How do you decide?

So I'm contemplating surgery but I don't know which is right for me.  I'm a 38 year old single mom.  My main concern is recovery time as I'm the only income in my house and can't afford to take more than a week off.  But also I'm concerned about pain.  I have a looooooow tollerance for pain!!  I've read up on both the band and gastirc and while I was at first thinking the band was for me, now I'm reading about having to get it filled and worrying about the band breaking, etc...so that seems like a lot of maintenance.

How do/did you decide which surgery was right for you?

Please educate yourself on ALL the surgical procedures not just RNY and Lap-Band. There are also the Vertical Sleeve and DS procedure.
RNY and DS both involve malabsorbtion, one more than the other. Malabsorbtion works great for many many patients but it invovles being very dutiful to taking numerous vitamins and supplements to compensate for what you body will no longer absorb naturally. I am not saying it is a bad thing, it is what it is. Malabsorbtion can also mean that meds you have already been taking will not work in the same way. Many of the sustained release and extended release meds will be a problem. With ByPass surgery you will also be restricted in what pain relievers you can take both over the counter and prescribed.
With malabsorbtive surgeries (like RNY) you may not be able to eat certain foods without getting sick and/or having a nasty reaction. This does not happen to everyone but can happen to anyone.
Because of malabsorbtion you may need to eat more of certain foods like fats (with the  DS) because your body does not absorb most of the fats you eat.
With both the DS and RNY scores of people are having great success with losing and maintaining their loss when the "follow the rules" I personally chose NOT to have a malabsorbtive surgery because I did not want to deal with the potential risks related to malabsorbtion. I did not want to change my meds, I did not want to have to eat a large quantity of certain foods to compensate for the malabsorbtion. I am not saying malabsorbtion or either procedures are bad procedures just saying why I chose NOT to get eitther the RNY or DS.
Lap band is restrictive only which again, is terrific for many and many have  been hugely successful when they too follow the rules. My concerns were the potential for erosion and band slippage. This does not happen to all but appears to happen to many leading to them needing/wanting a revision. I also did not want to have to go back often for fills and worried that either there would be too much restriction (cant eat, puking , slming etc). I also did not want there to be problems with too little restriction. I also worried about the band leaking or port flipping. Again this is not to say the Band is a bad choice, it was just not for me.
The reason I chose the sleeve was it had the restriction but not the malabsorbtion. It is a less complicated surgery than either the DS or RNY. I allowed me the best chance to eat like a normal person with normal size portions. I get full faster and stay full longer. With the sleeve (and DS) there is a great reduction in ghrelin production because of the way the surgery is performed. For many it eliminates hunger totally for many to a lesser degree.
Please do your self a huge favor and visit all the boards for each of the procedures and talk with folks that have "been there and done that" before making a final decision.

I chose my surgery based on LONG TERM results and not just a quick fix. I have 3 young special needs kids and needed to get it right the first time and resolve my comorbids permanently as well as keeping the weight of long term. The DS has the best stats hands down on EWL% loss and resolution of comorbids. In addition it offered themost normal type of eating  long term although low carbing is the way to go during the weight loss phase. I could not afford to dump and be incapacitated for 30 minuites to 2hours because my childrens severe needs required 24/7 supervision.. so I chose a surgery without the dumping. Only 30%of RNYers dump but I could not afford that chance. My husband has RNY and I have seen the dumping first hand... and for me..raising my kids I couldnt risk it. Its not like I coudl tell mykids to watch themselves for a while while I go lay down or take a nap from dumping.  I wanted to eat normal and not on low fat /low cal for the rest of my life as well. I already had 20 years of dieting undermy belt.. and it got me to 312.6.
 I needed resolution of myhigh blood pressure, sleep apnea, high cholesterol, edema of feet and ankles, chronic lower back pain,, pre diabetes ect.  
   I made the right choice for me. My comorbids are ALL  gone and I have lost 120 lbs.. 67% EWL ( goal 22.3 BMI)  in less than 6 months! Not too shabby!.
  My advice, Research research research. Read  the revision surgery board and the failed WLS board as well as the individual boards for peoples stories and lifestyles and figure out what kind of lifestyle do you want and can you live with forever.  Check out www.dsfacts.com as well.

 Good luck to you. HTH.

Ami

 

I'm echoing the previous poster -- please educate yourself on all four procedures.  The DS and VSG are worthy surgeries that warrant careful consideration -- especially in light of your comment of the band -- "having to get it filled and worrying about the band breaking, etc.." as the VSG is similar to the band in that it is a restrictive-only procedure but does not have any of the maintenance issues that the band requires.

(I'm sure that sentence will sound awful when I come back in a few hours to re-read it, but I've not had enough coffee yet.  I, too, am a mother -- and my two are under 4 so in the "I don't like to sleep" stage.)

