Which is best WLS for someone with Irritable Bowel Synd

This is my first time posting and i really need some advice:
I was due to have the RNY in Dec. 17 2008, but the week before it was post-phoned by one of my docs- but that may be a good thing considering maybe the RNY is not for me...
~~~months ago even before one of my doctors told me to have WLS, i had thought that the DS was the surgery for me: #1-you keep your pyloral valve, #2-your stomach still looks [and works] like a stomach - but then when i HAD to get serious about due to my doctor's insistence that i needed WLS, i called up 2 doctors' offices and was told: that DS is ONLY for VERY VERY OVERWEIGHT people - i was not heavy enough - people who get THAT surgery wind up on IV Nutrition - - the one office-, which had a nurse who herself had the RNY say that Dumping is a Good (helpful) thing! ...so EVEN though i have Diabetes #2 + Sleep Apnea using C-PAP (and borderline highBP - taking Beta-blocker), 5'6" weight low 200s = BMI mid 30's, i would not be able to get the Duodenal Switch.

~~~So i did not investigate the DS further nor find out about even getting just the VGS = Gastric Sleeve... i went to the orientation/information session/meeting and thus officially began that lovely lil trek into what some of us are now so very familiar with re: mal-absorption, by-passing of portions/sections of the small intestine, discovered the cure for my Diabetes would hopefully lie in the RNY(!!!) - i was told of dangers of dumping,and pouches - not = exterior bodily fashion accessories :) , and the surprise that i would be crushing my vitamins and mixing them into applesauce & yogurt--- because i would no longer be using the bottom part of my stomach, in a manner of speaking! *do you STILL have to do this with DS and VGS even months after operation? {i had also read :no more rice, no more pasta... i love pasta and rice- brown rice is really excellent for you, right? but it will fill up the lil' pouch :( } ...

Now I Have Some other problems:GERD-take Aciphex, Fibromyalgia, Chronic Fatigue Syndrome, Hypothyroidism -take ARMOUR Thyroid- 
      ***but the big major problem that concerns the WLS  choices is this:i have severe Irritable Bowel Syndrome IBS --- and bkz i need your advice must elaborate, sorry, my problem consists of 3-4 bms or more - can occur as often as i use the bathroom - at least 1 maybe 2 large amount,  but soft and or diarrhea- it is a mess- even when soft- it is getting really depressing now. {i already have known for yrs that i'm lactose intolerant, too}
I take generic ROBINUL for the IBS so MOST of the time i have no pain & no spasms - except when there was something extraordinary like the lower GI before my Pre-Admission Testing - THAT -Lower GI was Really difficult this time, but the rest of the testing including Upper Endo went really smooth! :)

So QUESTION #1 = what WLS Surgery would you folks with the experience and more knowledge think would be best for me- with my IBS and sensitive digestive system  ISSUES ~
~~~~~~~~~the VGS Vertical Gastric Band  ---or---
~~~the entire DS whi*****ludes the 2 part operation on the stomach and the small intestine

and QUESTION #2 =Also, with the DS and Mal-absorption of fat soluble vits A,D,E, and K - what about taking other important and helpful supplements that are in capsules/liquid gel-caps
    Fish Oil, Oil of Evening Primrose, CoQ 10 {i am asking bkz i do take these and they help with some illnesses and possibly prevent some health conditions such as heart, skin, hot-flashes-stopped mine!!!, and fish oil is brain food and may help folks with Alzheimer's!

Question#3-have your DS and VGS/Sleeve been covered by insurance?

