I had my meeting with the surgeon- but now I'm on the fence again.

Sonya,

All of your concerns are valid!  I personally believe there is no place in the Universe where an RNY should be performed.  The "fix" of the diabetes is only temporary, yes it may last a few years, but it comes back and so does the insulin.  IMHO, there are 2 surgeries for Weight Loss which should be allowed,  The Sleeve and the DS.  That's it.  Even with all of my complications of the DS, it has it's place in this world.  If you have diabetes, the DS is the surgery to have.  It has been done in Europe before the states specifically for "curing diabetes".

Since you are on the fence, I am recommending before you do "ANYTHING" to step back a moment.  Rather than asking which surgery at this point, ask "Why am I doing a Bariatric surgery to begin with?"  Think of the following questions: 

1. Are you doing it to get rid of your diabetes?

Answer:  If so, the only answer is the DS.  It is the only one that has a success rate for cutting out diabetes at over 95%.

2. Are you doing the DS because you want to be healthy or just weigh less?

Answer:  This is a big one.  With the DS there are trade-offs.  Yes, you have to supplements, depending on how your body reacts depends on how much you will have to spend on vitamins.  You may only be able to use certain kinds of Protein.  I spend more than a regular DSr, because I have too.  Based off what my surgeon's office said, I'd be spending around $130 for the entire month for protein and vits.  Well, I spend that just on protein.  You must get your labs done at minimum twice a year.  Can you committ to this?

3.  If your surgeon is this hesitant about doing a DS, I would find another surgeon.  It sounds to me like, he himself is not comfortable with doing the DS.

4.  You mentioned that your husband only works part time and you are the major breadwinner.  In the event that you need it, do you have short term disability or enough PTO to sustain you, if you need more than a couple of weeks off.

5.  Consider this, you can get a sleeve, then later on convert to a DS.  This is a much milder operation and you will have success, maybe not as much as a DS.  You can always convert a later date. 

6.  Some people have the DS and go through it without any problems at all.  Vitamins will always be a constant.  Even with an RNY,  those have to get Iron Infusions as well.

7.  What are your favorite foods to eat now?  The DS is very forgiving of food.  However, you have to work the surgery.  It doesn't matter what surgery you get, it is simply a tool.  You have to be willing to make the committment to work it.  Some people are lucky at 7-10 yrs out and not had any regain, other's have had a bit of regain because they fall into old habits.  I read a post of a woman on another board, just in the last few days.  Saying she failed the DS.  If you are going to have a DS, then you must know, it is a lifelong choice.  If you want to continue to eat bread and pasta, then this is not the surgery for you.  It is controlling carbs via a surgery.  I am gluten intolerant as well as LI now.  I'm ok with it.  I have my gluten free bread once or twice a week. 

8. Calcium is a problem with RNY & DS.  Not so much the Sleeve alone.  You must work at it religiously!

9. By no means am I trying to talk you out of having the DS.  I am wanting to make you think before going forward.  For some reason, I no nothing (literally nothing) of your surgeon.  I don't know that you are working with the right surgeon for your case.

10.  In the past couple of weeks, a Specialty Surgeon said something to me, which I actually posted on here.  Here it is, "If a person chooses to have a Bariatric surgery, picking the "right" surgeon is the absolute most important decision of your life even moreso than a spouse.  You can always divorce a spouse.  You are married to the Bariatric surgeon the rest of your life."

11. Huneypie, who posts on here, is a great example of a 2-parter.  She had the sleeve, then went back and had the DS.  She has had great success. 

With your indecision, that may be the best thing for you to do, get the sleeve, loose weight, then go back for a full DS.

Remember, I am not a Dr, I am a Compassionate WLS-DSr, who looks at the reality of each individual situation.  No one can make the right decision for you but you.  Weigh your options carefully, go to another surgeon to get a second opinion (it can't hurt).  Take your time about that decision.  Last but not least, the folks on this board are great!  The knowledge that the vets have and share is amazing.  This board is your stepping stone after the surgery to help you get where you need to be.

