Decision: Gastric Bypass or VSG?

(deactivated member)
on 12/21/14 3:04 pm - Edgewood, NM

Hi all! I have been lurking around the forums and considering WLS since 2012. I have several questions and I hope to hear from newbies to veterans. First, a quick bit of info.

I am 41 years old as of January 9th, 2015. Currently, I weight 371 pounds and stand 4 feet 11 inches tall, with a BMI of about 75. I have been referred to a Bariatric Clinic for help in losing weight. I meet with them mid-February 2015. In the meantime, my PCP wants me to get tested for sleep apnea. I have high cholesterol, high triglycerides, gallstones, vitamin D deficient, asthma, diagnosed with pernicious anemia, diagnosed with chronic venous insufficiency in both legs resulting in lymphedema, and Hashimoto's thyroiditis. Tonight, I felt like I was getting closer to the end of my life. I scared myself just walking through my house because I felt like I was suffocating. I was scheduled for gastric bypass and gallbladder removal in latter 2012 to beginning 2013 but the anesthesiologist cancelled because he didn't want to touch me in the operating room due to my high BMI, high weight, and that I have trouble breathing lying down. I honestly do not blame them but it frustrated me so I gave up, thinking I could lose weight on my own. So I never had the WLS or the gallbladder removal. I weighed 365 pounds in 2012, now I am 371 pounds so I haven't been able to lose despite joining Weigh****chers, using Slim Fast, Garcinia Cambogia, green coffee bean extract, etc. I gain 10 pounds, gain 6, lose 4, gain 5, etc., etc.

Some of my questions are:

1.) Given my height being below 5 feet and my BMI 75, does anyone know what the requirements might be before I am cleared for surgery? Such as monitored while I attempt to lose weight? Lose a certain amount prior to surgery?

2.) Which procedure is best for those with high BMI's?

3.) How successful (5 years or more) after having surgery of keeping the weight off with a.) gastric bypass? and b.) VSG?

4.) Has anyone had vitamin deficiencies PRIOR to the WLS? How are you managing the deficiencies today?

5.) Would you have weight loss surgery again knowing what you do today? Any advice to newbies considering WLS?

I realize the decision is mine to make with the help of my surgeon. I simply want to see how others are progressing on their WLS journey so I can make an informed decision. I have been watching videos, reading articles and such since 2012 yet I still have questions. lol I guess I want to be sure I make the right choice for me because I know it's a HUGE decision for someone to make.

Take care and thanks for reading my post! I appreciate any suggestions and advice.

Happy Holidays!

 

T Hagalicious Rebel
Brown

on 12/21/14 7:01 pm - Brooklyn
VSG on 04/25/14 with

My age & weight was right around yours when I started, but I'm taller. I was 43 (44 now) & was 366, but I'm 5'7. I had the vsg, although there are others that would suggest the ds since the rny & vsg kinda evens out in the statistics over the 5 year mark. While I had a high bmi, I didn't want my intestines rerouted, & I'm happy with my choice. There are times that my weight loss is slow, but I expect that & I still have a ways to go b4 I reach goal. I'm a newbie, & would choose the vsg if I had to do it all over again because this is a choice that I can live with.

The real question is which wls are you willing to live with? Each surgery has it's own pros & cons, & each person will have a different story for what they went thru.

I didn't have any vitamin deficiencies other than the occasional low iron. I do have diabetes, but I am now on the lowest dose of medication available & I hope to be off it as I get closer to my goal.

Check your insurance just to be sure you're covered & what they require. Some of them want you on a dr supervised weight loss plan for a few months. I had to do that, while I really didn't lose, it was very important to not gain weight. Good luck on whichever wls you choose!

