What type of WLS to have.

I am 38 yrs old and diagnosed with PCOS when I was 19.  I have a severe form of the disease and in 2003 had ovarian drilling.  Usually they do 10 drill holes on average.  I had 60+ drill holes on each ovary.  The Reproductive Endocrinologist couldnt believe how bad it was and he actually videotaped the session and gave me a copy.  Metformin doesnt work for me :(  In 1996 I was in a research study at The University of Chicago and finally found a drug that was a miracle for me.  Rezulin.  Unfortunately 6 months later the FDA took it off the market. I currently take Avandia for my PCOS.  After 14 yrs of ttc I had twin girls in 2004 after my 4th IVF.  Pregnancy agreed with me and I actually lost 30 lbs while pg with twins!  But post partum I have gained 60 back. My PC doctor referred me for WLS 2 1/2 yrs ago but we had an HMO and they would approve. Now my BMI is >40, I have sleep apnea and joint pain.  So insurance is no longer an issue. I was only interested in lap-band surgery because I am afraid of the malabsorption and dumping issues that can occur with RNY.  However, the more I read on here about people with PCOS who have had lap-band being disappointed with their results I am scared not to have RNY. I dont want to have the band removed if its not working or go through all of this and it now work but I am still uncomfortable with RNY. Please walk me through all this and give me your insight.

Wow...you've been through a lot!  The decision on which surgery to have is ultimately up to you.  I had the RNY and am happy with my decision.  I lost 112-114lbs and went from 254lb, size 24/26, diabetic, hypertensive, sleep apnea, infertile, severe pcos, acanthosis nigricans, skin tags, bad acne, and no cycles...TO...140-143lb, size 6/8, non diabetic, still hypertensive (genetic my doc thinks), no sleep apnea, fertile (got prego 1st month not using protection at 16m post op), PCOS under control, no acanthosis nigricans, no skin tags, minimal acne & regular 36 day cycles.  WHEW!  That was a mouthful! Research is showing that women with PCOS tend to do better with RNY than with lapband due to some way the insulin is utilized.  I'm not sure of the specifics.  I do know 2 ladies who have PCOS & lapband (on another website) who are not too thrilled with the weight loss at 1 year post op and one of them even looked into a revision to RNY only to be denied because she already had lapband done. What is it that makes you uncomfortable with the RNY?  Just curious... GL in your decision...let me know if I can continue to help! Kristy

What makes me uncomfortable about RNY? The malabsorption issues and the dumping are the biggest but also the fact that you are rearranging the way nature intended it.  Does that make sense? After my girls were born my cycles are regular for the first time in my life.  I have a period every 32 days.  Prekids I was lucky if I had 2 periods a year.  I am very hirsute and have to shave my face daily, overweight and have moderate acne.  I guess its worse than it should be since I am almost 40 :lol  But I dont really have a skin tag problem nor the nigricans issue.

I have to shave daily too.  It SUCKS. I've heard the same thing about PCOS patients doing better with the RNY vs LapBand.  There's no hard statistics from what I was told.. just the experiences of my RE team. I don't dump really.. and the malabsorption can be controlled by vitamins.  They are very real fears to have! Since my RNY, I am now ovulating on my own, my facial hair is growing slower, my acne is less, and I just FEEL better.  I can't tell ya right now if my periods are normal yet.  I had an ovarian cyst rupture last cycle so it was a bit longer.. but this cycle looks to be a 30 day cycle.  (I've normally be having 38-45 day cycles/)

