Hello OH. (Surgey choise flip-flopping)

Yes.  True.  Whatever procedure I get I want to preserve the stomach functions and most importanly retain the pyloric valve to control the emptying rate from the stomach.  So RNY is not for me.  But your are correct, it is a more mild bypass.  Thanks for the suggestion.  :)

Are you good at living on a low fat, low cal, low carb diet?  If you were, you wouldn't need surgery at all.  Most of the VSG folks I know live basically on a starvation diet, about 800 cal per day to maintain their loss.  If this sounds like what you want to do, the VSG is right for you.

If you want to eat a relatively normal diet, get the DS.

You mentioned your father so it seems to me there is a metabolic element to your weight problem.  And he was diabetic.  The DS takes care of these issues and levels the playing field for you.  And you won't become diabetic either.  The DS was made for you!

Just to be fair, you do have one huge advantage.  You are male.  Men lose more faster and seem to keep it off easier than most women.  WLS, diet, whatever, men outperform women every time.

Hi Patty,  Yes, I think that also.  I notice you have a 2003 surgery date.  And based on your response it sounds like the DS is good for you.  Have you had any issues maintaining weight after this much time? 

To be fair, I've seen MANY posts in the DS forums of people talking about regain and what they need to do to keep it off. I'm not saying the DS does not help with that.  I'm saying that it seems that even with the DS, what gets consumed still needs to me managed.  I do know myself, there is no way I would need to get down to 800 cal/day to maintain.  My number is more ~ 2000-2300 for maintenance.  1200 or so for weight loss.  Lower then that your body will go into starvation protection.  What type of calories has a big effect too.  I would like to get the positive aspects of DS, it's the negatives that concern me.  I got to 290lbs by drinking and overeating.  Now my stomach is streched to the size of a basket ball.  I can eat most of a pizza alone before I start to feel full.  And because I can, there are times that I do. 

I hear what you are saying about VSG failue stories (plenty of them).  There are some successes too...  If I was able to reduce the size of my stomach and had a decient diet and did some exercise I do think I would maintain without having to starve myself...  But I could fail, and maybe likely I will.  But I will have tried.  And a DS can always be added later.  Getting a VSG is at least part of the DS solution. 

The biggest thing holding me back from a DS is the suppliment requirement.  And what happens if I were to fall behind.  Not to count the higher level of medical monitoring involved... Then there is the fact that I'm pretty big, but not huge. Obesity is a progressive disease. If I were to drop down and start back up over the course of s few years I will have still "Held Off" on getting bigger from where I am currently.  I suppose at that time I would need to rethink my decision about getting a DS added before I regain too much weight.

I'll probably forget all this reasoning and be kicking myself for not getting a DS right away. I keep hopeing to hear that the suppliments are not really a as big a deal as it's portrayed, and that you can eat whatever you want without foul gas and smell, etc...  But the truth is these things are a real part of the DS experience.  The question for me is, do I want to sign up for these negative effects now, or do it later if the VSG fails.  I want to be careful about what I give up & when.  If the effort to hold off the weight with a VSG becomes greater then I think what the negative effects of DS are, then at that time the scales would be tipped toward the DS (without regret).  But for now, the way things are cirrently.  I'm not sure.

I'm not pushing back on what you posted.  I'm just thinking out loud.  And I do appreciate your input.

Thank You.  Tim

Tim, 

PLEASE stop talking about WLS options like the Customer Service counter at Macy's.  This is not something that you say "Oh, it didn't work for me, I would like to return it for a DS instead.?  You're talking twice the cost, twice the risks and twice the recovery.   It's not second-guessing whether or not to get dessert at dinner.  

If you're not getting success right now with eating less, then you're likely not going to get any better results with the sleeve.  Some people just need that metabolic shift.  I know I did.  I was the tiniest eating fat girl you ever did see, and yes, my father made a comment just like that one day.