No one surgery is better than the other, what works for one may not work for another. T-Rebel

https://fivedaymeattest.com/

Vivian Prouty
on 12/21/14 9:38 pm - Fort Worth, TX

Hi I am 9 yrs post op RNY.    My BMI prior to WLS was 50.   I am 5'1" tall.    I feel your pain.   I lost 140 lbs ( 40 pre op ).    I personally would wait to decide and let your doctor help in that choice.     Because of some of your health issues pre op my have something to do with which choice is better for you.    With RNY there are some medications that you may never be able to take.     If you choose to do the sleeve and don't loose enough weight it would be possible to get the second half of the surgery which happens to be the DS.    I know people who had the DS that were very large and lost all their weight.     I also know people who have failed at all the surgeries.     With as much weight as you have to loose your going to have to work very hard to loose it all....but then I know that you already know this.     Determination will help you get it off though and regaining your health is priceless.    I will pray that you and your surgeon make the right decision for you and your body.    Good luck to you.

 

Hugs and blessings ~~~ Vivian

GOD GRANT ME THE SERENITY TO ACCEPT THE THINGS I CAN NOT CHANGE;   COURAGE TO CHANGE THE THINGS THAT I CAN;  AND THE WISDOM TO KNOW THE DIFFERENCE !!!!    THIS IS MY DAILY PRAYER.
Vivian Prouty      Obesity Help Support Group Coach  "LOSE IT 4 LIFE"


 

White Dove
on 12/21/14 10:00 pm, edited 12/21/14 10:01 pm - Warren, OH

I would advise you to spend some time researching DS and DS surgeons. 

Most surgeons are not experts in DS, so they will steer you to having the surgery that they know how to perform.  That does not mean it is the right surgery for you.  It is like shopping at a Honda dealership, when you really need a Lamborghini.  The Honda dealer only has Hondas an will help you make the decision to buy a Honda.

From the title of your post, I know you have not researched DS. 

So your first step is to find a DS surgeon and work with them. 

Will you have to travel for surgery?  Very likely.

Will you have to work harder to avoid deficiencies?  Absolutely.

The problems with starting with a VSG and then converting to DS later are:

    You have to undergo two surgeries, with their resulting chances of complications and scar tissue.

     It will take you much longer to lose the weight

     An add-on DS does not work as efficiently as a "virgin" DS

     Your health issues will most likely multiply as you wait for the needed surgery to get the weight off

Use the same rule as carpenters do.  Measure twice and then cut once.

Real life begins where your comfort zone ends

Gwen M.
on 12/22/14 4:49 am
VSG on 03/13/14

With your list of health concerns, I'd be seeking multiple opinions from multiple experienced surgeons. And asking them lots and lots of questions!

VSG with Dr. Salameh - 3/13/2014
Diagnosed with Binge Eating Disorder and started Vyvanse - 7/22/2016
Reconstructive Surgeries with Dr. Michaels - 6/5/2017 (LBL & brachioplasty), 8/14/2017 (UBL & mastopexy), 11/6/2017 (medial leg lift)

Age 42 Height 5'4" HW 319 (1/3/2014) SW 293 (3/13/2014) CW 149 (7/16/2017)
Next Goal 145 - normal BMI | Total Weight Lost 170

TrendWeight | Food Blog (sort of functional) | Journal (down for maintenance)

SkinnyBonz38
on 12/22/14 5:53 am

Oh Lea you sound just like me! I attended a seminar a while ago and am still undecided. My bmi is also quite high and I have cardiomyopathy ( heart disease) and a fairly low injection fraction. I'm afraid of surgery and afraid to remain obese less I die. I reluctantly scheduled an appt with the surgeon on January 21st and will see how it goes from there. I will bring a list of questions and sorta interview her.

I don't want to die because even morbidly obese I love life and enjoy living I just want to live healthy and I don't think I can living at 273 poundies.  I'm not much taller than you are at 5'2". I don't think I have the head work down either because to fill my belly up is pure delight. And to relax with a BIG bag of cheesy popcorn is the best.

So now I'm still working to find the best fit for me and my body and my mind and my health which is all important. I hope your decisions and research goes well for you. Please, please, keep in touch and please provide updates.  I like the way some members have chronicled their journeys with dates for each step of the way i.e. (1st doc consult: 01.21.15 which is mine btw) and so on to see your progress and the positive steps you are taking for your health.

KattattaK
on 12/22/14 6:25 am

If covered by your insurance (unless you're self-pay), you may want to research and consider the DS?? Check out their forum on here and ask some of the vets about it. From personal research coupled with what I've read on this site, the DS is the best wls as far as longterm maintenance is concerned. Considering your BMI and medical conditions, this may be a surgery to seriously consider. Hope this helps. All the best. 

