Re-Thinking VSG
Like I care what you consider "fair"? Diana used an excellent analogy. Besides sweetie, I HAVE a VSG as part of my DS. You seem to forget that when you talk to DS'ers. We ALL already have your VSG.
We shall see what the VSG can do as more data accrues. In the meantime, the experience of decades of restriction-only procedures of other natures indicates that restriction-only procedures provide only a certain amount of EWL over the long term. There's NOTHING about the VSG to suggest that it will be an improvement in terms of THAT particular measurement of success.
The VSG is UNDOUBTEDLY an improvement over those procedures that involve the placement of a foreign object ( a band) or resecting the stomach without removing the excess tissue. The VSG leaves behind a normal functioning stomach anatomy AND removes excess acid- and ghrelin-producing tissue. There is NO evidence to indicate that these things will improve long term EWL maintenance. NONE.
It is only reasonable to assume that these changes in a VSG'ers anatomy will lead to reduced hunger. BUT there is NO evidence to support the hypothesis that reduced hunger = higher long term EWL maintenance. This is a case of "correlation does not imply causation."
This is something it's vitally important for those researching WLS to grasp: Your "hunger" and "appetite" do NOT necessarily have much to do with either losing weight OR (and this is a SEPARATE thing) *maintaining* that weight loss. The human body is a wondrous creation, able to adapt and accomodate incredible odds against it. MANY people have discovered, to their dismay, that their bodies accomodate to a distressingly tiny food intake and then put the fat back on.
There is an enormous body of evidence to indicate that the malabsorption-plus-restriction WLS procedures have better long term results over either malabsorption-only (no such procedure is currently done because the problems with the ones attempted thus far were so bad) or restriction-only procedures.
Since you've already chosen your procedure, you will get to contribute to the statistics regarding the VSG. Pre-ops need to read this message and the others like it and comprehend that there is a lot MORE going on in what makes them obese than just excessive appetite and excessive room to take in food.
So, since you're a postop, have a nice life. I'm going to post for the benefit of preops. You don't like it? Tough crap. ESPECIALLY in a "BMI over 50" forum, the information about the DS needs to be trumpeted, because it is the ONE procedure that gives the BEST odds of reaching something approaching a normal BMI and staying there for people our size. (And lest you forget, my dear, my starting BMI was 63. I belong here, too.)
We shall see what the VSG can do as more data accrues. In the meantime, the experience of decades of restriction-only procedures of other natures indicates that restriction-only procedures provide only a certain amount of EWL over the long term. There's NOTHING about the VSG to suggest that it will be an improvement in terms of THAT particular measurement of success.
The VSG is UNDOUBTEDLY an improvement over those procedures that involve the placement of a foreign object ( a band) or resecting the stomach without removing the excess tissue. The VSG leaves behind a normal functioning stomach anatomy AND removes excess acid- and ghrelin-producing tissue. There is NO evidence to indicate that these things will improve long term EWL maintenance. NONE.
It is only reasonable to assume that these changes in a VSG'ers anatomy will lead to reduced hunger. BUT there is NO evidence to support the hypothesis that reduced hunger = higher long term EWL maintenance. This is a case of "correlation does not imply causation."
This is something it's vitally important for those researching WLS to grasp: Your "hunger" and "appetite" do NOT necessarily have much to do with either losing weight OR (and this is a SEPARATE thing) *maintaining* that weight loss. The human body is a wondrous creation, able to adapt and accomodate incredible odds against it. MANY people have discovered, to their dismay, that their bodies accomodate to a distressingly tiny food intake and then put the fat back on.
There is an enormous body of evidence to indicate that the malabsorption-plus-restriction WLS procedures have better long term results over either malabsorption-only (no such procedure is currently done because the problems with the ones attempted thus far were so bad) or restriction-only procedures.
Since you've already chosen your procedure, you will get to contribute to the statistics regarding the VSG. Pre-ops need to read this message and the others like it and comprehend that there is a lot MORE going on in what makes them obese than just excessive appetite and excessive room to take in food.
So, since you're a postop, have a nice life. I'm going to post for the benefit of preops. You don't like it? Tough crap. ESPECIALLY in a "BMI over 50" forum, the information about the DS needs to be trumpeted, because it is the ONE procedure that gives the BEST odds of reaching something approaching a normal BMI and staying there for people our size. (And lest you forget, my dear, my starting BMI was 63. I belong here, too.)
P.S. What do you consider "massive amounts" of vitamins and supplements? I take about twelve pills in the morning and ten at night, and a third shot of two during the day. Yeah, so? I took that many prescription meds, plus four shots of insulin a day, plus umpteen finger sticks, plus 24/7 oxygen, etc., before surgery. What's a few vitamins? What's a LOT of vitamins?
Don't whine about not liking the dissemination of information when you're spewing MISinformation yourself.
Don't whine about not liking the dissemination of information when you're spewing MISinformation yourself.
