Deciding on which surgery

Hi everyone:  

I am in month 2 of my physician's monitored diet and in the process of deciding which surgery to have.  From the beginning I thought to have a sleeve, but after research am considering RNY or most likely the DS.  I have read a lot of forums for WLS, checked out Facebook, etc, but the realization that I have so much weight to lose and really don't want a revision down the line and the best long term success, makes DS most attractive.  I am not a carboholic, so I think the diet would fit my lifestyle best.

The surgeon I am seeing is Dr David Engstrand from Bariatric Institute of Wisconsin in Waukesha.  I went to several seminars in the area and liked this group the most, they had many answers and weren't trying to "sell" me on a specific surgery, or make me feel like I was their cash cow.  I spoke with past patients from their support group and got great feedback and just a gut feeling that this was the right group.  But, I needed more information, of course.

When I came to this site, I was excited to a dedicated DS forum, harder to find that elsewhere.  My concern though, is that Dr Engstrand isn't on your vetted list, indeed no one from Wisconsin is listed.  Does anyone have experience with him and what criteria is used to be put on the vetted list?

My info:  Highest weight: 316.  current BMI is 57.  Goal: healthy BMI of 24, goal weight 130, losing 186 pounds.

 

 

 

 

 

Hello and good luck on your journey.  If I had it to do over again, I would only do the sleeve.  I could have always been a 2parter. 

Here is what I posted on another post this morning where a woman asked if there were any regrets.  I copied it for you to read.  This is not a surgery for the weak at heart.  You must be proactive with your Dr's, your labs and your own advocate! 

Good Luck!

----------------------------------------------------------------------------------------------------------------

Hello...

First of all, do I think the DS is a great surgery?  Yes. 

I personally do not believe the RNY or Lapband should even be available on the market.  I believe in 2 WLS, that is the Sleeve and the DS.  The failure rate with the Lapband is 70% and the RNY after 5 yrs is also high, I believe it's in the 60 percent failure rate.  The DS for me was a trade off.  I have lost 160lbs now, look great, feel aweful. 

I am 10 months out as of yesterday.  I would not repeat this surgery.  Everyone is different, when people say "Your Mileage May Vary = YMMV", it is the most true statement in the world!

If I had it to do over again, as a Virgin WLS patient, I would have only done the sleeve (which is what I started out doing). 

There are several reasons I feel this way:

1.  Until you have the DS, you do not nor will you know how your body will react to it.  My body has rejected it from day 1.  I have been compliant with food and bites and vits from Day 1.  That has not made a difference.

2.  If you have any kind of digestion issues, whether it be GERD, Diver, Crohns, IBS, this is not the surgery to do.  Everything will get worse, it is a trade off.

3.  I am on various boards, it is odd, but those of us with major issues seem to find one another.   We do not speak out because of the backlash saying "your not compliant" yadayadayada.  Well, that is not true.  I spend a fortune every month and have the receipts & labs to show for it!  I decided that I would not let anyone tell me that I cannot be truthful and speak my mind.  I will be honest with people to a fault.

4.  Yes, the stink of the bathroom never goes away.  For some, the bathroom issues get better over time, for other's it starts at 4-5 yrs out and becomes a real issue.  Once again, it is a YMMV.  Me, I have chronic diarrhea - stems from complications/issues which are too lengthy for this question.

5. The committment of this surgery is great.  I was told by the surgeon's office, my vits would run about $60/mo and my protein about $75/mo.  Well, because of how my body reacted.  I spend a lot more than that.  I spent a small fortune at first trying to find a protein that wouldn't make me vomit (literally).  I now spend an average of $125/mo on my protein.  I have become Gluten Sensitive & Lactose Intolerant (which I was a bit prior to surgery), now I can eat yogurt  & butter.  Even cheese bother's me (which I love & loved prior to surgery) but cannot have now.  I spend a lot on vitamins.  We do my labs every 2 months now.  I have to adjust accordingly.  One month, I may spend $100 on Vits (including probiotics), then other months it's closer to $150. 

6. I work at a hospital too.  The bathroom issues are a problem on some days.  I have to run to a bathroom.  I am support staff.  My boss will tell you, this surgery zapped you.  She says "After about 1.5 hrs, I could wheel a bed in here and you'd fall asleep".  She's right.  My quality of life sucks at the moment.  Even though my vit labs are good (except for my K1), I'm wiped out and exhausted all the time.  My B12, was not working with sublingals, so I switched to Injectible, which I was doing once a month, now I'm at twice a month to keep it high.

7.  Issues may arise that you know nothing about.  I now have a low White Blood Cell count.  It's very common for DSr (found out after).  It is something to be aware of because if you have a family history (which I do) of cancer.  This is not a good thing.

