Cross posted/Not comfortable with surgeons suggestion

Hey folks! I'm new here and I don't really know where else to go with this. I apologize ahead of time and thank any who are patient enough to read through this.

I have basically agreed to something I'm completely uncomfortable with and I'm not sure what to do. I'm generally the type to follow my intuition and it's almost always a good thing. However, since his is something that has caused me a great deal of anxiety and fear for the last 5 years, I'm not entirely sure it's intuition only and maybe that fear creeping in with a different "voice".

So to explain a bit might help.

This is attempt number 3 for me to follow through with a Bariatric procedure. The first time I was scared by the "voice" that told me I would have major complications and might even die. This was because I went into the seminar wanting a sleeve gastrectomy but was told my insurance would only cover a BPD or Roux En Y. I walked out, bought a food scale, a new pair of walking shoes, a gym membership and started to reform my entire life. I weight 327 and within a year, I had lost 128 pounds with a low glycemic index diet/Ketogenic diet and exercise.

Got stuck for 2 years there so visited the Bariatric option once more. Was told the same thing so I walked away again.

Here we are now. 3rd time is the charm. I have re-gained 40 pounds but the sleeve is now an option for me!!! I have completed all the requirements and the surgeon is telling me that the first week in April is what we are looking at. I just need to attend a Support meeting and provide that to them, then we are a go. Should be ecstatic, right?

Here's where I need some insight and advice. I went in to my appointment knowing I was going for the Vertical Sleeve. Being a diabetic that was able to come off of all insulin and meds with my initial weight loss, he was impressed. We also talked about my recently noticing that,unfortunately, my glucose numbers have been Way too high again. Everything I eat, even protein and fats ONLY are still spiking my sugars. I don't want to go back on diabetes meds/insulin, so surgery is the only answer. My surgeon says that at 243 pounds, I barely meet the BMI requirements and he is only able to approve me for a surgery under a 'diabetes control' diagnosis. But to do so, I should let him perform the BPD INSTEAD OF THE SLEEVE. He says it has a proven long term remission (20+ yrs) of diabetes while the sleeve is linked to only 5-7 years. When he put it that way, I figured OK...this is why I'm having such an extreme procedure done. To allow me to avoid the deadly complications that have ravaged the rest of my family. So, I said yes.

 

But now......I'm terrified!! I am hearing that intuition once again telling me that the complication from the intestinal diversion will cause me tremendous complications and I am ready to walk away once again. My current diet consists of virtually no carbs that do not come from vegetables or a small amount of fresh fruit. I have learned that high amounts of good MTC fats are amazingly healthy. My biggest downfall and weight gain came in the last 2 years from falling off the no carb wagon and overeating in general. I turned back to food after my Brother died in 2013 and just never got back on track. With a BPD, my body will not tolerate the fats I know are healthy and I cannot imagine the vitamin/calcium deficiencies that will come with this particular surgery because of the inability to consume evhealthy fats. This is why I wanted the Sleeve to begin with!!! No deficiencies and plenty of restrictions!!!

 

I need advice/help with this issue. Anyone? Please help!! I'm scared to do what he suggests and scared to walk away for a 3rd time. I am not in control of my glucose and terrified he won't let me have the sleeve. What do I do?

thanks again for taking the time with me.

~K~

Okay, where did you hear this statement "With a BPD, my body will not tolerate the fats I know are healthy and I cannot imagine the vitamin/calcium deficiencies that will come with this particular surgery because of the inability to consume evhealthy fats."

Just because I was curious I googled MTC fat sources and here's the top list:

You can get MCTs from whole foods: here's a list of MCTs in foods, as a percentage of total fats (source):

• Coconut oil: 15%
• Palm kernel oil: 7.9%
• Cheese (if you tolerate dairy): 7.3%
• Butter: 6.8%
• Milk: 6.9%
• Yogurt: 6.6%

Cool. I eat every one of those things, almost daily. Not a day goes by I don't have butter or milk, and cheese & yogurt are my go to snacks. 

