Good Morning. Rock, paper, scissors, lizard, Spock

Rock--Paper--Scissors--Lizard--Spock is not a great way to choose the WLS best for you. lol
I thought I'd post again my surgeons philosophy or technique he uses to help patients choose the WLS that will most likely help them to be successful. It's in my OH profile but I have it set to "friends", so here it is again. Please tell us how you decided and what was the key to your decision. 

In my case, I fit all the definitions of grazer and even though I was a LW, my dietitian and surgeon said the DS would be best for me for long term success.

Dr Elariny's What Kind of Eater Are You? [Edit Post] on April 6, 2012 3:23 am Published Welcome!  Here's the run down my surgeon uses to help patients decide which surgery might help them address their eating demons the best. He describes our eating demons by categorizing eaters in 3 ways: 1) the bloater--eats one or two big meals a day, doesn't snack and is pretty active (busy) throughout the day. 2) the sweeter--is addicted to sweets/carbs/sugar and may need some help with volume eating. 3) the grazer--eats or nibbles pretty much constantly, getting 70% of their calories from snacks, and may eat a meal for longer than a half hour.   The bloater may do well with a restrictive only surgery such as the band or the VSG. With the band patients can expect 50-60% weight loss. It's a failure for sweeters and grazers. With the VSG expect 70% weight loss. This surgery can be converted to DS easily. (Note: we have seen lightweights be 100% successful with both the band and VSG here on this board) My surgeon sees about 55% weight loss maintained after 5 years with the VSG but he makes his sleeve larger than most. The sweeter may do well with the RNY using negative reinforcement of dumping on sugar and fat. There is a 20-25% chance of late regain after 2-3 years--a regain of 20-30% of the initial pounds lost. When successful, expect 60-65% weight loss. (I think these numbers are also more for heavy weights because we see much better success in the lightweights who stay hooked in here on the board) The grazer may do well the DS and has a 80-90% success rate long term. Patients can expect 90% weight loss. It is also puts type II diabetes in remission for approximately 90% of patients long term. The DS works well for sweeters, grazers and bloaters but can be beat with excessive sweets, fats and grazing. (My surgeon calls the DS the bazooka of weight loss surgeries. Some surgeons won't do the DS on lightweights but some will reduce the amount of malabsorption and give lightweights the DS using a longer common channel. For more info on the DS, see www.dsfacts.com.  There aren't that many surgeons skilled enough to do the DS. Don't jump into this one without doing a lot of research on your surgeon. Surgeons who don't do the DS will use scare tactics and lies to dissuade patients from pursuing the DS. We call them bait and don't switch surgeons, or outright greedy lying *******s.)

 

Good morning...

As a cross between a sweeter and a grazer, I have to be extra diligent...by just doing what I had been doing for almost 10 years....keep the sweets/carbs OUT of the house as much as possible...or make them such as I have to THINK about what I am doing.

If it has to cook, then I have the time to actually think...is this what I really WANT? Or if I have to go to the store to get it, I have the time to think.

Mindless snacking went by the wayside LONG ago due to my diabetes and insulin pump and my need to control that as best I could.

I could never live in the future we've seen in ST where food is avaiable in a Replicator, LOL...the only advantage that would have is the ability to make "good for us" stuff look and taste like the stuff our MOUTH wants.

The odd thing is that most of the time, my MOUTH wants good for me stuff just not necessarily protein...like green veggies. That's why I like salads that I can add meat too...get the best of both.

Liz

Between my insurance and the doctors availible (1-2hr away), I had the choice of RNY and band.  I had wanted a sleeve, to be able to have NSAIDs and because I am basically a volume eater.  No way according to the insurance.  So RNY was my choice.  I think I made the right one.  I have never had any issues and have lost 100% of excess weight, now just working to keep it off.

Initially, I went in thinking band. Then I did about 10 minutes of research, and changed my mind.

