Jiliana2
Why VSG was Right For Me
Jan 22, 2015
I'm going to preface this by saying, "Remember, I'm in Canada, and things here are done very differently in Canada than in the USA. The process is NOT the same."
Now that we have that out of the way...
I live in Ontario. Here in this province, WLS is covered by our provincial health care plan. But you still have to go through the process in order to get there. It starts with a referral. I got my referral to the Ontario Bariatric Registry from my family doctor, my general practitioner (GP). If you don't have a GP, you can get one from a specialist, or a walk-in clinic. It can be done online or your GP can fax the information to the numbers provided.
The Registry receives your information and will assign you to a WLS Centre based on your postal code. There are a few centres around the province. I live in Ottawa, and we have a centre here so I was referred to the Ottawa Weight Management Centre (OWMC) at the Civic Hospital.
The OWMC received my information from the Registry and they sent me a manilla envelope with a questionnaire and an invitation to a general information session. The session was to be held three months after my initial referral from my GP. I highly recommend taking your spouse or a support person to the session with you. More ears are always better! And in the meantime, soak up everything you can on the Obesity Help forums!
Now, here in Ontario, I'm told that three surgeries are covered by our provincial plan. They are the DS, the VSG and the RNY. However, some centres in Ontario (OWMC included) view the RNY as the "gold standard" surgery. That is to say, this is the 'default' surgery that you will receive unless there is a darn good reason why you should have either the DS or the VSG. That reason has to be documented and agreed upon by your surgeon.
For me, I researched a lot prior to even asking for the referral. I found out that with the RNY, taking NSAIDs post-op is a definite no-no. It's not even a good idea for VSG folks really. But I have a huge problem with that, and here's why:
I have psoriatic arthritis. And I have a bad case of it too. My rheumatologist tried a number of medications to control it, when I was diagnosed a few years ago, but only the NSAIDs worked and kept my symptoms under control. There is no cure, only control. So I am taking NSAIDs every single day. And I likely will have to take these for the rest of my life. My arthritis did not go away after WLS and is in my case, related to heredity (many of my family members have psoriasis and psoriatic arthritis) so it's with me for the long haul. NSAIDs are what help me get out of bed in the morning with no stiffness. They help me walk. Without them, I was in a cast before I was properly diagnosed! The NSAIDs are what permit me to go to the gym, get on a treadmill and run for 3 miles without stopping. They're my lifesaver and they help my health. I cannot move, literally, without them for my stiffness is extreme.
So before I met my surgeon, I made an appointment with my rheumatologist and told him of my WLS plan. In so doing, I explained the types of surgeries available to me. I asked him for his thoughts. And he recommended the VSG. It was he who wrote me a note then and there in his office to explain my history, my medical needs and his recommendation for the VSG rather than the RNY so I could continue to take NSAIDs and keep my psoriatic arthritis under control. This recommendation letter was also entered into my electronic health file, and was thus visible to my surgeon when I went to my Meet the Surgeon appointment at OWMC.
Upon meeting the surgeon, he said, "So you want to have an RNY?" and I said, "Yes... but no. I think VSG is the better course of action. Here's why." I told him my history and gave him the details. The surgeon replied, "Well, we'll have to get a letter from your doctor that says that VSG is better." And I said, "I happen to have that here with me and it's in my electronic file too." I pulled out my file folder of previous tests, letters, bloodwork results, etc. (I keep this and take it to every doctor appointment) and he blinked. I think he was shocked that I'd been so proactive on the matter. I simply didn't want to add any extra waiting time before surgery could be scheduled! He read my letter. He looked up my electronic records. And we signed the legal document that agreed that he would do a VSG for me, rather than the RNY (unless something drastic changed during his findings in surgery after he opened me up, of course).
Again, some centres in Ontario are more open to permitting the patient choose. Some offer the VSG as often as they do the RNY. But some, like OWMC, do not. So I advise you do your homework on your particular conditions, your own history, and determine if there is anything there that will contraindicate either surgery for you or indicate that one surgery is particularly more advantageous for you. Do your homework. Be prepared. Know what is required and be aware of what it means in the long run.
For me, having a VSG and taking NSAIDs every day means that I need to have a presription acid blocker (PPI) every morning. I will take this for as long as I need to take the NSAIDs. It protects the lining of my new sleeve and minimizes the risk of my getting an ulcer.
That said, in the USA, things are very different. I like GwenMo's reasons for choosing a VSG over an RNY. Because, yes, in the USA, patients have the choice of surgery type, with input from their surgeons, of course.
(NOTE: The content below was taken from GwenMo's many posts on this topic. All rights are reserved for her.)
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Here's why I chose VSG --
The four WLS are - sleeve, gastric bypass (RNY), lapband, and duodenal switch. My insurance covers the first three, but not the DS.
I ruled out the lapband immediately because the only people I know who have had it are miserable or have needed it removed. The complication rate is atrocious and it only lasts for 10 years or so. It's billed as being a "reversible" surgery, but the damage it can cause, like from erosion into your esophagus, is permanent. So no lapband for me. Here's an article on that topic.
The choice really boiled down to RNY or VSG and I chose the sleeve for a number of reasons. (Even if DS had been an option, I would not have chosen it.)
1. I really like the simplicity of the sleeve. All it does is remove 85% of your stomach. That's it.
2. I dislike the idea of having my intestines rerouted.
3. The "good" malabsorption that the bypass gives (of fats) is a temporary thing that only lasts for a few years whereas the "bad" malabsorption (of vitamins and minerals) lasts for forever. That's not worth it to me.
4. The sleeve is restriction only, no malabsorption. This also means that I CAN eat anything at all. Fats and sugars won't screw up my bowels the way they can for the bypass. (Of course I still need to make healthy choices, but that's a choice, not something that my surgery requires.)
5. With the bypass, you're left with a remnant stomach that can't be scoped. That scares the crap out of me. First, the idea that I have this weirdly connected non-stomach but then to not be able to get it checked out with an endoscopy if there's a problem? Eek. Do not want.
6. My understanding is that complication rates with the bypass are significantly greater, especially longterm due to malabsorption. While I will be taking vitamins for the rest of my life, chances are that I won't end up in the hospital if I stop because the sleeve has no malabsorption involved.
7. For the most part (and there are exceptions) the people I know with the sleeve look and seem healthier than the people I know with the bypass. That's nothing scientific though.. just a gut feeling.
8. The sleeve leaves you with a fully functional pyloric valve at the bottom of your stomach whereas the bypass gives you a stoma which can stretch over time.
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There you go. My reasons and rationale for the VSG in Ottawa over the RNY. Your situation is individual and must be treated as such. Research. Know your health history. Know the contraindications for the various surgeries. And talk to your doctors. Be your own health advocate. We all need to play an active part in our health and decisions pertaining to it. Speak up and be heard, but listen to the professionals. They know what they're talking about and have likely seen it all before. Rely on them for professional advice but know that you can go elsewhere if you need to. Be aware though... you might get the same advice from multiple professionals. If so, there's a good reason for that!
Take care all and good luck finding your own path.
