Hello from the Delaware Watergap

[Denis Korb]

Your assumption that I wasn't still researching is, and was flawed...a simple suggestion to read the Revision forums as Larra suggested would have been sufficed to accomplish the same goal that you felt needed to be accomplished without the insulting overtones that I may or may not have been intelligent enough to do "my own damned research" I see no need to ignore you as I have no problem communicating my position. I am free to make any mistake I like, I served to preserve that freedom for you and I. As I stated, I have no issue with looking at the DS, however the idea of cutting up my small intestines doesn't appeal to me. There is nothing in my first post that I would define as "clearly wrong" and all you have done is inspired me to prove you wrong.

 

[Denis Korb]

Welcome, @Denis Korb

I was great at LOSING weight but my issue was being able to keep it off. Sounds like you as well....and while I applaud your effort in what you have done so far, it's become apparent to you that you need more help or you wouldn't be considering surgery.

Since you are near Philly and NJ, check into Dr. Greenbaum in NJ...he does the DS and let him explain it to you. Or Dr. Bonanni at Abington.

Read everything here...there is a wealth of information.

I'm gonna tag a few of the active male members, @robs477 (who couldn't lose weight regardless of what he tried, even on 800 calories a day) and @chevtow

One thing I do suggest is remember that everyone here may not be as warm & fuzzy as we might like. This is the internet.

Thank you for the suggestion, but given my circumstances I do not have the ability to actively search for a new surgeon. I will wait to meet my surgeon and ask him the pertinent questions and then consult my social worker. You are correct, I injured my back and have had to take steps toward surgery as a means toward the ends.

 

[Munchkin]

Once you get really heavy, odds of keeping the weight off are less than 5%. Your body will work full time at trying to get back to where it was before. The only chance you have is to get the most malabsorbtion you can and that's the DS.

When it comes to things like BMR/metabolism, all math is fuzzy because there is too much we don't know about the human body. The numbers do not add up and they never will. I was part of a study and I had all that metabolism work done. According to them, post DS, I should be able to to eat over 5K calories per day and maintain with my activity level at that time. No way.... If I even came close to that I would gain. And a calorie is not a calorie. If it was, my diet experiment as a normie would have worked. My favorite flavor of Baskin Robbins was 1K calories for a pint. For 30 days I ate 1 pint per day and that's it. So I was on a very strict 1000 cal diet. Did I lose weight? Nope, I gained.

I was also a fat kid. And I lived a very rural area where there was no access to food other than what I was given. All the other kids were skinny, and ate stuff like candy and ice cream. I was fat and my snacks were celery sticks. I got my first 'diet' as a 6 week old breast fed baby. Eons before I ever made a single food choice. How does it happen that a breast fed baby needs a diet? The answer is there is something different about me and the way I use the food I eat. I have always called myself a superabsorber.

The math argument is logical and it should work but it doesn't. You can give your self a 3500 calorie deficit per day but you will not lose a pound a day over time. If all that mythology was true there would be no fat people. In reality, your body may give up a few pounds but it will very quickly figure out how to conserve and be more efficient. Remember Liquid protein? One of the most awful diets ever. 3 doses a day was under 300 calories. I should have lost weight like crazy. In three months, I lost 80lbs then quit losing completely.

I'm close to 15 years postop. And I'm still fat. I still diet but I eat more normally now than I ever did before surgery. I no longer feel guilty about every bite of food I eat. I look like an average old lady. But I probably wouldn't have made it to today if I hadn't had the DS. And yes I would still like to lose weight but even with the DS, it's hard. And it shouldn't be. But it is because all the math isn't correct. There are unknown variables.

To me, the real truth is that obesity is a disease. It is not a character flaw. And a disease should be treated. Aggressively!

 

[southernlady]

Thank you for the suggestion, but given my circumstances I do not have the ability to actively search for a new surgeon. I will wait to meet my surgeon and ask him the pertinent questions and then consult my social worker. You are correct, I injured my back and have had to take steps toward surgery as a means toward the ends.

Make sure you ask everything you can think of and then some...
I understand the back issue...had a second back surgery 18 months ago.

Okay, so while the ideal is to get it all at once...getting the sleeve may give you enough loss to get to the point of being able to help your back...then maybe get the rest later.

 

[Denis Korb]

Once you get really heavy, odds of keeping the weight off are less than 5%. Your body will work full time at trying to get back to where it was before. The only chance you have is to get the most malabsorbtion you can and that's the DS.