Are you getting confused because you don't absorb all the fat? I could see that...They say you absorb about 20% of the fat you eat. My body needs fat. My body lives off fat. If you look at what I eat most of my calories come from fat, then protein, then carbs. Now my body doesn't really tolerate simple carbs, but you shouldn't eat them anyway.

Also, "plenty of restriction" with the sleeve only. Sure it might work for some people, but stomachs stretch over time. I personally know people who have had the sleeve and wish they did more because they are about 1.5 years out and can eat similarly to what they did before. 

I'm a firm believer in the DS. I suggest you do some more research on the surgery and your nutritional needs after. I have a feeling you are going to be surprised and see that the diet you need to follow with the DS is pretty much what you aim for to begin with. 

I hope this doesn't come across as harsh or critical, thats not my intent at all. I just really think you have either been given false information or need more research. 

Read the daily food diary. Check out what those of us who post eat. Read a few of the threads where others are asking for guidance. 

I wish you all the best. Ultimately it is a life changing surgery, and all surgery has risks. You need to be comfortable with them though before you continue. 

I did not take your response as harsh at all. Sounds like exactly what I asked for.

I'm here because this is where the REAL LIFE EXPERIENCE in this matter resides. And it is becoming very clear to me that I have come to the right place.

The plan you and a few others are following is pretty close to what I'm doing already and that's exactly where I want it to be. I'm wanting to stay as close to my past Ketogenic plan as possible. I appreciate you taking the time to answer my concerns. It appears that part of the info I was getting was incorrect. BUT...I also feel I may have misunderstood a portion of the conversation with my surgeon as well. I believe I will have a second sitdown with him soon to clarify. It clicks when you say that the absorption amount is only about 20%.  But I think I "heard" something completely different about the fat and that's what sparked my concerns. 

Again...much appreciation for your experience and input. 

I had the sleeve. Am now seeing surgeons for revision to DS. I was also stuck on the sleeve...and I wish I knew then what I know now. I would have done this in the first place. I was also terrified of the instestine stuff.

I believe it's important for every patient having any bariatric surgery to feel confident that they have made the right decision, and that they are committed to living with the vitamin and nutritional requirements of their operation to maintain good health. As you are clearly aware, this isn't just about weight loss, it's about your long term health.

Having said that, I'm not sure why you are so very fearful of the DS (note - it's the DS or at least BPD-DS, NOT just BPD, an older operation that isn't done anymore. There is a lot of confusion over these names). With the DS you are not limited as to the fats you can eat. Since we only absorb about 20% of the fats we consume, we can eat fat freely. With this comes the need to supplement the fat soluble vitamins - A, D, and K (E is also fat soluble but I have yet to hear of anyone with vitamin E deficiency). So that's a requirement that's crucial, but honestly, it's not difficult. You buy the "dry" form (the usual and prescription forms are packaged in oil, which is fat, which you won't absorb) and take as much as you need in accordance with your labs. It' becomes just a routine part of your day, like brushing your teeth.

    We need to eat a lot of protein because we absorb about 40-60% of the protein we eat. But, because we absorb so little fat, we can use any form of protein, lean or fatty. That opens up lots of food choices and cooking methods. We do still need to limit carbs, but it sounds like you're familiar with that already.

    We also need to take lots of calcium citrate, and some iron, and multivits. Again, these become a routine part of your day.

    The DS has a rate of permanent resolution of type 2 diabetes of at least 92%. Some studies go as high as 98%. The sleeve - no where near as effective for diabetes. That's why your surgeon is recommending the DS for you. You are right to be concerned about being diabetic and unable to control your glucose levels.

    I'm not sure why the DS terrifies you so. I have lived with the DS for almost 10 years and it was the best decision I ever made. Yes, I take more vitamins and minerals than someone with a sleeve, but I knew that going in and made the commitment. I've had to adjust things a few times over the years based on lab results, but it hasn't been difficult at all.

