re: thinking about surgery choice
I wanted to post a thread responding to nicole's post about surgery type. Please read her post if you haven't already.
http://www.obesityhelp.com/forums/wls_in_your_20s/4316877/Thinking-about-surgery-Serious-Questions-to-ask-yourself/
I can't stress enough how important your choice of surgery is. I am 15.5 months post gastic bypass, and I am trying to get approved for revision to the DS to correct complications of severe dumping syndrome, constant nausea, and food intolerations.
As Nicole mentioned in her post, it is very important to consider the long term impact of your choice of surgery, including: the long term success of maintanance, resolution of diabetes if present, and the quality of life (complications, variety in the diet, etc).
What you first need to understand about WLS is that there are two types of surgeries: 1) restrictive 2) malabsorbtion
The RNY bypass is considered a primarily restrictive surgery with partial malabsorption. In contrast the Duodenal switch (DS) is primarily a malabsorbtion surgery with partial restriction. The restrictive component of the DS is the vertical sleeve gastrectomy (VSG). Essentially, if you had the VSG, then you had half of the DS surgery.
The problem with the bypass is that the malabsorbtion component of surgery lasts for about 2 years after which you will have to control your weight via diet and the proper use of your restriction. The problem with this is that the standard RNY pouch is generally not permanently restrictive, and so the RNY has a bad RAP for regain. Mechanical failure of the surgery is quite common and about 20% of RNY patients have revision in the first five years. Of course some of this is due to patients poor dietery decisions.
The issues of mechanical failure (dilated pouch, stoma) can be avoided by having the banded gastric bypass (AKA the fobi pouch procedure. FYI I had this surgery). With the addition of gastric banding in addition to the RNY, the fobi pouch is permanently restrictive and therefore has much greater success than the RNY as shown by statistics. The stats for the two procedures are the following (you can look these stats up anywhere. WLS success statistics are determined after 5 years post op. Medical research defines success as losing 50% excess weight by 5 years. This includes any regain which is common).
Excess weight loss: RNY 65% Fobi pouch 70%
success rate 70% 90%
revisions 15-25% 3-7%
You can see that the permanently restrictive fobi pouch has much greater success than the RNY. It only makes sense that the gastric bypass, which is a primarily restrictive surgery should be successful by permanent restriction. Unfortunately this is not always the case with the RNY.
Despite the success of the Fobi pouch, I still would not recommend this surgery due to other horrible complications that will affect you life post op. In generaly your diet will be greatly affected for with your new small pouch you will likely not be able to tolerate all foods. Everyone is different, but you may have intolerations to: beef, bread, rice and pasta. You may also have dumping syndrome from sugary and fatty foods. Many people can't enjoy fruit or dairy because of the sugar content. Furthermore, you may have severe dumping syndrome, which will cause you to dump off of just about anything you eat.
Of course not everyone has these problems, but the dietery restrictions and complications that may greatly affect your social life (including dating which Nicole discussed in her thread).
Think about it. You're a post op RNYer and you go out with your friends. Let's say you go to Hooters. Your buddies order a 50 piece chicken wings pitchers of beer and cheeseburgers. What are you going to order?
Scenario number two: You take a lovely babe (or stud) on a hot date. You go to a nice dinner. What will you order that will ensure no vommiting, dumping or anything awkward caused by having a "tool" in you.
Just think about it. You may not have issues, but if you have a pissy pouch like me, then these scenarios will be a daily challenge. When you are with friends you will feel ostracized by not being able to join in on the fun (within reason of course). Also, on dates, you may have awkward pouch moments. It's not fun. With the DS, you genarally do not have these dietery complications, and are able to have a much wider variety in your diet due to the permanent malabsorbtion component (of course you have to be mindful of simple carbs and not be completely reckless with food choices).