I'm pushing on my 9th year, and had lost 145 lbs and regained a whopping 20 lbs.  Big whoop.  I got my boobs back and I'm not panicking.  We should be expecting to regain 15-20% of the ewl and not stay the smallest size we ever saw forever.  Some are lucky enough, but even I am below average and I'm not working hard at any diets.  I enjoy food and eat a little of everything.  When I feel my carb cravings spiraling out of control, I reel myself back in with protein-loading.  I have a bowel movement once a day if I'm eating correctly.  I found that eliminating straight milk and onions have really controlled the smell.  Over time, I learned how foods affect me.  I travel as a corporate trainer and have no interruptions with my hectic work schedules.  Time zones pull a fast one because my bowels like their schedule, so worst-case scenario, I'm getting up very early for my morning routine.  The vitamins aren't a big deal either, and yes, I have survived forgetting to take them with me on a trip for a week.  I picked up a multi and calcium citrate, then doubled up my dry vites for a couple weeks afterwards with no ill effects.  I don't recommend this practice on purpose, but it didn't kill me and I try hard not to forget them EVER.

Dr. Ungson has a lot of respect out here.  Trust what he knows and has seen in his experience as to cc and what and how much to bypass.  You don't want to mess up a formula that works.

LOL... Hello Valerie. My better half (my lady of course) has been saying the same thing.  This whole process has her completely freaked out and she is looking at me like I'm treating this surgery WAY to casually; Like I'm shopping for socks or something. I work in Production Operations at a large remote oil facility. It's a pretty dangerous place so I deal with managing risk all the time. It's become second nature for me to try and look at any situation from all angles.  Doing that in this case I'm sure is portraying a somewhat "detached" attitude. Truth is I'm pretty nervous. But I do want the best procedure for me.  And I do feel fortunate for having Dr. Ungson as my surgeon. 

If I really was as carefree as I seem I would just get the DS without more thought. Concern over the side effects of the DS are really what is driving me to act this way; The money, not so much... I've been trying to zero in on what it is that is bothering me.  I think it might be something like this.  I've abused and stretched out my stomach to where I feel it will forever inhibit my ability to loose weight or feel satisfied with normal portions. So doing the VSG to shrink my stomach is fixing something that is damaged.  And by fixing that I may be better positioned to try and change my habbits to not abuse it again.  My intestines are not broken, or damaged, they just do what they are supposed to...  So the DS part seems different then the VSG in my mind.  It might be this thinking that has me stuck.

As far as your comment that I'm saying... "Oh, it didn't work for me, I would like to return it for a DS instead.?"  I'm not looking at it that way at all.  As you know the VSG is half of a DS procedure. In many ways the full DS procedure is actually less risky when done in two stages.  What I'm really saying is this… “ If I did not get enough help from the VSG tool on its own... Having had the VSG already completed will allow me to expand my tool to a DS level if I so choose”.  That is the reason why I'm not even considering RNY.  I'm not shopping at Macys; I'm looking at this more strategically.

I do appreciate your sharing the specifics of your life with DS.  That information is really helpful.  Thank You...

PS:  My lady is against me getting WLS surgery (she is frightened by it). Furthermore, she is STONGLY against me getting the DS done at this time.  It's taken a lot of talks for her to become comfortable with doing the VSG to see how it goes.  So there is that aspect to this too...

Your intestines "working" now has nothing to do with whether or not you need a DS.  The DS part changes the way your body metabolizes food, which is what makes it so successful in the long term and why 98% of type 2 diabetes is cured with the DS.  If you can lose weight simply by pushing your chair away from the table, then the VSG may be just the ticket.  Getting the DS done in two surgeries is only safer when the patient has too many health issues to warrant the longer procedure.  For the average 38 BMI bear, that is NOT the case.  You will go under anesthesia twice (risks), get opened up twice (risks), and have to recover twice.  The revision is no picnic.  Situations change, and many find that later their insurance only coveres one wls per lifetime, or their job situation changes and it's not a possibility anymore.  

Think twice - with the absolute goal to only cut once.

