Need Help Making a Decision

I initially thought I wanted the VSG, but my surgeon recommended the RNY for me based on the amount of weight I needed to lose. I will be 54 in October (had my surgery last year). Absolutely no complications and I have had great results. Follow your doctor's guidelines and use the boards here to get additional information. The only regret I have is that I didn't have this surgery years ago. Good luck on your journey.

Trust, smust.  Make sure your surgeon has done hundreds of RYN before you and with good results

Other than the weight loss,  the disappearance of heartburn because they fixed my hiatal hernia at the same time, was the best.  RYN done by an experieinced has about the same risk level as a gall bladder operation.

That being said it is major sugery with a .5% mortality.  Perhaps your obesity problem is not significant enough to warrant major surgery.   I never wanted VSG.  At 57 and a BMI of 48.5, I knew I only had one chance and RYN has alot more research behind it.

Personally, I was 57 and RYN saved my life, but I knew I would be having knee surgery if I didn't get the weight off and RNY is easier to recover from than knee replacement surgery.  I believe the complications from obesity get more impactful as we age (at least the ortho ones do).

It does not seem to me that you have done enough investigation into the surgery itself and do not have a good perspective on the probablilty of post-op complications and of the down sides of not having the surgery.  Write that down and that a good look at what the + and - mean for you.  No one can do that for you. 

I've posted this before, but here is my approach.

SHOULD YOU GET WLS?

It's major surgery and carries risks - I do not see your weight or BMI posted, so like everything with risks - you have to identify the pros and cons for you and make the right decision for you.

About your stats for success - the 75% gain back a good part is not the whole story.  Roughly, 25% of people gain it all back, even with weight loss surgery(WLS).  That compares with 95-97% of people gaining it all back without surgery.

About 50% of people keep off at least 50 pounds.  If you lost 100 and gained 49 back - for a net loss of 51 pounds - you may not feel great, but a 50 pound permanent weight loss may still be a significant health improvement for your body. 

Then it seems like 20-25% of people make the permanent changes needed and with the edge that surgery gives them, can live on a ~1000 cal/day diet for the rest of their lives. 

So, you ask youself - how significant is my weight problem? - I don;t know for you, you could be at 175 and unhappy or you could be a 400 pounds with many health issues.

So, you ask yourself - how hard are you willing to work at this?  You have one best chance with WLS, so if you are not ready to make permanent changes, I might suggest waiting until you are.  Even after surgery, expect to measure your portions, track your calories, avoid snacking and too much drinking, give up smoking, and working through the emotional issues that cause you to make unwise choices. 

Then, ask yourself what you will gain - for me I avoided knee surgery because I've lost 145 pounds and distanced myself from diabetes because my A1C is back down. 

About GERD - I discovered I had a hiatal hernia which was repaired during my RNY surgery - IT HAS BEEN HEAVEN without the constant heartburn. Again, that is a risk that might tip in the other direction for you.

Me personally, I ask WHAT THE F&^% was I waiting for?  I am at 18 months post-op, so this is still the honeymoon phase, but I worked to get down to a normal BMI, 13% body fat, and a size 6 from a 22/24.  I weight lift with a trainer and get in 10,000 steps most days - that is very different from my pre-WLS behaviors.  The WLS gave me enough help, that I could do the rest of the work, but WLS does not do it all.  I could not still be a cream-pie guzzling couch potato and keep the weight off.  

This is an important decision and I commend your wanting to make it an informed one for you.

WHY I HAD WLS SURGERY

Be as nervous as you like, that's normal, but also use this time to get clear on why you are doing it.  Most likely your reasons are more than your appearance. I would suggest making a list and then you can check them off over the next months and have motivation to keep the weight off.  For what it's worth, here is the logic I had for surgery: 

   1 - My knee is messed-up and if I do not get the weight off, I will be looking at knee surgery.

   2 - I just lost 100+ pounds with a conventional diet and put 90% of it back on within 2 years, so I am not one of the lucky 3-5% who will keep the weight off.  This may be you, also.

   3 - WLS is easier to recover from than knee surgery.

   4 - WLS was (and is) the right option for me. It may not be perfect, but it is my best option.  If I don't get it, I will yo-yo every 5 years - 2 years to take it off and 2-3 years to gain it back. 

   5- Things that will be better:  enjoying the outdoors, clothes, . . .

I was more than nervous - before surgery I updated my will, changed my insurance benficiaries, had everything notarized, made sure a lawyer-friend had a folder with all my important papers, (I had the advanced directives form to fill out but I did not get around to it).  That is just me - be prepared.  But, now all that stuff is done. 

But, when it was all said and done, and I was in pre-op and felt the first wave of sedative kick in, I looked at the clock and my reaction was - 7:42, my new lucky number!  I had difficult times - most of us had, but pre-op clarity will help you get through a lot of post-op crap.

May I humbly suggest you generate a list and write down your motivations for surgery.  It might help you prevent 'buyers remorse' and give you focus to get through any difficult times. And give you something to do while you are waiting for the insurance approval. 

