Early stages of research

Hi all - so I am in the very early stages of researching WLS.  I just switched my insurance over to the plan that covers bariatric surgery and it goes into effect Jan 1, so I can't even really start doing a consultation until then, so I am using the next 8 weeks to research, soul search, etc.  

A little about me - I am 33, live in NYC, theatre geek and occasional actor/stage manager/director, work a day job at a desk to actually pay those NYC bills though!  I am at my highest weight right now of 315 lbs, and I never thought I would see that dreaded "3" at the beginning of my weight but it happened this year.  I went from being super anti-WLS in my invincible 20's (I feel fine! I'm totally healthy! This weight will never affect me!!) to being in my 30's and aching everywhere, all the time, not fitting in theatre seats at Broadway shows, needing 2 seats on the plane, squeezing sideways through the turnstiles on the subway, getting that horrified/disgusted look when you get on the bus or subway when people are afraid you might sit down next to them, asking for chairs without arms at restaurants and being afraid when you see those little plastic lawn furniture chairs on the patio at brunch that it will just twist and collapse and leave me in a heap on the ground in front of everyone.  So basically, I want to live a life where my size doesn't dictate every single action I do or do not take and WLS seems to be a viable tool for that.

I have already started trying to be more aware of what my life would be like after surgery...I am trying to start eating smaller meals now, being aware of my portions more, seeing if I can lose any weight naturally first.  I eyeball my meals and think "so after surgery I would probably eat this much instead of that much" and chewing my food a lot to get into practice for what that feels like, and which foods might be a problem.  Let's just say, the bacon in my omelette last night took a lot more chewing than I think will be possible after surgery!  

I guess what I am looking for right now is some feedback on what helped you make the decision that WLS, and specifically VSG was the right choice for you?  What things have you been pleasantly surprised about since having surgery?  What things have you been UNpleasantly surprised about? What foods are just out of the question for you now, not because of calories or anything, but because your post-surgery body just won't accept them?  How about alcohol - Yes? No? kinds?  What do you wish someone had told you before you had gotten the surgery? Also, why exactly can't you drink liquids while eating?  Also, while prepping up for this decision, what generally is the process from first consultation to actual surgery and how long did it take you to get to that point?

Thanks for the (anticipated) help everyone!

~Christine

It sounds like we might have similar starting points!  I was 319 when I started my process and age 36.  (Now I'm 8 months post-op, age 37, and 202 pounds.)  It's great that you're doing ALL THE RESEARCH now.  :)  Although, I do eat bacon with no problems now.  Just for the record.  

Here's what I've written about why I chose VSG:
The four WLS are - sleeve, gastric bypass (RNY), lapband, and duodenal switch. My insurance covers the first three, but not the DS.

I ruled out the lapband immediately because the only people I know who have had it are miserable or have needed it removed. The complication rate is atrocious and it only lasts for 10 years or so. It's billed as being a "reversible" surgery, but the damage it can cause, like from erosion into your esophagus, is permanent. So no lapband for me.

The choice really boiled down to RNY or VSG and I chose the sleeve for a number of reasons. (Even if DS had been an option, I would not have chosen it.)

1. I really like the simplicity of the sleeve. All it does is remove 85% of your stomach. That's it.
2. I dislike the idea of having my intestines rerouted.
3. The "good" malabsorption that the bypass gives (of fats) is a temporary thing that only lasts for a few years whereas the "bad" malabsorption (of vitamins and minerals) lasts for forever. That's not worth it to me.
4. The sleeve is restriction only, no malabsorption. This also means that I CAN eat anything at all. Fats and sugars won't screw up my bowels the way they can for the bypass. (Of course I still need to make healthy choices, but that's a choice, not something that my surgery requires.)
5. With the bypass, you're left with a remnant stomach that can't be scoped. That scares the crap out of me. First, the idea that I have this weirdly connected non-stomach but then to not be able to get it checked out with an endoscopy if there's a problem? Eek. Do not want.
6. My understanding is that complication rates with the bypass are significantly greater, especially longterm due to malabsorption. While I will be taking vitamins for the rest of my life, chances are that I won't end up in the hospital if I stop because the sleeve has no malabsorption involved.
7. For the most part (and there are exceptions) the people I know with the sleeve look and seem healthier than the people I know with the bypass. That's nothing scientific though.. just a gut feeling.
8. The sleeve leaves you with a fully functional pyloric valve at the bottom of your stomach whereas the bypass gives you a stoma which can stretch over time.