I would recommend the VSG and DS routes instead of the bypass. The Ds surgery is considered the most successful procedure. It has the best weight loss statistics, including maintanance and also has the highest percent resolution of diabetes, without the complications of reactive hypoglycemia, which is very common in gastric bypass. If your BMI is over 50 and or you have diabetese, then this is absolutely the best option as proven by medical research. It is also a viable option for lower BMI patients; however, many prefer to have the less invasive part of the surger, the VSG which is just the restrictive component of the surgery. If your BMI is over 50, I would not suggest only the restriction for you are highly likely going to need a second operation longer out to complete the DS. Lower BMI patients have issues also that many times requires the malabsorbtion component of the DS, so if you are considering the VSG, I would urge you to weigh your options (pun intended), and really make sure that you really think you can work with the pure restriction long term (not just the first few years.). As Nicole pointed out in her thread, many insurance policied are now implementing the one WLS per lifetime, and if you ever need revision, you may not be able to finance it. That would be a horrible scenario. I would encourage one high quality surgery that has very little chance for revision. There is no need to gamble with possibly needing a second surgery.
This is also the case with gastric bypass. Many (myself included), need revision to the DS to correct complications (with or without regain). It is for this reason as well that I would recommend the DS as your initial surgery, for you will likely never need a second surgery. Occasionally surgical intervention may be required to correct complications with the DS, but revision to another procedure is almost unheard of.
* of course these are my opinions, and you should do thorough research. I am not a doctor.
http://www.obesityhelp.com/forums/wls_in_your_20s/4316877/Thinking-about-surgery-Serious-Questions-to-ask-yourself/
I can't stress enough how important your choice of surgery is. I am 15.5 months post gastic bypass, and I am trying to get approved for revision to the DS to correct complications of severe dumping syndrome, constant nausea, and food intolerations.
As Nicole mentioned in her post, it is very important to consider the long term impact of your choice of surgery, including: the long term success of maintanance, resolution of diabetes if present, and the quality of life (complications, variety in the diet, etc).
What you first need to understand about WLS is that there are two types of surgeries: 1) restrictive 2) malabsorbtion
The RNY bypass is considered a primarily restrictive surgery with partial malabsorption. In contrast the Duodenal switch (DS) is primarily a malabsorbtion surgery with partial restriction. The restrictive component of the DS is the vertical sleeve gastrectomy (VSG). Essentially, if you had the VSG, then you had half of the DS surgery.
The problem with the bypass is that the malabsorbtion component of surgery lasts for about 2 years after which you will have to control your weight via diet and the proper use of your restriction. The problem with this is that the standard RNY pouch is generally not permanently restrictive, and so the RNY has a bad RAP for regain. Mechanical failure of the surgery is quite common and about 20% of RNY patients have revision in the first five years. Of course some of this is due to patients poor dietery decisions.
The issues of mechanical failure (dilated pouch, stoma) can be avoided by having the banded gastric bypass (AKA the fobi pouch procedure. FYI I had this surgery). With the addition of gastric banding in addition to the RNY, the fobi pouch is permanently restrictive and therefore has much greater success than the RNY as shown by statistics. The stats for the two procedures are the following (you can look these stats up anywhere. WLS success statistics are determined after 5 years post op. Medical research defines success as losing 50% excess weight by 5 years. This includes any regain which is common).
Excess weight loss: RNY 65% Fobi pouch 70%
success rate 70% 90%
revisions 15-25% 3-7%
You can see that the permanently restrictive fobi pouch has much greater success than the RNY. It only makes sense that the gastric bypass, which is a primarily restrictive surgery should be successful by permanent restriction. Unfortunately this is not always the case with the RNY.
Despite the success of the Fobi pouch, I still would not recommend this surgery due to other horrible complications that will affect you life post op. In generaly your diet will be greatly affected for with your new small pouch you will likely not be able to tolerate all foods. Everyone is different, but you may have intolerations to: beef, bread, rice and pasta. You may also have dumping syndrome from sugary and fatty foods. Many people can't enjoy fruit or dairy because of the sugar content. Furthermore, you may have severe dumping syndrome, which will cause you to dump off of just about anything you eat.
Of course not everyone has these problems, but the dietery restrictions and complications that may greatly affect your social life (including dating which Nicole discussed in her thread).
Think about it. You're a post op RNYer and you go out with your friends. Let's say you go to Hooters. Your buddies order a 50 piece chicken wings pitchers of beer and cheeseburgers. What are you going to order?
Scenario number two: You take a lovely babe (or stud) on a hot date. You go to a nice dinner. What will you order that will ensure no vommiting, dumping or anything awkward caused by having a "tool" in you.