Best of luck to you!

 PLEASE NOTE:  I personally believe the RNY as well as the band should not be available for WLS.  The RNY cannot be compared to the DS.  Some other of the posters have really put it in a great way for you to think about.  PLEASE for your sake, DO NOT do the RNY!  Another Example:  The Echo Tech at the Stress Lab of my cardiologist had the RNY 9mo before my DS.  He was at 385,  He is at 295, 19mo out.  Never reached his goal.  He told me, "I'm hungry all the time, what can I do"  I told him, "You had a RNY, it's totally different than me."  In 10mo, I am now down 160lbs.  He was on insulin.  He's is now on pills but no injections.  His weight loss & health goal was not met.  I have not had smooth sailing in any way shape or form, but I would say it's better to do a 2part DS than a RNY any day of the week!

 

 

Each of us is individual BUT as a group....here is what I have found.

Nausea is not the issue he thinks it is. Nausea NEVER bothered me...I did get the foamies ONE time when I ate too much and too fast.

Vitamin deficiencies happen to ALL who have WLS and do not get lab work and supplement properly. It might take longer in others but it will happen. Heck even normies have vitamin issues...my D tanked LONG before I ever had a DS.

RNY can NOT take NSAIDS. If you have need for that or a family history that suggests you will head that way, steer away from the RNY.

While 85-93% of type 2's resolve their diabetes with the RNY, However about 40% redevelop diabetes 5/10 years after surgery.

http://www.ncbi.nlm.nih.gov/pubmed/23161525

RESULTS:

Overall, 68.2 % (95 % confidence interval [CI], 66 and 70 %) experienced an initial complete diabetes remission within 5 years after surgery. Among these, 35.1 % (95 % CI, 32 and 38 %) redeveloped diabetes within 5 years. The median duration of remission was 8.3 years. Significant predictors of complete remission and relapse were poor preoperative glycemic control, insulin use, and longer diabetes duration. Weight trajectories after surgery were significantly different for never remitters, relapsers, and durable remitters (p = 0.03).

CONCLUSIONS:

Gastric bypass surgery is associated with durable remission of type 2 diabetes in many but not all severely obese diabetic adults, and about one third experience a relapse within 5 years of initial remission. More research is needed to understand the mechanisms of diabetes relapse, the optimal timing of surgery in effecting a durable remission, and the relationship between remission duration and incident microvascular and macrovascular events.

ONLY you can make the decision...I know which way I decided.

Liz

 

 

I certainlly agree with one thing the surgeon said - he's biased!

It is NOT about whether or not you, or any other potential patient, loses 10 - 15% more. Not only is the difference in weight loss much greater, that isn't really the most important point. The rate for resolution for every comorbidity except GERD is greater with the DS. Not control, resolution  The rate for resolution for type 2 diabetes with RNY is not nearly as good as was once believed, as the statistics already provided for you show. but the Ds also does better with hypertension and sleep apnea and arthritis - all comorbidities where the closer you get to a normal weight, the better you will do.

And then, let's also consider quality of life. Even if we set aside the improvement in quality of life with more weight loss, we also need to consider that with the DS you won't dump (and dumping is NOT a weight loss mechanism, it's a nasty side effect that some people with RNY get). With the DS you will be able to take NSAIDs safely. with RNY, you can no longer take them for the rest of your life. With the DS there are no foods you can never eat again. Granted, some foods will cause gas/bloating or other side effects, but this is something you learn as you go, and you can decide when and whether eating a certain food is worth the side effects.

And if you have been lead to believe that people with RNY can't experience malnutrition, guess again. It does happen, and the usual cause is the same for both operations, that being lack of compliance. Yes, we need more supplements with the DS, and we can get into trouble more quickly if we don't take our supplements, but the principle is the same. In addition, if someone with the DS either just won't supplement appropriately or runs into serious problems years after surgery, it's relatively easy to adjust the lengths of the common channel and alimentary limbs, or even to reverse the intestinal portion of the DS. Reversing RNY is a huge and much higher risk procedure, and many RNY surgeons tell their pre-ops to think of RNY as being irreversable, even though technically it can be done.