    If you really, really, just can't bring yourself to accept the DS, don't get a DS. Just know that if you get a sleeve, chances are that you won't lose as much weight and chances are not nearly as good that your diabetes will go away permanently. But the ultimate decision should be yours, not your surgeon's. He can't force you to have a DS if you don't consent to it. My opinion, FWIW is that he gave you good medical advice, but the final decision is yours.

Larra

 

Your doc gave you good advice.  He is right.  I think he did you a huge favor.  That sleeve you want stretches.  No matter how small they make it.  A couple years postop you will be able to eat a normal meal.  Where's that going to leave you?

 

Why do you think you can't eat fats?  The typical DS diet is high protein, high fat, and low carb.  Eat all the fat you want.

 

You have already proved diets don't work long term.  Just like almost all of us you have lost and regained hundreds of pounds.  If you know diets don't work long term why would you want just the sleeve?  That's just another diet with a smaller stomach.  Stop and think about this.  You have proved you can starve and lose weight.  You just can't KEEP it off.  You didn't fail.  The diets failed you.  So what's another diet going to get you?  Will it get you to a decent BMI and let you stay there?  No.  You need the 2nd component of the DS, malabsorbtion.

 

The DS is the best and most powerful WLS out there.  Hands down.  There is nothing better you can get.  And if the intestinal part scares you, guess what...if you have problems, it is reversible.  And there is over a 95% chance your diabetes will be gone.  Poof.  You do have to be willing to take supplements.  If you can't or won't do that, the DS is not for you.  An honestly almost everyone would benefit from some supplements.  All women should be on a multi, calcium, and D.

 

Did you know people in Europe have been having the DS for almost 20 years now just to get rid of type 2 diabetes?  My H had this surgery in Spain in 2004.  He never had another dose of diabetes meds and he could eat anything he pleased.

 

So yaaay for your doc.  He told you the right thing!  He gave you the best possible recommendation.

Welcome to the DS board Mystrys. The people here and the other place I messaged you about have loads of experience and knowledge to share. I hope you find what you are looking for. Good luck :)

Hi Mystrys!!

I'm also new here. As I read your post, I could totally relate.  I too went to the information seminar thinking/wanting the Sleeve. I know 3 other people that had gotten the Sleeve, and swore by them. One of them has diabetes, and although he doesn't take as much insulin as before, he's still taking it! I did not want to continue taking diabetic meds, &  I KNEW I didn't want a Gastric Bypass!! Once I got to the information seminar and the Drs. started talking and explaining the benefits of the different surgeries, I knew then that the surgery that would benefit me most was the DS. (Mainly because of the resolution of diabetes. My A1c was 13.1) Still, I went to my 1st Dr. appointment asking for/about the Sleeve and my Dr. informed that the with my diabetes so out of control and along with my other co-morbidities, the DS would best benefit me health-wise in the long run.  The first thing being to get my diabetes under control and resolved.  I had done some research and knew that what he was stating was the same thing I had read in my research. So, after praying about it, researching more, joining sites like this one, & talking/asking questions with my Dr., I feel a whole lot better about having the DS.  I also had concerns about malnutrition and vitamin deficiencies and my Dr. put those concerns to rest also. I'm feeling so much better about having a DS now.  I'm ready to move forward. 

Now I have as surgery date of March 21, 2016!! :-D  I'm excited and scared at the same time!! I'm ready to get on "the losers' bench"!!

Good luck on your journey and Keep us posted!!

What the other's said about fats is spot on for me as well.

 

About malnutrition.  With the disciple you describe above, it will never be an issue for you.  Just take your vitamins daily and get your bloodwork done every six mo/year.  It is that simple.

 

I was seriously nervous beforehand as well.  It is a big deal.  Distraction and research helped me the most. 

 

Good luck! 

 

If your inner voice is telling you not to do something big like weight loss surgery, than I'd say wait.

Weight loss surgery is a life long commitment. If you are not 100 percent sure than wait. Get some therapy to explore your feelings, etc.

You can always come back again to the option in the future.