Thank you so very much for your time and input!
i am sure you folks can understand how this has been "consuming" me and you folks know firsthand what it's like - if you think the RNY would be best for me + me intestines , the plz let me know :)  but if you think it is best to completely leave the sm. intst. untouched - but i will lose and keep off most weight - and eventually lose Diabetes, please say so - but if you think - or know from you or someones experience that the IBS will be OK- same- may even improve by the DS-- I really would appreciate knowing- i do NOT want to make my situation worse with the IBS, and now that I think this delay has been a blessing from the Lord - maybe even a way for Him to direct me  to a different path that He knows is safer, better suited for me.
I AM trying to learn + listen to Him ---and i have been learning much already from your posts and the info on Obesity Help re: DS & the Sleeve - i have been given not only better hope for new life but for digestive system i can live with-thanks! :)

{{{P.S.   I will post this on both the DS and VGS Forums - just so you folks know- okay---
                and i thank you all ahead of time for your help!}}}

KAMEKO DMDS

Hi Kameko! Wowsers let me refresh my memory of the questions while I look above at the post. Ok Here I go.

First off, the DS is not just for the SMO. I had a BMI around 41 when I had mine, and no comorbitities. My surgeon did give me a longer common channel. His standard is 100cm but he gave me 150cm.

1. I would never in good conscious tell you what surgery to get. But I do remember one DSer that said they had IBS and it is much better after the DS. And I think you mean VSG- vertical sleeve gastrectomy or something like that lol.

2. I have no idea what the anser to that is....I don't even know what all that is lol. You want to take all medically neccessary vitamins in thier dry form. No oild based pills. Also no time released meds.

3. My DS was covered my Aetna. They do not approve the sleeve.

Good luck with your decision!

Hmmm...I am in no way a medical person.  So to answer your question would, in my opinion, better be left to someone in the medical field.  You have many issues with your health already, I'd be afraid to steer you the wrong way.  I *do* know that some DSers had IBS before their DS and have faired well after surgery, but each person's experience is different.  I'm going to direct your post to someone that I think can help.  Hopefully they will be along soon!!

Good luck hon!

Lori

Kamedo, I can't tell you what surgery to choose, but I will make a few general statements.

First, you give your height and approximate weight but not your BMI. Most insurance plans won't cover any WLS for someone with a bmi less than 35, even with comorbidities. However, if your bmi is at least 35, you meet the NIH criteria for WLS. That would include the DS. Some insurance plans only cover the DS for people over a certain bmi (often 50), but this is outdated thinking. We now know that the DS works well for MO people with lower bmi's as well. You will need to check with your insurer to see if you are covered. It is less likely that the VSG would be covered but again, you would need to check for specifics with your insurer.

    Regarding malnutrition - true, we have malabsorption with the DS (and some with RNY as well) but malabsorption doesn't equal malnutrition. If you follow instructions regarding eating plenty of protein, taking all necessary vitamins and supplements every day, and getting regular lab work to check levels, most people are fine. The rate of nutritional problems longterm with DS is 2%. The rate with RNY is 1%. For BOTH operations, the cause is almost always noncompliance. In other words, if you make that committment and take protein, vits and supplements every day, you should do fine. Very, very few people need IV nutrition after the DS, and when they do it is almost always short term.
  
    Regarding oil based meds - we need to take dry forms of vitamins for absorption. Anything in oil won't be well absorbed. That would include over the counter products and prescription products. Dry forms of the fat soluble vitamins are available and that's what we need. With the DS there is no need to crush vitamins and mix them with anything, you just take them normally.

    Regarding type 2 diabetes - the Ds has the best rate of resolution of type 2 diabetes of any wls.  Results for sleep apnea are also best with the DS. It sounds like your high BP is mild and would likely resolve with weight loss from any surgery.

    One of your biggest concerns is your IBS. I really can't speak to this - sorry! I didn't have IBS pre-op, there are others who did, and I've seen some say it improved with the surgery, but I have no personal experience in this area. I hope other people will be able to answer this question.

    So if you are unsure what to do, keep on reading and learning. Get a second opinion, if at all possible, with a surgeon who does the DS, as you will likely not get unbiased information from one who only does RNY (or from his nurse!). Good luck!

Larra

 

 

HI! 

You ask some very good questions, the others have explained the malabsorption stuff pretty good.  I'll hit your main concern, that of IBS.

