XPost: VSG vs DS, insurance issues, what would you do?

Poodles
on 7/21/11 1:46 pm - TX
My insurance is denying my hubby's request for a DS because his BMI is not greater than 50. 

In our opinion the only other option is the VSG.   The band is not an option, as I had a failed band experience and don't recommend them, and no RNY as I worked at a bariatric clinic and know way too much about the "behind the scenes" things with that one.

When I needed a revision from the band, I wanted the VSG.  Did the research and fought the insurance company and was denied at every turn for it.  Yet they approved me for the Rny, and then when requested for the DS.  I did the DS at a BMI of 53.  Siince that time they have started approving the sleeve.

Well, I love my DS.   I know I basically have the VSG stomach with the extra bonus of malabsorbtion.  The stomach part is heaven when compared to the band, so I have no problem recommending that.  But, I know how my hubby likes to eat and wonder if the restriction alone will be "good enough" for him.

My concerns are that he will not have adequate weight loss, and that it will stretch out and he will regain.  

So now we have to decide to either quit, or "settle" for the VSG.  I know I am posting this on both the boards, and I know that we are probably biased because of the choice we made, but if you had ONLY the choice of VSG or nothing... would you do it?  And if you did have the VSG how do you lose weight and keep it off? (Low fat, low carb, low cal?)

I am so spoiled now with my DS, and I know how my DH likes to eat.  It just does not seem that the VSG would be enough for him.  He is wondering the same thing, so we are looking for some hopeful/helpful information.

Thank you in advance and please remember, I do not want to be flamed for the questions, I honestly need advice/help.

Thank you!
 Come to the Dark Side!!!                     
Band to DS revision 11/09/09.
Learn about the Duodenal Switch at dsfacts.com ! Off site comparisons of the 4 WLS 
http://www.thinnertimes.com/weight-loss-surgery/wls-basics/w eight-loss-surgery-comparison.html
http://www.lapsf.com/weight-loss-surgeries.html
 
  
ruggie
on 7/21/11 2:11 pm - Sacramento, CA
Honestly, no one in the forum is going to tell you to do nothing when the option for VSG is on the table. Pretty easy choice, really. Even if your husband doesn't lose the "most" weight, he'll still lose a bunch of weight, and he'll be happier, healthier, and probably can live longer too. Also on the plus side is he won't have the negative effects associated with malabsorption.

And remember, we all love to eat. The question is about whether he's at the point he's willing to change his life and diet forever. If so, the sleeve is a terrific tool to cut out hunger and greatly limit the amount of food he can put in his body. Make sure he's ready to commit to the life changes of any WLS.

Get the surgery, and good luck! You really already know the answer to your question.

     

Heaviest weight:  310 pounds  (Male, 5'10")

ruggie
on 7/21/11 2:17 pm - Sacramento, CA
Oh yeah, I suppose there's always the third option of going into debt / self-paying for the DS if that's what he wants. Don't know what a DS out of pocket is though. Have you considered it?

     

Heaviest weight:  310 pounds  (Male, 5'10")

Poodles
on 7/21/11 2:41 pm - TX
Self pay is out of our range... about 22,000.00.   If we do the sleeve right now it would be about 1400.00 out of pocket with our insurance.  If we wait until after Sept 1st it goes up to about 8,000.00 with the new insurance rules regarding WLS.

When you say: diet forever:  Is it low fat, low carb, low cal?  

Do you have any current stats long term?  I can't find much past 2 year post op and it shows about 50% average weight loss, which is about the same as the band.

I keep thinking something is better than nothing.  But, don't want him to have surgery if it will not work for HIM.

The band did not work for me, for a lot of reasons, but the malabsorbtion of the DS has been the Godsend I needed.  And the way of eating you are allowed is very easy to stick to. (High Protein, Low carb, High Fat)

 Just worried he will need the malabsorbtion to be successful too. 
ruggie
on 7/21/11 3:22 pm - Sacramento, CA
I mean diet forever just like you're dieting forever now with your own surgery.

Diet restriction is much less. Doctors advise to go low carb, but many people on here et carbs just fine. They say to avoid carbs mainly to avoid cravings buidling up.

I agree that some progress is better than none. You'll find patients on this forum that are doing well seven years later.

Also, recall that average weight loss with any surgery is average; you can definitely exceed averages with commitment to diet, exercise, and lifestyle changes. Look at some people's tickers in this forum, there's a bunch that have lost 90 to 100% excess bodyweight. Either surgery is a tool, and it's even possible to gain weight with either surgery as well.

You can search PubMed for a lot of research on the success of the sleeve; let me know if you'd like to read specific papers - I have a lot of subscription access at work.

Oh, a few folks maintain a pretty great VSG FAQ, but the URL escapes me at the moment. I'll try to find it.

     

Heaviest weight:  310 pounds  (Male, 5'10")

heathermc44
on 7/21/11 3:12 pm - Bremerton, WA
If I were him, I would go for the vsg and then if he hasn't lost enough weight then they can convert to a DS.  I totally understand your reasoning for wanting the DS but I think given how much the cost is going to go up I would just go for the vsg.

This is just my opinion, though
    
(deactivated member)
on 7/21/11 3:58 pm - San Jose, CA
"If I were him, I would go for the vsg and then if he hasn't lost enough weight then they can convert to a DS."

This kind of short-sighted, simplistic and bogus thinking makes me NUTS!!!

How many times do you VSG people (yes, I'm generalizing, but I'm pissed, and this misconception seems to be RAMPANT on this board) need to be told that you can't "just add the switch" and expect the same or even remotely similar results that you would have gotten with a DS from the git-go??

The two parts of the DS work in synergy as compared to doing them separately.  No, I don't have stats to back me up - there hasn't been and CANNOT BE an ethical randomized clinical trial* to prove this - assigning people to surgeries randomly isn't ethical, and people who "chose" one over the other are highly likely to have non-comparable situations, both medical and emotional.  But there is a metric ****ton of anecdotal evidence that adding the switch after more than a few months does not do much, most of the time, to improve weight loss with a stretched out sleeve.  And resleeving is a DANGEROUS surgery, especially if your first sleeve was cut small and then stretched out anyway.

*
See http://www.ncbi.nlm.nih.gov/pmc/articles/PMC300808/ for a sarcastic and humorous view of RTCs.
Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomised controlled trials
ruggie
on 7/21/11 4:57 pm, edited 7/22/11 2:52 am - Sacramento, CA
I don't know, I might need to only be told four or five more times with a post like that. Perhaps even as few as three with the bolding and words all in caps; those are moderately effective mnemonic devices, after all. Good tricks to use in the Sunday classifieds as well. They charge extra for it though.

"You people!"

     

Heaviest weight:  310 pounds  (Male, 5'10")

Cristina S.
on 7/21/11 10:29 pm - New Britain, CT

       
injeneral
on 7/22/11 2:51 am

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