Adrienne,
I had the VSG and my BMI was 79.3 when I started. I am just over 8 months out and I have lost 168 lbs and my BMI is now 50.8. I love my Sleeve. I don't crave or even think about all of the junk I use to eat. It's as if somebody turned the switch off for the desire of all those foods. When I first talked to my doctor about having the surgery, he told me that because of my size, we could do the sleeve first and then later down the road we could do the RNY. At my last appointment, he told me that I didn't need a second surgery. So, you can get the optimum weight loss with the sleeve and without the replumbing. What ever your choice is though, just make sure that you are comfortable with it. Good Luck and GOD BLESS!
Andrea
I had the VSG and my BMI was 79.3 when I started. I am just over 8 months out and I have lost 168 lbs and my BMI is now 50.8. I love my Sleeve. I don't crave or even think about all of the junk I use to eat. It's as if somebody turned the switch off for the desire of all those foods. When I first talked to my doctor about having the surgery, he told me that because of my size, we could do the sleeve first and then later down the road we could do the RNY. At my last appointment, he told me that I didn't need a second surgery. So, you can get the optimum weight loss with the sleeve and without the replumbing. What ever your choice is though, just make sure that you are comfortable with it. Good Luck and GOD BLESS!
Andrea
I am not blocking people because they disagree with me. I dont think the hostility is good for my health and I wont live a life filled with anger, esp at random people online :)
But if you do your research there are papers that say taht staging is safer for people with BMIs over 55. My husband is a research physician for the biggest cancer center in the world and I am an ex nurse. We know how to read papers and can weigh the pros and cons and have come to this decision, not lightly.
Either way, what you decide is fine for you. Find a doctor you trust and talk to them. I made my choice for myself and I don't think any angry person can change that. Its surprising to me someone wouldn't wish me well and understand that I am going into this well educated. I have always thought people who push their own agenda have some hole or flaw they are trying to disguise.
Here is one paper. I have a couple in prinit my husband got from his medical library. I will look those up when I have time. Also, there is an yahoo sleeve group that has alot of people who are knowledgeable and alot of help.
Laparoscopic Sleeve Gastrectomy. A multi-purpose bariatric operation
Aniceto Baltasar MD 1, Carlos Serra MD 2, Nieves Pérez MD
2, Rafael Bou MD 2, Marcelo Bengochea MD 2, Lirios Ferri 2
But if you do your research there are papers that say taht staging is safer for people with BMIs over 55. My husband is a research physician for the biggest cancer center in the world and I am an ex nurse. We know how to read papers and can weigh the pros and cons and have come to this decision, not lightly.
Either way, what you decide is fine for you. Find a doctor you trust and talk to them. I made my choice for myself and I don't think any angry person can change that. Its surprising to me someone wouldn't wish me well and understand that I am going into this well educated. I have always thought people who push their own agenda have some hole or flaw they are trying to disguise.
Here is one paper. I have a couple in prinit my husband got from his medical library. I will look those up when I have time. Also, there is an yahoo sleeve group that has alot of people who are knowledgeable and alot of help.
Laparoscopic Sleeve Gastrectomy. A multi-purpose bariatric operation
Aniceto Baltasar MD 1, Carlos Serra MD 2, Nieves Pérez MD
2, Rafael Bou MD 2, Marcelo Bengochea MD 2, Lirios Ferri 2
Missy
Hi, Adrienne!
For info on the DS, feel free to visit the DS forum here on OH or www.dsfacts.com.
The DS has the BEST success rate of any of today's weight loss surgeries, including the LapBand and RNY. On average, DS patients lose the most weight and more keep it off 7-10 years out, which is what we all should shoot for, right? See page 10 of this guideline document of the American Society of Metabolic and Bariatric Surgery. It lays out the stats nicely.
http://www.aace.com/pub/pdf/guidelines/Bariatric.pdf
The DS has a excess weight loss rate, 7-10 years post-op, of 60-80% and the RNY has a 25-68% rate. That means if you only had 100 pounds to lose, the DS would keep 60-80 pounds of that off and the RNY would keep 25-68 pounds of that off, on average. The sleeve only has short-term data as it has not been used as a stand-alone weight loss surgery for very long, but at 3-6 years, its EWL is 66%.
I had a starting BMI of 55 and wanted something with good, long-term results and a wonderful post-op lifestyle. The DS fit the bill. Just 11 months later, I have lost 180 pounds and feel awesome! My labs are good and my energy is through the roof! I eat what I want and have kicked my diabetes and high cholesterol to the curb.
DSers do not dump, we can take NSAIDs for pain, we do not get ulcers, we do not "slime" or get the "foamies." And as long as we get our protein and vitamins in, we can eat lots of different foods, from steak to dessert to cheese to well, you name it. AND still lose weight.
Best of luck to you, no matter what you decide.