When it comes to things like BMR/metabolism, all math is fuzzy because there is too much we don't know about the human body. The numbers do not add up and they never will. I was part of a study and I had all that metabolism work done. According to them, post DS, I should be able to to eat over 5K calories per day and maintain with my activity level at that time. No way.... If I even came close to that I would gain. And a calorie is not a calorie. If it was, my diet experiment as a normie would have worked. My favorite flavor of Baskin Robbins was 1K calories for a pint. For 30 days I ate 1 pint per day and that's it. So I was on a very strict 1000 cal diet. Did I lose weight? Nope, I gained.

I was also a fat kid. And I lived a very rural area where there was no access to food other than what I was given. All the other kids were skinny, and ate stuff like candy and ice cream. I was fat and my snacks were celery sticks. I got my first 'diet' as a 6 week old breast fed baby. Eons before I ever made a single food choice. How does it happen that a breast fed baby needs a diet? The answer is there is something different about me and the way I use the food I eat. I have always called myself a superabsorber.

The math argument is logical and it should work but it doesn't. You can give your self a 3500 calorie deficit per day but you will not lose a pound a day over time. If all that mythology was true there would be no fat people. In reality, your body may give up a few pounds but it will very quickly figure out how to conserve and be more efficient. Remember Liquid protein? One of the most awful diets ever. 3 doses a day was under 300 calories. I should have lost weight like crazy. In three months, I lost 80lbs then quit losing completely.

I'm close to 15 years postop. And I'm still fat. I still diet but I eat more normally now than I ever did before surgery. I no longer feel guilty about every bite of food I eat. I look like an average old lady. But I probably wouldn't have made it to today if I hadn't had the DS. And yes I would still like to lose weight but even with the DS, it's hard. And it shouldn't be. But it is because all the math isn't correct. There are unknown variables.

To me, the real truth is that obesity is a disease. It is not a character flaw. And a disease should be treated. Aggressively!

I appreciate where your coming from Munchkin. I have noted that on my diet there are times where I haven't lost weight but I know I have gained muscle mass and proper water weight. I'm sure there are going to be times when I will plateau...but I am determined, I will not allow myself to stop losing weight, and I will not be changing my diet to drastically. I have noted that my current diet allows for 2300 calories a day, I have a very hard time maintaining that without a Ribeye steak every night, which is quiet unrealistic long term. I have no intention of ever allowing myself to be sucked into sugar or simple carbs ever again, it will be all about vigilance. I would not eat Ice cream...my wife would tell you before she and I got married I wasn't a big sweets eater...that was a more recent phenomenon in my life...cutting them out I don't believe will be that big of an issue for me, and now that I have made that decision it seems to have become much simpler for me to maintain my diet. My wife is and was a huge fan of coke, and she tends to not live without her sweets, once I made the decision to stop, and since I have been on this life change, I can look at the stuff and I see zero appeal for it anymore...I'm feeling really good having the protein shakes and what not...I think my problem was my blood sugar levels and now that I have been vigilant about maintaining them I don't seem to have any of the cravings I once had

 

[hilary1617]

Hi and welcome Denis.

I like your concept of having goals as inspiration, even if they don't appear entirely realistic to others, they may be motivational. I hope you are well on the way to 250!

I am a mathematician, so I can't ignore numbers. The one that strikes me most is that 95% of obese individuals who attempt weight loss through diet and exercise alone are unsuccessful long term. As someone recently wrote elsewhere on this board, that's why there aren't Biggest Loser Reunion / Where Are They Now shows. The weight loss part is difficult, but feasible. The keeping it off part is near impossible.

Almost everyone on this board has lost at least once, probably many times, loads of weight, then yo-yo'ed up again, perhaps to a higher weight than at the start of the diet. We have broken metabolisms that dieting will not fix. So, if you don't succeed, it won't be because of a lack of willpower, but rather that your body is extremely efficient at absorbing and retaining calories. I have no doubt you can stick to your guns. I do think the metabolic odds are stacked against you so it will be an incredibly difficult road.

I wish you the best in your journey. I highly recommend the DS, which has resulted in me being less than half the woman I once was by weight with a pretty darn normal lifestyle and higher calorie diet than I consumed when I was SMO. Like the others, I think the DS is the single tool that will provide the most realistic chance of getting to 250 and staying there. Not sure if you have diabetes, but DS is the surgery with the best resolution of that condition as well.

Of the other surgical options, I'd rather see you with a sleeve than a RNY because I believe that a pyloric valve is incredibly helpful and that the RNY tends to fail patients because it results in hunger without healthy means to satisfy it. The sleeve will definitely not provide the quantum of weight loss you are seeking, but preserves the pylorus and can be converted to a DS down the road.

Thanks for coming over. I look forward to reading about your future successes!

