Hi!
    Hair loss - some people think zinc or biotin help, most docs say they don't. Some people lose a little hair, some a lot, some none at all. Other than eating healthy, it isn't really subject to your control. The good news is that it WILL come back!

    Skin - again, not really subject to your control - sorry! Depends on genetics, age, amount of weight you lose, location of excess fat lost, etc. It can get ugly, but even so, you will look better in clothing once you're thinner, and if the skin really bothers you, you could look into plastics down the line. But as someone else pointed out, the reason for all this is to be healthier.

 

I am also sending you a pm.

 

Larra

Come on over to the DS forum and ask the same question. There are several people posting there who have gone from RNY to DS, also from VBG or lap band to DS, and lately we've been seeing inqueries about VSG to DS.  Revisions are higher risk surgeries, it's best to get it right the first time.

Larra

You've already received many great answers, but I wanted to clear up your statement (or maybe just assumption) that the DS is higher risk than the RNY. Not so! It used to be thought that this was the case, but that was during a time when the DS was "reserved" for the heaviest patients, who of course are, as a group, higher risk.
    There was an excellent study from the University of Chicago published in 2006 in which they compared 2 groups of patients of comparable BMI and health. One group had RNY, the other had DS. The complication rate was the same for both groups. But the people in the DS group lost more weight, and as time went on the difference in weight loss got larger and larger.
    The other issue I'll speak to the the "after 2 years you're on your own" with the RNY. Well, not precisely true. You would never be able to binge eat again because even though the pouch stretches out, it doesn't stretch enough for binging. But there is very little caloric malabsorption with the standard RNY to begin with, and once the pouch stretches out (and it will) there is less restriction, so at some point, all you have going for you is behavioral changes. I used to work with a group of bariatric surgeons who were honest enough to actually tell their pre-op patients that by 18 months, that would be what they would have to rely on. With DS, there is some adaptation of the intestine after a couple years, but never so much that you don't have malabsorption of calories. This is extremely helpful in maintaining weight loss.
     I looked very seriously at RNY, read this message board daily, went to a local support group, etc. I found that some people had wonderful success, but many others were in a day to day struggle to keep off the weight they had lost (which often wasn't as much as they wanted to lose) and many were failing at that struggle. I knew that if I had an operation where, after initial success, I had to struggle, I would fail. With the DS, the weight came off easily and thus far (2 and 1/2 years) I have not had to struggle at all to keep it off.
    Take a good honest look at yourself. Can you succeed with a low fat, low carb, restricted calorie diet for the rest of your life? Can you tolerate the possible dumping, food getting stuck issues of RNY? No liquids with meals? No NSAID's? Whole catagories of foods you are never supposed to eat again? I looked honestly at myself and knew that RNY wasn't for me. The malabsorption issues of the DS have not been a problem at all. Do your research, learn all you can, be honest with yourself, and then make an informed decision. Best of luck.

Larra
   

I don't know the answer to your question, but my suggestion would be to contact her insurer, get the names of some bariatric surgeons that are in-network, and give their offices a call. And I would ask if they would do either lap band or sleeve rather than RNY as that would avoid the issues with malabsorption. But ask about all the operations, what do you have to lose?
    I agree that the issues raised by other posters are serious, but only a bariatric surgeon can answer this question definitively for you and your cousin.

Best of luck!

Larra

   

I don't know of any insurance that covers the so called mini gastric bypass, and can't think of any reason that they should. It is only done by a couple surgeons on the fringes of the bariatric surgery community and not accepted by the ASMBS, or any other reputable organisation in the area of bariatric surgery. It has a high incidence of bile reflux gastritis and bile reflux esophagitis.

    Please do some more research into the accepted forms of WLS, all of which are represented by different forums on this website - DS (my choice), RNY, lap band. VSG is also being done more now, though it still is not accepted by the ASMBS due to lack of longterm data, and a lot of insurers don't cover it, though that may change in the future. But mini gastric bypass is not a well regarded or accepted operation.

Larra

Has your dad had any kind of work-up to see if there is anything technically wrong with his bypass? Back then they didn't usually separate the pouch from the blind stomach the way they usually do now, and the incidence of staple line breakdown, etc. is higher inthe older RNY's.

He might benefit from an upper GI x-ray study and upper endoscopy. Sorry I have no advice on the diet, I had the DS and not RNY.

Larra

It's great that you're asking questions and doing your research before surgery, not having regrets after.
    I strongly recommend that you give the DS serious consideration. It has the best statistics for percent excess weight loss, maintaining that weight loss (so important!) and resolution of comorbidities.  With you BMI where it is, and the added concern about the spinal cord disorder, you need an operation that will get a lot of weight off and keep it off. The DS is your best bet.

    It's true that some people do well with lap band or RNY. It's also true that some regain large amounts of weight, or don't lose as much as they need to lose or would like to lose to begin with. To some extent it's about lifestyle changes, and to some extent it's about the nature of the different operations. You DO need to make lifestyle changes to be successful with any WLS, but it's much easier with the DS. The Malabsorption allows you to eat a more varied diet, which is both easier and healthier. No dumping. You can drink liquids with your meals. You can take NSAID's. No food getting stuck. Strictures are rare.

