Introduction and questions ~RNY v. DS v. Sleeve

Hi all~

I am seeing Dr. Meilahn out of Temple Hospital in Philly.

I have all of my medical release finished and my psych and nutrition class on Tuesday.  I have a tentative surgery date on 2/26.  My BMI is 40.5, I am 5/2" and 216 lbs with diabetes, high cholesterol and sleep apnea.

 

The doc said that although my BMI is only 40.5 my belly is actually more like a higher BMI as my hips are still quite narrow...SAY WHAT....I've never heard that before although I didn't mind :-)

 

My main goal is to get off the medications that I take and stop using my c-Pap machine.  Most of the medical people I have seen to get my clearances keep telling me I am the perfect candidate for WLS. While the medical isssues is my reason for pursuing this surgery I am now getting excited and curious how I will look as a result of the surgery.  How much or quickly did you lose as a lightweight?

 

The last time I liked the way I looked I was 142 and a size 10/12.  I can imagine being smaller than that...is it possible?

 

I did ask about DS but they don't seem to want to do that for me saying it is more for larger people as a step toward RNY.  I've seen many people who have had great results with DS.  One think I know I will have difficulty with is taking pills/supplements after the surgery.

I'm sure I can do the chewable vitamins and calcium supplements.

 

What are the difference between RNY and DS from a lifestyle perspective?

 

Which is better for lightweights?

 

Diabetics?

 

Thanks for you help.

 

Deb

DS is a much better choice as far as diabetes goes.  The remission rate is higher and some people with a RNY have found their diabetes returning even without significant weight gain.  It is also the best as far as keeping the weight off and a more generous post op eating style.  Of course there is a downside, like there is with the RNY which is, as you mentioned, a lot of supplements and lab work.  If you can't commit to that then don't have any WLS.  You don't want to go from being sick from morbid obesity to being sick from vitamin deficiency.  There are also some who have bathroom issues after the DS but that can be controlled by food choices.

The RNY is more popular and more surgeons do it and it is easier to get follow up care but the downside is that the malabsorption of calories is short term, around 18 months to 2 years usually, but you will always need to take extra vitamins.  Also, you lose the use of your pyloric valve opening up the risk of dumping and reactive hypoglycemia, neither of which are pleasant to deal with.

The sleeve could be a good choice as it probably has the least maintenance of all WLS as far as vitamins and lab work but it's downside is a lack of long term follow up as far as keeping the weight off and some people have problems with GERD after the sleeve or DS, which of course includes the sleeve, too.  If you have problems with GERD the one good thing about the RNY is that it does help it a great deal, even curing it for many people.  Most surgeons don't recommend the sleeve if GERD is an issue but it can be treated with medication so it shouldn't be a deal breaker.

 

I was told that the sleeve doesn't treat the diabetes so much.

 

I am concerned with the procedures that let you eat a lot and that is my impression of DS and the sleeve.  I also don't think I will be good at taking any big pills for maintenance.  I can deal with chewables and they say the calcium citrate and vitamins are available that way.

 

I've seen the term "vetted DS surgeon" on the boards.  What does that mean?

 

The sleeve and RnY have similar results in terms of resolution of co-morbidities and weight loss. They are about 10% less effective than DS in those regards.

I think you might have misheard about DS being a "step to" RnY. DS is more powerful than RnY and you can't convert a DS to RnY at all. A sleeve is the DS stomach only. So a sleeve is a step to a DS as some people get a sleeve and then later get the switch part to malabsorb.  In fact, originally no one got stand-alone sleeves. You either got the DS in one step or you got it in 2 steps. They started doing the sleeve as a standalone surgery when people got the sleeve and never came back for the switch beause they'd lost the weight just fine without the malabsorption.

Typically, at one year out, someone with RnY can get about a cup of food. Most sleevers can eat about half what a RnY can eat any one meal. DSers vary depending on the size of the sleeve. Some have a sleeve the same size as a stand-alone sleeve and so can only eat 4-6 oz. at a time too. Others can eat more like a RnY (8-12 oz).

 

Taz hit some great points. Also, you can do some research on www.dsfacts.com. You want to be sure you're seeing a surgeon who actually knows how to do the DS, most don't and will use scare tactics to push you towards the surgeries they do.

