New here, but not new to this world

Hi everyone! I've been lurking around for a while and greatly appreciate all the information from everyone!

I had the lap band in 2002 and removed in 2009, so I've been around the world of WLS for many years. I'm finally taking the plunge for another surgery and I am in the early stages now of trying to decide what's right for me and scheduling consults. I have ruled out 1. RnY 2. Sleeve. So that leaves me with DS...or SIPS. I searched and can see that SIPS isn't widely accepted around these parts or there aren't very many recent posts that I can find.

When I first discovered SIPS I was sold and felt deep down it was the surgery for me. It had all the things I wanted my WLS to be: Sleeve stomach, better weight loss than RnY, not as drastic as DS, pyloric valve intact, less invasive surgery, lower risk of deficiencies and GI issues. But then I felt like if I'm going that far why not go all the way to DS and be sure I've done EVERYTHING possible to get healthy?

Then I came here and read many many posts and I'm scared of DS again. I'm really concerned with the long (LONG) term consequences of this surgery and seeing a lot of posts from people 10-18 years out having brand new issues, which is what the first surgeon I spoke to told me would happen. He was 100% adamant that I would regret the DS (not right away, but 8-20 years down the road) and it's not a popular surgery for a reason and no way, don't do it. He does not perform DS, so I'm waiting to meet with 3 surgeons who do, but meanwhile....can you guys answer some questions?

1. How far out are you and what issues have you faced?

2. How did you get over the scary stuff and decide to go for the DS?

3. What's your take on SIPS - not comparing to DS, but comparing to RnY?

4. Who and where was your surgeon?

I'm 44, 52 BMI, Type II diabetic, Sleep apnea, hypertension, and high cholesterol. I've got it all. I also have IBS, history of anemia and Vit. D deficiency and supposedly GERD, but don't have typical reflux symptoms, just vocal/mucous issues. This makes choosing DS difficult because I don't want to end up even more unhealthy than I already am.

I appreciate any feedback you can provide!
Jen

It is unlikely that anything BUT the DS will fix your issues, including the diabetes, for good. The rate of resolution of type 2 is 95% with the DS. And you will have low cholesterol. The rest of your issues will resolve with weight loss. My H had the DS for diabetes in Spain in 2004. All of his diabetic retinopathy went away completely. He had the switch only because he was not a lot overweight. And BTW the resolution of the diabetes is usually almost immediate postop and that means it is NOT related to weight loss. That should speak volumes to you.

I had my surgery in 2003 and I have never had issue 1. None. Nada. There is nothing I can't eat but I still diet and have to choose wisely. I can eat a normal meal. You would never know I had surgery unless I told you. I am always still trying to lose weight. I was never thin. I just look like a normal old bag who could stand to lose a few pounds. And most of that is because I never had any plastics.

I do have a hernia. It COULD be DS related. Or not! I got it 2009. I will be getting it repaired in 2020 and I am hoping to get a panniculectomy at the same time. If I get this done, I will look a LOT thinner. If I try to extrapolate, without the hernia and the panni I would most likely wear a size 6 or 8.

I eat low carb. I try to get consistent exercise. 98% of the time I take all my supplements every day. It's no big deal. I have 1 organizer for AM and another for PM and I fill them up once a week.

Let me tell you a little story. 10 people in my office had WLS in the same time frame. 1 band, she never lost a pound. 8 RNY, 7 of these people weigh more now than they did when they had surgery. And 1 DS, me. So in the still quasi normal category is me and 1 RNY person.

I chose the DS because it works. I believe in the think twice, cut once theory. The others just don't work well and many never lose or regain. Read the revision boards. You usually won't find DSers there. What scary stuff? I was more afraid of what my future would be if I did nothing! And the other options looked a lot more miserable than life post DS.

Surgeons want to sell you the surgery they do. Just like the Toyota salesperson wants you to buy a Toyota. They want your money. The only way to get HONEST information from a surgeon is to see one who routinely does all the surgeries, including the DS. Always follow the money. Surgeons are human too.

Most people on the planet are D deficient. You should be taking D, iron, calcium, and a multi vitamin every day already. The time to start working on all this is now.

SIPS/LOOP/SADI are DS look alike surgeries. Surgeons like them because they are easier and take less time. They are relatively new and usually still labeled experimental. This means insurance won't pay and if your surgeon submits to insurance as a DS, it could be fraud. Some people have done well with them and others have not. A LOT more studies need to be done. One study that came out maybe a year ago showed people losing all their malabsorbtion of fat VERY quickly and that screams increased chance of regain to me.

AHA... I found the study. https://www.soard.org/article/S1550-7289(17)30428-8/pdf#/art icle/S1550-7289(17)30428-8/fulltext And it's worse than what I remembered. At 1 year none of the SADI people showed ANY fat malabsorbtion left. This is not a great study but there is not much info out there.

Best of luck to you!

Patty L

I'm curious to know of the people in your office who had bypass, did they lose their weight and gain it back? If so, were they able to keep it off for any length of time? Or did they not lose much to begin with? Obviously it's up to the person to keep it off but I've seen SO MANY conflicting statistics on long term weight loss for bypass so I'm just curious.

Lost it and then gained it back. Most of the regain people start gaining back around the 2 year mark. One of them started out fat, lost it with surgery, gained it all back, lost it AGAIN, and than gained it all back again.

My theory is that so little is bypassed in a standard proximal RNY that by the second year the body has adapted to the bypass and the regain begins. At least that has been my observation.