Just think about it. You may not have issues, but if you have a pissy pouch like me, then these scenarios will be a daily challenge. When you are with friends you will feel ostracized by not being able to join in on the fun (within reason of course). Also, on dates, you may have awkward pouch moments. It's not fun. With the DS, you genarally do not have these dietery complications, and are able to have a much wider variety in your diet due to the permanent malabsorbtion component (of course you have to be mindful of simple carbs and not be completely reckless with food choices).
I would recommend the VSG and DS routes instead of the bypass. The Ds surgery is considered the most successful procedure. It has the best weight loss statistics, including maintanance and also has the highest percent resolution of diabetes, without the complications of reactive hypoglycemia, which is very common in gastric bypass. If your BMI is over 50 and or you have diabetese, then this is absolutely the best option as proven by medical research. It is also a viable option for lower BMI patients; however, many prefer to have the less invasive part of the surger, the VSG which is just the restrictive component of the surgery. If your BMI is over 50, I would not suggest only the restriction for you are highly likely going to need a second operation longer out to complete the DS. Lower BMI patients have issues also that many times requires the malabsorbtion component of the DS, so if you are considering the VSG, I would urge you to weigh your options (pun intended), and really make sure that you really think you can work with the pure restriction long term (not just the first few years.). As Nicole pointed out in her thread, many insurance policied are now implementing the one WLS per lifetime, and if you ever need revision, you may not be able to finance it. That would be a horrible scenario. I would encourage one high quality surgery that has very little chance for revision. There is no need to gamble with possibly needing a second surgery.
This is also the case with gastric bypass. Many (myself included), need revision to the DS to correct complications (with or without regain). It is for this reason as well that I would recommend the DS as your initial surgery, for you will likely never need a second surgery. Occasionally surgical intervention may be required to correct complications with the DS, but revision to another procedure is almost unheard of.
* of course these are my opinions, and you should do thorough research. I am not a doctor.
My doctor discussed all of the options with me.. DS, VSG, RNY, LAP band... everything but the Fobi gastric bypass and the VBG.
I thought long and hard about everything. I really truly did. For me... I think the VSG and DS offer TOO much freedom. FOR ME. I do tend to eat higher fatty foods, and I do tend to favor sweets.. and my break up with carbs... it was devestating. I hate putting it like that, but I was absolutely 100% an emotional eater and food was my savior. so I'm currently using my pre-op time to cut all of those out of my life... (fatty stuff, sugars, carbs) and I'm also re-directing all of my emotions into something more constructive (like working out, blogging, cleaning--my house has never been so clean).
The reason why I say I think the VSG and DS offer too MUCH freedom for me... is because I've lurked around those forums... I see a lot of "oh, my diet hasn't changed much, i can still eat sweets, just less of it" and stuff like that.
Me personally.. I need that control. I need that... threat of Dumping. but thats what I need.
And to answer your questions about hooters and date nights... I've never been to hooters, so I'm not quite sure what they offer in the way of grilled options... but i'd get something grilled and eat what i can of it. Same thing for hot date nights... I'd order something i KNOW i can have. But that's just me. I know a lot of people say that they're dedicated to their tool,and the lifestyle change... But reading a lot of the posts and what not... I see a lot of people who don't. Not every one... but a lot.
Thats my 2 cents anyway.
I thought long and hard about everything. I really truly did. For me... I think the VSG and DS offer TOO much freedom. FOR ME. I do tend to eat higher fatty foods, and I do tend to favor sweets.. and my break up with carbs... it was devestating. I hate putting it like that, but I was absolutely 100% an emotional eater and food was my savior. so I'm currently using my pre-op time to cut all of those out of my life... (fatty stuff, sugars, carbs) and I'm also re-directing all of my emotions into something more constructive (like working out, blogging, cleaning--my house has never been so clean).
The reason why I say I think the VSG and DS offer too MUCH freedom for me... is because I've lurked around those forums... I see a lot of "oh, my diet hasn't changed much, i can still eat sweets, just less of it" and stuff like that.
Me personally.. I need that control. I need that... threat of Dumping. but thats what I need.
And to answer your questions about hooters and date nights... I've never been to hooters, so I'm not quite sure what they offer in the way of grilled options... but i'd get something grilled and eat what i can of it. Same thing for hot date nights... I'd order something i KNOW i can have. But that's just me. I know a lot of people say that they're dedicated to their tool,and the lifestyle change... But reading a lot of the posts and what not... I see a lot of people who don't. Not every one... but a lot.
