Why DS rather than VSG?

I'm not asking you guys to convince me, but to literally provide me with information or studies that you're aware of for me to give to my surgeon. I'm a 43 BMI and the program I'm in has a strong preference to perform the VSG on people under a 50 BMI. I'm looking for info that will help me to convince the surgeon that the DS is medically necessary in my case.

I'm pre-diabetic, so I know about the better resolution of diabetes already. And the medium term EWL stats for VSG at 24 months are looking like around 65%. So, if you know of any other reasons or know of any specific studies that might be helpful, I'd love to hear about it.

Thanks!

Well I knew the VSG alone wouldn't work for me, and heres why.

I had a very efficient system, and several things related to metabolic issues, like PCOS, insulin resistance, and suspected hashimotos. Low thyroid diagnosed later.

I had been on Dr supervised exercise and diet for over 2 years, and had established that if I ate over 800 calories a day, I'd gain, and that was WITH doing treadmill, bicycle and rowing for no less than 90 minutes 6 days a week.  

Some is likely due to genetics, but years of yo-yo diets, eating disorders and fasts had ruined my metabolism, so that even years of continuous aerobic exercise would not reset it.  I ate fairly healthily, and had spent years honing my diet down to low fat / low calorie, just to maintain. I really was an expert and healthy eating.

So, getting a sleeve, which would allow me to keep eating small, healthy meals, might help me maintain, but wouldn't get the extra weight off. I just had to have the metabolic help and malabsorption.

I will say, that if portion control was my issue, and my only issue, I'd have gotten the sleeve instead.

My doctor decided that I must be lying on my food logs (the tech at the hospital gym logged the exercise, so no argument there) when I didn't lose, and in fact started gaining when she raised my calories to 1000. WHY would I do that, since I went to her and started this for help, and felt my last chance was gone when she decided that. I started the WLS search that very day. 

You know better than anyone (and that means better than your doctor, too) what your issues are, and that pretty much dictates what surgery you need. Good luck.

Who is your surgeon? It's the malabsorption of the DS that helps us keep the weight off long term. With the sleeve there is no malabsorption so after the first year or two, unless you diet (in the true sense of the word) you will gain the weight back because the sleeve will stretch. But remember that with the DS you are committed  to monitoring your labs, taking lots of vitamins, eating the right amounts of proteins, etc., etc., etc., for the rest of your life. This is not an option and will not change. You have to do the same thing with the sleeve but not to the levels you have to with the DS.

IMHO its all about the commitment you are willing to make for the rest of your life.

If it's proof you want, go to dsfacts.com and read everything, particularly the articles section. There are journal articles that would interest your doc. You are headed for diabetes and the sleeve will not cure or prevent that but the DS will so articles that focus on diabetes resolution would be good to print out and show the doc. If the doc still does not agree, find another one. There is a list of vetted surgeons on this site and that's where you should choose your surgeon from.

I started with one surgeon who wanted to sleeve me and when I explained I was pre-diabetic (a misnomer really; pre-diabetes = mild diabetes so  you already have it) and I did not want to develop full blown diabetes, he stopped trying to talk me out of the DS (my BMI is a little lower than yours at 39-40) and decided I was a good candidate as I knew what the procedure entailed and I was committed to the follow up (labs, vites) that having the DS would demand. I since switched to one of the vetted surgeons on the dsfacts.com website and I feel way more confident in this surgeon as he has boatloads of experience with the DS including revisions. I am not a revision but it is comforting to know my surgeon is that much more experienced with doing the DS.  Hope this helps!

Hi, I don't have the links saved but if you go to pubmed and search for "duodenal switch" you'll find a lot of helpful studies to show your doctors.

Thanks for your help everyone. Just to clarify, I am definitely using a vetted surgeon for surgery, Dr. Gagner. It's just that before I see him, if I want the government's provincial health insurance to pay for my surgery, it must be deemed medically necessary by a surgeon in my home province of Ontario first. It's that surgeon I need to convince because the provincial health insurance guidelines in Ontario state a preference for RNY, if not possible then VSG, and only the DS if those two are both medically inappropriate (the most common reason against the VSG is a BMI over 50, which I don't have). I can get out of the RNY easily with my need to take NSAIDs, but I'm having a harder time proving why the VSG is insufficient for my BMI. It's up to me to prove why VSG will be insufficient, but finding 'proof' of this is difficult due to the lack of info on it as a stand alone procedure.

I'll look up more on the diabetes stats. The info I'm seeing is showing that about 40% of diabetics are having resolution post-VSG. What worries me most is that the surgeon will want to do VSG and then 'wait and see' if DS is necessary later on and I really don't want to take that gamble or have to do surgery twice.

Perhaps Dr. Gagner's staff could offer you some guidance,even prior to your appointment.  Try giving them a call and explaining your position.

That's not a bad idea. Thanks!

I don't havethe study on my computer but either DianaC or EN has one on the VSG.  I belive it was a small study but the results for VSG were the same as RNY as far as weight loss.  Also EN has the study that addresses people with a lower BMI getting the DS.  I should have bookmarked them, sorry.

Try to PM those 2 people and get the studies.

Sorry I am not more help.

Good luck!

Michele

Thank you!