I read your office story while lurking and it doesn't surprise me. I've been in a wls group since 2002 and the couple of DSers are still holding on to their weight loss.

The scary stuff I'm referring to are the deficiencies people can't seem to reverse. Stomach issues. Chronic diarrhea. The stuff surgeons throw at you! I'm definitely leaning towards the DS, I'm just scared. I have only been a diabetic for 4 years, but it's gotten worse with every pound I've gained as I approach what is possibly looking like early menopause. I started insulin injections 3 times a day a couple weeks ago and it's still not great....this is not the life I want. I've been on blood pressure meds since I was 19, my body hasn't worked right for a long time.

What is your take on weight set point with the DS? Any thoughts on this?

appreciate your detailed reply!!

Jen

Forget set points and previous failures. The DS is strong enough to FIX you. The DS is a metabolic reset. You most likely have PCOS too and it usually resets that as well. You have to be very careful with birth control postop!

I wanted a 50cm CC. My surgeon wanted to do 100cm. So we played let's make a deal and settled on 75cm. Theoretically, that's short CC and I should have had deficiencies. But never a one. I do take good care of myself and take my supplements. If you can do this, you will be OK. Especially since you won't be able to find a surgeon willing to do less than a 100cm CC these days.

Compared to what is going on with you right now, the DS is easy. Since I have had the DS, I have thrown up once and that was hernia related, not DS related. Since I had the DS I rarely get colds and I have never had bronchitis or the flu. And I used to get all of these before surgery. I would guess the DS has improved my immune system. I am now 64 and healthy as a horse. I can go out and run 5 miles. I take no prescription meds at all. I regularly use a treadmill, a rowing machine and a vertical climber. I have no physical limitations.

I used to have skin tags from most likely PCOS that was never diagnosed. They all went away postop. I used to get heartburn and that went away too. I have probably taken 4 Tums in the last 15 years.

Diarrhea. I think almost everyone has some issues in the beginning. It takes time to figure out your new system. When I was brand new I probably took a couple packages worth of imodium. I had diarrhea and I treated it. For a while I carried the pills with me. I stopped that about 15 years ago. I usually poop once in the morning and maybe 30% of the time, again in the evening. And that's it. Since my DS, I have ridden a horse across Mexico, gone on rappelling trips, climbed mountains, went diving in Tahiti, and all sorts of other things. If I had chronic diarrhea there is no way I could have survived.

Let me tell you what will be different. You will have stinky poop. It will smell much worse than it does today. You will poop more(volume) than you do today. And it will not smell like roses. Bad farts too! But over time you will learn to eat properly and avoid foods that give you gas.

I still do low carb because I can gain weight. I still drink coffee and have diet soda every day. I am pretty strict on carbs. Holidays and out of town vacations are my cheat days. I can eat anything I want. 4th of July I had chilidogs, potato salad, muffins, chocolate, and ice cream. And it's less than 2 months to Labor Day now. Another cheat day on the horizon.

The DS is not set it and forget it. You have to be willing to learn about the surgery and educate your medical professionals. You must be capable of being assertive and being your own advocate. You must be able to question your doctors, etc, and stand up for yourself. You have to be willing to take the supplements and eat a high protein diet. You need to be willing to avoid sugar and carbs. If you can do those things, the DS will fix you.

I was told in my 20s I had PCOS, but I've always had regular periods. Recent years I was told I do not have PCOS, so who knows. What I do know is my body is broken.

I was actually wanting a longer CC, not shorter. But these are all questions I have for the surgeons.

I am not looking for a set it and forget it, I know that's never going to be a thing for any tool for MO. I also am no stranger to pills/supplements and poop/gas problems. Living with Diabetes, Sleep apnea and IBS is NO JOKE. What I am looking for is health and better quality of life and to not be malnourished and sick as I age. It's not an easy decision when there are so many unknowns.

Jen - I can't talk to your diabetes (fortunately I never became diabetic), but I can talk to the sleep apnea. I had life threatened sleep apnea that was diagnosed several years before I even thought about WLS. It was actually the pulmonologist who first suggested WLS. I also had a co-worker who had just had the RNY and was doing great. I was going to go that route, but her doctor wouldn't take my insurance at the time (thank goodness). My co-worker started gaining about a year after her surgery (she lost about 100 pounds). I did my research and discovered the DS - I knew immediately it was the right surgery for me. Within 6 months of the DS, I was completely off my c-pap and two years out, I had the pacemaker they put in removed.

I don't have chronic diarrhea. You learn how your body reacts to food and you plan accordingly. I have battled some deficiencies - I take lots of D3 but my numbers are good. I have battled iron deficiency anemia, but infusions take care of that. I won't lie - I have osteoperosis. I blame 50% on the DS and 50% on genetics. I also don't take any prescription meds (I do take OTC prilosec once a day but never had a real issue with GERD).

I was 46 when I had the DS (first WLS) -- I'm 62 now. My starting weight was 320 (but I had probably been as high as 340) and this morning I weighed 153.

I wouldn't change anything about the last 16 years.

Thank you :) My ENT Is the one who diagnosed my apnea because I was having daytime choking episodes! I have had 3 doctors recommend WLS to me.

Osteo seems to be pretty common. That's not something I ever worried about, but I'm learning I will have a different set of worries after DS. I just pray I don't have to take my current worries with me and then add the new ones. There are no guarantees, right?

Oh and I do already take D3, iron, multi, magnesium and probiotic.