I did not have second thoughts after surgery until I reached my goal weight and had this thought that maybe I could have lost it on my own (again) if only I tried harder.  Then I found research that showed that dieting makes your hunger hormone, Ghrelin, go 38% higher and STAY THERE.  That study popped by little I could have done it without surgery balloon.  Never second guessing my decision again.

Best wishes on your journey,

Hi Sharon, I appreciate your reply very much! my stats are posted on my home page. I don't know why they're not showing up, but here's a run down of my stats: height 5'2", weight 282.2, BMI 51.6, and Yes, I need the wls no doubt there! Like many others I've yoyo dieted all my life, and failed to keep it off. My last attempt at weight loss was back in 2009. I weighed 392lbs my highest weight ever. I had a lot of health related issues due to my weight at that time. Sleep apnea, type 2 diabetes, high blood pressure, high cholesterol, and osteoarthritis. When I found out I had type 2 diabetes I freaked, and that very day I started on a very strict diet and exercise program. It took me 3yrs to lose 240lbs, but I did it all on my own. I kept the weight off for 2yrs before I started packing it back on at a very fast rate. So here I am 159lbs gained back.

I have all the negative feelings about myself again like all the other times I tried and failed. I have very bad eating habits nothing medical going on here that I can blame my weight on.  I know the surgery will help me lose the weight, but It's going to be up to me to work very hard once I do to keep it off. I thought to my self so many times this last time I allowed my self to gain all this weight back; What in the world are you thinking did you need a reminder of how bad you felt mentally and physically at almost 400lbs! Did you need a reminder that your life at that high of a weight was pretty much over! I'm so thankful that I got a grip on myself before I gained it all back, but gaining 140 lbs back so quickly has really harmed my health and quality of life.

I've done a lot of researching on the vsg and the rny over the past 8mos. So I'm not in the dark about either surgery just nervous about the complications I've read about on the rny complication forum.  I feel very confident in the choice I've made with the surgeon I have chosen, Dr. Douglas Olsen, you can look him up on the forum. He has really good reviews, and many years of experience with great outcomes for both the vsg and rny. First time I met with him I was very impressed with the way he put me at ease right off. I was very nervous and afraid I might be judged upon my appearance, but that was not the case at all. Dr. Olsen, was very polite and friendly right from the start and took his time in explain both surgeries, and answer all my question and concerns about them.  I left feeling very confident in him and with myself that I was making the right decision. 

I had my heart set on the vsg, and was very excited when I found out I was approved, but with the results of my UGI it's no longer possible to have the vsg. My surgery date was set for 9/26/16, for vsg I believe that will change too. I have an appointment to see Dr. Olsen again next week to go over my test results, and decide then if I want to move forward. I just want you to know the surgery itself I'm not afraid of it's the after complication I read about in the forum. I don't know if you have read any of them, but if you have please let me know what your opinion about them are. I know in the end this is my choice, and I have to be prepared to live with it. 

Thank you again for your reply, and all you help! Lory

If I were still pre-op, we would almost be twins.  (I don;t drink, so please consider this a handshake)   I was 284 at my highest and only 5'3 on a good day.  I lost 120 pounds in 2011 and after 1 day at my goal wt, began gaining 110 of them back.  I remember telling myself today I will do better and then being a diet failure by 2pm.  I finally gave up trying - I could only be a failure at keeping it off for so long before finding other goals where I could succeed.  (This was not the first time I had lost >100 pounds and fought every gosh darned day to keep them off,)  I had know about the stat that only 3-5% keep an sig weight loss off but I always assumed I could/should/would be one of them.  When I went to my surgeon's Free Seminar and heard him say it, I was finally ready to consider that I was NOT one of those lucky few.  It took me another several weeks before I could truly accept that I was not. I was a little weepy when I true acceptance sunk in.  That helped me forgive myself for gaining all the weight back.  As did the fact that the cure rate for obesity is the same as for pancreatic cancer (one of the worst cure rates at 3%) and would I tell a cancer patient that they are a failure because the cancer came back - of course not - so I had to accept that the weight loss stats applied to even me and move on with looking at my options.  When I look back, I am annoyed that my PCP did not intervene and suggest that I look into WLS as the pounds began returning - I could have had WLS at 220 pounds instead of 264.  A co-teacher who had it reached out to me.  Thank God for him.

That being said, are you still thinking that you could be one of the lucky few who can lose it and keep it off? This is called magical thinking and I am not sure where you are at with this question.  If you really accepted how limited your options are (stay MO, yoyo for the rest of your life, or throw your hat in the ring for RNY and do everything you can to min your risks), you would focus on min the risks - whatever they are.  

For me, when I really accepted what my options really were, WLS was you only viable option, then I focused on how to minimize chances of complications, whatever they might be.

In other words - VSG is out - so what - RYN is there to save your life.  

THIS IS WHAT I THINK A PREOP PERSON CAN DO TO MIN RISKS WITH RNY.  If you think you are serious about RNY, I might post question this as a sep post and see what you get from others,  I will be 2 years op-op in Dec, so might get different answers from more recent or more long term RYNers.