--gina

 

I was about in your situation but no diabetes.  I had a RNY and have been very happy with it.  No more meds, no sleep apnea.  With any surgery, cholesterol can still be an issue because sometimes it is dependent on your body, not what you eat.  Any surgery should work for you, just see what fits best.

As a lightweight, you are more likely to get to a normal BMI, probably in around a year.  Everyone loses differently so don't compare yourself to others and get hung up with a certain goal.  if you work the program, it will work for you.  And in terms of how long it takes, it doesn't matter.  This is for the rest of your life.

Welcome and come back often.  Your date will be here before you know it.

Thank you.  I know it will not be easy but I am looking forward to my life after WLS.  I want to do all the things I haven't for the last 15 years and I want me life to no longer be about food but being healthy and strong.

 

Deb

Taz & Gina gave you the best info...

I will say that 95% of the reason *I* chose the DS was because I wanted to be able to take NSAIDS. I already have arthritis before my DS (knees, back, hands, etc) and while it's gotten better due to taking the weight off the joints, I still have achy days/esp mornings.

I also found thru searching here that many (I think the % is something like 40%) of the RNY'ers develop Reactive hypoglycemia even if they were NEVER diabetic pre-op. I already HAVE RH (predates my DS by about 20 years) and I knew I didn't want something that would exacerbate it.

Now, even with a heavy protein/very "fatty" diet, my genetically high cholesterol is in normal range with NO meds. I came off my insulin pump and metformin after my DS...I manage my diabetes thru diet and exercise only after being insulin dependent since 2002 and diabetic since 1997.

There is a DS surgeon in PA, and he will do the DS on lightweights who are diabetic.

Liz

Thank you.  I was told that I could take NSAIDS for headaches and things, just not on a long term basis.

 

What time of schedule do you need with vitamins and supplement for DS?  With the gastric bypass, they told me daily vitamin and Calcium Citrate chews4-6 times a day (can't remember which one).  I may need to take iron.

 

I am looking forward to living a new kind of life after this. But there are certain things that are deal breakers for me and taking large pills is one of them.

I've seen the term "Vetted DS surgeon".  What does that mean?

At Temple, I am definately getting the impression that they thinkg DS is a stepping stone for severely obese patients.  Any help is appreciated!

 

I have had Diabetes for 3 years and not on insulin.

 

Deb

MOST bariatric surgeons will tell you NO NSAIDS with a RNY...too easy to develop an ulcer in your blind stomach.

A vast majority of surgeon's and nuts out there have NO clue what needs to be taken as far as supplements after any WLS..

You can see the list of what is recommended by someone who has studied this, who has WLS herself (almost 20 years ago now) and has helped more current WLS people out of a hole created by following their DOCTOR'S/NUTS recommendation than anyone else we know...her name is Michelle (Vitalady) and here are the documents in question:

www.gblcreations.com/Resources/Gina/VitaLadysLabsandTargets_ 11-2009.doc
www.gblcreations.com/Resources/Gina/VitaladysPre-op_ideas_11 -2009.doc
www.gblcreations.com/Resources/Gina/ProgramAGB&VSG2-2010.pdf This one is for the Lapband and VSG
www.gblcreations.com/Resources/Gina/ProgramDRNY_ERNY_BPDDS3- 2010.pdf This one is for the DS and the Distal/Extended RNY
www.gblcreations.com/Resources/Gina/ProgramPRNY2-2010.pdf This one is for the Proximal RNY

The lists are a starting point...and depending on your lab work as to which you can decrease or which to increase.

I'm gonna be honest...if taking vitamins/supplements are a deal breaker, please rethink your options. While we want you to have the surgery you want, we do not want you to get one and then develop serious vitamin deficiencies. Taking vitamins (and I do not mean chewables) is not an option...if you had to take big pills due to having heart disease, would that be a deal breaker? I suspect you would find a way to manage them.

A vetted DS surgeon is one we know has done at least 100 DS's and has a good reputation for a surgeon. Many bariatric surgeons will say they do a DS but what they are talking about is actually a DISTAL RNY which is also known as the BPD (not the sleeve as the stomach, but has the intestines of one). DS'ers do not consider the PBD as a DS...it's a RNY with a DS intestines.

A vast many surgeons will only do the DS on those over a 50BMI...they think we can lose too much with a DS as a lightweight...but that is NOT true. It CAN happen with any surgery.

Liz