I have/had IBS prior to surgery (7 months ago).  It was severe diarreha and more than three to four times a day.  I was to the point of the ONLY things I could eat were the junk food as any time I tried to eat meats, veggies fruits they "didn't agree" with me and they would reappear in a matter of 30 minutes, sometimes more but alot of times less.  I couldn't eat when I traveled (hard when you take a bus ride to Canada, Saskatoon from Nebraska!) or couldn't eat out unless I knew that we were in a restaruant that I wouldn't have to wait for a restroom stall.  Suffice to say, I basically didn't go any where.  Nothing really worked to stop the problems either.  I was thrilled if I went two or three days without an episode...but those were few and far between.

Today, I eat whatever my heart desires (well high protein lol) and even the IBS Trigger foods (high fats, porks were really bad, fried foods etc)  don't trigger my IBS.  I had a little bit of problems at the beginning, but it was just an extended period of what all new post ops with the DS go through, the runny stuff.  At about 6 weeks out (I think most talk about having problems closer to two weeks, but I may be wrong) it was done.  I have not had any episodes of the problems I had pre op.  I lived for 15-18 years that way and I feel so much more relaxed when going to get groceries, out to families house, just going out in general now. 

I don't know if this is the "norm" or not but this is what I have experienced.  I have a NORMAL bowel routine (like most DSers, first thing in the a.m. once sometimes twice, with more maybe one more in the evening depending on what I have eaten).  My hemmroids (sorry can't spell lol) are healing, no more sore butt at all.  I would have almost done the DS just to get rid of the IBS symptoms and problems  I am so happy with the results.  But like I said, I really don't know if this is the norm or not. 

Hope this helps! 

QUESTION #1 = what WLS Surgery would you folks with the experience and more knowledge think would be best for me- with my IBS and sensitive digestive system  ISSUES ~
~~~~~~~~~the VGS Vertical Gastric Band  ---or---
~~~the entire DS whi*****ludes the 2 part operation on the stomach and the small intestine

Only you can determine what is best for you. Keep researching each and obtain the medical facts, compare side effects, complications, etc. and you will be able to decide which surgery you will be live with for life. 


QUESTION #2 =Also, with the DS and Mal-absorption of fat soluble vits A,D,E, and K - what about taking other important and helpful supplements that are in capsules/liquid gel-caps
    Fish Oil, Oil of Evening Primrose, CoQ 10 {i am asking bkz i do take these and they help with some illnesses and possibly prevent some health conditions such as heart, skin, hot-flashes-stopped mine!!!, and fish oil is brain food and may help folks with Alzheimer's!

There are dry form vitamins that we take that replace the fat soluble ones and not consider an issue or hard to find. I do take CoQ10 with no problem and at over 2 yrs postop have never had any difficienciesor red flags with any of my bloodwork results. I also take boron that has many positive benefits from helping your bones and inflammation to helping with memory function.


Question#3-have your DS and VGS/Sleeve been covered by insurance?

My insurance did cover the DS and my BMI was 42 when I had my surgery. regarding the VSG, some insurance covers it, some don't.


i was told of dangers of dumping,and pouches - not = exterior bodily fashion accessories :) , and the surprise that i would be crushing my vitamins and mixing them into applesauce & yogurt--- because i would no longer be using the bottom part of my stomach, in a manner of speaking! *do you STILL have to do this with DS and VGS even months after operation? {i had also read :no more rice, no more pasta... i love pasta and rice- brown rice is really excellent for you, right? but it will fill up the lil' pouch :( } ...

During the first 2 weeks of surgery, I did have to crush my pills, since my inside was very raw from the surgery. But, I was able to take regular pills without crushing them about 3-4 months postop.

In regards to eating rice, pasta, I ate white rice and beans (arroz con gandules)  14 days out of surgery with no problem. I wasn't able to eat much, but enough to satisfy the taste of it. It was after I had my pernil (latin roasted pork). Pasta took me alittle longer to tolerate and was able to eat it with no problems 5 months post-op. Tonight, I had angel hair pasta with meatball and marinara sauce. 


