Ugh, Choices Choices

Really torn at this point as far as which surgery to go with.  My doc's recommendation is RnY due to my existing heartburn, and with the failure rates long-term with the lap band I'm inclined to agree but have some...  *cough* unique...  issues to deal with.

5 1/2 years ago I was diagnosed with Hodgkin's Lymphoma and had to do the whole set of fun with that (six month's chemo, one month radiation).  Hey, it happened, got through it, and six months from 5 years remission / cure.  However, I've had enough radiation between scans and the actual therapy that I could microwave a small meal probably :)  

While its a small risk (particularly in the stomach), that radiation does increase my risks for secondary cancers in the future.  So, given a big portion of the stomach is uncheckable by traditional endoscopy following RnY, I'd have a black hole as far as being able to keep tabs on the stomach for possible malignancies.  Also doesn't help that my wife is scared about me getting the big surgery done, as if any cancer comes around it would be harder to get calories into me.

Given the heartburn, the sleeve is probably out.

That leaves me with the lap band, which studies show have a very high failure rate long-term, and why my doc doesn't really do them much anymore.  I agree with that - I'm certainly not in this for a quick fix, this is a rest-of-my-life thing.  The fact that I am ready willing and able to give up beer tells me so :)

So I'm left with what I think are no good options.  I have an appointment with my doc on Monday, but I am curious what others think given my cir****tances.  It also was a good way to vent / whine, to which I appreciate everyone listening :)

Since you're pretty much ruled out the band, and the sleeve is not a good option because of the reflux/heartburn, you might try posting this on the RNY forum, where a lot of the "vets" could possibly address the issue of the residual stomach,

I would recommend consulting with your Oncologist to see what they say.

While the sleeve can make heartburn worse it isn't a given for some folks it improves or goes away. Please don't even consider the band unless you want another surgery a few years out, it's not for life long use, needs to be removed after 5-10 yrs. It seems the sleeve is really your only viable option. Even IF you do have increased acid that can be treated with PPIs and such. I too am a cancer survivor and that is the only surgery I would consider. Have you spoken to your oncologist to get their take on it also? I wish you luck and success whatever you decide on, you are in a unique situation.

I think I may be missing something here.  I definitely would not go with the band.  I know only one person out of six friends who got the band who has been successful.  The rest have regained all their weight and still get obstructions and pain when they eat. Given the choice between the RNY and the Sleeve, I'd go with a Sleeve.  But, that's because I had an RNY and ended up with severe hypoglycemia.  You'd be better off with more of your natural anatomy intact.  I don't see how an RNY could be okay for heartburn and a Sleeve would not.  You'd have much less acid, of course, with an RNY, but you'd have more room to contain the acid without it backing up if you had a Sleeve.  Can you get a Sleeve and take Prilosec?

I had a resectional rny because I had a huge fear of having a blind stomach that couldn't be scooped ( it was also damaged in a previous surgery so may as well have come out)

the band caused me nothing but trouble and was honestly the biggest mistake of my life- the reflux I suffered was a nightmare and I had never once in my life had that issue before I got the crap band.

good luck with whatever you decide.

It seems you are overlooking the best option, so I suspect your surgeon doesn't offer it, so didn't mention it. 

I didn't want an unscopable "blind stomach" either, or many of the other issues that come with RNY like the possibility of dumping, reactive hypoglycemia, inability to take NSAIDs for life or regain, so I went with the DS.

I haven't had one episode of reflux or heartburn since my surgery.  Most DS surgeons make the DS sleeve slightly larger than a stand alone sleeve, but my surgeon didn't, and my reflux is better anyway. I had reflux because I was fat, and those issues left with the excess weight. 

The DS is the most successful surgery, and you should research them all and not limit your future success by any surgeons limitations.

First, congratulations and continued prayers for your successful remission!!!  I am a vet of RNY surgery going on 3 years.  I cannot speak to your concerns regarding your blind stomach and not being able to easily test it, but I can give you some first-hand experience on what you could expect as far as RNY successes.

I also had pretty significant GERD and was taking Protonix daily, with little relief.  My other co-morbs were insulin-dependent diabetes, high blood pressure, high cholesterol, sleep apnea (with a CPAP machine at night), joint/back/foot pain, and just being so God-awful tired!!!  I had my RNY surgery in April of 2010.  By one month post-op, I was off my GERD, cholesterol and high blood pressure meds.  By 3 months, my insulin began to be tapered off and Metformin stopped.  By 6 months, I had energy, had lost about 100 lbs, and was significantly smaller.  My feet stopped hurting so badly.  My knees got stronger as I walked and as my exercise progressed (little by little) my body didn't hurt anymore.  I stopped sweating in the dead of winter (now I'm freezing! LOL).  Those were my physical changes. 

Now, onto an issue I don't feel is discussed nearly enough--your head issues.  They operate on our bodies when doing any type of surgery, but not our brains.  This was, by far, the most challenging issue to conquer, and its an on-going battle.  I suggest anyone that is seriously considering any type of wls to get in to see a therapist or psychologist.  One that you are comfortable with and one that will assist you in getting through these type of obstacles.  For me, I had a very unhealthy relationship with food--I used it as a drug.  It soothed me, made me feel good, even if for a short time, and everything was okay after I ate.  After you take that aspect of the relationship away, you are left floundering, acting out, aggressive, emotional, not really knowing what to do or how to cope.  I never felt my emotions, just buried them and stuffed them away with every bite I would take.  You really need to develop a healthy relationship with food, to live, as nourishment, and not a drug.  Its not like a drug like cigerettes, alcohol, or cocaine--you can live without them---you HAVE to eat.  Very tough to do on your own and in my opinion, if you don't change your head and the way you cope with stressors, you will not be successful with long-term weight loss and living a healthy life.   (stepping off my soap-box now!!! LOL)

I would suggest taking your concerns to your specialists---these are the experts.  After you do that, you can make an educated decision on what wls you would like to pursue. 

Mallisa

Look into the DS. It has the same stomach as the Sleeve, but usually made slightly larger than in the stand-alone Sleeve. Plus it has an intestinal bypass similar to, but more effective than, that of the RNY. The DS has the very best long-term, maintained weight-loss stats, period. It's also the best at resolving or preventing co-morbs like diabetes and high cholesterol.

The DS certainly isn't a quick fix, although most folks do get some pretty fast results. The DS is the form of WLs for the long haul. But your surgeon doesn't DO the DS, so the odds are strongly against his giving you complete, accurate info about it. You can learn more on the Ds board here at OH, and at http://www.dsfacts.com

This whole thing about how they consider pre-existing heartburn as a deterrent for sleeve has always confused me.  I had heartburn pre-sleeve, which was well controlled with medication.   it is still well controlled with medication, so I can't help but think that the more relevant factor is how well you have responded to treatment meds.  That's my two cents worth on the subject!