Hello OH. (Surgey choise flip-flopping)

Hello OH Members,

This is my first post and I seem to have a common question.  I’ve read as much as I can find but I wanted to ask it again within the framework of my own situation.

I’m a 54yo male currently at ~290lbs with a BMI of 38.5.  I’ve been overweight since my mid 20’s and technically obese for the last 25 years.  I have a family history of obesity where it seems we just get bigger & bigger until it’s too late. My father passed away at 71yo as a diabetic ~420lbs. I’m built very much like he was (an apple belly figure that is slowing turning thicker all over).

Although my weight is not as bad as others, I have been steadily climbing over the years.  Efforts to lose weight through diet and exercise have failed again and again (same story as most of us).  I’ve done some homework and I understand that all WLS procedures are tools. I “get it” that these tools (by design) will force my weight down at first through shear restriction, and that it is up to ME to alter my lifestyle to try and maintain my new weight level. 

The challenge is that as time goes on, the effectiveness of any WLS will diminish. The restrictive aspect of a VSG or pouch will decrease as they stretch, and the efficiency of caloric malabsorption will decrease (and in the case of RYN can be lost entirely) due to adaptation and morphological changes. So weight regain will be an issue I’m going to face at some point.

So here’s my dilemma…

When I study VSG posts I can see that for many folks the sleeve work very well.  Many folks are quite happy.  That said I rarely see posts that are more than a few years old. Many of the older posts begin to describe the efforts it takes to maintain the weight. And when some folks share the amounts calories they consume to maintain it concerns me (it's low).  I really do not want to end up where for the rest of my life food is the enemy. And that I must make it a habit to limit my portions to levels that are much less than an average person does…

The DS folks have an edge when it comes to the amount of food that they can consume due to the bypass. And although the efficiency of the bypass will dimini**** would seem it takes a fairly long time to do so. Furthermore, because of type of bypass it is (full bypass of the Jejunum), the caloric malabsorption effect is never completely lost. Yet in a “bad card” dealt to us by our biology, the absorption sites responsible for absorbing vitamins and minerals do not adapt like the caloric absorption sites do. So although our body may change to “fix itself” to be able to absorb more calories, the same does not hold true for vitamins & minerals.  Hense...  Suppliments for life (or else!).  :o

I take the malnutrition of the DS procedure pretty seriously. It seems that the stool and gas effects are something to be concerned with but it’s not the same as the vitamin deficiency issue (maybe I'm backward here. or maybe the suppliments are not really a big deal). I know that I could later on have the bypass added if the VSG was not enough to help me maintain.  The only problem with that thinking is...

1.) I would need to endure a 2^nd procedure

2.) I may only regain enough weight to be unhappy with a poor quality of life, but not enough weight to warrant the bypass.

3.) The regained weight will make the DS less effective overall…

I’m scheduled for VSG surgery at the end of July. Due to the unfortunate passing of  Dr. Aceves, I will be having my surgery with Dr. Ungson.   Dr. Ungson has a very good reputation as a DS surgen. Part of me wants to just stay with the plan (get the VSG and see if it’s enough for me.  If it’s not, move toward a DS revision).  Yet another part of me thinks that maybe I should go ahead and get a DS with a slightly longer common. In this way I will get some malabsorption to help me maintain for the long run, and for me to be able to eat more normally… Besides that, I'll have access to a well respected DS surgen at the time of my procedure. Should I take advantage of that?

So there it is…  I need to decide.  I understand this is a personal decision. But comments and thoughts from folks like you is so very valuable…  Any input that might help me in my decision will be greatly appreciated.

Best Regards,

Tim

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Hi Tim,

I think most or many of us struggled with that very same decision.  My friend went with the VSG and I went with the DS.  She is a much more disciplined person than I am in regards to calorie restriction, food choices and exercise but she is poor on vitamin supplementation and bathroom issues (she doesn't have access to bathrooms most of the day due to her job).  She is also less likely than I am to do more doctor's visits and lab work.