1. The biggest thing you can do to min the chance of complications is to get an exp surgeon - this is based on med journal data.  I think Complications fall after 100 surgeries.  (Don't be someone's beta tester.)

Ideas that Fall Under the category of "The healthier you go into surgery, the healthier you come out"

2. Work though any heavy duty eating disorder stuff before surgery - binge-purge, grief counseling, childhood sex abuse, etc.  There is so much other stuff to work through post-op and post-100-pound weight loss that anything you can address before surgery will make it better,  You only have one best try at WLS so max your chances of success.
3. Get mobile - you do not have to be running - but get to where you can walk because you will need to walk within a few hours of getting out of anesthesia to avoid blot clots and other bad stuff like pneumonia.
4. Prepare for post WLS life - there are hundreds of posts on this.  But the biggest for me looking back: be prepared to continue to use every dieting skill you ever learned.  WLS is not a magic bullet but an assist that increases our chances of success.  I still have a set-point of about 1000 calories a day and that is intolerable long term without WLS, but with it, it I work at it, I can do it, if I watch and work at it.  Most successful long-term RYNers use:

• Portion control
• counting calories and PROTEIN and FLUID
• reasonable exercise - for me weightlifting to rebuild muscle mass and walking 10,000 has been enough.  I have not yet had to return to the purgatory of hours each week at the gym - but I am prepared to do so, if ambivalent.
• avoid carbs, sugar and empty calories - a bit of a challenge for me at the present
• taking the vits - there are non-chewable bariatric vits that just came out, so this may be easier going forward.

5.Commit to doing the long-term follow-up.  At a min an annual checking with your surgeon (no matter where you are on the weight loss spectrum).  Just because you gain the weight back does not mean that you did not have WLS. In fact, if you think you cannot do this, you prob do not want to have the surgery.  You would be a complication waiting to ****** visit.

6.Being willing to get professional  help to address issues - physical, emotional or life style. Keep your eye out for a good eating disorder/body image psych to have in case you need one.  (I have a great one for central new jersey.)  You do  not want to have to search around for someone if you are in a crisis.  My surgeon even has one come to his office once or twice a week - when he is doing surgery on M W and F.  You want to nip any issues before they become ISSUES.  Actually since we have had weight loss ISSUES for so long, we want to address them before they become ISSUES.

This has been a good post for me to write to reinforce my commitment to health.

I wish us both clear sailing on our WLS journeys.

PS - My famous last words:  Pre-op clarity will get you over a lot of post-op crap.  (And there will be some)

I was 56 when I had my RNY. I had some complications immediately following surgery (I'm an odd ball who heals so fast, the scar tissue was closing up stuff before the surgery was even finished and it was closing stuff that was supposed to stay open)... but all that got sorted out but I did go under the knife four times with the last being a full open incision. So healing for me was pretty slow. That said, knee surgery (like the poster above) was looming in my future and frankly, had I not lost the weight, I doubt the knee surgery would have been successful. You know it's bad when it even hurts to swim.

And best of all, I don't need knee surgery now. My feet problems have resolved themselves. And my back problems are, for the most part, gone. Go figure.

I do not regret the surgery at all. Not one bit. I am faithful with following the recommendations of my NUT, I use the vitamin patches faithfully and take my calcium faithfully.

I also made some MAJOR life changes that I believe makes my ability to follow those recommendations possible. I quit my job (okay, I retired early), but the stress that relieved has been so significant; I don't even think about eating as a way to make myself feel better emotionally any more. But I sure struggled with it when I first went back to work after surgery... thankfully, I was early enough on that the stuff I craved would have made me very ill and I hate puking more than I hate not eating. But once the hated job was gone, the desire to stress eat was gone.

I'm learning to do other things when I'm angry or stressed (cause you know, life still happens) such as paint, sew, weave, garden, and read. I couldn't do that stuff before because I didn't have time and I was so overwhelmed I couldn't even really THINK about alternatives to eating.

I still hate exercise per se, but I'm just naturally moving more and walking a lot more because it's easy to do now and it doesn't hurt.

I should also mention that the problems I had been having with my heart before surgery... racing, racing and dizzy spells and skipping beats... well, that has stopped as well. It seemed to improve the most around the 50 pound lost mark. So, I'm not nearly as tired as I was lugging around that excess weight.

My bones and cartridge were breaking down in part due to extreme wear and tear but I also think my diet was very poor. I eat far more healthfully and with the nutritional boost of the vitamins and the additional exercise, I'm hoping my bones hold up longer than they would have otherwise. I might have bounced more with the extra weight on, but I'm a lot less likely to fall and break something with it off. In fact, I haven't fallen down at all since I had the surgery and falling was a regular part of my life before, now that I think about it and I'm doing a whole lot more stair/ladder/climbing/walking/running activities than I have in many years.

Hi Catek2652, Thank you so much for your reply. I appreciate it very much!