Kind regards,
Hilary

 

[Denis Korb]

Hi and welcome Denis.

I like your concept of having goals as inspiration, even if they don't appear entirely realistic to others, they may be motivational. I hope you are well on the way to 250!

I am a mathematician, so I can't ignore numbers. The one that strikes me most is that 95% of obese individuals who attempt weight loss through diet and exercise alone are unsuccessful long term. As someone recently wrote elsewhere on this board, that's why there aren't Biggest Loser Reunion / Where Are They Now shows. The weight loss part is difficult, but feasible. The keeping it off part is near impossible.

Almost everyone on this board has lost at least once, probably many times, loads of weight, then yo-yo'ed up again, perhaps to a higher weight than at the start of the diet. We have broken metabolisms that dieting will not fix. So, if you don't succeed, it won't be because of a lack of willpower, but rather that your body is extremely efficient at absorbing and retaining calories. I have no doubt you can stick to your guns. I do think the metabolic odds are stacked against you so it will be an incredibly difficult road.

I wish you the best in your journey. I highly recommend the DS, which has resulted in me being less than half the woman I once was by weight with a pretty darn normal lifestyle and higher calorie diet than I consumed when I was SMO. Like the others think the DS the tool that will provide the most realistic chance of getting to 250 and staying there. Not sure if you have diabetes, but DS is the surgery with the best resolution of that condition as well.

Of the other surgical options, I'd rather see you with a sleeve than a RNY because I believe that a pyloric valve is incredibly helpful and that the RNY tends to fail patients because it results in hunger without healthy means to satisfy it. The sleeve also can be converted to a DS down the road, but will definitely not provide the quantum of weight loss you are seeking.

Thanks for coming over. I look forward to reading about your future successes!

Kind regards,
Hilary

Awesome, a well constructed argument without insulting or demeaning overtones and encouraging to boot. Great to hear from you Hillary!

 

[DianaCox]

"I cant imagine removing that much intestine being good for anyone." = Wrong. No intestine removed with the DS.

That you have chosen to misconstrue some of what I said, because you didn't like my "tone," is on you. You don't get to come on a message board, especially in one of your first posts, and tell the regulars how to post. That is message board nannying, and is not your right. If you don't like what I say, ignore me. If you were offended, that's your choice.

If I have inspired you to prove me wrong by doing research sufficient to allow you to make a fully informed decision, great, then I've done what I set out to do.

If I have inspired you to prove me wrong by sticking to your unscientific magical thinking that you can overcome your metabolic disorder by diet and exercise and a subpar surgery, then you are probably one of those people who don't have what it takes to manage the minimal but critically important requirements of a DS anyway.

As we have learned over the years, even if someone clearly NEEDS a DS to lose weight and maintain that weight loss, and remission of comorbidities, they are not always the best candidates if they don't have the wherewithal - intellectual or emotional intelligence, mental health, and financial common sense - to properly manage a DS. Such a person would probably be better off morbidly obese under those circumstances, rather than dying from malnutrition because of the inability to manage the minimal requirements necessary to properly care for themselves post-op. And yes, we've seen that too often - people who can't manage a DS give it a bad name anyway by MAKING themselves sick by not following the minimal rules.

Which is why I am still a proponent of there being an IQ and EQ test to get a DS.

Saying you don't "have the ability to actively search for a new surgeon" says it all. You made up your mind without all the facts, and will not let yourself be contaminated by new information. We've seen plenty of people in worse situations than yours persevere when they made up their minds to have a DS - but being unwilling to even TRY is for sure an insurmountable obstacle. Who knows, maybe the "easy way out" of accepting what you have and know about now (and is approved by your social worker??) is the best way for you. Good luck with that - and I do mean that sincerely.

And with that, I think we're done. I'm sure you'll get whatever support you want to hear and are willing to accept from others here. And if/when you are ready for something different, I'll probably still be here too.

 

[robs477]

Hi Dennis and welcome to the site. Let me just start of by addressing your one grossly misinformed assumption “math doesn’t lie”….First off my friend, I am an Electrical Engineer and I LIVE by math and science. According to the very fundamental laws of Thermodynamics. A calorie is a measurement, a unit of potential energy that is available to be expended or stored. 3500 calories = 1 lb either gained or lost, i.e., excess or deficit. Someone my size has to eat 3,000+ calories a day to maintain, (allegedly)…LOL…LOL…LOL. I could only eat 800-1000 calories (PER DAY OR I WOULD GAIN WEIGHT), puts me in in a 2,200 caloric deficit per day. Per this mathematical constant, which is non-negotiable according to the Laws of science and math that they go by, I should be losing about .50 - .75lbs a day.