My final decision hit me when my surgeon said "The VSG portion of the DS will get you the weight loss, the Switch portion of the DS will keep your weight loss".  I know myself and what I can and can't do.  Both my friend and are have been very successful with our surgeries but it was based on lifestyle and knowing what we could do.  I never for a minute thought that surgery would make me different than who I am. 

If I had diabetes or a strong family history of it then I would have chosen the DS regardless.  I hope that helps!

Cheers,

Cathy

Thanks Cathy. That does help.  Your doctors statement is really what I'm concerned about (maintaining).  Can you give me some insight to how life is like with DS? Do you have any regrets? How many suppliments do you have to take? How often?  Do you eat freely or is it just a trade-off as far as restrictions are concerned. Not to be crude but is the bathroom issues an issue?  Most importantly, was your doctor correct? Do you think the DS is a key factor in your ability to maintain weight?  Tim

I have absolutely no regrets.  I wish I didn't have to have surgery to get the weight loss but I've accepted that.  I was the type of person who was very limited by my weight.  I was both physically limited but also mentally limited.  I hated my life and I feared that it would only get worse (it already was).  The DS gave me hope and joy where there was none.  Even during times when I wasn't super obese I still hated myself so I never had a break from self hatred until after my DS.  Once I was losing weight the self hatred fell off and my life opened up in ways I could never imagine or dream possible.  It's amazing to be NORMAL to the world and to myself. 

Because of this life transformation taking lots of supplements, tracking my labs, having 2 iron infusions and low cholesterol have been so insignificant to me compared to what I've gained in happiness.  Everyone has a different experience though.  I had an easy surgery, easy recovery, easy time losing weight and maintaining that weight loss.  I can eat a lot and I eat almost anything I want.  I think so much of your experience is based on your expectations, perceptions, body image etc.  I am a positive thinker so someone else with the exact same experience may perceive it differently than I did.  They might see my size 12 as being still too big, or they might still see themselves at 300 lbs or see the loose skin as disgusting.  They might hate the expense and time consuming task of supplementation.  I also have a very supportive husband who loved me regardless.  This made my marriage even better. 

My biggest issue is my fear of going to the bathroom at work or at people's houses.  Again perception is an issue.  I have always been a person who couldn't go anywhere but home.  With the DS it isn't always a choice.  That causes panic in me at times but I deal with it the best I can.  I found pen sized spray containers that I have in my pocket always.  I also spend 30 minutes on the toilet in the morning just so I make sure I am empty.  I see it as training my body to go at that time and not at other times.  98% of the time it works.  The 2% SUCKS!!!!!  I hate it.  If I didn't eat so many carbs it would probably be better but I'm not willing to give them up. 

I am still an addict.  I eat chocolate, candy, ice cream, etc.  I crave it and I withdraw with out it.  I am not ready to tackle that right now.  I don't gain weight from it and I am able to get in all of my protein so it works for me.  I have a lot more capacity than most people I know with the DS.  I also don't gain weight from eating carbs like some people do.  I don't want to have a diet mentality.  I am also 100% sure that if I had any other surgery except the DS that I would be back to obese.  Over the last 5 years of reading this board I have seen the whole gamut of experiences and I have only seen a handful of people regret the DS.  Even people with serious complications said they would do it again.  Dr Rabkin is in my opinion is the best WLS surgeon there is.  I trusted his opinion completely and I feel he was correct.  He bases his opinions on statistics, not money. 

I supplement 5 times a day.  I try to take the high end of the Vitalady schedule plus some other items for good health.  Lots of A, D, Calcium. 

Cathy,  Thank you very much.  Straight honesty from the heart. That helps me a lot. I'm happy you are doing well with your DS.  I can only hope I will be as sucessful as you are.  Thanks again.  Tim

I think what Cathy heard from her Doctor is exactly what swayed me. After a life time of losing and gaining back more I knew
I could lose but I needed and edge to maintain. I'm 15 months out so I will see about the maintaining as time goes on. I'm still losing.