I have a video on my blog that has a pretty good representation of all four surgeries.  It's not perfect -- but it's a heck of a lot better than some of the comparison charts I've seen floating around of late with outdated information about the DS and VSG on them.  The link is here if you are interested.

Your title was "How do you decide?" so I'm just going to answer how I chose.

I first heard about VSG about 18 months ago when a friend was looking into WLS.  Her surgeon recommended that surgery and, at the time, my friend didn't know about it.  She ended up having it done almost a year ago and has done very well.  Fantastic, actually.  I remember thinking about how the only thing that was stopping me from getting WLS was the fact that (this is what I thought at the time) my only options were the band and RNY. 

The band wasn't for me...placing objects into my body skeeves me out.  I would have a hard time with a pacemaker b/c of my "phobia".  On top of that, there was maintenance.  Too much, IMO, when I have a 45-60 minute drive to my surgeon.

The RNY?  I know several people who have had this done.  2 have done well, although one has made poor decisions and gained a bit back and the other has had a horrible time since about 7 years out.  She has maintained her weight for the most part (meds made her gain, but she has since lost 30 of those 50 pounds), but has had many medical problems that even her surgeon says is related to RNY.  Even though the odds are in RNY's favor, I didn't want to go as far as malabsorbtion/rearranging my intestines.

So, once I learned of the VSG, I knew that was the surgery for ME.  If, several years down the road, I find that I need the malabsorbtion, I have the option of going to the DS.  

Now, you should really go research all surgeries.  Please don't come back saying these are your only choices b/c of the surgeon that you have chosen.  Get what you WANT, don't choose from a limited list if what is available.

I did a lot of research.  I read everything I could find online and I also talked to all my treating doctors about my options.  I have a lot of treating doctors -- a primary care doctor, a gastroenterologist, a nephrologist, a cardiologist, a sleep apnea doctor, and my OB/GYN.  I also met with multiple surgeons to ask them about the pros and cons of each surgery.  I was a self-pay patient so I wasn't limited by what my insurance would cover -- that simply wasn't an issue.

I also talked to all the people I know in real life who have had weight loss surgery.  I know a bunch of gastric bypass people (including a close family member) and they have all done well and maintained their weight loss.  I know several band patients, and only one of them is happy with the surgery.  Most of the band folks I know didn't lose much weight or have had complications that required additional surgery.  (There is a risk of needing additional surgery down the road with any of the surgeries though.)

In the end, I felt that the RNY was the best choice for me.  My decision was based on my own research, conversations with my physicians, and talking to other people who had already had WLS.

It is a very personal decision and no matter what you choose, the surgery is just a tool.  You have to make it work.

I wish you all the best with your decision.

I did not decide based on recovery time nor pain. I took 2 weeks off from work for my recovery and, while that may seem like too much for you, is another week really that big a deal when you're deciding on something you have to live with for the rest of your life? Also, if you work full time, do you have a short term disability benefit available? Many use that to continue earning a percentage of their income while recovering. I used PTO (vacation time) for my entire 2 weeks, so I didn't miss a penny.

I will also say I consider myself a huge wimp when it comes to pain, or really any discomfort (my hubby will tell you right now that I am practically intolerable simply because I have a cold!). So, yes, it hurt, but I kept telling myself the results would be worth it, and so far, they absolutely are!

Now, how I DID decide was, well...I never wanted surgery for myself. I have a very negative impression of WLS in my mind. Until I was diagnosed with type 2 diabetes. So, that was my push toward surgery, so I never even considered the band or the VSG because the procedures that include a malabsortive component have a higher resolution rate for type 2 diabetes. So, I was immediately narrowed down to the RNY, DS, or miniGB. After about 30 seconds of research, I knew the miniGB was a load of phooey and that I wanted a real procedure. So, RNY or DS?

I chose the DS because it has better long-term stats for KEEPING the weight off. It also has better short-term stats as far as how much excess weight is lost. Plus, it has the highest rate of diabetes resolution of ANY WLS procedure (also the highest rate of resolution for almost all comorbidities, including high cholesterol, high blood pressure, etc.). Plus, with a VSG stomach instead of a pouch, there is no blind stomach to potentially cause future problems, no man-made stomas to stretch out, no bypassing of the pyloric valve (meaning no dumping syndrom)...I really couldn't find a single reason why I would chooe the RNY over the DS. The only reason I might ever recomend it to anyone is if they have persistent, serious acid issues, such as severe reflux or Barrett's esophogus. Other than that, for me, there was no benefit to having the RNY over the DS, yet multiple reasons in favor of the DS over the RNY.

AFTER I chose my procedure, I sought out a surgeon who had great stats in the procedure I chose. I think this is a big mistake many make - they see a surgeon before choosing their procedure, so they end up getting whatever procedure that particular surgeon happens to perform instead of something else that might have been better suited for them had they done their own independent research first.

