Hello all!  My name is Linda and my BMI is 69.something.   I'm in the process of starting my WLS journey and hoping to gain (no pun intended) a lot information from folks in the same situation.

Thanks!

Welcome!!!! You will find a lot of useful information on this forum as well as the others.

What surgery are you looking at? My only suggestion would be to check out all the surgery options, don't limit yourself off the bat to one or the other.

Any questions you have, feel free to post them here!

I have no idea what type of surgery I'll be having and I really didn't realize that they had different WLS options out there.  I'm still in the research phase and have not met with my surgeon as of yet.    Once I meet with him I'll find out what surgery is the best for my situation.

Thanks for the support!

Hi Linda,

Since you are still researching surgery options, I invite you to learn about the DS.  I came across this option by pure luck as I was looking into WLS.  I had no idea it existed, and was reluctantly willing to settle for RnY, knowing that I would not be happy with the post-op lifestyle, but thought I had no other options.  I can't even tell you how happy I am with my DS post-op lifestyle, and how grateful I am every day that I found the surgery option that was right for me BEFORE I was cut into.

Since I don't recognize the name of the surgeon listed on your profile, I doubt he performs the DS, which may mean it isn't even discussed with you as an option.  Or, what often happens is if the surgeon doesn't perform the DS, they provide some very inaccurate information about it.  There are very few surgeons that are qualified to do the DS, but please don't limit your decision on WLS to what the most convenient surgeon can perform -- this is the rest of your life!

Come over to the DS forum and read about why people are so happy with this surgery choice: 
www.obesityhelp.com/forums/DS/

Here is a link for a great online resource:  www.dsfacts.com

Almost daily someone researching surgery options asks why people decided on the DS, here is a thread from just today to read over:  www.obesityhelp.com/forums/ds/a,messageboard/action,replies/board_id,5357/cat_id,4957/topic_id,3822771/

On this thread, you will find the following information that a fellow DSer put together on considering your surgery choices:

RNY compared to the DS

RNY – expected weight loss

• 50-65% expected excess weight loss (percentage varies in opinion – this is the most commonly seen estimate)
  • Results may vary
• Regain
  • Possible regain: more prevalent after 5 years
  • 50-100% regain of weight has been recorded
  • Results may vary
  • Must follow “pouch rules" in an attempt to not regain

DS – expected weight loss

• 85% expected excess weight loss
  • Results may vary
• Regain
  • Studies show little to no regain (20-40 pounds recorded)
  • Results may vary
  • Highest success rate over 10 year study (78% avg. Excess Weight Loss – EWL)

 RNY – have a stoma (stomach made into a pouch – size of an egg)

• Size: 2 oz
  • Stretch to average size of 6 oz in 2 years  (possible to stretch up to 9-10 oz)
  • You can eat more as time goes by
  • Average after 1 year is 1-1.5 cups of food
• No Endoscopes on blind stomach/remnant stomach that is bypassed
  • Doctor evaluation: cannot use an endoscope (to find ulcers and tumors)
  • RYGBP construction makes the large bypassed distal stomach inaccessible to standard non-invasive diagnostic modalities. Neither x-ray contrast studies nor endoscopy can assess this potentially important but hidden area.
• Stoma: pouch
  • Should not take Nonsteroidal Anti-Inflammatory drugs (NSAID).
• NSAIDs are: Advil, Alka Seltzer, Aleve, Anacin, Ascription, Aspirin, Bufferin, Coricidin, Cortisone, Dolobid, Empirin, Excedrin, Feldene, Fiorinol, Ibuprofen, Meclomen, Motrin, Nalfon, Naprosyn, Norgesic, Tolectin, Vanquish
  • NSAIDs are used for arthritis, bursitis, tendonitis, back pain, headaches, and general aches and pains.
  • Taking NSAIDs could develop into a bleeding ulcer and interfere with kidney function.
• Possible Problems
  • Ulcers (Some doctors recommend taking prilosec for 6 months to 1/2 years in an attempt to prevent the ulcers)
  • Possibility of a staple line failure
  • Noncompliance: simply do not lose enough (even with following the rules)
  • Vitamin Deficiencies
  • Narrowing/blockage of the stoma
  • Vomiting if food is not properly chewed or if food is eaten to quickly
  • Dumping syndrome, NIPHS, Hypoglycemia
    • No Valve (pyloric valve that opens and closes to let food enter intestines is bypassed) which means food empties directly into the small intestines and causes dumping and/or can cause NIPHS or Hypoglycemia
• Dumping: food (most commonly sugar but not necessarily “just" sugar) enters/dumps directly into small intestines and causes physical pain (some people believe this pain enforces good eating habits)
  • Dumping varies in degree of occurrence and discomfort
  • Dumping symptoms:
    • Nausea
    • Vomiting
    • Bloated stomach
    • Diarrhea
    • Excessive sweating
    • Increased bowel sounds
    • Dizziness
    • “Emotional" reactions
• NIPHS (insulin over production): “the body overproduces insulin in response to food entering the intestines at a point where food would normally be more digested already - this part of the intestine is not used to coping with metabolizing glucose in the condition it arrives after RNY, and it is suspected that the intestine signals the pancreas for more insulin to aid digestion, causing a MASSIVE overproduction.  The change occurs on a cellular level, hard to diagnose.  Treatment: Removal of half the pancreas."
  • RNY stoma that is created allows food to go straight through the stomach into the small intestine unrestricted so it does not control the flow.  Because of that the body reads that it needs more insulin because the food is moving through so quickly and it thinks there's going to be a lot more food.  With the DS, the normal peristalsis works because the pyloric valve is in place and can control the movement of food into the small intestines.  
  • NIPHS, Hypoglycemia is deadly if not corrected