Like Liz, I'm a cross between a sweeter and a grazer. However, for me, I chose rny, in great part because my grazing goes for fats - and that said to me that I could out-eat it just by sheer volume. Sleeve was out for me because, per several doctors, I'd screwed up my metabolism enough that I needed at least a couple years malabsorption to essentially "reset" what I had.

At this point, I look for substitutes. If I want a Reeses, I make a chocolate/pb2 shake. If I want lemon ice, I make a crystal light lemonade flavored protein shake. And if I want a big, frothy pitcher of mudslides, you guessed it, I make a protein shake with irish cream SF syrup in the blender so it's huge and thick.

Yeah, most of my substitutes work around protein, either shakes or greek yogurt. So far, so good!

I like how he thinks! LOL I have a friend who had the RNY. She struggled with everything. Not saying that everyone does!! I just know what I saw from her. She kept telling me how hard life was but kept persuading me to have one. I also knew an aquantance who had one and seemed not too happy with it. I knew I would not be going that route as it was just not how I wanted to live. I knew I needed something more forgiving. I looked into the VSG but knew I needed more. For a long time I watched different people on OH with different surgeries and lurked about before making up my mind. It was one of the hardest things I have ever done in terms of making my mind set that I was going to do it. I am glad your surgeon thinks outside the box and checks which patient fits with which surgery. Shows that he cares.

Hey, I have that t-shirt. Or at least I did before my kid stole it from me!

Anyway, I don't agree with Dr. Elariny's criteria at all as I've said before. For one thing, I'm both a sweeter and a grazer and the VSG is not a failure for me nor is it for many people that I know who are sweeters and/or grazers. IMO it works great if your main problem is that your appetite is out of control. Once you fix that, the sweets thing and/or the grazing thing is minor and easily dealt with.

This is what I think:

1) If you are a volume eater or you have an out-of-control appetite (always hungry no matter what you eat), then get the VSG or the DS. Both of these surgeries are very metabolically active because of the reduction in ghrelin and they have the best appetite control of any of the WLS also becuase of the reduction in ghrelin.

How do you decide between them? If you always lose weight when you restrict your calories and you are able to exercise regularly and your BMI is under 50-60, then get the VSG. If any one of those conditions isn't true -- you have trouble losing weight even with a large calorie restriction, you have exercise restrictions, you are SMO -- consider the DS. You still may decide the risks outweigh the benefits and the VSG may still work for you (My friend Jimbo has lost 300+ pounds with a VSG), but you really need to seriously consider that you need the extra oomph that the DS will give you. And you need to be willing to accept that not getting the DS may result in less than stelar weight loss. (As is the case for many more SMO people I know.)

2) If you think you need the negative reinforcement of dumping and you won't be driven crazy by the capriciousness of it or your insurance won't pay for the VSG or DS and you don't want to fight them (or have fought and lost), get RnY. It's as effective as the VSG in terms of comorbidity resolution and weight loss in the long run. But it has more risks and more long-term complications so you need to consider carefully if the dumping thing is worth it. This is particularly true because a lot of RnYers don't even dump.

Also be sure you will never have a serious need to take NSAIDs.

Here are some other reasons to get and not get various surgeries:

VSG: If you have GERD, VSG might increase it and so you might not want to take the risk. 

DS: This is the most successful surgery statistically and some people want that even if on paper they don't "need" it. (i.e., Lightweights) Some people also like the added reassurance that the DS is about 10% more effective than the other surgeries in curing most co-morbidities.

Some people don't want to get their surgery far away from their home and don't live near any good DS surgeons and so the DS is out for them.

RnY: some people like the fact that this surgery has been around the longest, is performed the most and as a result has the most long-term data. They like the fact that many surgeons call it "the Gold Standard".

If you have GERD, RnY has the best track record at curing it.

The Band: why haven't I talked about it? Because it is the least effective surgery and the most likely to fail long term in a way that requires another surgery. This is not to say you can't lose weight with one. My own neice has done wonderfully with her band. It's just that IMO the risk-benefit analysis makes it a poor choice for most.

