas wears out more.  The magic number for diabetes remission seems to be under seven.  If you are diabetic for more than seven years before surgery your chance of remission is lower.

The BPD is basically a very-large-pouch, distal RNY, but the pouch is cut horizontally and the lower part and a portion of the small intestine are completely removed from the body. BPD stands for Bilio-pancreatic diversion, and the DS is sometimes called the BPD/DS because the DS also has a BP diversion.

DSers, on average, only absorb about 20% of the fat we eat, about half the protein, and about 60% of complex carbs. Like everyone, we absorb nearly 100% of simple carbs. (*sigh*)