I also used to have to shave daily...but now it's every 2 days.  As for the malabsorption issues...it's not too bad.  The DS has the most malabsorption as they bypass a lot more of the intestines than with the RNY.  I actually have quite good absorption.  When I was about 5 months post op I tested positive for TB (skin test).  And although my chest xray was normal was started on anti TB meds (INH) for 9 months.  My concern of course was the aborption of the medication...becuase if I wasn't getting enough of it for it to be effective I would have had to go to daily injections.  Which of course is NOT what I wanted!  Anyway, an hour after I took my meds they did a peak level which should have been between 6-7...my result?  6.5!  So I was able to maintain the oral medication for the 9 months.  When I mentioned this to my WLS doc he said that I have good absorption and aborb mostly everything I take in...from food to vitamins. As for the dumping...it's not guaranteed.  I know lots of post ops who don't dump at all...or if they do it's not bad.  Dumping doesn't really mean that you'll be doubled over vomiting.  When I dump typically my heart will race, I'll get a little dizzy, a little hot...if it's really bad I may get a bit nauseaus...and I get tired.  I don't vomit...I don't get diarrhea...and I have a low sugar tolerance.  I can tolerate about 10g.  Most post ops can tolerate way more than I can.  But I'm ok with it...it helps keep me in line and which is part of the reason that at 3+ years out I've not really regained any weight (I tend to bounce around the same 3lbs). Anyway, I hope this helped! Kristy

Look into the VSG surgery...It reduces stomach size without any malapsorbtion issues.

I was interested in the VSG but I read that there are only 20 surgeons who do this type of surgery.  Can that be true? But the more I think about it the more I am leaning toward RNY because it makes sense that if you have a problem processing sugars/insulin resistance then simple restriction methods would not change that.  THerefore your body would still be holding onto and storing those sugars which causes the weight. So malabsorption may be needed and as afraid as I am of the dumping it certainly would be a negative reinforcement for corrective eating. I have an appointment on the 18th to talk for the first time with a bariatric center. I called the insurance company and I qualify just having a BMI>40 but I have sleep apnea too so hopefully this should be a somewhat easy process. I just have to get through the month of January.....we are going to Disney through Make A Wish for my daughter. Thanks for all the info! Laura www.caringbridge.org/visit/cassidyconway

Okay, I'm gonna chime in on this. I was born without lipid receptors....its a one in a million disorder. On top of that I started having PCOS symptoms at age 17-after I'd lost 89lbs. I am a complete metabolic screw up..Anyway, during my research for a treat ment for my disorder(there aren't many), I found all kinds of info and medical studies about RNY and it's effects on the metabolic system. PCOS is a metabolic /endocrine issue.  Long story short- the reason I had RNY was because it actually reroutes and changes the the way food is absorbed and processed in the body. It has probably leterally given me 30-40 years of life. The side-effects are real- but I was gonna be gone in few years anyway. I was scared. I'm very analytical. Lapband hasn't been shown to have the same effect as RNY on the endocrine system(other than actaully losing the weight...which itself helps) Hugs, Angie

Thanks Angie, That was exactly they way I was seeing things.  I hadnt read anything that says that directly but I work in the medical field and that just made sense to me. I dont have the same endocrine problems you do but I am a complete hormonal mess :lol  Not only do I have PCOS, I have Hashimoto's Disease and what they have termed "precushings" because my cortisol is high and my ACTH is normal.  They suspect that I have a microadenoma on my pituitary gland.  So the major hormone producing organs of my body, outside of the adrenal gland, are screwed up, thyroid, ovaries and pituitary. I hope that WLS helps me.  I am both scared and excited about the prospect. Laura www.caringbridge.org/visit/cassidyconway

Hi all, I'm going to join the discussion because this was the exact question I was battling.  I am blessed to be seeing one of the foremost researchers on PCOS in the world, Dr. Kathleen Hoeger, my endocrinologist.  She is the one who wanted me to look into WLS in the first place.  She was accepting of the lap band, but she really was much more supportive of the RNY.  Her experience has shown many people who have RNY simply do not have PCOS any more post-op.  Angie, what you said is right on the money with what she told me.  She says that  lap band has not been proven to rid the body of the hormones that perpetuate this disorder.  RNY changes the way that you body handles food, while lap band just slows and restricts the process of eating itself.  This was hard to hear at first because I really wanted lap band, but the more I think about, the more I warm to the idea.  If I'm going to have surgery, I want to make sure I do everything possible to get rid of these dang hormones that cause us all so much grief.  I'm still young (22) and I want to have babies in the future and live a normal life.  But, as everyone says, it is a very personal decision that everyone must make.  I wish you luck and keep us posted!