 DS – whole stomach (size of banana)

• “Whole working stomach" - meaning the stomach’s outer curvature is removed as opposed to making a pouch/stoma.
  • Part of the stomach removed is where most of the hormone called Grehlin is produced.
  • Grehlin gives the sensation of hunger so by removing most of that section of the stomach a DSer is not as hungry as before.
• Whole working stomach: no blind stomach.  Endoscope can be used.
• Can take NSAIDs
• Do not need to take Prilosec to prevent ulcers.
• Valves are in tack: no Dumping Syndrome or NIPHS

 RNY – Eating

• Eat protein first
  • 60g of protein a day
• Recommended to chew food to liquid consistency (pureed, soft, thoroughly chewed)
  • This is more important for people early out (new pouch stomach will stretch out with time).
  • Food is thoroughly chewed to prevent blockage (the hole/path leaving the stomach and into the intestine is roughly the size of a dime).
  • To get food unstuck, patients drink meat tenderizer mixed with water.
• Low carbohydrates
  • Carbohydrates can slow weight loss and lead to possible regain
  • Avoid sugars in particular (to prevent dumping syndrome)
• Low fat
  • Foods high in fat may cause Dumping Syndrome
  • Fatty foods can lead to slow weight loss or possible regain
• 64 oz of water
  • Stop drinking within 15-30 minutes of a meal
  • Do not begin drinking after a meal for 1-1.5 hours
  • Some doctors do not encourage the use of a straw (pushes food too quickly through the stomach and can cause gas/discomfort)
• Water Loading
  • 15 minutes before the next meal, drink as much as possible as fast as possible. 
  • Water loading will not work if you haven’t been drinking over the last few hours.
  • You can water load at any time 2-3 hours before your next meal if you get hungry, which will cause a strong feeling of fullness.
    • Disclaimer: this is a practice some people use to feel “full" and lose weight. Not a requirement.

DS – Eating

• Eat protein first
  • 80-100g of protein
  • DS patients can on average eat more food than any other type of weight loss surgery.
• Low carbohydrates
  • Carbohydrates can slow the weight loss and lead to possible regain
  • No dumping syndrome from eating sugar (or fat)
• Eat high in fat
  • DS only absorb 20% of fat (do not need to eat low fat)
    • If a taco has 20g of fat, a DSer only absorbs 4g while a person without surgery or RNY absorbs ALL 20g. (this is just an example, measuring absorption is not an exact science)
    • When experiencing a “stall" (slowed weight loss/plateau) a DS patient commonly increases fat consumption to resolve
• 64 oz of water
  • Can drink with meals
  • Can use a straw

RNY – Possible Issues

• Vitamin deficiencies: Must follow a vitamin regime for the rest of your life
  • Common vitamin deficiencies found in vitamins B12, iron, and zinc
  • Calcium must be supplemented for the rest of your life
• Bathroom issues
  • Gas
  • Constipation
  • Dumping in the form of loose stools
• Reversible procedure (Reversals of any surgery is very complicated)
  • Revision often performed instead of reversal
  • Revising to a different type of surgery is possible.

