I'm New, Nervous and Excited!

I have to get a sleep study done in 2 weeks. My dietitian and PT both told me to maintain my eating and workout routine (1500-1700 calls/day, eating a balanced plate, at least 30 min of exercise 6 days/week) and they will clear me at my next appt (Feb 10). I was a smoker, so I can't even be scheduled for surgery until I am 6 mos. nicotine free. At my 6 mo mark he will nicotine test me and then he will schedule me. He said he could set surgery between 2 weeks and a month after my nicotine test which will be May 15. 

Lots of changes have been made, and lots of anxiety just waiting for the big day to get here! 

I was a smoker as well, but I had a nice $1,000 bonus incentive from my employer to quit, so my husband and I quit together. We've been nicotine free for 18 month now. Best decision we've ever made. We took that money that we were throwing away and put it towards a new Jeep GC for me. Winner winner!

The sleep study was fun! I twitch a lot and kept trying to take out the cannulas from my nose. Pretty sure the nurse did not like me! The part that sucked was that lights out were at 10p and wake up was at like 6a, so I had to miss Friends. smh. 

That's really awesome that they're able to schedule it so soon after your nicotine test. I'm impatient so of course, I want my surgery date yesterday.

My PA thinks I may have sleep apnea. I didn't believe him when he told me this, in fact I remember chuckling a little. My husband is the snorer, not me. I don't wake myself up from snoring, and my husband was just as confused as I was when I told him about my appointment because he's the one who sleeps next to me every night and has said many times that no, I do not snore, or sound like I can't breathe. My PA also said my EKG showed patterns consistent with heart disease. This really got me. I'm only 29 years old! And also, my grandfather who was like a dad to me had heart disease for 27 years before he had congestive heart failure and passed away. That appt last week really opened my eyes and my decision to go through with this surgery has never felt so right. 

Did the results of your sleep study come back OK?

Sleep Apnea runs in my family unfortunately, so my obesity wasn't a helpful factor. My sleep study came back for mild-moderate sleep apnea but we're going to revisit after the surgery. I want to lose some weight to see if it helps, or if Darling Dad gave me yet another wonderful ailment. So far he's handed down 1 copy of the Factor V Leiden gene mutation, severe allergies, migraines and hiatal hernias. He's an awesome father! lol. 

My sister had an EKG in her 20's and her heart showed something similar. Heart Disease runs very highly on my mother's side and my sister seems to have inherited everything that they've got (hypertension, diabetes, heart issues, etc.). As long as you're tackling this as early as you are (which btw, BRAVO on not pulling any punches), then I imagine that you'll most definitely gain the upper hand on your health. 

I can't express enough how awesome it is that you're doing this now. My mom was the "Next Week" lady - I start next week. She was moved to a nursing home yesterday for hospice care. Her heart has about had it. Her lungs are shot. She's amputated up to her knee and needs to have the rest of her leg amputated due to infection, but she's not a candidate for surgery due to her heart. So it is so commendable that rather than waiting, you're taking control. Be proud of that!

Thank you, Amanda! That means a lot. I'm sorry to hear about your mom. It's so common for people to want to ignore their issues because facing them can sometimes mean that there were measures they could have taken to prevent or manage them but chose not to. Or because they simply don't feel their age and addressing those issues would mean facing the fact that they are really getting older.  Denial can get you into real trouble. My grandpa also had sleep apnea, hyptension and many, many other heart issues. He's the main reason I finally decided it was time for me to get the surgery. I knew if I kept avoiding changing my lifestyle I would soon follow in his footsteps. I think the thing that is scaring me most right now is the thought of having to sleep with a CPAP. I just can't imagine how anyone could get a good night's rest with a huge mask covering your face! Obviously if it comes down to wearing it for awhile or not wearing it at all and not getting surgery, I will shut up and wear it...begrudgingly mind you! I will have a follow up with the pulmonologist two weeks after the sleep study who will have to clear me before I can have the surgery. That's frightening as well. I have so many other people I am seeing who have to clear me, to add another to the list is frustrating but I take comfort in knowing that they want to make sure I am prepared and healthy enough for the surgery. I appreciate that much more than I show. 

I wouldn't worry at all about sleeping with a cpap! My father is the one with SA and he absolutely loves his cpap. They've come a long way in the last 15-20 years. What used to make him look like he was fixin to go deep sea diving, now is just a small nob on nose. I have a couple of friends who also use cpaps and they as well love theirs. They're pretty much silent. I've been on the phone with my dad while he's using it and couldn't tell that it was on until he switched to facetime. 

