Just doing my homework...

Hi all,

I posted this on the VSG discussion board and someone suggested that I post it here as well. I hope you don't mind...

I'm looking at both the VSG and the DS. I'm not excited about the long-term issues that may occur with the malabsorptive aspect of the DS, but I'm encouraged by the results. I've been on this board for a few days looking for vetran responses and posts, but most of responses I've seen are from folks relatively new to the VSG. I know that initially, the weight loss is significant and relatively comparable to the DS, but I saw a presentation that suggested that there were issues with regain around year 4. I am hoping to hear from some vets, 3-4+ years out, to see how their long-term results have been. Are there issues with regain, stalling, malnutrition? Anything I'm not mentioning? I really appreciate your perspectives and taking the time to answer my questions.

Happy New Year!

Hi and welcome to OH.  You are going to hear many different opinions on this and that is great, doing your research now is the only way to go.  VSG is relatively new as a stand alone surgery for weight loss, however there is some research out there for you to consider.  You might want to visit MacMadom's profile, as she has a great compilation of articles and threads on this topic.  Many of the studies you are going to see are on patients with BMI's over 50 and bougie sizes that are much bigger than the ones currently being done.  Because of this, the longer -term stats are not as good as we would like, however, my doctor will be publishing new stats this summer on 32 boughie and dividing it up by BMI.  He told me the stats looked really good.  Good luck with your research. 

Thanks, Elina. I think I understand about the stats being skewed due to the different size Bougie that was previously being used. I realize that the DS is for higher BMI patients. Mine is about 43, so I'm sure that the VSG would be be suffiient. I need to get a handle on what exactly is contributing to my weight as I believe that would help me understand how the different procedures would ultimately work for me. I look forward to seeing your docs research.

Thanks again :)

    Was the presentation you saw by Dr. Cirangle? (my doc)  If so it was probably from a couple of years ago....he is trying to "standardize"  a smaller bougie size 32f for VSG as a stand alone procedure.  The regain after 4 years was when a larger bougie size was being used, (I think a 48?)  He has switched to the smaller32f now and has very good results. (he is in the final stages of finishing up another study on this)  Some "regain" is  possible W/ any procedure.  I don't think that the patients had a "significant" regain, like W/ other WLS.  
    The most important point when researching a WLS type is...... knowing yourself, and how your lifestyle/physiology got you to ***lbs.  Are you a volume eater?  Do you graze?  Are you a refined carb addict ? Do you have any metabolic issues,i.e. PCOS, hypothyroidism, insulin resistance, diabetes?  Are you active, or sedentary?  Will you commit to exercise? These are all questions only you can answer.....if you are honest with yourself it will make your decision clear.  
    As for the DS you should do your homework on it too.  I'm assuming you have been.  But in case you did not know I would go ask on the DS board.  From what I understand about the DS. (I originally looked into it as I was 580lbs! many comorbidities)  It is not for everyone!  You must be VERY compliant W/ supplements! ( If not the consequences of deficiencies can be dire!)  You must be on top of labs! ( many DSers do them 2/3/4 times a year)  You must know how to read/understand the results of your labs.  It is a procedure that will take much longer than the VSG....higher risk, more complications etc. ( I was on the table for a little over an hour....zero complications during or after I was a VERY high risk patient too!)   The DS would have been a 2 stage procedure for me ( like many DSers say "think twice , cut once"  why do 2 procedures when 1 will get the results I needed, with less risk?)  YES the DS has the best resolution of.....diabetes, hypertension, sleep apnea etc.  It has the best stats on long term weight loss too.   BUT there is some trade off for EVERY WLS......for ME the DS was a "trade" I was not willing to make.  One more thing....as far as "normal" diet is concerned (many DSers will talk about how they can eat ANYTHING)   Well I can eat anything too, (just small amounts) and i have no digestive "issues" when I occasionally eat refined carbs.   Any WLS  patient will need to stay away from high refined carb intake....this is how most of us got MO! 
    So do your research, be honest W/ yourself, consider the "lifestyle" changes you're willing to make, consider your level of "risk" as a patient, consider your current comorbidities,  and your decision will be clear to you.  BTW  I have to add I LOVE my sleeve......down 273lbs in 16 months!!  My VSG KICKS ASS!!  Good luck!

It was indeed Dr. Cirangle's presentation I saw. Someone requested the link so I watched it. It was very informative. I understand that the long-term results are a bit different from the more recent VSG patients due, possibly, to the larger Bougie that was previously used. I think my biggest fear is having the same sort of regain that is common in the RNY. My mom had an RNY about 10 or so years ago and lost a lot of weight. I'm not sure whether or not she got to goal, but it was significant. I didn't really talk much with her about the whole thing. She inded up regaining alot of it back, but not all of it. I just don't want to go through a procedure that would fail me. I'm aware that all of them are only tools and that I need to work with it continuously. Figuring this whole process out about which procedure would work best for me is really turning out to be a journey of self-discovery. I need to do more research not only about these procedures but about my own issues relative to my weight. I've never really looked at my eating patterns and behaviours. I eat relatively normal but sometimes  - typically around hormonal swings - I can get a bit ravenous. I generally leave  - or take home - a little less than half of a meal when I eat out - only because I can't eat another bite. I'm content with smaller portions - but I"m sure they are still way more than I need. I'm not an emotional eater. I just don't know what exactly my issues are. I need to find a resource that will help me understand these things.

