Wanted DS, doc says VSG

Had part 1 of my surgical consult yesterday - have to see the psychiatrists separately because they were off for the holiday and I couldn't reschedule with the surgeon soon enough. After a lot of talking and back and forth, he is insistent that I should go with the VSG rather than the DS. I'm "only" a BMI of 41 right now according to my official weigh-in, I'm young and fairly otherwise healthy (even though I have lots of precursors to a variety of comorbids) and he thinks I should be able to lose "enough" with the VSG. 

On one hand I'm ok with this idea because if I *can* do well with the VSG, it will be great not to have to have such a heavy vitamin regimen and risk of deficiencies. Also nice to have another option if I am facing regain in 10-20 years. However. 

On the other hand, I'm really worried I won't lose as much weight as I feel is necessary. Average EWL for VSG is only 65% as opposed to the DS's 85% and at that point, I'm still over 200 lbs and not at a weight any lower than I've gotten to in the past with plain ol' diet. Sure, this will be more sustainable, but I didn't *feel* that much better at that weight, you know? Also I'd really rather not have to do another surgery to be successful. 

So that's where I'm at right now. Anyone have uplifting experiences to share with me? 

Is your surgeon experienced with the DS?  I wouldn't be surprised if he was pushing VSG since it's an easier surgery that he is more experienced with.  If you're set on the DS, I'd find a different surgeon.  

As for weight loss - you'll lose as much as you work for.  Many people who post here had 100% EWL and maintain it with the VSG.  

Actually, yeah, he is. He's been doing them for 13 years and has written in scientific journals regarding them. He's a big believer that it's right when it's right, but he also took a lot of care to hear my specific story and I felt like he heard me as far as what my goals are. Thanks for your insight about the weight loss!

Hm.  Well.. if you trust him, and it sounds like you do, then going with his recommendation seems wise, since I'm sure it's an informed one!

Don't let the 65% average EWL statistic scare you off the VSG.  There are plenty of people who have exceeded that number.

My weight on the day of surgery was 392.  Today I'm 235.  That's in 13 months losing 157 lbs.  Granted, I'm a heavyweight and will lose more initially, but the restriction of the sleeve really does work.  Some of the problems associated with the DS are a little overwhelming.  

Ultimately it comes down how much you put into it.  Our only limitations are ourselves.

If in your heart of hearts you feel that you need more than eating less to lose weight and keep it off, then insist on the DS. I know several who had the DS that had lower BMI's than you do, and they are happy and healthy at a perfectly normal weight (not underweight). 

My BMI was 44 when I had my DS, got below my goal weight and bounced back up 14% and settled in a happy place.  Nutrition is second nature, some 9 years later.  I know more today about my nutritional needs than my doctors, for the most part. 

One thing I can say that the DS patient has to be a strong, curious and stubborn personality.  You must be curious enought to want to learn about nutrition, strong enough to say what you think and what you want, and stubborn enough to go against the standard RNY guidelines that they hand us.

The sleeve is a very easy procedure to live with, and easier than any dieting effort you've ever tried in the past.  That's the glory of it all.  Some people do wonderfully with it, while others realize they needed something more even though they gave it everything they had. 

Thanks, Valerie! I've read a lot of your posts here and you are always so helpful and knowledgeable! I think my doc was mostly concerned with the long term effects of the vitamin deficiency. He pushed pretty hard on the idea that economic troubles can really endanger your health in an unprecedented way if you've had this surgery and suddenly coming up with $80/month for vitamins isn't do-able anymore. I think I'm more likely to be able to afford that than another $25k surgery. I have no guarantees of having health insurance that will cover WLS in the future. 

But if I could be successful with the VSG, I'd love a lower-risk procedure. 

I spend less than half of that on vitamins, but he does have a point.  For that very example, many of us have a considerable stockpile, especially when we find a good BOGO deal. 

I've found that many deficiencies are from those who follow doc and nutritionists recommendations (designed for RNY).  Sad, I know.  I was one of them, watching my levels plummet as my surgeon shrugged her shoulders.  I decided to go rogue and try what the vets found successful and finally saw good results.  I found a PCP who was young and curious and basically recorded what I decided to do, collaborating where she had more knowledge.

You are not a statistic, you get out of it what you put into it, what's important is picking the right surgery that you feel you can live with & be successful. Some people need that malabsorption to be successful, only you can know if you need that based on your past experiences.

I choose the vsg, restriction only procedure has worked well for me & this is a lifestyle that I can maintain & I really didn't want my intestines rerouted. Choose what's best for you, your surgeon can't be in your shoes. 

So what kinds of experiences do you use to gauge that? Obviously I've never had 80% of my stomach removed before. :) How do I know if I need more than restriction (though my doc also said that VSG is about more than restriction, that there are hormonal changes that happen as well)? 

My most successful attempt at weight loss was eating very low carb, fluctuating back and forth to a 1000 calorie 90% fat diet. This is the biggest thing that makes me think malabsorption might be key for me. Low calories never did it. But Dr. is insistent that calories are not all they are cracked up to be, that there is much more to VSG than just limiting your intake. And this is a pioneering DS doctor who has been doing them 13 years, was one of the first to do them laparoscopically, and has written papers on them.