Thats my 2 cents anyway.
<3 Katie facebook.com/katielynn8806 http://notjustaface.blogspot.com/ My blog!
~~ Life is too important to be taken seriously~~ Oscar Wilde
Includes the 50lb loss pre-op
~~ Life is too important to be taken seriously~~ Oscar Wilde
Includes the 50lb loss pre-op
I understand, but if you have severe dumping syndrome ou will be miserable. Wth a permanent malabsorbtion surgery you don't have to be so "clean and green," but you can always opt to abstain from sweets anyways. you might as well have a surgery that will help your weight loss more than the bypass and not have the ill effects of dumping and food intolerations.
Just FYI: dumping will not curb your junk food addiction. Also severe dumping syndrome is generally linked to weight regain. Sounds backwards, but it is true.
Also if you have diabetes, the DS is the best.
Just FYI: dumping will not curb your junk food addiction. Also severe dumping syndrome is generally linked to weight regain. Sounds backwards, but it is true.
Also if you have diabetes, the DS is the best.
I know that dumping will not curb my junk food thing... But it will deter me from eating it.
All WLS have their ups and downs... and not all of the downs are guarenteed to happen.
I also think it depends on what you're okay giving up. I won't mind being so clean and green with food, which is why I'm cutting everything out now.
Right now, the only thing keeping me from eating sweets is the fact that I'll gain weight from it, and on my pre-op diet I have to keep a food log, and it will be embarrassing to show my NUT that i'm cheating and not showing that I can change my lifestyle.
Yes... I can abstain from treats... but its the knowing I can have something that leads me into the temptation.
I also think that everyone is an advocate for the surgey they had as long as it went well.
Plus, I'm not one of those people who think when a doctor looks at me, all he sees is dollar signs. Perhaps thats because I'm in the medical field and have worked closely with many different types of doctors, or maybe because I have no reservations about my surgeon that I chose. Who knows. I just think not all doctors are out for the cash.
Thats just me.
All WLS have their ups and downs... and not all of the downs are guarenteed to happen.
I also think it depends on what you're okay giving up. I won't mind being so clean and green with food, which is why I'm cutting everything out now.
Right now, the only thing keeping me from eating sweets is the fact that I'll gain weight from it, and on my pre-op diet I have to keep a food log, and it will be embarrassing to show my NUT that i'm cheating and not showing that I can change my lifestyle.
Yes... I can abstain from treats... but its the knowing I can have something that leads me into the temptation.
I also think that everyone is an advocate for the surgey they had as long as it went well.
Plus, I'm not one of those people who think when a doctor looks at me, all he sees is dollar signs. Perhaps thats because I'm in the medical field and have worked closely with many different types of doctors, or maybe because I have no reservations about my surgeon that I chose. Who knows. I just think not all doctors are out for the cash.
Thats just me.
<3 Katie facebook.com/katielynn8806 http://notjustaface.blogspot.com/ My blog!
~~ Life is too important to be taken seriously~~ Oscar Wilde
Includes the 50lb loss pre-op
~~ Life is too important to be taken seriously~~ Oscar Wilde
Includes the 50lb loss pre-op
I understand your thoughts on junk food and dumping. We all believe that preop, but it doesn't help in the long run. There are no studies that indicate that gastric bypass patients who dump are more successful then those that don't. Dumping will not stop you from eating junk food.
I'm no doctor, but I would highly recommend the VSG or DS over the RNY. If you have complications with a RNY, it will need to be reversed before revising you to the DS. The VSG is the restrictive component of the DS, so if you ever need the malabsorbtion, the revision is straight forward, because you already have the sleeve half.That's a lot easier then requiring a reversal of a procedure.
My dad is a doctor. I think you are mistaken of their motivation.
I'm no doctor, but I would highly recommend the VSG or DS over the RNY. If you have complications with a RNY, it will need to be reversed before revising you to the DS. The VSG is the restrictive component of the DS, so if you ever need the malabsorbtion, the revision is straight forward, because you already have the sleeve half.That's a lot easier then requiring a reversal of a procedure.
My dad is a doctor. I think you are mistaken of their motivation.
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