Hi Friends.  I am new to the site, and have been approved by Kaiser for weight loss surgery.  I have a meeting this week to decide which path I want to pursue.  I live in the Denver area, and the only options shown are Lapband or RNY.  Of those two, of course I will choose RNY.  However, I have researched DS (Duodenal Switch) and I see the benefits of it and now am not sure which way to go.  The only problem is, Kaiser does not offer DS here in Colorado.  I have heard if you pressure them you have a chance to get that approved under certain cir****tances.  I have 120 pounds to lose (I am 5'7" tall and 280 pounds).  Currently, Kaiser approves DS only if you are above 50 BMI.  (I have a BMI of 42-44). But I have heard of exceptions to that, if someone is willing to pay to fly to another Kaiser region to have an in-network surgeon perform DS.

In short,  DS seems like a better long-term solution, but I know it is more extreme than the RNY.  RNY is great, but requires a person to use the tool well, and change one's lifestyle drastically to ensure its success. I get that and am motivated to do that.  I just get scared when I hear of people who went through the RNY only to get back right where they started after the first year.  I have a sluggish metabolism and a tendency to regain after diet success anyway, so this is of concern. I want to take responsibility for my life and choices, of course.  But if I am going under the knife, I want the best solution available, and I have heard that DS offers a better long-term success percentage (not sure if this is true for everyone, but just saying what I have read).   

So here's my question - any thoughts out there as to why you chose one or the other?  I am truly not sure which path to go.  Any advice or simply sharing your experience with me would be so helpful!  Thank you 

I chose the RNY over the DS due to longer term studies as well as there is NO way I was going to stick to the vitamin regimin that DS requires. I was even concerned with the amount I would need with RNY but it has proven not to be an issue thus far. I can't swallow pills and am very anti medicine for the most part so it was a real concern for me. I also found that the real life people I knew who had RNY the success rate far outweighed the failure rate. Perhaps it's just the people I know but it made me feel more at ease.

Hi Mrs. L. - That really helps me because I am the same way - I don't swallow vitamin pills well at all and I do try and avoid medications as much as possible, myself.  I also know this is a tool, something I use to take better care of myself and get me on the road to health, rather than a "magic cure."  So if I really stick to that attitude, RNY definitely sounds like it can fill that bill.  It's good to know that from those you have seen, the success rate far outweighs the failure rate.  Thanks for sharing your experience :)

There are several RNY's that take even more vitamins than I do, and even more that are sick because they don't take enough.  Whichever you choose, don't take the vitamin thing lightly.  If you don't think you can keep up with keeping healthy, then don't get either.  Go instead for a VSG.  If you already know you don't have the maturity to keep healhty, don't put yourself at risk.  Mrs. L is either exceptional (some are) or on short-time to disaster.

I will have the RNY within the next year, I'm on a waiting list. All the surgery's have both negatives and positives, you should always take the advice of your surgeon under consideration. That being said, my surgeon said that the DS wasn't what he recommended for me because he doesn't like the malabsorption from it. If you make the lifestyle changes, the RNY is effective.

I think regain is something we are all scared of, but we have to make choices on what is best for us. 

Hi Tamantha,

Very well said -- it is a personal decision, absolutely, and will be discussing that this week.  I just like to come in armed with the best knowledge, and getting perspectives is part of that.  I know that my doctor has expressed the same thing about DS.  

Thank you for your reply!

Patrice

Two days from now, I'll be ten years post-op from the DS. I've never once regretted my decision. I chose the DS for many, many reasons.

Statistically, DSers have a better chance of long-term, maintained weight loss. This doesn't mean that every patient who has the DS will do better than every patient who has a different surgery. Statistics don't deal with individuals, but with large groups. One thing that's really interesting is that while RNYers, Sleevers, and DSers ALL seem to do very well during the first couple of years, at ten years out the DS group seems to be maintaining significantly better. I can say that I've had NO regain, and it's not because I stick to a strict diet. (*grin*)

ALL forms of WLS mean you're going to need to take vitamins and get regular bloodwork for the rest of your life. Because the DS provides permanent malabsorption of calories it makes it easier to maintain your weight loss, but it also means you've GOT to be serious about your vitamins. (That said, I know RNYers who take more vitamins than I do. In reality, what you will need to take will depend on what YOUR lab results are.)

Pre-op, I knew that I was lousy at sticking to a diet. I figured it would be much easier for me to toss back some pills 4 times a day than to resist temptation all day every day for the rest of my life. My DS allows me to eat pretty much anything I choose, and I rarely eat less than I want. BUT---I want SO much less than I did pre-op. I was thinking at lunch today that I don't really know how much restriction I still have, because it's rare that I get 'full' before I get 'all I want'. (Watermelon's a different story. *grin*)

Another reason I chose the DS was because it has the best stats for resolving or preventing diabetes and high cholesterol. My cholesterol was creeping up, and diabetes runs in both sides of my family. Last labs, my cholesterol was 112---and I eat a LOT of fat. My blood sugar runs around 85.

And I knew I would always need NSAIDs. I've had severe, extensive arthritis since age 20, and without NSAIDs my quality of life would be bad. That alone was enough to steer me away from the RNY.

As for that BMI of 50 nonsense---highly appeal-able.

Ms. B - All great points.  Thank you for sharing as well.  I also have arthritis and need NSAIDs.  I will have to raise that with my doctor.  I don't know if there are "workarounds" but that's a huge thing for me.  I am 55 and arthritis runs in our family.  I sometimes wonder, though, if I lost the weight if it would make the arthritis pain better.  Not sure -but will ask.  My cholestrol is low and my glucose normal - just lucky, since I am so overweight.  SO much to think about and I really appreciate your sharing your experience.  That gives me another layer of things to consider.  

All the best to you - and definitely want to stay in touch.  

Patrice

Here's what you need to understand about NSAIDs. They pose some risk for anyone who takes them, even people who've never had stomach surgery or any trouble with ulcers. It's largely a matter of weighing the risks versus the benefits.

One side effect of NSAIDs is that they thin the mucosal lining of the digestive tract, which can allow the stomach's own acid to cause damage. This is a systemic effect---in other words, it doesn't matter how the NSAIDs get into your blood stream. You can swallow the, inject them, or rub them on your skin---the side effect will be the same. For most people, this is really a very small risk, but people who have an RNY have a huge remnant stomach that's 'blind'---can't be 'scoped in the normal way to check for ulcers. This is why most surgeons tell their RNY patients no NSAIDs, ever. (Some surgeons tell their Sleeve and DS patients no NSAIDs, too, but I think it's just laziness---same reason some of them give out RNY post-op diets to all their patients.)

Many RNY patients are told to take Tylenol. Sadly, for some people---like me---Tylenol just has NO effect, especially for things like arthritis where most of the pain comes from inflammation. Also, Tylenol is hard on the liver, as is rapid weight loss. You really shouldn't take Tylenol while you're in the losing phase.

I will say that losing weight helped a little with my arthritis pain, especially in my knees and feet. But it did nothing to help the arthritis in my hands, my shoulders, my neck...

Thank you for all this information, I had no idea!  I really appreciate knowing this.  Okay, so it's really something that would be there regardless of the type of weight loss surgery I choose.  Eeks.  Well..... it's a tradeoff, isn't it?