Pleasant and unpleasant surprises.  I had a weird complication at 3 months, through no fault of my own, and was throwing up after eating.  But my surgeon gave me an antispasmodic for 10 days and everything was good afterward.  That was unpleasant!  As for pleasant, I'm just amazed, every day, at how awesome my life is.  I mean, I thought it was awesome before, but now it rocks.  I'm also astounded that I've turn into someone who actually enjoys exercise.  I ran my first 5k last month, something I never thought I'd be interested in doing let alone capable of doing!  I'm also pleasantly surprised by how easy the eating actually is.  I feel fine with my small portions, I don't feel awkward when I eat with friends, it's all cool.  

I've also been pleasantly surprised by just how supportive almost everyone in my life has been.  It's amazing.  

Nothing is out of the question, except dry foods.  I ate salmon that was too dry once and learned my lesson.  Heh.  So I keep things moist now and that's a lot better.  

I didn't drink pre-op, don't plan to start post-op.  My surgeon says no alcohol for a year.  A lot of people here say, "start drinking when you want to stop losing."  I do cook with it.  

Honestly?  There's nothing I wish someone had told me pre-op.  I read so much that I almost felt overwhelmed with information!  But I felt prepared, ready, calm, and capable when I went into surgery.  I still do!  

You can't drink liquids because of how the pyloric valve works.  Food closes it up so if you drink liquid, that will just fill your stomach up and mean you can get less food or make yourself uncomfortably full.  

The top post in my blog lists all of the appointments I had to go through.  I made my decision in September 2013 and had surgery in March 2014.  I was delayed one month due to an insurance change and another month due to an ulcer found in my pre-op endoscopy that needed to be treated before surgery could happen.  

I hope this helps!  

Thank you so much for all that detail!  One of the things that draws me to VSG of RNY is how much more "normal" (as it were) your system is after it is done.  So your information is very promising to me.  I had my gall bladder out 11 years ago and have had really bad IBS and acid reflux since then, so I am hoping the surgery could also help get that (along with my sleep apnea) under control.  

I am trying to decide how many people to tell, also.  I have talked to my husband about it (of course), and my best friend.  I am holding off on talking to my parents about it because they have been some of the biggest critics of my weight in the past and I just don't know if I am ready for that whole discussion.  I am also deciding, when it comes to it, if I want to tell my coworkers (since I will have to take significant time off work for recovery) or if I want to make up another medical procedure so I don't have to deal with the questions and comments.  I guess I will have to tell my roommates too, since I will be agonizing all over the house for awhile.

That's interesting about not being able to eat dry food - funny question, does that include things like jerky?  There is an amazing salmon jerky at Trader Joe's that I was already thinking would be a good high protein option when I get to that point.  I know, weird things to plan ahead for! Haha!

I have both IBS and GERD, and the sleeve has not helped either. My reflux may be slightly worse but is well controlled with medication. Some doctors will recommend RNY if you have acid issues, but I didn't want to experience dumping syndrome (and if you already have IBS you know how awful bowel issues can be), I thought the VSG seemed more natural than any surgery that had a malabsorption component, and I didn't want a weird stomach remnant left over. I wanted to be able to eat anything, and so far I have been able to. If I eat too much too quickly, or if it's too dry, I feel very uncomfortable, but I have never been sick. I've even had several glasses of wine (half glasses really) because wine is a cultural thing for me and I love it, and a few bites of some candy/cake/chips, but very little. I usually compensate by cutting other calories that day as long as I get my protein and water in. I feel like my diet is "normal" but now protein first and low carb, and that is a lifelong commitment, but it is a conscious commitment whereas with the RNY it's out of your hands (for better or worse).

Even with my acid issues, I would do the VSG again in a heartbeat. I totally sympathize with all the issues you describe, and I can tell you I almost cry with joy when I can sit at a booth without having my boobs sitting on the table top or get in an airplane and not cramp up from having to lean away from the person next to me so my fat doesn't encroach on their space, and the list goes on.  