I am (or were pre-DS) a SUPER absorber and convert calories more efficiently and so are a LOT of obese people and you maybe one too.

If you want to live, I suggest you shut the fuck up and LOOK, LISTEN AND LEARN. These people on here saved my life! They don’t flippin play, they are the best of the best. Diana is a GD Scientist AND a Lawyer and she has NO agenda other than to try to save people from their own ignorance BEFORE its too late and sometimes (as in your case), theres just no nice way to do it!!.....and MANY of these folks here forgot more about WLS and nutrition than any GD Doctor.

You are about as clueless and green regarding this subject as I think I’ve ever seen on ANY board and that is coupled with a false confidence that you actually have knowledge and that is a VERY dangerous combination my friend…NOT for us, but for YOU! PLEASE go back and read some of my previous posts. I have NEVER wire brushed someone as I have just done here in this post! That is NOT my style and I am always nice and kind etc, but dude, you need to get a serious grip…or, your tough times have just frickin started! Either way, I really do care and sincerely wish you the best. Rob

And BTW...I'm ex-military too and so are a lot of folks on here.

 

[chevtow]

I am not spending any great amount of time trying to convince you one way or the other, it's obvious you have made up your mind. If you're brave enough we'll talk to you in 2-4 years after your current plan goes awry. I sincerely hope you are one of the amazing 5% that succeed in long term weight loss without surgery.

 

[Larra]

Denis, I was not "amused" by you. I take you and what I contribute on this board very seriously (well, most of the time - we do have some humor here at times). By now you should have figured out that a whole lot of people are trying valiantly to reach out to you and get through your head the realities of your predicament. You have a serious disease, the disease of morbid obesity. Even if you started life with a normal metabolism, by now it's shot to hell. While I respect your determination and willingness to stick to the so-called lifestyle changes you have adopted, they won't work long term. We have finally learned that diets don't work. So the answer to that was that if fat people would only adopt lifestyle change...but this ignores everything we are learning about obesity and how complex and multifactorial it is, and how our bodies change with obesity, how they changes are greater the heavier we are and the longer we are obese, and how even with weight loss these changes don't revert back to a normal metabolism. We have learned about hormonal changes that don't go away, that actually get worse when you lose weight without surgery. We have learned that contrary to what was believed for years, some people - generally obese people - absorb calories and not just water through their colon, where it was always thought that all caloric absorption was in the small intestine. Just imagine if you (or I) absorb, let's say up to 500 calories/day extra through the colon and the naturally thin person next to us doesn't. You like math, so I'm sure you'll see that this will add up very quickly. And people who have never struggled with their weight will wonder why we just don't have the willpower to lose weight, while they shed calories through their colon and we soak them up.
We have only to look at your own experience to see the pitfalls of this approach. Here you are, genuinely trying your best. But your efforts to exercise have been sabotaged by a knee injury and now a back problem of some sort. To the point where you are apparently stuck at home. And if it weren't that, it would be something else. I've seen this play out many times, where a very heavy person has an injury that seems mild enough for a good recovery yet that recovery never happens, and their situation only gets worse and worse. Right now, that's you. Not a pleasant message to hear, but that is your reality.
And using your present mobility issue to explain why you can only go to that one clinic is a big mistake. It will forever limit your options. This is an issue of logistics that someone with your smarts and military experience should be able to overcome. For example, you could - as others have - do a consult with Dr. Greenbaum via email and phone. He works with people from far away - @jillc who posts here went to him from Canada for her revision, and did all the preparatory stuff by phone. There is no reason you couldn't do this, and if an ambulance can take you to Geisenger or whatever it's called, it could just as well take you to NJ and Dr Greenbaum once all the arrangements are in place.
Do you really want to let logistics determine your care and future? Wouldn't you rather consider ALL the options available to you, determine for yourself what is best, and then figure out a way to make it happen? That's what I would do.

 

[Barb1]

Welcome @Denis Korb to our community! Believe it or not you really are in the right place. The people here are the best and have the long term experience with trying to help. They are so very dedicated and devote so much time to help everyone. They are the best of the best! Please just start reading others journeys. Check out @DuodenalSwitchaRoo and her album pictures and @more2adore. I believe reading their stories might help you. I really you hope you stick around and I promise you won't regret it!

 

[newanatomy]

In case you have questions, someone pointed this out for you:

From where you are,
64 miles down PA 611 to Warminster, where Dr. Bonanni can be found, at
Abington Memorial Hospital, Institute, Metabolic and Bariatric Surgery
225 Newtown Rd. 2nd Floor
Warminster , PA 18974

 

[bearmom]

Welcome Dennis! I'm glad you made it over! You've certainly noticed this is the tough love group, lol. We may not be all warm and fuzzy, but posters here make an effort to be accurate and help those who are open to it. The other site is rife with terrible information, and many there follow right down the primrose paths to lapbands or malnutrition from following bad advice.