I totally understand about having to see it seems like a million doctors to clear you for surgery. However, once it's all over it seems like it was nothing. There were a couple of doctors that I already had my own of, but because they didn't have any affiliation to the specific hospital I'm going to, I had to go with the docs they use. It ended up being fine and I liked all of the doctors that I met, but of course I was a little bit of a brat at first. We like what we know, what's familiar to us. Just like you, knowing that if something were to go wrong, all of those docs are available at a moments notice rather than a 30 minute drive.

 I'm sure you'll do fine! 

Greetings!

I have rheumatic/psoriatic arthritis as well.  I had VSG on the advice of my rheumy, and so far things are good.  My inflammatory factors are down, my meds are working better, and we are able to put biologics on the back burner indefinitely.  :)

I don't want to second-guess your medical team, but want to make sure that certain things have at least been considered.  I was not an ideal candidate for VSG because I have a history of reflux.  But RNY has a complete contraindication against NSAIDs and steroids because it's possible to get ulcers in the residual stomach (the part that isn't in use anymore but is left in the body) without any symptoms until it's very advanced.  Auto-immune conditions often need NSAIDs and/or steroids for treatment.  The VSG surgery has a relative contraindication for those drugs, meaning the ulcer risk is still there, but because the unused stomach tissue is removed, the ulcer can't be "hidden", so the drugs can be used if the benefits outweigh the risks.  That usually just means you have to be on a PPI in order to use them.  I have to be on one anyway because of the meds I'm on for my RA/PsA, so I am able to take NSAIDs as needed.  My rheumy hates steroids, but keeps them in reserve for really bad flares.

There's also no formal studies on it yet, but my rheumy said that the VSG had a slight preference in her book, because the stomach tissue that's removed secretes hormones that are a part of the inflammatory cycle, so the surgery itself can have a positive impact on inflammation.  With RNY that tissue is left in and still secretes hormones.

Anyway, if your team has already discussed this with you and the options have all been weighed, disregard.  If this has not been discussed, you may want to bring it up and get your team's thoughts.

Best of luck to you!

I take Humira for PsA and Meloxicam for my OA. I also have a hiatal hernia and severe acid reflux which has me taking two Prilosecs most days. I thought about VSG, but because of the reflux, I got the same response. The hope and theory is that with the weight-loss, the OA will be relieved to where I will no longer need the NSAID. I made sure that both my Dermatologist and Rheumatologist knew what was going on so everyone was on the same page. 

In regards to what you said about the stomach tissue and the secretion of hormones - I wonder if they've ever considered removing the excess tissue for that exact reason. It's definitely something I will talk to the surgeon about - what's a better option, less arthritis pain or zero reflux. 

Thanks for the feedback!

It may be worth some more discussion.  I did not have a hiatal hernia, but I've heard a lot of people have them fixed at the same time as the VSG, and it resolves a lot of reflux issues.  We took a bit of a chance with my history of reflux, but my reflux was not bad.  A normal dose PPI and the occasional Tums/Gaviscon was all I ever needed, so it was theorized that a lot of my reflux was diet and/or obesity caused.  I've also heard there's a new treatment for reflux after VSG if needed, but I haven't done any research on it since I've had zero issues with it post-op.  I was more willing to risk the reflux than to take treatment options off the table for the auto-immune.  Like I said, I hate to suggest second-guessing the medical team, it's just that this is a huge and potentially permanent step that has a huge impact on treatment options available down the road.  I just wanted to make sure you and your team had looked at all the risks and benefits of each option.

I firmly believe that any WLS is a good thing with most chronic illnesses, so I don't think the RNY is a bad decision.  It may even be that they can allow some NSAIDs/steroids with RNY in certain conditions.  I'm sure you'll do great, and that this will be a positive thing for you, whichever surgery you have.  :)

Best of luck!!

OH no, I really appreciate the feedback! These are things that I definitely want to discuss, but I also have to see if my insurance would even cover VSG. I know they cover RNY, but I know that they don't cover LB so it makes me wonder about VSG. I haven't heard that I would lose the option of taking Humira post-op, but he did say that I will likely not need the Meloxicam afterwards... However, the weight isn't going to come of magically overnight so I will need it at least at first so...

Gonna make a few calls.