I told some people but not others (only one person at work knows), I told my very supportive siblings, and I didn't tell my parents until after surgery (I mean, what were they going to say at that point really). I was very worried about it at first, now I am fine with those decisions. I have gotten no negative feedback (at least to my face) about my decision, and if I did I would be comfortable telling people to F off! I had a friend who was sleeved two years ago and after seeing her go through it I knew it was the right choice for me.

The reflux might be caused by a hernia and, if it is, the hernia can be repaired during surgery.  Something to ask your doc about.  

I've been diagnosed with IBS in my life, but, as years went on, I learned that IBS is what doctors say when they don't know exactly what's going on :P  I figured out that the real problems were fructose malabsorption and anxiety.  I've been more regular post-op than I've ever been in my whole life, which is pretty awesome.  

I think that your co-workers are going to talk about you regardless, since this is what co-workers do, so it's better to tell them what's up so that you won't damage your credibility in the future when they learn that you lied.  Or you could redirect and just say, "I'm having surgery, it's none of your business.  How about the local sports team?"  

I've had luck with jerky, salmon and beef, I've just got to chew it a LOT.  

I haven't had my surgery yet but am scheduled for 1 week from today. I still have many of the questions you are asking. I can answer how long it takes. I went to an information session June 17th. Decided I was going to go through the process.  The first thing you do is call your insurance company and ask what their requirements are. Mine was a 3 month weight management program(some require a 6 month program) whi*****ludes education on eating and nutrition, attendance at group support meetings, psych. eval. Also 3 medical visits at the center. My first appointment at the center was July8 and I finished the program October 8. They told me the earliest surgery could be was about 4 weeks after I finished the program. During that time I had a surgeon consult. Medical clearances. Pre-op tests. Good luck on making your decision. I'm anxious to hear the other responses you get.

This reply is from my husband, he had sleeve surgery 7 days ago. Mine is scheduled for 12/9.

I think this may be useful, I'm a week out from surgery on 11/4 - got the sleeve.  Before the surgery my doctor required I lose at least 50lbs in 3 months, I lost 56.  My highest weight was 510 on the morning of the surgery, I weighed 402.  The surgery was a blur, they  had me in pre-op and then the operating room and post-op within 90 minutes.  My surgery took 39 minutes. Losing weight prior to surgery helps shrinks the liver which helps with surgery.  I spent 2 days in the hospital, on the 2nd day I had bad nausea. Make sure you get a motion sickness patch from the hospital, prior to surgery or just after. 

They will put a main line in your arm during surgery. Ask them to keep it in so subsequent blood draws after surgery will be easier.

If you have a significant other that is willing and the hospital allows, allow them to stay with you in the room the whole duration of the hospital stay.  My wife stayed with me, she saved me, going to the bathroom, helping me in and out of the bed, she helped me walk, we watched DVD's together.

There are a number of things they're going to look for in the hospital.  They want you to cough, walk, breath heavily, pass gas, urinate and to not vomit.  All these things will occur soon after surgery.

You won't be too sore except when you use your muscles - to sneeze, cough, get up from sitting, etc.

Don't be startled when you take the upper GI after surgery, and you see your smaller stomach, it just looks like an extension of your intestines.

Don't believe what everyone says about hunger, if you lose weight prior to the surgery, you may be hungry somewhat after surgery. The doctors agree with me on that.

A week out from surgery and I've lost 13 lbs. You're not going to be allowed to eat anything after surgery, just drink liquids and protein drinks.  Staying hydrated is important.  Blood thinner shots for 10 days after surgery.

My doctor has taken me off my blood pressure medication because with the blood thinners, my pressure dropped too low. 

I have not taken any insulin since right before surgery and have not taken any since. 

My response hopefully will help with what's going to happen during and after the surgery. My journey is just beginning, even though over several years I've lost 120 lbs.

The sleeve to me is an excellent choice. I'm only a week out, but I hope my story / journey is similar to others. My doctors believe that is the case.

This is a life saving surgery for me. That is my reason for having it. I hope this helps.

I don't seem to have any food intolerances but there are a lot of foods I choose not to eat. And I currently can't fit in more than a few ounces of protein so I don't eat much in the way of vegetables yet, at all. 