But if your insurance won't cover a VSG and you aren't willing to deal with malabsorption (RnY and DS), then it's your only choice. It's also your only choice if you aren't willing to have permanent changes made to your stomach.

With all the pros and cons, one of Dr E's points is that people generally are more successful if they get to choose which surgery they have. Nothing worse than a used car salesman approach and not listening to the patient and understanding their pschological (eating demons).

--g

That I agree with!

I get so exasperated when I read online things like "my surgeon won't do X surgery on me" unless it's for some medical reason that really does preclude a certain surgery.

Please tell us how you decided and what was the key to your decision. 

I was originaly going to get a band. I only knew about Band and RnY like most people starting out and I didn't like the idea of getting a surgery with permanent malabsorption of nutrients.

But then I started looking into it and found the sleeve and DS. DS seemed like total overkill to me because I've always been able to lose weight when I dieted and because I like to be active. I was very concerned with losing too much weight, in fact. (Ha ha ha! I laugh at that idea now.) The sleeve just seemed too extreme. I saw a video of a sleeve and, when they removed most of the stomach and threw it away, I freaked out.

But I couldn't get my surgery until the Fall due to my work schedule. So I kept hanging out on a band board and the more I hung with those guys, the more scared I got. I saw person after person who seemed reasonable to me (i.e., not bat**** crazy--there were those too) who followed all the rules but 2-3 years out from their surgery, their bands turned on them and they had to get a revision or they took all the fluid out and gained back all their weight.

This concerned me.

Then a series of studies were published that showed that the band had a failure rate of 25-40% over a 5-10 year period. That was it for me. I absolutely did not want to get a WLS and then have it fail so I had to get another one. I'm in my 50s and I felt like "This is it" for me. One surgery, one shot. The band was just too iffy. 

On top of that, I found out that I'd been misinformed and that there was no insurance at work that would cover WLS (I was told mine didn't but another one did and I could switch during open enrollment). So, if I was going to have WLS, I had to pay for it myself.

So I started completely over. I looked at ALL the surgeons in my area (not just the ones my insurance covered) and some in Mexico too. I also reexamined the four WLS types. I figured, if I was paying for it, I'd get the surgery I wanted and the surgeon too.

This is when I took a second look at the sleeve. At this point, I had come to realize that all WLS is permanent and that there was no 100% safe surgery. Yes, you can take a band out, but then you regain all your weight. Plus, no one I know had to get their band out because they were losing too much weight or they were suffering from malnutrition. They all had them taken out because the band failed. IOW, if they hadn't gotten a band, they wouldn't need it removed. So suddenly the whole "it's reversable!" thing seemed like a big scam.

But the sleeve removed all your ghrelin! And I knew from my research that my big problem was ghrelin. I was hungry ALL THE DAMN TIME no matter how much or how often I ate. The idea that I wouldn't be hungry after surgery seemed like the answer to all my prayers. I wasn't too sure about this "restriction" thing. I didn't think I'd really need it. But I was game...

So I had my sleeve and I lost 100% of my excess weight and I never looked back really.

Which is not to say that it's been all good. For the first 3 years I had problems with my serum protein levels. It turns out that I can't keep them up when I train as much as I did (I got into triathlons post-op and was training for Ironmans), probably because of the small stomach and maldigestion of proteins.

Also, that pesky restriction thing got to me many times. I tend to eat too fast or take one bite too many. I'm much better at that now and I have to say that I'm glad I have restriction after all as it keeps me in line many times. I laugh at my earlier self who was convinced I didn't need it!

I also got some hunger back and much earlier than most. At first I was disappointed. But now I think it's a good thing. I now have normal hunger. If I'm hungry, I eat and the hunger goes away and I'm satisfied for a few hours. Just like normal people! For the first time in my life, I can listen to my body like a normal person. It's cool.