evaluating the risks (xpost)

  Hello,

I'm in the process of deciding between the sleeve and a DS. I am a stay at home mom with a limited circle of support and have a 4 month old and 6 year old. I am trying to evaluate the risk of both surgeries to best make a decision.

I have a BMI of 42 with no comorbities other than a sore back from wearing my baby in a carrier most of day. I would have my husband home for two weeks after the surgery but otherwise I would have to figure things out on my own.

I've made a list of pros and cons of both surgeries but I was wondering how you all went about weighing the risks for complications. I think I would sincerly regret having had any surgery if my quality of life would be worse afterwards. I feel that if anything were to go wrong with the surgery or major complications afterwards that my whole family would be affected - not just consequenses for me.
 
I would appreciate your insight.

Meta

My surgeon helps his patients decide by helping them identify what kind of eating demons you are trying to overcome and which surgery matches those.

Bloater- eats one or more big meals a day but rarely snacks. A restrictive WLS may be enough, such as the band or the VSG.

Sweeter-is addicted to sweets and may need some restriction help. The RNY may be enough and are willing to take more vitamins.

Grazer-eats or nibbles all day or evening and needs a little restrictive help. The DS is the recommended WLS for a grazer, if they can keep up with the required vitamins and protein.

I did a pros and cons list too, but not anything related to complications. They all have a chance for complications. I did one related to success rates and whether I could live with the lifestyle change requirements.

Good luck with your decision.

--gina
 

 Without commorbidities you may be able to get away with the sleeve.  We have many successful sleevers here.  It depends on whether or not you believe that your weight is because of volume eating or if you have a metabolic disorder that makes it extremely difficult to lose weight and more difficult to keep it off.  In that case then the DS is your best choice.

I went with the sleeve for these reasons:

-I knew I would lose weight with any surgery as I can lose weight without surgery (no metabolic issues here)

-I knew I could keep off my weight if I had hunger control and the hunger control of VSG and DS is the same (at least the way my surgeon does the DS-if the sleeve is made bigger, as some surgeons do, not all the fundus may be removed so there may be more ghrelin)

-I was worried about medicalizing myself and so wanted to avoid malabsorption if at all possible as malabsorption increases the risk of issues due to malnutrition over and above the sleeve (which still has some, but has much less)

-I didn't want to deal with the digestive issues that often accompany malabsorption (I already have some of that due to not having a gallbladder and didn't want more).

-I knew I would get more active as the weight came off and I was worried about losing too much if I had malasborption and not just restriction. At this point, I'm not sure how valid that concern was, but I currently eat 1800-2100 calorie a day depending on what kind of races I'm training for (I'm a triathlete). Eating as much as twice that amount on a regular basis would be a major pain in the ass. I could do it, but I'd hate it. (I already have to do it sometimes and I already hate it.)

While I agree with the idea that you need to know what your food issues are, I really disagree with Gina's doctor's analysis of what kind of eaters should get what kind of surgery. I was never a volume eater and I was a grazer of sorts (and still am to some extent), but the reason I was doing that was because of ghrelin. I didn't need the malabsorption of the DS to deal with grazing, just getting hunger control was enough. (I also disagree that people with a sweets issue should get the RnY. I also have a sweet tooth, but, again, removal of ghrelin was enough to make it manageable.)

I agree with LadyTazz that the reason to get the DS over the VSG as a lightweight is to combat a metabolic disorder (such as PCOS or diabetes). I would add to that, if you have exercise limitations, a DS may be necessary as well. Plus, some people just want the peace of mind of having the surgery that has the best weight loss stats even if (on paper at least) they don't "need" it.

Finally, for the SMO, the difference between a VSG and DS can make the difference between getting to goal or not and also how easy the journey is. That doesn't apply to us lightweights though.

I hope my question isn't too "off topic....

Doesn't RNY also help with your body's ghrelin? I am seriously managing my hunger since my surgery, and on top of small portions, I have a lot of control now a days, as oposed to pre surgery which was a roller coaster of sorts...

I sure hope my hunger control NEVER goes away! It is a God send...

There are a couple of issues. First, hunger isn't all about ghrelin. There are other hormones involved in hunger control. Second, hunger is also about psychological factors -- how we interpret our body's signals, for example.

So, with RnY, there is ghrelin reduction according to some studies I have read and no ghrelin reduction according to others. The blind stomach is still there and it still produces ghrelin. But apparently at a muchly reduced rate, at least in the cases where reduced ghrelin was found.

OTOH, with the band, there is no ghrelin reduction. In fact, one study found band patients had TWICE AS MUCH ghrelin as pre-op. But people with the band do experience hunger control (as long as they find their sweet spot).

For me, my hunger issues seemed clearly related to ghrelin. I had the same symptoms as were shown in the lab when subjects were injected with extra ghrelin. So, for me, I wanted ghrelin to be gone. I wasn't willing to count on the hunger control of RnY or the band. Anecdotally, it seemed to me that their hunger control wasn't as complete or long lasting as with VSG.

That said, even with reduced ghrelin, while I no longer have raging hunger that makes me want to hunt something down and kill it and eat it raw often as early as half an hour after eating, I do still experience hunger. It's just that it's more manageable now. It's normal hunger. Other people get these operations and never experience hunger ever again.

Meta
I had a long discussion with my doctor on which surgery would be best for me.  We discussed my health history, my family history, and the pros and cons for each.  I suggest that you take the time to have the same discussion with your doctor, as I am very comfortable with what we decided together.
Take Care

I agree with everything MacMaden has to say.  I'm a sleever as well.   Hunger was a huge issue with me pre-op as well as desiring to be Thanksgiving full at least once a day.  I now have normal hunger (yes, I do get hungry when it's time to eat),  Some sleevers never get hungry.  The satisfaction of being overly full is gone (for good I hope).   Now over full is simply uncomfortable so I don't go there.

I had a sweet tooth pre op and was concerned about controlling that.  I can only eat a small amount of suger now.  I will dump if I over do it (not all sleevers dump).

Good luck making a decision.  Looks like you are doing your research.

K       

 Thank you all so much for your thought-provoking replies - I am taking it all in and it has helped me add a few more questions to my list.

I have already had my initial meeting with my surgeon and will have to make a decision before the end of June if I want to have the surgery by August.

Meta