MsBatt
on 12/22/14 12:59 pm

" I have high cholesterol, high triglycerides, gallstones, vitamin D deficient, asthma, diagnosed with pernicious anemia, diagnosed with chronic venous insufficiency in both legs resulting in lymphedema, and Hashimoto's thyroiditis."

You need to research the Duodenal Switch. Not only does the DS have the very best long-term, maintained weight-loss stats (especially for those with a BMI greater than 50), it's also got the best stats for resolving or preventing things like diabetes and high cholesterol/triglycerides.

The VSG/Sleeve and the RNY/gastric bypass have pretty much equal 5-year maintained weight-loss stats, but less good than the DS.

I'm pretty sure I had low D before surgery---most of the people in this country DO. I, like most DSers, take a 'dry' formulation of D. I've managed to raised mine to a good level with a dosage of 50,000 IUs a day. Some people take more. ALL DSers take a lot of vitamins and mineral supplements, and most RNYers SHOULD.

Would I do it again today, 11 years later, knowing what I know now? In a heartbeat! Heck, I'd have it once a year if that was necessary. (*grin*) And no, I wouldn't consider any form of WLS but the DS for ME.

Advice to newbies? RESEARCH EVERYTHING. Choose the procedure YOU want, THEN choose a surgeon based on his experience in doing that procedure. And with a BMI of 75, I'd want only the most experienced surgeon possible.

Consult a surgeon who is actively known to regularly do all three surgeries---VSG/Sleeve, RNY/gastric bypass, and DS/duodenal switch. Remember, no surgeon is likely to advise you to choose a procedure he doesn't do. You're a CUSTOMER, after all. I'm sure many of them genuinely care about their patients, but they are interested in getting paid.

 

(deactivated member)
on 12/25/14 12:43 pm - Edgewood, NM

Happy Holidays everyone! Sorry taking so long to respond guys but I have been researching DS. I plan on talking to my surgeon about DS and figure out how each potential surgery could effect my health, including mental, after surgery. I appreciate everyone's advice and suggestions. I plan on asking some questions on the DS forum in the next day or so.

Surgery makes me extremely anxious as I had a family member die a few days after minor surgery. So I take WLS very serious and life changing. 

I have watched tons of WLS videos on YouTube including those that discuss complications and the dreaded regain.  What causes weight regain after WLS? Is it refalling into bad habits? Does an after-effect of the surgery go awry which causes it? Is there a way to prevent it from happening? 

Thanks again for the responses!

Happy Holidays!

MsBatt
on 12/27/14 6:36 am

Regain can happen with any form of WLS, and the causes are probably as diverse as the people involved.

Restriction generally lessens with time, whether you have a Sleeve or an RNY pouch. The Sleeve never causes you to malabsorb any calories, but the RNY does---for about 18-24 months for *most* people. (Remember, there are exceptions to nearly ever rule.)

This happens because the RNY only bypasses a small amount of the the small intestine, and the body is VERY good at repairing itself. Most bodies manage to grow enough new villi (the little finger-like projections inside the gut that do the actually absorbing) to get back to absorbing about as many calories as it did before the RNY. The DS is rather different, in that it bypasses a great deal of the small intestine---so much that the body simply isn't capable of overcoming it. I'm certain DSers absorb more over time, just like RNYers do, but the mathematics of it are stuff for another time.

Also, as it gets easier to eat, it also gets harder to NOT eat. This is where the old 'diet and exercise' thing comes back into play. Some people have better strategies for restricting their eating than others do. Bad habits can be a part of regain, certainly.

And---there's metabolism. Our metabolic rate just naturally slows as we age. Some of us were born with very slow, or 'thrifty' metabolisms, and years of dieting didn't help that any. The first few months post-op of near-starvation rarely does anything to improve it, either. One advantage the RNY and the DS have over the Sleeve is that they DO generally speed up the metabolism. For some, this is permanent, for others, not. In most cases, the DS makes a far greater change in metabolism, and a more permanent one---but again, there are always exceptions.

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