Nicolle
For info on the DS, feel free to visit the DS forum here on OH or www.dsfacts.com.
The DS has the BEST success rate of any of today's weight loss surgeries, including the LapBand and RNY. On average, DS patients lose the most weight and more keep it off 7-10 years out, which is what we all should shoot for, right? See page 10 of this guideline document of the American Society of Metabolic and Bariatric Surgery. It lays out the stats nicely.
http://www.aace.com/pub/pdf/guidelines/Bariatric.pdf
The DS has a excess weight loss rate, 7-10 years post-op, of 60-80% and the RNY has a 25-68% rate. That means if you only had 100 pounds to lose, the DS would keep 60-80 pounds of that off and the RNY would keep 25-68 pounds of that off, on average. The sleeve only has short-term data as it has not been used as a stand-alone weight loss surgery for very long, but at 3-6 years, its EWL is 66%.
I had a starting BMI of 55 and wanted something with good, long-term results and a wonderful post-op lifestyle. The DS fit the bill. Just 11 months later, I have lost 180 pounds and feel awesome! My labs are good and my energy is through the roof! I eat what I want and have kicked my diabetes and high cholesterol to the curb.
DSers do not dump, we can take NSAIDs for pain, we do not get ulcers, we do not "slime" or get the "foamies." And as long as we get our protein and vitamins in, we can eat lots of different foods, from steak to dessert to cheese to well, you name it. AND still lose weight.
Best of luck to you, no matter what you decide.
Nicolle
I had the kick-butt duodenal switch (DS)!
HW: 344 lbs CW: 150 lbs
Type 2 diabetes and sleep apnea GONE!
Essentially the VSG and the DS folks have the same stomach so we can eat the same foods, the primary difference is there is no malabsorbtion with the sleeve. While there are some longer term studies with the DS than with the sleeve this means that the longer term results for the sleeve are not in yet. I am not implying they will be on par with the DS but I would not rule the VSG out either.
For people for whom malabsorbion is not a desired outcome the Sleeve is a great option.
Whatever you do is it truthful, necessary and kind?
A few clarifications.
The VSG stomach is significantly smaller than the DS stomach
There are MANY long-term studies on the DS, not just "some."
Malabsorption is not the "desired outcome" of a DS--losing weight and KEEPING IT OFF are the "desired outcomes."
With the DS, malabsorption is the mechanism by which the weight loss is maintained. The sleeve does not have that feature. After the weight loss is finished with a VSG, it is back to a strict diet. As the stomach becomes a bit stretchier/bigger, more food can be consumed and it becomes more difficult to maintain the weight loss over time without malabsorption.
You are still early out, liveinphx. I wish you much success.
Nicolle
The VSG stomach is significantly smaller than the DS stomach
There are MANY long-term studies on the DS, not just "some."
Malabsorption is not the "desired outcome" of a DS--losing weight and KEEPING IT OFF are the "desired outcomes."
With the DS, malabsorption is the mechanism by which the weight loss is maintained. The sleeve does not have that feature. After the weight loss is finished with a VSG, it is back to a strict diet. As the stomach becomes a bit stretchier/bigger, more food can be consumed and it becomes more difficult to maintain the weight loss over time without malabsorption.
You are still early out, liveinphx. I wish you much success.
Nicolle
I had the kick-butt duodenal switch (DS)!
HW: 344 lbs CW: 150 lbs
Type 2 diabetes and sleep apnea GONE!
On February 3, 2009 at 9:20 PM Pacific Time, Nicolle wrote:
A few clarifications.The VSG stomach is significantly smaller than the DS stomach
There are MANY long-term studies on the DS, not just "some."
Malabsorption is not the "desired outcome" of a DS--losing weight and KEEPING IT OFF are the "desired outcomes."
With the DS, malabsorption is the mechanism by which the weight loss is maintained. The sleeve does not have that feature. After the weight loss is finished with a VSG, it is back to a strict diet. As the stomach becomes a bit stretchier/bigger, more food can be consumed and it becomes more difficult to maintain the weight loss over time without malabsorption.
You are still early out, liveinphx. I wish you much success.
Nicolle
My reference to the stomachs was intended to show similarities between a VSG/DS stomach and those of Band/RNY. It was not and did not compare sizes.
My use of the word some was not intended to diminish the number of studies..
In terms of "desired outcome" since the post was related to malabsorbtive vs restrictive procedures that was the outcome I was referring to.
While the VSG sleeve may be smaller initially and while it can stretch so can the DS sleeve.
I continue to hold the opinion that for me, and many others restrictive only procedures can and do work. Yes SOME do need/want revision after surgeries other than DS. The FACT remains that many do not. There are many long term successful restrictive only procedure post ops. They are happily maintaining their weight loss and eating like a normal human being that are not on " a strict diet" or feeling deprived of the things they love to eat.
Whatever you do is it truthful, necessary and kind?
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