Question:
Is there a particular surgery that is recommended for higher loss?
I weigh about 575 with a BMI of 80.2 I was planning on the Fobi Pouch but workmans comp won't cover it but they will cover a less expensive Dr. We are in hearings about it now but I was wondering if I had to choose another type, what would be the one that would help me lose the most? — Scott D. (posted on December 11, 2004)
December 11, 2004
With that high a BMI you are a candidate for the DS, which involves
increased mal absorbtion, or a long bypass RNY. With the right surgeon you
may be able to get LAP. Get a very experienced surgeon with your BMI your a
bigger risk. I have friends who have long RNYs with around your start
weight youy should do fine:)
— bob-haller
December 11, 2004
Scott,
Dude! The DS would be awesome for you! Check out www.duodenalswitch.com,
http://www.gr-ds.com/generalinformation/comparison.html, and
http://www.johnhustedmd.com/switch.htm - all have good info about the DS.
The great news is that since you're in California there are several really
good DS surgeons in your state. Probably the best DS surgeon in the world
is Dr. Rabkin in San Francisco. His contact information is at
www.duodenalswitch.com under the Surgeons button, then choose California.
He has done successful Lap DS on the highest BMI patients.
If insurance ends up balking, you might consider self-paying. I went to
Spain for my surgery with Dr. Aniceto Baltasar (www.drbaltasar.com or
www.bodybybaltasar.com) 2.5 yrs ago and it was the best decision I ever
made in my life! Everything all tolled for my surgery and travel was
$15,000.
Let me know if I can answer any questions, okay?
Blessings,
dina
— Dina McBride
December 11, 2004
I would also recommend the DS if you are looking for the most weight loss.
If they won't approve that then a Distal RNY would be my second choice.
With the DS I believe you also eat more normally. Just absorb a lot less.
— FaithMills
December 12, 2004
Very much in the minority here, I have a distal RNY. I have both
restriction and malabsorption. I do not have a ring of any kind. As long
as I don't graze, I can't get the volume in, and the malabsorption takes
away almost everything but sugar. A mixed blessing, but one I can live
with.
— vitalady
December 12, 2004
Last Feb, Rabkin did a 700lb man. LAP DS! Amazing. Do a lot of research
and read read read. Do what's best for you!
— PattyL
December 13, 2004
Chances of Workman's Comp approving a DS is also slim. While all the
faithful DS people feel it is the ultimate best surgery for the SMO I feel
differently. The only surgery that is the best is the one that will work
for you! You need to examine your eating habits and food demons and do
tons of reading. My surgeon regularly does 600+ people with a 150cm bypass
and they have awesome results because they embrace their surgery and their
choice and make it work. I was 442 and a 65.3 BMI and I hang in the mid
190's these days, which is 5 lbs below my goal weight. I lost all of my
weight in 13 months time, so the DS does not provide faster results. I am
far from the exception. I co-moderate a WLS board for people over 400 lbs
or 65 BMI and there are many of us that have lost 200-300 lbs and typically
within the normal window of opportunity or sooner. We have people who are
5+ years PO and maintaining their weight. It all comes down to choices and
what we choose to do with the tool we are given.
<p>Many DS people feel an RNY doesn't eat hardly anything - FALSE!.
We just happen to eat normal amounts of food instead of the super large
amounts we ate pre-op. Granted it is once we are to maintenance that we
are eating these larger quantities, but typically we are not hungry along
the way as we get a full feeling on much less food. Yes if I overeat I am
miserable and sometimes want to die, but truthfully that's a good thing.
There is no need in life to gorge ourselves on food. Normal quantities
should be adequate. I realize that for some the only surgery they could
have dealt with is the DS or Lap Band etc, but that does not make it the
right surgery for every one, any more than the RNY does.