I may very well be underestimating the risks associated to the surgery itself (regardless of the procedure).  You have some very good points.  I've not even had a chance to speak with the surgon about this. So I'm not sure what his advice will be.  I'll be going down prepared to go either way.  I may not know until the day before the procedure what he thinks (kinda odd considering what is being done).

Tim, Valerie and others have already pointed out the disadvantages, both for risks (doubled) and for logistics (recovery twice, more pain, etc) or having 2 bariatric surgeries instead of one, I would like to add that most people lose more slowly if they have the DS in 2 parts instead of one, and also that sometimes, when "completing" the DS, it's also necessary to do a re-sleeve as sleeves do stretch with time, and a re-sleeve is much more difficult and higher risk than the original sleeve is (I could go into why, but will spare the details here).

I realize you are not taking this decision very seriously and trying your best to make the right decision. I respect that. I've seen other people pick the VSG with the attitude of "well, I can always get the switch part later if I need it, no big deal" but it really is a big deal. Now, you aren't thinking that way, I see that, but the DS really isn't intended to be done in 2 stages unless the patient has such severe surgical risk that it MUST be done in 2 stages. That isn't you.

So keep studying and figure out what operation is going to work for you longterm. If that is the DS, there is no value in doing it in 2 stages. And while I also respect your desire to frighten your significant other as little as possible, that just isn't the right reason to choose which operation to have. It's all scary. It all carries risk. There is just no getting around that. But your remaining MO carries risk as well, it's just that the risks are less immediate. You do not have a risk-free alternative.

Lastly, regarding travel. I have traveled out of the country since my DS. I take my vitamins with me, with a bit extra just in case there is a travel problem, such as a cancelled flight. It isn't a big deal. Really. It's just part of taking care of yourself. You clearly have more than enough intelligence and travel experience to handle this.

Larra

Larra,  You have reached out to help and given me some very good advice.  It's much appreciated.  I'll make a decision soon enough.  One thing I will say is that I've come to embrace that I should not even consider a solution that involves a second surgery.  I'll need to make up my mind, and i will.  I'll come back at some point and let everyone know what it was...  Everyone here has been quite helpful.  I'm very appreciative. Best Regards,  Tim

I am 4.5 years out from vsg and 16 months out. From adding the switch. I wish I had done the switch to start with. I lost a lot of. Weight almost 100 pounds with the vsg and couldn't lose anymore. 

The restrictive diet,for me,meat and non carby veggies,was boring but not a problem,cause my hunger has never come back. I eat by the clock or I will starve. 

Inthe time I have had theDS,I.  Have learned that bread and other wheat type products will give me stinky gas about 8-12 hours after I eat it. I usually eat it during the day so the gas happens at night after iam in bed,poor DH. So that canbe controlled by choosing the time you eat carbs or not eating them at all. 

I have one or sometimes two loose, DS"pudding poo" each morninging. That is usually it for the day. They are quite stinky and more so if I have eaten carbs. There are all kinds of stool odor reducers you can buy and carry with you that work well. There is also an oral product called Devrom that you can order and take to tone the odordownfrom the inside out. 

Vitamins,pfft, a handful several times a day and iam. Good to go.I can  take a handful of pills,about 10 at a time with a good drink of. Liquid with no problem at all. Ppl make a big deal about all the vitamins,but really it is less of an issue than you would imagine after you get you program down and get used to it. It becomes no more than brushing your teeth twice a day. 

Most everyone,even lap banners have to take some kind of vitamin supplementation simply because our sleeves/pouches are so small we can't possible eat enough to get all the vitamins and minerals we need,so factor into you decision making that you will likely be taking some vitamins withany Wls. It is an awesome trade off for me.

it is not really true that everyone gains at some point after Wls. I haven't,maintaining a 118 # loss for over 4 years. Also if your sleeve is constructed properly,it won't stretch. As the stretchy part is removed. It will mature over time and relax a bit,but stretch? No.

 My best advice? Think twice,cut once.

gl