Don't get a band. They suck. Do you want to be dependent on fills/unfills AND staying on a very low calorie diet for the rest of your life, to have only a 50% chance of keeping off half your excess weight for five years?

Please learn about the vertical sleeve gastrectomy, if you simply MUST have a restriction-only procedure. But for the best possible results and the best possible quality of life, the duodenal switch is the way to go. Learn more about it at www.dsfacts.com.

Here's what I post to people who ask about how I decided on the DS over other options:

I was originally on track to have RNY back in 2002, but got derailed after preop testing revealed that I had pulmonary hypertension. It's a long story, but it's on my profile if you'd like to read about it.

Even though I was off the track for RNY, I continued to attend the program my then-surgeon required of all his patients. I'd paid for it, so I figured I could benefit from it anyhow :-).

I saw some disturbing trends there. This was a big group, as several surgeons sent patients to it. There was, of course, a cadre of very successful patients (all RNY). They finished their year of program and went on with their lives, and as far as anyone knew/knows, all is well.

There were a surprising number of people, though, who fought and fought and fought to comply with what was expected of them, and the weight didn't come off well. At every meeting, there was word of someone else in the hospital with this or that problem--usually an ulcer or a stricture.

I listened to stories of dumping episodes, of getting food stuck episodes, of the mental/emotional challenges of having to live on highly restricted diets.....and I thought, "There's not a chance in hell I could live with this." (I should add that I have a major vomiting phobia. I'll do just about anything to not vomit. Not a good thing in some cases.)

Well, time passed, I got fatter and sicker, and eventually (again, story in my profile), it came out that the pulmonary hypertension was caused by the fat on my torso squashing my heart and lungs. It went from, "You cannot have any surgery at all," to, "You must have surgery or die."

I came back here to OH, feeling desperate because the lap band wouldn't give me enough weight loss to have any real hope of curing what was ailing me, and the RNY seemed to me like foolish butchery for not enough good results.

Someone told me then about the duodenal switch, invited me over to the DS board, which at the time was pretty much brand new, and the rest was history.

What I like about the DS:

1. 98% cure rate for type II diabetes. This was a major biggie because I had very bad diabetes.
2. Normal stomach anatomy and function is maintained. The stomach is reduced in size, but the normal stomach outlet, the pyloric valve, remains intact and functioning. There is no "stoma" with the DS or the vertical sleeve gastrectomy (VSG).
3. The intestinal changes that are done in the DS "jump start" the body's metabolism. Mine was shot to hell from a lifetime of PCOS, dieting and other factors.
4. I'd already done many years of low fat, low carb, highly restrictive dieting and I knew I sucked at it. The DS gives an eating quality of life that I find easy to live with: eat a primarily animal protein based diet. I'm a happy carnivore :-). I had to learn to restrict my carb intake, but it was a lot easier to do when I could eat meat, cheese, fish, eggs, etc. with abandon, with little regard for fat content. (DS'ers only absorb about 20% of the fat they eat, so for most of us, fat is almost a "free" food.)

I felt so strongly about the superiority of the DS to any other procedure that I traveled and paid out of pocket to have it done, rather than have the RNY done fifteen minutes from home and covered by insurance. It's been three years, and so far, so good :-).

Please come over to the DS board and visit with us there. Lots of folks will be happy to tell you about their experiences.
 

Research WLS.  And if your job doesn't have a sick time/short term disablity plan then save up some money because you will need more than a week off.   Or find a job that has sick time/short term disability.

Do you have any medical conditions, or a family history of any? Do you have any condition, such as arthritis, that means NSAIDs should be available to you? Are you good at dieting? Are you good at faithfully taking vitamins and supplements? What foods can/will you give up FOREVER? How hard would it be for you to change your lifestyle permanently?

These are all questions you need to answer about yourself. For ME, I chose the DS because, at 45, I realized that I was TERRIBLE at dieting. Resisting temption takes work ALL the time, whereas taking pills four times a day is easey-peasey.

I've always been a happy carnivore, and meat, while high in protein, is generaly high in fat, too. With the DS, I don't count fat because I only absorb 20% of the fat I eat. I didn't want to give up ANY of the foods I love, and with the DS, I didn't have to. (Read up on 'DS Math'.)

I had a family history of diabetes on both sides, high cholesterol, asthma, Gerd, and arthritis---the DS was my best hope of resolving all of those.

Basically, the DS offered me the best chance of good, long-term results, while requiring the least change in the habits I'd formed---and come to love---over a lifetime. I take more vitamins and supplements, eat less bread, and get regular bloodwork. That's ALL the changes I've made.

Oh, there is ONE other change---I weigh 165 pounds less, and I have zero guilt about eating whatever I please. (*grin*)