Hello!

[Kaj]

New to this page, not new to wls. I had a vsg in 08/13 and the weight loss was slow going. I figured it was just because I'm "a woman of a certain age" not to mention I have one of those bodies that fights tooth and nail to hang onto every ounce. I ultimately lost about 48% of my excess. I managed to see 199/200 on the scales for about 24 hrs once, but my low was 210 and without extreme measures, even that didn't stay there for more than a week before the weight started to creep. As it stands now....I've gained 35 lbs back and am pretty sure I'll just be fat the rest of whatever years I have on this planet. But that isn't the worse, the worse is the acid reflux and the living on ppi's. If I run out and miss a day...it is really painful and my reaction is to eat everything possible in an attempt to "sop up" the acid. I have had acid issues since my late teens and am no stranger to zantac and added it to the omeprozole about 6 wks out of surgery. Then I started to try other ppi's until I finally settled on lansoprazole which works wonderfully. But I know it can't be good to be living off a ppi daily for 3 + years. So, ....I don't know if I should be looking at a revision to RNY for the acid, try to qualify for a DS for the excess weight...or just forget the whole thing and die as a fat woman with weak bones and bad kidneys from proton pump inhibitors. Any thoughts would be greatly appreciated. And thanks for this site. Nice to see a place that is about mentoring....

Kaj

edited for typos.

 

[DSRIGGS]

I have taken a PPI for 10 years, in fact I take 40 mg of Protonix twice a day. It is a necessary evil for me.

A RnY has lots of other issues like dumping and it doesn't work for weight loss, and I am not convinced it is a long run GERD cure either. My GERD is no worse now than it was before I had my DS and I personally believe the DS is the only bariatric surgery that works long term.

Do you have diabetes, high blood pressure, high cholesterol and or sleep apnea? If so the DS is quite likely to get rid of all of those. It did for me.

As far as getting approved for the DS by insurance it is policy dependent but there are ladies here who can provide some guidance for you. They have helped so many who were denied to fight and get it approved. If not driving Esquerra in Mexicali has given a DS to several people here on the board and it costs around $12k out of pocket.... But you can get it done quickly.

Welcome. Keep asking questions.

Where do you live. We can recommend a surgeon. There aren't that many qualified DS surgeons out there so it is important to choose the proper person even if just gathering information. Beware that some are offering the SADI or sips and calling it a DS. It isn't so that is one reason the surgeon choice is important.

 

[Kate]

Welcome!

 

[JuliaDS]

Welcome!

 

[southernlady]

Welcome @Kaj

I had a vsg in 08/13 and the weight loss was slow going. I figured it was just because I'm "a woman of a certain age" not to mention I have one of those bodies that fights tooth and nail to hang onto every ounce.

I suspect being a woman of a certain age also meant you have been on a diet of one sort or another and the VSG was not your best option to begin with. You needed the malabsorptive component of the DS. The RNY is also malabsorptive BUT not of calories forever. Just vitamins/minerals forever. The RNY adapts and starts absorbing calories about 2 years out. And the five years stats for maintaining is much MUCH lower for the RNY (about 40%). A good 80+% of DS'ers maintain their weight loss. And if you read revision stats you will see people revising from the lapband, the vSG, and the RNY but seldom do you see someone revise their DS.

Okay, GERD...I have a tiny sleeve with my DS just like MOST VSG'ers. I had GERD pre-op, I still have GERD. BUT I wanted to be able to take NSAIDS and knew I needed the malabsorptive component. That meant I needed the DS cause at 56 (I'm now pushing 62), I KNEW NSAIDS were an absolute requirement for my quality of life. And the RNY would never allow me to take them again.

 

[Susan in Tennessee]

Welcome, you've come to the right place.

 

[Larra]

Welcome!
It sounds like you have a VSG with a tight sleeve, which has served you badly both for weight loss - you never got any metabolic benefit, only restriction, which will only take anyone so far with a crappy metabolism - and worsening your pre-existing GERD. You would have been far better served with a DS with a not so tight sleeve. Unfortunately, when sleeve started being done as a stand alone, they found that it didn't work well unless the sleeve was made very narrow. With a DS, the goal is a combination of moderate restriction along with good malabsorption and some very beneficial metabolic changes.
Given your location (TX) I would recommend a consult with Dr. Ayoola in Denton. He is a well regarded DS surgeon. If he feels that your GERD is so bad and so intractable, and that you are placing you long term health in danger with the PPI's, he may recommend gastric bypass rather than DS. Severe GERD is the one and only comorbidity that does better with gastric bypass than with DS. However, many of us had GERD to some degree and have done just fine with the DS, so hopefully that would be his recommendation for revision.
Gastric bypass is a very imperfect bariatric surgery, and many of us here, including myself, went to great lengths to avoid it. However, there are times when it's the best option, and there are some people who are successful with it. Only you can determine whether or not the potential benefits to you - relief of GERD, at least some weight loss beyond where you are now, etc - outweigh the potential downsides of possible dumping, never being able to take NSAIDs, etc.