<p>My biggest concern with any bypass longer than the 150cm I have is
the risk of severe malabsorption. I have slight to moderate deficiencies
in iron, zinc, vitamin D and calcium as it is. Scary to think what it
might be with a longer bypass. Granted the iron might not be an issue with
the DS, but there are much greater risks of being low in many other areas
due to the massive malabsorption. The bottom line is just know that not a
one of these surgeries is a magic bullet and you can screw them all up if
you are not on board with the program. You may be faced with having to
choose an RNY when you might prefer a DS and that is something you will
have to figure out for yourself. It is a shame that anyone should have to
not get the right surgery if they and their doctor feel it is what will
work best for them, but that's reality in many cases. Do realize that if
you opt to self-pay and get any surgery that is not covered by your
insurance then you are left holding the bag for all future medical costs
that can in any way be attributed to the WLS. This can be astronomical if
you have problems. I realize some people really are left with no choice
and that is unfortunate, but you just need to fully have your eyes open
before jumping in.
<p>All I can say is that I have done wonderful with my RNY and yes I
struggle with old eating habits and yes if I had had the DS I could just
eat away and never give it a thought, but for me I needed a total lifestyle
change. It feels good to eat a normal amount of food and not be making
multiple trips to the food bar in order to fill myself up. I am fortunate
that I truly can eat anything, even sugar. Yes sometimes I eat too much
sugar and I pay for it, but that's not a bad thing in my opinion. You need
to do a ton of research is all I can say. You do not want to end up
leaving a prison of fat only to find yourself in some new kind of prison
and not enjoying life anyway. If you are interested in joining our WLS
group for people over 400 lbs, send me an e-mail and I will send you the
link. We have all surgeries represented there, but people are a little
more realistic that the type of surgery is in fact a small part of the big
picture and long term progress. It's what we do with the surgery we get
that is the most important. I will definitely put my 252 lbs loss with a
150cm RNY up against any of the other surgeries any day of the week. I
think we can all be successful if we want to. It truly is up to us in 99%
of the cases.
— zoedogcbr
December 17, 2004
A distal surgery (be it a distal Roux-en-Y or the bibliopancreatic
diversion with duodenal switch, which is always distal) offers the best
chance of losing the most and keeping off the most. Neither works for
everyone, but the distal surgeries give you the best chance of success,
particularly when you have several hundred pounds to lose. It is true that
the high malabsorption that causes the majority of the weight loss and
protection against regain raises the specter of nutritional deficiencies;
but many who undergo proximal RNY's suffer nutritional deficiencies as
well. And the nutritional deficiencies can be persistent even if the
weight loss is less than spectacular. At your weight, a proximal or medial
RNY could leave you still morbidly obese and suffering from low B-12 or
other nutritional problems. You must be committed to taking nutritional
supplements and regular blood testing if you're going to have any
malabsorptive surgery.
If you are considering the BPD/DS (often shortened to DS), do not be misled
into believing that you will be able to eat huge amounts of food
thereafter. Nearly four years after my DS, I can eat one plate of food at
a buffet. One. No way can I eat as I did before my operation. I can eat
moderate amounts of whatever food I like, which I continue to regard as one
of the great and legitimate pleasures of life.
It is important to realize that any weight-loss surgery can fail, even the
distals--and even if you "eat right" and exercise with
near-religious zeal, as do many in the revision groups at Yahoo. That's
why it's important to put the odds in your favor by picking the right
surgery for you the first time. And pick the surgery that's right for you
as you know you are now--not the you you'd like to be, who'd exercise like
a demon, swear off sugar for life, and probably never would have needed
surgery in the first place. It's important to do this honest assessment
of yourself, and to treat the surgery as a one-time shot at overcoming your
obesity, because it probably will be your only shot. If you choose to go
with a conservative, low-malabsorption surgery, do not do so in the belief
that you "can always get a revision," because you probably won't
be able to. Insurance companies are much less likely to pay for them,
surgeons are much less likely to perform them, they are more dangerous, and
adhesions often prevent them.
Pick the surgery that offers you the best chance of success, and go for
it. Best of luck.
— Kay B.
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