My mom died not too long ago and she had a plethora of health issues prior to her surgery  - the usual, Type 2 diabetes, hypertention, high cholesterol. My brother died as well and was MO and had all the same issues she did. I know that I'm on the verge of those issues as well, but so far, I've enjoyed generally good health. I have hypothyroidism, slight glucose intolerance, and just recently, my BP started to fluxuate. Sometimes it's on the high end of normal and sometimes it's a bit above, but this is new.

I've been on the DS site as it was something I discovered while researching the Lap Band. It seems like a very effective tool that has long-term benefits, I think the malabsorption has it's benefits, but there are just concerns that I have about the risks as I age.

I'm very encouraged by your progress. I'm happy to hear from someone who started as a higher BMI as I see that this is a tool that works for a wide range of people. I'm on the side of the cut-once mentality, which is why I'm not rushing in to this.

Thanks so much for your time and your input. You've been most helpful

you are wise to do research and learn as much about both procedures. A lot depend on how much you have to lose. If you have less than maybe 150 lbs to lose then the ds is probably too strong a remedy since I understand its mainly used for the heaviest patients. The vsg is acutally just the first half of the ds and surgeons began performing it as a first stage for risky patients and then found that in many cases the second stage intestinal bypass became unnecceary. Elina is right that McMadame's blog page  and separate blog site "Fatty Fights Back" has a lot of good links. Also, go to dr. cirangle's web site lapsf.com for comparative information on the procedures. Its a great information source even if you use another surgeon. I personally was not interested in a procedure that involved malabsorption because at age 58, i did not want any limitations on medication that I would be able to take  and was not interested in the possible side effects of malabsorption. But I had a BMI of 42 which probably did not make me even a ds candidate though i was not interested in the rny for the same reason. So i would try to search out as many people as you can here on OH who have had one procedure or the other and who have taken the time to write detailed accounts on their blog pages. Those personal experiences will tell you a lot. As for regain, its possible with any weight loss procedure though it appears at 5 years the regain for vsg is about the same as for rny. At least, thats what I think the 5 year study will be reporting - won't know for sure until its published. But I would not let that factor be the deciding one in your surgery - rather factors such as the amount you need to lose, the nature of your overeating problem, the extent of comorbidities, recommendations of your surgeon, and your willingness to participate in your surgeon's program and utilization of follow up care are all important. Studies show that those who have long term follow up and support do better than those that don't. All these things play a part. But welcome to OH - a great resource - and to the start of a project that will change your life unbelieveably.  As you do more research  you will have more specific questions and feel free to direct them to anyone on any of these forums. Thats what its all for. diane

Thanks for your response and the welcome, Diane. I have a BMI of roughly 43 and I think I have about 120 lbs I'd like to loose. Thanks for the recommendations for the resource sites your listed. I'll be sure to check those out today. I agree that the detailed personal experiences are very helpful. I've found just a couple. I'm still trying to figure out how to use this site.

I suppose that a nutritionist would be the one who could help me discover what the nature of my overeating problem is, then? Or are there websites that others have utillized to figure things out?

I really appreciate you taking the time to share these things with me. It's been very helpful.

I think that the decision between a VSG and a DS is a very easy one.  VSG is stage one of the DS, so why not just have the VSG, and if at any point you feel that you are failing with the VSG alone, you go back and have the DS.  That's what my plan is and I have over 200 to lose.

This way you don't go full boar with every possible tool in the toolbox, but leave one card up your sleeve and pull it out if you need it.  With only 120 to lose I think you will have no problem.. I've almost lost that much and I have a lot of food issues and I'm not even 6 months out yet.

You say you don't have as many food issues so it will probably work great for you.. and if not then you add on the DS.  Easy decision. :)

Thanks for your perspective, sublimate. I have been exploring that perception and leaning on it rather heavily. Ironically, however, it's not making the decision any easier. I'm not exactly sure why yet. I'll figure it out eventually though, I'm sure. Having the card up my sleeve is reassuring, but then there the whole "second surgery" thing. I just hope I'll have the courage to do it once! I'm utterly freaked out by the thought of having surgery at all, but I know that this is something necessary. I know that I'm a ticking time-bomb and I want to make this decision while I can still thing rationally about it rather than wait till the diabete****s and then feel like I have to rush into it. I know that with only (haha!) 120 lbs to loose this will work, but it's the long-term issues that I'm looking at, not the immediate results.

I'm still looking to hiding my ace :)

Thanks again.

Hi, me again! (I replied to your post on the main vsg board)

You shouldn't have any problems losing your 120 lbs. with the sleeve, but you're right--the long term issues are the things to really consider. The DS is the most "forgiving" of the WLSurgeries in terms of the calories you can consume because there is so much malabsorption---but only fats and proteins, not carbs. They absorb all of them, just like us. For so many of us, carbs are the real problem, and the DS really doesn't help with that. I was just reading on their board...a woman who had the DS ten years ago and gained back 55 lbs. from eating carbs. So you really CAN eat around any surgery. If you have good long term restriction on your sleeve (i.e., it's made smaller in the first place, so it doesn't stretch later...), you really can eat as much protein as you want. And as I mentioned in my post on the main vsg board, I've never worried about fat either.

If you are a big simple carb eater and don't think you can control it, then the DS might help because simple carbs often produce gas and other intestinal issues, so there is a strong motivation to stay away from them. For me, I wanted to be able to eat whatever I wanted. Yes, i have to be careful that I don't go overboard with sweets or "white carbs," but I was willing to make that trade-off to not have to worry about the more massive supplementation, blood draws and potential bathroom issues. But we're all different...and I am a big believer that there is not a "one surgery fits all". I think you're very wise to be looking at your own eating issues, triggers, patterns, etc. BEFORE the surgery!

Lizanne