8.  I had no co-morbidities prior to my surgery.  I did not have HBP or Diabetes.  I had PCOS (some consider pre-diabetes) & Arthritis.  The PCOS is gone but the surgery threw me into menapause.  According to labs from last year, I wasn't even perimenapausal.  My arthritis is worse on some days now.  I went from having 4 Dr's (An Internist, Endo, Gyn & Derm) to now having 9 Dr's (Internist, GI, Endo, Gyn, Hema, Bariatric Surgeon, CRS Surgeon, Cardio & Derm).  I was tired of being fat and nothing was working that I tried.  I needed a WLS or at least felt that I did.  I wish I would have had just the sleeve. 

9. Just because a website or Dr will say "It's reversible", think again.  To reverse this surgery, is very dangerous.  I know this first hand because of my issues, I have been looking at my options. 

10. If you are single, then make sure you have enough friends or family to help is you need it.  You need the support around you!

There are no statistics that anyone has been able to show me of how well this surgery works and the malnourishment that occurs and what occurs later on.  There is no database for it.  Which irritates me to no end.  This surgery has been done in Europe for much longer than the states for curing Type 2 diabetes which it does do.  If you are a type 2 diabetic, then the risks are worth it.  If not, it's a very personal decision.  Yes, the weight stays off, there might be a regain a few years out, some have it some don't.  from what I know, it's not but about 20lbs.

I am one of the problem children from this surgery.  My experience has been terrible.  I still to this day 10 months out (I use Poo Pourri) cannot stand the smell, and the bathroom issues (forget all my complications).  I was at a friend's house (didn't realize I hadn't put the poo pouri in my purse),  my friends husband didn't say anything.  Their hallway bathroom stunk.  People went in after me.  Came out telling them, I think you have a plumbing leak.  My girlfriend knew I have issues, I took her to the side to ask if she had any fragranced spray.  She lit a candle.  Her husband was ready to call a plumber.  It was a dinner party, I couldn't eat.  It totally sucked.  It's only one of about 5 things I've done in the last 10 months.  Stools stink with the DS.  I take my probiotics.   I've tried different brands.  Makes no difference for the stink. 

I have become dedicated to helping people with this surgery to work it better.  The surgeon who did mine, (who some think of as a GOD) is not.  He is simply a man who happens to be a good cutter.  After he get's your money, he doesn't give a flip.  A lot of surgeon's are that way.  I am with another one now.  He said this to me "Picking a WLS is the most important thing in your life, if you choose a Weight Loss Surgery.  He said "It's even more important than a spouse.  You can always divorce a spouse.  You need your WL surgeon the rest of your life"  That is a huge statement!  Makes you think a lot!

Final thought, any Weight Loss Surgery is just a tool.  The DS is easiest because it controls you, you do not control it.

If you want more information, feel free to PM me.  It may take me a bit to answer.  I will answer.

One thing to note:  this surgery has taught me a lesson, when signs are cropping up all around you, then you must listen.  The month prior to surgery, a lot of stuff happened to me.  I felt 2 days before surgery I wanted to cancel, the day before and the day of... I wish I would have looked at those signs. Felt the signs, payed attention to the signs.

In the end, if I had to do over again, I would just do the sleeve.

It is a personal choice, you are not going into it blind.  Do a lot of soul searching!  The rest of your life will be changed with the DS.  A lot of Dr's do not understand it, so if you have problems, finding those to help is really difficult.

Good luck with your journey!

If you do go ahead with the DS, this group is a lifesaver.

 

 

 

 

 

No matter what operation you look at, you can find some people with complications. It's all major surgery. But I think you have done a great job with your research and have taken into consideration you individual concerns regarding your bmi, overall health, and weight loss goals. And you are right, the DS is the operation most likely to get you to where you want and need to be. It has the best statistics of any wls for excess weight loss, maintainence of that weight loss, and resolution of almost all comorbidities. It also has, IMHO, a much better and more normal quality of life in terms of eating than RNY - no dumping, no food getting stuck at the stoma, no laundry list of foods you can never eat again, you can drink liquids with meals (not right away, but eventually). You also would be able to take NSAIDs if needed, which you can never do with RNY. Many, many advantages.

While the DS works well for "lightweights", it is clearly the best choice for those with a higher bmi.

I have heard of your surgeon and while he may not be on that list, I believe him to be a legitimate DS surgeon. OF course you can always ask him at your consult how many DS's he has done and what his experience has been like. It's then up to you whether or not you are comfortable with him and with his level of experience.