***but the big major problem that concerns the WLS  choices is this:i have severe Irritable Bowel Syndrome IBS --- and bkz i need your advice must elaborate, sorry, my problem consists of 3-4 bms or more - can occur as often as i use the bathroom - at least 1 maybe 2 large amount,  but soft and or diarrhea- it is a mess- even when soft- it is getting really depressing now. {i already have known for yrs that i'm lactose intolerant, too}


I had severe IBS for 10 yrs. I was first a RNY pre-op and because of my severe IBS, the RnY was not recommended due to the pylorus being removed and it being a gastric bypass what would cause more aggravation because any food I eat would slide right through to the intestines and cause my diarrhea to continue and not be controlled as it what was happening to me then. The problem would still exist for me.

I changed to a new gastroenterologist *****commend I get tested for the DS and my insurance does cover it. She informed me that the DS would help with my IBS, severe obstructive sleep apnea and weight loss that would improve my health. She also informed me with the DS, I can continue taking me pain medications that were NSAIDs with no complications or for ulcers to occur as with the RNY. During the first year post-op, I was on Naproxen for painful menstrual symptoms that you are not able to take with the RnY.

I am 2 yrs post-op and ever since I had the DS, I am completely CURED of my severe IBS condition that I no longer suffer from. I go once or twice a day now since I was early out of surgery. They first 10 days, I did have frequen****ery stools and with time it fixed itself. By the time I was 1 year out, my bowel movements are soft, yet firm and no****ery and never had any diarrrhea. The DS helped control my bowel movements and eliminate IBS.

I was told that I might get lactose intolerant after having the DS and would need to change to Lactaid milk and use Lactaid pills prior to consuming any lactose or milk sugars products. I have never since having surgery been lactose intolerance and drink milk products daily with no side effects. Some DSer do get lactose intolerance and some don't.

Everyone else has given you good answers to your questions -- so I will not go into all of that again.  I, too, had what I thought was IBS prior to surgery.  There were times when the urgency was terrible and others when I would go days without a bowel movement.  The cramps and pain would make me think I was going to pass out.  I asked my surgeon if this would be helped by DS and he told me there was no way to know for sure.  But I have to tell you -- all of this is gone.  I do not have the pain and cramping and I no longer experience the urgency.  Now a typical day is going potty once in the morning and I am done!   I have no bowel issues.  The DS cured me!  This may not be typical and I cannot say this will be your experience -- but it is true for me.

My best advice would be to see a DS surgeon and get his/her opinion.  I see you are in PA -- are you anywhere near Scranton?  If so go see Dr. Peters or a little further away is Dr. Greenbaum in NJ.  But you owe it to yourself to seek out the best possible medical advice you can find and in this case that means finding an experienced DS surgeon and letting him/her discuss your options.  Don't settle for what an RNY or less experienced DS surgeon may have to say -- you need the real deal.  You have many co-morbidities and only an experienced DS surgeon can explain how the DS will impact your total health picture.

Red

Hi again, DSers :)

I wanted to thank you for your kindness and help in giving me your replies to my inquiry back on January 14th about which surgery would be more benificial for me with my severe Irritable Bowel Syndrome - and i had asked both you and the Vertical Sleeve forum - both groups of you folks are very, very kind and supportive - and i appreciate your honesty and genuine helpfulness, too :)

    I found out from some of the Vertical Sleeve folks who had IBS that it had improved  with their surgery- even though, they said that of course that was the case for them and they could not say that would be the case for all/or me- even from what they said-- the sleeve would probably NOT make it worse and might even improve some  :)  -- however it seems that your experiences have been even MORE positive-- which is hopeful -- so VERY hopeful for me--- and even from what ya'll said - all your personal experiences were extremely helpful, and PrettyDove- what you said your RNY Surgeon told you would happen re your IBS ***NO ONE told me that- my 2 RNY(in practice together) did not know what would happen with my IBS, so that was excellent that your RNY Doc knew and told you!- and you did NOT have the RNY but had the DS instead - you were very blessed to have been informed of the ramifications of the 'very popular RNY' and to be able to have the DS-- and I think the same will be for me!