 DS – Possible Issues

• Vitamin deficiencies: Must follow a vitamin regime for the rest of your life
  • Common vitamin deficiencies found in vitamins A, D, and iron
  • “Water soluble"/ “water miscible" / “dry" vitamins absorb best (in other words get vitamins that are not fat/oil based)
  • Calcium must be supplemented for the rest of your life
• Bathroom issues
  • Gas
  • Loose stool (Most common in the first few weeks of surgery. Generally food related)
• Reversible procedure
  • The intestinal bypass is reversible for those having absorption complications
    • revision: lengthening common channel (to stop losing weight and/or to absorb vitamins)
  • Stomach is obviously not reversible (part of stomach was removed)

 

RNY - Diabetes

• 85% cure rate
  • RNY can put diabetes in remission.
  • Diabetes may come back in two or three years--even if the
    patient maintains most of their weight loss.
  • Even a small amount of weight gain, long-term, can cause a diabetes
    relapse.

 DS – Diabetes

• 98 % cure rate for type II diabetes.

 

DS – Myth or Fact

The DS is only recommended for the super morbid obese (BMI over 60) = Myth / Not True

• To be eligble for ANY type of weight loss surgery, a person has to be 100 lbs. over weight or have a body mass index (BMI) of 40 or more.
• BMI’s under 40 have also been approved (usually require a comorbidy/health problem - an example is sleep apnea).

The DS is “experimental and investigational" = Myth / Not True

• Medicare approves the DS
• Many insurance companies are starting to cover the DS.
• DS has been performed since the 1970s

DSer will have a problem when they become old = Not True

• We wont need to eat as much when we are older b/c our bodies will adapt
• The little hair-like villa located in the intestines grows longer to adjust to the new digestive system (grows longer to increase absorbtion).

DSer’s gas stink = true

• The gas does smell. (This is true for the DS and RNY)
• There are products called air fresheners that a person can use.
• May take Flagyl or fish zole

DSers may need to wear a diaper = Myth / Not True

• That is silly

Skin color turns yellow or pallor = Myth / Not True

• Patients who follow their regular vitamin regime (keep up with blood work) do not turn pallor
• If someone looks pallor, they could have a vitamin deficiency.  This applies to any type of weight loss surgery. For both RNY and the DS.
• Vitamins and blood work must be monitored for life. For both RNY and the DS.

DSers will have a heart attack from all the fatty food they eat = Myth / Not True

• Cholesterol levels lower after having the DS. 
• 80% of the fatty food is not absorbed – the fatty food is healthier to eat as a DSer than a person without surgery.
• If a taco has 20g of fat, a DSer only absorbs 4g while a person without surgery or a person with the RNY will absorb ALL 20g.  Good meal for the DSer. (this is just an example, measuring absorption is not an exact science)

Dsers don’t need to exercise = Myth / Not true

• DSer’s are aware of the benefits of exercise (body and soul).
• Exercise helps in losing weight and maintaining goal weight 

 *Possible issues are just that, “possible," and may or may not occur.  

Not every surgery will be covered by insurance. Good luck to everyone and thank you for reading my comparison chart. Hayley F.

Hi Linda -

Welcome!!!  I started out at 440 lbs and my BMI was around 70.  I had RNY on 12/17/07 and today I weigh 251.  It has been a most incredible, at time most difficult, journey of my life.  I don't regret having surgery for a single moment.

I agree, check out various types of surgeries.  I chose RNY for myself for a lot of different reasons - but everyone is different and it is a choice you only (usually!) get to make once.  I think we have a sprinkling of all the forms of surgeries represented on this board - if you have a question, post it and I'm sure people will respond.

Good luck to you and I look forward to getting to know you better.

Take Care,
Jana

Hi Miami and welcome to the board. You are wise to take your time researching I spent over a year looking and reading and stalking different support groups till I decided what surgeon and which surgery was for me. ( I was fighting with my old insurance at the time thank God for my new one) while I still learn everyday and well have rough days and bad I was so prepared that the nut said I could have taught the 10 day pre op diet class my doctor required LOL! We look forward to having you around and I will help answer any questions I can.

Sarah

Welcome! I'm not very far ahead of you, still pre-op myself. This is a fabulous place for resources, support, and unselfish sharing. I wish you all good luck.

Thank you all for the support!  I will most definitely update you guys during my process!

Welcome Linda!!!  Good luck with your journey!!!

Welcome. Come here and get info, vent, or just to be. this is a wonderful board. Jump on in