I have a few concerns about you, and one is that it's a bother to go to a new surgeon, even if the one you have already talked to doesn't do DS. I've seen too many times to count that a surgeon doesn't send away a paying customer, and only recommends the surgery they happen to do, EVEN IF IT'S NOT BEST FOR THE PATIENT. I also get that mobility is much harder at your size. But, I promise you the little extra effort to get to a real DS surgeon is likely to pay off in success and lifestyle for the rest of your life, which I hope is very long.

It also sounds like you have made a valiant effort to lose by diet alone, and that is no small feat. You certainly have the determination, but diets aren't maintainable for life, and every yo-yoing of our weight does some damage, even to our metabolism just making us a more efficient calorie hoarding machine.

My only real regret about getting my DS is that I waited while trying diets and exercise for an extra 15 years, that did irreparable damage to my body. Had I just gone ahead an done it back then (assuming I could have found a DS surgeon back then) I'd have done far less damage to my skin, metabolism, knees, hips and back.

Stick around, keep posting.

 

[more2adore]

Hey Denis - I thought it might be useful for you to hear from me. I was 600 pounds when I moved to Australia in January 2014 from the US. So... I started where you started. When I first arrived, for several months, I ate low GI foods with my insulin-resistant hubby. Because of that, along with the difference in food here (there's not corn syrup in everything like in the US), I lost 75 pounds in about six months. Then, my weight loss plateaued. I gave it a few months, but (despite all the exercise I was doing in just walking around my new city) the scale didn't budge. So hubby and I decided to go low-carb. "The Math" (yes, I used an actual nutrition program for this that asked really in-depth questions) said that I should need to take in about 3500 calories a day to maintain my weight, and 3100 to lose (at 506 pounds). But, with low-carb eating, I actually couldn't manage to eat that much most days - I typically ate between 1500-2000 calories. Guess what? I lost weight for about a month (18 pounds), and then that was it. I'd lose a few pounds overnight, gain a few pounds the next day, lose a few overnight, gain a few the next day. My weight had plateaued again.

This is what I would be looking at with a sleeve. Most of the people I've read about who start the sleeve at about 500-600 pounds only ever lose about 150 pounds with the sleeve, IF they do everything right. If they aren't compliant/eating low-carb post surgery, they can lose even less. The sole person who started out as a "heavyweight" (400+ pounds) who I know of who actually lost more than that ate ONLY protein shakes during the entire 18 month weight loss window. I know that for myself that's not practical. 150 pounds would not be enough to make a difference in my life - that would still leave me SSMO at 350+ pounds. That's not good enough for me. And I know from what you've said that it's not good enough for you.

My goal is 225, and I know that I will never get there with just a sleeve. The sleeve was originally designed to be Part I of a DS, so it's relatively easy to get it revised to a DS if you do end up going the sleeve route. But why put yourself through the risk and expense of 2 surgeries? The metabolic gains from the DS are actually *greater* if it's done in combination with the sleeve rather than in two stages. I have to personally do it in two stages, because the only vetted surgeon in Australia will not do it in one for me because of how large I am, and because hubby and I are looking to have kids in the next couple of years. I don't have the option to go to another surgeon because he's the only one I have to choose from. The vetted surgeons in the US, though, see this as a surgery that's ideal for SSMO patients like us, and will typically do it in one step even for the largest patients.

I know it would be a hassle, but do at least look into what can be done to get yourself to a vetted DS surgeon. If you want to lose that much weight, the DS is really the only suitable option. I learned this for myself when I was originally doing my research - I found a great chart from a reputable source that I now can't find on my computer (really need to reorganize my desktop... whoops) that compared the most popular WLS surgeries and how much excess weight was lost, how much was kept off 5 years out, percentage of complications, and what percent had to have the surgery revised/reversed because it didn't work for them. The only category in which the DS wasn't far and away better than others was "complications," and the reason for that is two-fold: 1) There's no discrimination in the statistics on the experience level of the surgeon (that's why a "vetted" surgeon is so important), and 2) larger, higher-risk patients with more comorbid conditions tend to pick the DS or be steered towards the DS because it's the most effective, which skews the statistics. If you looked at experienced surgeons performing the DS compared to the RNY, the difference in complication rates would be negligible.

Ask away if I can answer any questions for you. Seems like we're on the same path right now.