I wish I had shopped around a little more for a surgeon. While I think my surgeon is talented as a surgeon, his practice and his nutritional counseling leave a lot to be desired. I wish I had known more about how B12 absorption works beforehand, we DO have some malabsorption because removing part of our stomach impacts our ability to absorb B12.  So we're not free and clear of those issues but I do think we see less of them than RNY patients do. I really wanted to maintain my pyloric valve. The more I read about that aspect of the surgery, the more attractive the surgery was to me.

I will say this, if you are already dealing with reflux you should seriously consider RNY. VSG can bring on or worsen reflux, but the way the RNY works, it's more likely to resolve it, IIRC. It's not like the RNY is a bad surgery at all and that's why I chose VSG. I feel like the differences are on the margins. Bottom line is that both can get you to your goal, most people have vastly improved quality of life and almost all complications are manageable. Now, I wouldn't recommend my worst enemy get a lap band... but the RNY and VSG are both good choices. 

BTW, not fitting into theater chairs is the WORST... except when the handicapped seating is a better seat than what you purchased. 

I will keep the answers simple, but if you want more detail don't hesitate to ask.

Went to a RNY consult, husband was scared, I didn't do it. 2 years later, diagnosed with cancer and utterly unable at this point to lose nor even slow down rapid gain. Heard about the sleeve over the summer, immediately called to start the process. It took 3 months. Would have been faster if it didn't take so long to schedule the pre req appointments. 

I can eat just about anything. Dry protein (overcooked meat type) is not a friend, but generally I eat anything. 

Surprised that I made goal to be brutally honest. I was in such a dark place before surgery I was simply hoping to lose enough to be able to move around a little better. Unpleasant surprise- my cholesterol went up. Surprised how much the NUT and going to support group helped. Surprised my husband did a 180 (he was scared and didn't want me to have surgery). Surprised he lost over a 100 pounds with me. Love how healthy I feel now. 

I rarely drink both before and after surgery. It hits me fast though, so one glass of wine and I am done. 

You don't drink with food because it washes the food through faster, hungry faster, and takes up real estate- of which will be heavily restricted.

what helped you make the decision that WLS, and specifically VSG was the right choice for you?

I had been obese my entire life and at 339 lbs I was desperate. I had tried many times to lose weight, and either never managed to lose a significant amount, or gained it all back and more. I knew I had to do something drastic. When I met with my surgeon we discussed all the wls options and agreed that the sleeve is a good choice for me. My other option was gastric bypass, which is also a great surgery. I wanted to keep my medication options open in the future and I felt like vsg would leave me more leeway there.

What things have you been pleasantly surprised about since having surgery?  

How easy the recovery was for me. That my blood pressure dropped from dangerous levels to normal within a few days after surgery. That I had no hunger whatsoever for the first six months after surgery.

What things have you been UNpleasantly surprised about?

Honestly, nothing. It's been very smooth for me and I've had no problems.

What foods are just out of the question for you now, not because of calories or anything, but because your post-surgery body just won't accept them?  

Carbonated drinks make me uncomfortable, as does yeasted bread. So I stay away from them.

How about alcohol - Yes? No? kinds?

No, or at least not often. I have had a couple of glasses of wine when out for celebratory dinners/occasions. But to me it's just empty calories, not worth it.

What do you wish someone had told you before you had gotten the surgery?

Nothing, but I researched the hell out of it and had six months of supervised diets and meeting with dieticians and my surgical team beforehand.

Also, why exactly can't you drink liquids while eating?  

Others have explained it above. Let me just say that once you get used to it, it isn't a big deal. To me it's the most natural thing in the world now. I tried eating and drinking together a couple of times recently because I was in a hurry, and it was weird, uncomfortable, and slightly painful. Won't be doing that again!

Also, while prepping up for this decision, what generally is the process from first consultation to actual surgery and how long did it take you to get to that point?

The process will vary widely depending on your insurance requirements, assuming you have insurance coverage and are not self-pay. As mentioned, I had to do six months of supervised diet and coaching. As it turned out, it actually took me almost a year to get my surgery because my insurance messed up and gave me bad information about what I had to do to get approved, so I had to start over again about four months into the process.