There is no perfect operation. It would of course be far, far better if we didn't need surgery for MO at all, but who knows when that day will come. If you are looking for an operation where you avoid all risks, you will never find it. I believe your surgeon has considered only the potential risks and left out consideration of the potential benefits of each operation, and that you need to consider both risks and benefits.

Larra

One thing I'd like to address is: who is this surgeon?  Is it Dr. Lalor that you have listed?  I am mostly concerned because in 5+ years in the DS community, I have not heard the name.  I don't have a well known surgeon either, however, you're in an area with a lot of DSers and, therefore, presumably a good set of tried-and-true DS surgeons as well and I might suggest a sit-down with one of them before you make up your mind.  

That said, he definitely didn't lie about the DS, but I don't think he was upfront about the issues with the RNY either.

1. He said that many DS patients have issues with nausea for about 3 months or so. (Would I still be able to work, etc?)

I'd say that is accurate for some.  I actually had terrible nausea for 6-9 months, in some part it was my own doing, though.  Dehydration causes (or exacerbates) nausea and I definitely didn't keep up with my fluids.  I'm sure RNYers get nauseated as well.  There are medications to help, but yes, you should still be OK to work.

2. He said that he might be a little biased but he has a lot of patients who had DS longer than 10 years ago (done by a surgeon who was there before him) who didn't have issues with malnutrition until many years out.

I've seen people with this issue, yes.  The worst cases were because they stopped taking vitamins or had terrible advice on what to take.  The best thing you can do is to stay active in the community so you can stay up to day on the current supplementation that is required.  

He said it kind of creeps up on you. So my response to that was-- you can fix that by taking vitamins and supplements, right?? He said not always. Some people have to have iron infusions, etc.

Also true.  Been there, done that.  I know several DSers that have had iron infusions.  He'd be lying if he told you RNYers don't have this problem, too, though!  My hematologist has definitely seen his fair share of RNYers needing iron infusions, too.

He said the other big thing is problems getting DSers to get in enough calcium long term to avoid osteopenia and osteoporosis. He said some of his DSers who had it done a long time ago have had a lot of issues with that. 

Yes, seen it.  It's a legitimate concern and there are the few that will have problems (whether it's calcium or some other combination of nutrients is debatable).  Again, this is also something that happens with RNY.

He said because my DM isn't severe now he feels like if I can maintain my weight after RNY my diabetes likely would not come back.... 

Only you can make the decision about your post op lifestyle.  Are you OK with the dietary restrictions of the RNY?  What about the possibilities of food intolerances after the DS?  What can you or can't you life without?

I am worried if I have DS something really bad is going to happen.... LOL.... But then again, I am a worrier. 

I worried too.  And yes, complications are a possibility with any surgery.

I think the other big thing is that I am the bread winner. My husband only works part time so if I were unable to work we would be in trouble. :(

Something to think about...not just before surgery, but in general.  You could get in a car accident and be unable to work at any time.  It's good you're stopping to think.  Complications can arise at any time and being prepared is always good.

All that said, I think this gentleman said it himself...he's biased.  I think you should seek out an unbiased opinion before deciding.  

My thought process before getting a DS: Yes, I was scared, but I also wanted the best chance at maintaining my weight post op.  I wouldn't have been satisfied with just 50% of excess weight loss.  I wanted better chances and a better post op diet.  Turns out I have a fair few food intolerances, certain grains are no-gos for me.

Also, you really need to be dedicated to the post op supplementation.  

Thanks so much for all of the info. I really appreciate it. 

I feel like I need to clarify something. I asked about the risks. I went into that appt with about 100 questions and he answered them all. LOL. I only wrote about my concerns. 