    The DS does require a committment to emphasizing protein in your diet, and to taking vitamins and other supplements for life. This is true for RNY also, though the types and amounts are different. It also requires a committment to regular lab work to check your levels.

    As others have said, this is a personal decision. It's vital to look beyond what you learn at a seminar, and to look beyond what your insurance company prefers for you. The insurance company won't be the one living with this decision. You will. It's up to you.
Come on over to the DS forum to learn more. Take as much time as you need to be certain of your decision. Best of luck with whatever you decide.

Larra

Yes, I've seen this before. I don't know if it's true or not, but there are certainly a lot of MO people drinking diet soda. Is that part of the cause of MO? I don't think we know yet. But where I live, a lot of the local school districts are removing soda, both diet and regular, from the school vending machines, and I think that's a good idea.

Larra

I love water. I rarely drink anything else. I have the DS, not the lap band, but I really don't understand what your doctor was trying to say. Of course you can't live on JUS****er, coffee, and tea, you have to eat food, too, but I don't think you were trying to tell him that you never eat, just that these are the beverages you drink, right?
    Anyway, look into ALL the surgical options before making your decision. With the DS you don't ever have to consume artificial sweeteners if you don't want to or can't. You can eat a normal, varied diet with emphasis on protein. Personally, I do use Splenda, but I could get along fine without it if I wanted. Come on over to the DS board and learn about it. Ask questions if you want. Whatever you decide, let it be an informed decision.

Larra

Great post, Neely! I hope more people read this. I'm going to bookmark it for future use.

Larra

I chose the DS because it has the best percentage of excess weight loss, best maintainence of that weight loss (very important!) and best resolution of comorbidities. It also has better eating lifestyle - no dumping, no food getting stuck, you can drink liquids with meals, you can take NSAID's if needed. I have lost 100% of my excess weight and I'm very happy with both my health and my quality of life.
    With DS it is very important to eat plenty of protein and take vitamins and supplements faithfully, and get regular lab work (usually once a year once you get settled in) to make sure your blood count and vitamin levels and so on are ok. I haven't found any of this to be burdensome. It's very helpful not to have to worry about fat, as we absorb only 20% of the fat we consume. This allows for a great variety of food choices. We do have to be careful about carbs, esp simple carbs, as we absorb them very well. So, it isn't a free ride, but I had researched RNY thoroughly before learning about the DS and it's way easier to live with and succeed with than RNY. Yes, some people do great with RNY, but it's a lot harder, and the failure rate with RNY is much higher.

    I hope that helps. If you want to learn more, come on over to the DS forum, where anything and everything pertaining to the DS is discussed. Best of luck with your decision!

Larra

Marcy, I'm so glad Diana and the other Ds'ers found your post. I had the DS with Dr. Robert Rabkin, older brother of Dr. John Rabkin and now retired, about 2 and 1/2 years ago. I chose the DS rather than the RNY for several reasons, mostly because it has the best percentage of excess weight loss (on average), the best maintainence of that weight loss, and the most normal eating lifestyle. I had qualified for the RNY and the surgeon was ready to schedule my surgery, but I just didn't feel it was right for me - looking at the post-op diet that you are supposed to stay on for life and how very restrictive and limited it is, I felt that if that was what you needed to do to succeed longterm, I was going to fail.  But once I researched the DS, I knew it was the right choice for me.
    The DS is especially good for people who need to lose a lot of weight, because if you only lose let's say 60% of your excess weight (pretty average with RNY) you will still be significantly overweight or still MO. With DS people lose on average 80% of their excess weight. This is not to say that some people don't do great with the RNY, they do, but there is a significant longterm failure rate. My RNY surgeon quoted a 30% longterm failure rate, and I appreciate his honesty.
    With the DS I have lost 100% of my excess weight, and so far no trouble maintaining that weight loss even with enjoying good food.  We need to eat protein first (true for RNY also) and take vitamins and supplements religiously for life (true for RNY also though the specifics are different), and get regular lab work to make sure our levels are ok. We can eat protein and fat liberally as we malabsorb about 50% of the protein we consume, and about 80% of the fat we comsume. We do need to be careful about carbs.
    I hope you will look into the DS seriously before making any final decision. And while it would be good to lose a little weight before surgery to shrink your liver, demanding that you lose 100 lbs. is unreasonable. 
    Once you are approved for "WLS" by your insurer, you can get coverage for the DS whether your insurer likes it or not by appealing to the DMHC.
     I hope you'll come on over to the DS forum and learn more about it. There is also a support group meeting sponsored by Dr. Rabkin and Pacific Laparoscopy on the second Wednesday of the month in San Francisco that you could attend. Dr. Rabkin gives an educational presentation for new people that might be valuable for you. Whatever you decide, I wish you the best of health and great success.

Larra