Question regarding WLS requirements

I am interested in getting lap band surgery but I am still in the "research" stage.  My biggest concern is that I haven't had a primary care physician in about 10 years.  I did finally look up local doctor's and made an appointment to see a doctor next week.  All my research tells me that you need to have a stable relationship with a PCP for at least 1 year in order to be considered for surgery.  Is this truly the case or are there exceptions made on a case by case basis?  I am 5'8 and 315lbs.  I have tried every diet out there and although some did seem to work and I would lose some weight, the weight always came back plus extra.  I'm to the point now where I can't even exercise without severe lower back and joint pain.  I feel that WLS is my last option before giving up altogether. Can anyone shed some light on my dilemma?

I have not heard about that requirement before but may very well be the case.  When I went for the lap band, they wanted a letter of recommendation from my PCP for WLS, I don't think they cared which type. 

I am not a "band basher" really but I do have one since 2007 and am hoping to have a revision .  I want my band OUT.  As many others have recommended to those seeking the band, you should go over and read the posts for "Lap Band Failure" posts and decide if you truly want this tool.  I followed the rules to the "T" but lost most of my 79 pounds to vomiting from issues with the band, not because the band was working to it's potential.  4 years ago, I had 1cc removed after 12 hours of vomiting!! and have not had more put in but I regained all of my weight.  That is mainly my fault because I gave up on everything due to other things going on in my life. Point being, even with the band, you can regain everything so don't let it fool you.  It is only a tool and turning out to be not such a good one at that.

I have read about the failures as well as the success stories.  I am very sorry that you have not seen success with your band.  I know that everyone is different and will see different results.  I first looked into getting gastric bypass surgery but the idea of all the scarring, pain, and recovery time scared me into looking at alternatives.  I have heard about the sleeve as well but I haven't done any research to see if it would be a better fit for me.  I suppose I'll talk to the doc next week about my options.  

I just know that the process to get WLS is long and I don't want to have to add extra time to that just because I've spent the last 10 years self diagnosing via Google instead of doing the smart thing and going to a doctor!

Surgery is a highly personal decision that your surgeon of choice can help you decide upon. However, as a post-op RNY patient I can assure you that I have very little scarring, was back to work on my feet in two weeks, with good results thus far.  

As far as the PCP requirement, as a pp already commented, if differs by your insurance company.  Mine required 9 months of supervised dieting which was largely completed by my PCP. In any case, you're smart to develop a relationship immediately. Post-surgery requires a lifetime of commitment to follow-up, no matter which surgery. So it's good to forge a strong partnership sooner than later.  

Good luck to you!

@enchantrix - and I completely understand what you are saying.  I was at work on my 5th day post-lap surgery and never had any problems as far as that was concerned.  I just want you to really look at all of the WLS surgeries because you owe it to yourself to get the one YOU are comfortable with.  Just giving you warning that the Lap Band is not what I thought it would be and for these past 4 years, I had no idea so many others had the same issues because I had stopped coming onto these OH boards.  had I known, I would have sought revision in 2010.

 

Whichever you choose, I wish you well!  :)

You need to call YOUR insurance company and find out exactly what YOUR policy requirements are---they can vary a lot.

You also need to do a lo more research on the various forms of WLS. There are basically four---LapBand, VSG/Sleeve, RNY/gastric bypass, and DS/duodenal Switch. The LapBand is the one with the lowest success rate and the highest re-operation rate.

If you truly believe that restriction alone will allow you to lose and keep off all the weight you want , look closely at the Sleeve. The Sleeve makes your stomach permanently much smaller, but it will stretch some over time. Current research indicates that the removal of about 90% of the stomach also causes some metabolic changes, but this research is still in the early changes. Some advantages of the Sleeve include still using your pylorus, which means your stomach is still fully functional. You can still take NSAIDs, since there's no blind, remnant stomach like there is in the RNY. Most people with the Sleeve don't dump, or develop reactive hypoglycemia---also a potential side-effect of the RNY. And most Sleevers don't have food intolerances.

If you think your metabolism is shot, a common side-effect of dieting, losing, and regaining, then you need to consider a malabsorptive surgery like the RNY or the DS. The RNY bypasses most of the stoma*****luding the pylorus, leaving you a tiny 'pouch' to hold your food. Because the pylorus is bypassed and the opening between the pouch and the gut is always open, you should avoid drinking during or immediately after meals. The stoma can stretch, which means you no longer have restriction, which can lead to regain. And the stoma can get too small, causing something called a stricture. In most cases, this can be fixed by dilation of the stoma. Long-term, the Sleeve and the RNY have about the same maintained weight-loss stats.

And finally, there's the DS. The DS has the same stomach as the Sleeve, and all its advantages, plus an intestinal bypass similar to that of the RNY, but more effective. The DS has the very best long-term, maintained weight-loss stats for patients of any size, but the higher your BMI the better the DS will serve you compared to the other procedures. It also has the best stats for resolving or preventing things like diabetes and high cholesterol.

All forms of WLS will require you to take vitamins and minerals and get regular bloodwork done for the rest of your life. The Sleeve, because it has no malabsorption, requires the fewest supplements. Both the RNY and the DS cause life-long malabsorption of certain vitamins and minerals, and being faithful to your vitamins is more important than with the Sleeve. The RNY causes temporary, slight malabsorption of calories, but this goes away after about 18-24 months (which can lead to regain.) The DS causes permanent malabsorption of a significant per centage of the calories you eat, especially the calories from fat. (This is why it's so easy to maintain your loss long-term with the DS.)

Understand ALL your options before you choose a procedure, and choose a procedure before you choose a surgeon. Most insurance policies now have a 'one per lifetime' clause regarding WLS, so if you still choose to go with the Band remember that YOU will be the one paying for its removal on down the road.

This is the most complete and balanced explanation of all the surgeries I have seen on this forum. You're awesome MsBatt!

Thank you! I've been at this a LONG time, and it grieves me when I see someone have the wrong surgery for their needs "because my doctor said". I nearly made that mistake myself, and I'm thankful every day someone enlightened me about all the choices.

When I had my consultation they said that if someone didn't have a primary doc they would give them a referral.

 

I don't have any real advice about your primary care. I only wanted to share that my research of the lapband was not favorable. There are to be many complications long term. I did not wan to committed to regular fills/unfills. The sleeve was my choice because it seemed so natural post-op. Good luck.