If you do decide on the two step, as far as I can tell, that while weight loss is slower most people do well.

No doubt I was freaked early on at the number of pills I was taking a day but now it is part of my normal routine. Maybe 13 vitamins I consider
on my must list and another 4 or 5 that I have added because they sounded like they would help in the long run. So maybe a little over 30 pills/tablets/capsules a day. 5 doses with 5-7 pills in each dose. Once your organized you can add pr delete some according to your 
own labs. I recently had to add iron because I came in a little anemic in my last labs.

Eating - as you are losing, and adapting, you will be on high protein. You won't have room for much else, just like a standalone vsg. The further out you are the less restrictions you will have but the DS is like anything else - try hard enough and you can muck it up but even a strict DS diet is leagues beyond what you describe for older VSG patients. You end up watching different things than calories. (protein, liquids, carbs, fats).


There is no doubt that DS bathroom trips can be very stinky. You will se a lot of posts about products to use about this. The further out you get
the more you can cope/avoid issues. Some of it is food choice related. Some of it comes from being regular. A log of people get to the point where they go once or twice in the morning and they are good for the day. A lot of people are helped by probiotics. There are some products to try for things like vacations. Devrom seems to be hit or miss but for those people that it works for they are very happy with the results. 

I guess what I am saying is that anything that happens in the normal course of a DS can be handled.

Pete

You've done a great job with your research and understanding of the various types of bariatric surgery, and you've made a crucial observation, that being that many of the people who are so happy with the VSG and not old timers. And you won't be able to find lots of old timer VSGs anywhere because it only became widely used as a stand alone a few years ago. The DS, on the other hand, has a well established track record as having the highest percentage excess weight loss and, of equal of more importance, the best maintenance of that weight loss, of any bariatric surgery presently available. For me, that was crucial.

    I think the key for any potential patient is to be honest with yourself. For the VSG to be successful longterm, you must be willing and able to stick to a low calorie, low fat, low carb diet for the rest of your life. That wasn't me. I can't say whether or not that describes you, only you can make that determination.

    You have chosen an excellent surgeon for the DS if you decide to go that route. And there is so much more to this decision than your bmi. Family history? struggle with weight loss even with proper diet? Comorbidities? These are all factors for you to take into account.

Larra

PeteA,  Thanks for your post.  The comments you made are quite helpful.  Taking pills 5X a day is something new to consider.  I was thinking that you would take a batch of pills once a day either in the morning or before bedtime...  It's those types of detials that are really important to hear.

Larra, Your comments about being real with myself about what I'll likely be able to do is very valid.  I'm not the most disciplined person when it comes to doing things that I do not like to do. Fortuanatly my eating habbits are not terrible.  Truth is, I usually eat better foods then many FIT people I know.  But I do eat to much, that is a fact...

My "Common Sense" tells me... At my current weight (which has been steady for ~ the last year), considering my BMI of 38.5, the fact I'm not diabetic (yet)...  My strong sense says I should try the VSG, and try to make it work.  If I do what is necessay to make it work I'll be more healthy.  I suppose I simply do not have faith that I'll suceed due to so many failures in the past.

I think that going straight to DS for many people is an absolute correct desicion.  But that said, I think for others (like myself), I need to be careful about jumping into the additional issues that come along with DS.  My work takes me overseas every other month.  My work location is very remote. Medical resources, good selections of foods are not readly available.  And I'll be doing this for another 5-6 years most likely.  I need to consider the unique conditions of my life and the current state of my weight condition before I decide...

I appreciate the thoughts and information.  Thank You.

Tim

So another question...  Is there no type of more "mild" form of the DS procedure.  I know about the longer common channel, but that is only in the Ileum (which only can absorb only some types of vitimans & minerals).  Can some portion of the duodendum & Jejunum intestines be left in service?  (25% for example...)

The difference between VSG and DS is like "All or Nothing" (as far as pypass is concerned).  Is there no way to have a reduction of the small intestines without completely bypassing them?

There is RNY.