He acknowledged he's done a few DS's but that isn't his primary procedure. I think a lot of his experiences with the malnutrition and vitamin deficiency from DS are from patients who had there DS with another physician who had previously worked in the area and then ended up with him for follow up. He acknowledged that it was likely that those who were having problems that were still coming. Possibly the other with no issues weren't coming for follow up. 

I did not feel like he was trying to talk me out of it. I felt like he answered my questions and wanted me to know the risks. I don't think that was a bad thing. 

I also don't think it was a bad thing that he was upfront about it not being a procedure he does often. I appreciated the honesty. That gives me the opportunity to go to someone else if that is something that I'm worried about. 

I'm not worried about that. I work as a nurse in the area. I've never heard any of his patient;s say they've regretted letting him perform their surgery (even the non bariatric surgeries he does). He's a straight shooter. He's an excellent surgeon. I know DS is complicated. I also know that doctors (surgeons) and nurses who don't something regularly are especially careful when they do have to perform it.  In a perfect world, would I feel a little better if he had done 1000? Yes. But its not a deal breaker. As long as I know there have been others before me, and the surgeon has a record of practicing safe surgery and being meticulous and not having having complication rates, that's fine with me. 

I sought out a patient on OH who had DS done by him. He had a great experience and highly recommended him if I wanted a DS. He had no issues afterwards. (At least not to date. )

In Northwest Ohio there are 3 centers that do bariatric surgery. He is the only one that does DS. 

I called my insurance company Friday. If I decide to go to out of the area I will have to self pay. That's not going to happen. There is no way we could fit that in our budget right now. 

I feel like I unknowingly threw the surgeon under the bus by only listing the bad stuff that he said. I only wrote about that because its what I am worried about. 

He acknowledged the numbers don't like and DS has superior numbers. I'm not firing anyone. LOL. 

I really AM leaning towards the DS. I still have more questions but think I am going to start them in another thread. 

I really appreciate ALL of your input. I knew one person that had a DS ( and did GREAT!!) I lost touch with her though. 

If it weren't for you guys, I'd never know what to ask or look at, or think about. You are the best resource I have!! And I am grateful for that! 

I know you've gotten a lot of feedback already, and I'm not a veteran, only 10 months out from my DS, but I can comment on the returning to work thing.  I work in a  psychiatric hospital.  I would  have been fine to return to work after two weeks.  I was riding my bike at two weeks out; however, I stayed out of work three weeks just in case there may have been a violent patient.  I had no real problems with nausea.  In fact, I have thrown up only once since surgery, and that was at 8 months out, when I ate something that turned out to have been expired. 

Thanks for responding. That's about what most people say. I'm really glad to hear that. 

If you had to do again, would you? 

That's my questions of the day. LOL/

Yeap, in a heartbeat!

So far, I would say I'd definitely do it again. 

OK, I'm over to the side here, with my hybrid surgery. pouch but bowel arrangement the same as many DS surgeons are using today.

I fell into aw vat of luck 19 yrs ago. My surgeon's nutrition plan was far advanced then over today's basic guidelines. I was certainly considered a freak when I got online in 1998.

As for 10 years ago, there WAS info out there. I put it there. But in those days, it was a matter of "my doctor is better than your doctor". We had one guy in this area who said, "I don't sell vitamins, so you don't need them." As opposed to? My doc insisted on vites, but he didn't sell them, either.

It was almost like a religion in those early days. My doc says I don't need (fill in name of supplement). so I'm not going to waste money on it/them. They did mind wasting money on dentures, broken bones being treated, and so on.

The need for supplementation was always there, always will be, and a rough regimen has been available on line since 1998, a little earlier if you were local to me. It's better now.

It was all in the "launch", as I call it. Someone who has all the nutritional issues and lousy weight loss, but who knocked themselves out trying to follow a bad program, I refer to it as a "bad launch".

Nausea. Peculiar to DS only? I don't THINK so! Why? What's the logic there?

People have nausea from anesthesia, from some med they've been told to take, from force feeding foods they don't like or tolerate............. and that's not surgery specific.

So, back to my original statement, the info has been available. But, who to believe?