And Laurie-- what you wrote about: "I would have almost done the DS just to get rid of the IBS symptoms and problems  I am so happy with the results"- that really has made an impression- And Red, your profound improvement is awesome- almost makes one forget that we are even getting that "bonus" of major and best chance of long term weight lost! :)  

*PLUS* there is the problem of the Insurance- when i tried to see if the Sleeve would be covered- it seems it would not, just like you said, Shani/Star ...

~~~and also i have for the most part been convinced for a few years that my intestines -which i learned a few years ago from an Upper GI -the Doc performing it told me that for a young person my intestines are long - are stretched out - that as we get older our intestines stretch- --- somehow mine- in my 40's then- were more stretched than average--- and in our Bariatric Studies, Ladies & Gentlemen, haven't we learned that our intestines are responsible for what & how much we absorb? :) :) :) ...(((by the time we hit the O.R. we know a lot, don't we, folks!))) ...
well, in my case, i think it would be helpful to rearrange my small intestines - ... but it is very good to know that if i could not have the DS, there is the Sleeve --- either one is something i could live with--- much better --- for me that the RNY - and even the Band--- when i looked at the possible side effects of the band--- and the restrictions in food & life-style of the RNY--- and the saddest thing is looking at the 2 pictures of what is done to the stomachs in the DS and/or Sleeve and then see the RNY stomach ---

well, recently I had a consult with one of the docs Red suggested: Dr. David Greenbaum, Willingboro, NJ - he and his partners do ALL :DS & Sleeve & RNY & Band ----he does the DS -he spoke with me just about the DS and he seems to think I'll be Okay for the DS --- so and my Insurance should hopefully cover it--- gotta get few things taken care of -but i already had and passed all my physical/medical tests for the RNY and my meetings with the Nutritionist and Exercise Evaul. and Pulmonary all for the RNY- and just had my PSYC Evaul with one of Dr. Greenbaum's Psycologists this week - and he told me right then at the end of the session that he was going to pass me - which is AWESOME so seems like on the right path now -so now Dr. Greenbaum's office will hopefully submit to insurance for approval! ((still have ta visit one of his Pulmonary guys but won't have hopefully go thru testing again - had that done in Nov- but he wants them following me before surgery rather than after he said))

~~~and re: the Fish Oil /and CoQ 10 Q-Gel /oil based caps/vitamins - i talked with Dr.Greenbaum at the consult about them- bkz it is important to me- among other things
of family history-& my my has Alzheimer's Disease, and the Fish Oil may help with that[& good 4 so many other things!], and is brain food, plus has helped me with hot flashes- after increasing my doesage- stopped having 'em- only had 2!!!--- he said he could 'tweak' the amount of the small intestine he takes--- which is tremendous--- i really liked THAT- EXTREMELY pleased with THAT- i was hoping he would say that!!! I liked his manner and his explaning things to me, things worked out really well :) -
and what is extremely rare, my husband and i do not agree on a lot, he was sorta but not all the way okay with the RNY... but he COMPLETELY is in favor -100% OK with the DS - the STOMACH + INTESTINE operation!!! Now THAT should be MAJOR COMFIRMATION, RIGHT?!!!  

I really appreciate your advice, comments, encouragement, and interest--- you guys really helped me in making this major decision...
THANK YOU for your kindness and concern!!! (((HUGS))) Star/Shani, Lori, Larra, Laurie, PrettyDove, Red, and anyone Else(sorry i missed)
Good to know I have you guys to talk to and turn to if i need help and advice in the days to come! :) :) :)

~~~ Oliwni! {Thanks!}~~ Olegwasi! {Dream well !} ~~ arigatou gozaimasu { thank you very much}
~~"Pray,hope, and don't worry." Ven. Father Solanus Casey
~~"Thank God ahead of time." St. Padre Pio

KAMEKO DMDS ~~ "Nan-kuru-nai-sah" = "It'll all work out"