Larra

 

I think from your stats, the DS makes sense.  In general, the sleeve works well as a stand-alone for lower BMIs ( less than 40), but for higher BMIs, DS is the way to go.  I've seen far too many RNY revisions to ever recommend that.  IMHO, your choice should be between the VSG and DS.  If you want to hedge your bet, and are not sure if you need a "full" DS, see if you can get approval for a two-part DS so that if you need the second part, you don't have to jump through hoops again.

 

BUT, yes, as a previous poster stated, complications can happen.  Both the RNY and DS can have bathroom issues.  

Both can have serious vitamin issues, so either way, you need to commit to having blood work, at least yearly, for life.  

You will have to take vitamins. It's not negotiable.  You can't stop once you lose weight.  

You will probably have to supplement with protein shakes early out, but some people get to the point where they get all their protein from food.  Your tastes may change after surgery, so what tastes good now, won't later (or vice-versa).

In terms of a revision, both an RNY or a DS revision are serious surgery.  If your fear is revision due to lack of weight loss, then you're far less likely to need one with the DS.  

Some things I would ask:

1) What size bougie would you use to size my sleeve? For a stand alone sleeve, usually it's a 32-34 French.  For a DS sleeve, some go that small, others larger.

2) How long would you make my common channel? Why?

3) What is the biggest complication you see from your DS patients? How do you manage it?  What is the biggest complication you see from your RNY patients? How do you manage it?

4) How often do you recommend post-op blood work? What do you check on your post-op RNYs? Post-op DS patients?

One other thing to consider, do you like lots of Beef & Pork?

The surgeon assured me that after my DS, my system could process them.  (I hadn't had a gallbladder in years)  I still struggle with them.  In fact, am so tired of wasting money that I decided not to try beef anymore at this time. 

Chicken a lot of people struggle with the first year.  Sometimes it agrees with me sometimes not.

The same reasons you are thinking is what I was thinking.  My current insurance only pays for one lifetime WLS.  So, I went for the Platinum.  The surgeon who did mine said "With your BMI, you really don't have a choice".

I've since met quite a few people who have lost over a 100lbs with just the sleeve, keeping it off for 4 yrs. 

If you decide to do this, make sure what your Bougie (stomach size is) and what your CC is... I was poofed and told not to worry about it, that is why I have my surgeon from his NP.  Well, if I would have had a longer CC and a bigger bougie (mine is a 30F bougie) CC not less than 100cc . 

If you decide on the DS. 

Good luck in whatever WLS journey you decide to go...

Your sleeve was sized with a 30F and you have a DS? No wonder you're having trouble.  Yikes.  

Have you tried seeing if a gastroenterologist can dilate your sleeve for you? It might make things easier.  

That's what my op report says.  Yes, I had one last month, April I should say.  She only used a 12size ballon.

I am waiting on a scheduling call from a new GI Dr to do it with a larger balloon size 20 (this GI Dr works only with WLS patients).  The new surgeon is going to be present to see what is going on.  I have little ulcers beginning in my alimentary limb.  I overproduce acid now.  Very odd!  Taking 2-3 PPI's a day. He and the GI are going to see what is going on. 

 

Thank You Sami... It is a journey...

 

Good luck.  There were a few folks on the VSG boards early on who had sleeves in the 30-32F range...and they were usually miserable.  Completely miserable.  They were the people who had issues.  Larger sleeve, even in the 32-34F range, usually meant a gigantic difference.  

The good news is that your sleeve really will stretch some over time.  I had the opposite issue, not much restriction--but then my surgeon said that my stomach was very long (longer than usual) so that probably plays a part.  

Based on what I remember from the early VSGers... I really think if you can get your sleeve issues resolved, you might find your DS 10000x easier to live with.  A lot that you described in one of your posts on regrets... well, nearly every thing you said I saw with people with too tight sleeves.  

Lots of luck. Not sure if I can be any help with regards to referrals, but if I can, shoot me a PM.

 

Thanks Sami...

I hope it helps... I'm sure ready for some relief!

Every morning, I eat Greek Yogurt with a scoop of protein powder and either almond milk or coconut milk, making it like a mousse.  It tastes yummy and I enjoy it.  I'm able to take meds/vits with it.  It works well for me overall.  Then about once a week, I throw it up... It's yogurt!  I was eating it faster than usual this morning because I pushed the snooze one too many times.  Still it's yogurt!  I didn't have my vits or meds with it.  Frustrating!

I was able to stop and get a sausage patty on the way to work but it felt like it was going to come up but didn't.

I hope when they do the 20 balloon EGD, that it will open me up!

Thank you for the kind words!

I've had great success with the weight loss (no complaints there), a rough time with everything else...and I know at times, I can be a bit "whiney" but then again, we all can be at times.!

I do better with just shakes for the most part which my new surgeon says shouldn't be at 10mo out.  Hopefully things will get fixed!