 

[Susan in Tennessee]

eded the malabsorptive component of the DS. The RNY is also malabsorptive BUT not of calories forever. Just vitamins/minerals forever. The RNY adapts and starts absorbing calories about 2 years out. And the f

Southern Lady, is this due to the villi growing more plentiful to enable more absorption? Does this NOT happen in a DS, or rather I'll ask, what exactly is the difference in the DS that makes it work? The sleeved stomach eventually enlarges some (and that is intended?) so restriction isn't the forever answer. Hubby has been quizzing me and need help giving right answers.

 

[Kaj]

Welcome @Kaj

I suspect being a woman of a certain age also meant you have been on a diet of one sort or another and the VSG was not your best option to begin with. You needed the malabsorptive component of the DS. The RNY is also malabsorptive BUT not of calories forever. Just vitamins/minerals forever. The RNY adapts and starts absorbing calories about 2 years out. And the five years stats for maintaining is much MUCH lower for the RNY (about 40%). A good 80+% of DS'ers maintain their weight loss. And if you read revision stats you will see people revising from the lapband, the vSG, and the RNY but seldom do you see someone revise their DS.

Okay, GERD...I have a tiny sleeve with my DS just like MOST VSG'ers. I had GERD pre-op, I still have GERD. BUT I wanted to be able to take NSAIDS and knew I needed the malabsorptive component. That meant I needed the DS cause at 56 (I'm now pushing 62), I KNEW NSAIDS were an absolute requirement for my quality of life. And the RNY would never allow me to take them again.

Yes...NSAIDs are a necessary evil for me and have been for as long as I can remember. Without them, I pretty much can't move around too easily. As for certain age...I will be 64 in November and the weight battle has been my nemesis since my first child 42 years ago. Everything I read about the DS (and have read literally since before I had the VSG) tells me it is the gold standard. I just don't know if I am up to battling the insurance company for a revision/addition. I am as you can see in the midst of a fact finding phase so need to just keep reading and thinking. Appreciate the feedback.

 

[Kaj]

oh..and as for where I live...I am in Austin TX and my VSG surgeon was allegedly highly thought of and gifted....and I got virtually no support and he and I didn't exactly "click"....his surgical skills are excellent...his personality not so much.

 

[Clematis]

I went to Esquerra at Mexicali Bariatric Center for virgin DS at the age of 62 (63 now). That was $11k. I'm sure your switch-only would be far less. Screw insurance and jumping through hoops only to be denied. Pay cash if you have the money and get it on your own terms. They could do it in a month. Recovery from the switch is nothing. (The VSG is the tough recovery.) I thought people were crazy who went to (gasp) Mexico but I can assure you the care you will get will be better than in US.

 

[southernlady]

Southern Lady, is this due to the villi growing more plentiful to enable more absorption? Does this NOT happen in a DS, or rather I'll ask, what exactly is the difference in the DS that makes it work? The sleeved stomach eventually enlarges some (and that is intended?) so restriction isn't the forever answer. Hubby has been quizzing me and need help giving right answers.

The Distal/Extended RNY is like the DS but RNY surgeons typically do a Proximal now. (Longer intestinal length left as they count on the smallness of the pouch for restriction. And like the LapBand, people discover that a very small pouch can be eaten around with slider foods. And unfortunately the surgery is on our guts, not our head.

All malabsorptive surgeries adapt...but the DS (and the Distal/ERNY) have less intestines available exposed to food to adapt. The proximal is the one that adapts easiest.

The downside to the Distal/ERNY is that you get the issues of having a pouch (dumping possibility, inability to take NSAIDS, etc) along with the downside of the DS, change in bowels, vitamin issues if not properly supplemented, etc.

Right now there isn't a perfect surgery but the DS is closest as it allows you the sleeve along with the malabsorptive component.

Yes...NSAIDs are a necessary evil for me and have been for as long as I can remember. Without them, I pretty much can't move around too easily. As for certain age...I will be 64 in November and the weight battle has been my nemesis since my first child 42 years ago. Everything I read about the DS (and have read literally since before I had the VSG) tells me it is the gold standard. I just don't know if I am up to battling the insurance company for a revision/addition. I am as you can see in the midst of a fact finding phase so need to just keep reading and thinking. Appreciate the feedback.

IF NSAIDS are an issue for you, then you either need to stay with the VSG or move forward for the DS but make sure you tell your surgeon why you feel you need the DS. I had to weigh the need for NSAIDS over my GERD. I chose to go with being able to take NSAIDS. My first surgeon would not do the DS on me as I am a lightweight and my starting BMI was only 35.2. HE said that I could just take opiates for pain. I FIRED his ass.

oh..and as for where I live...I am in Austin TX and my VSG surgeon was allegedly highly thought of and gifted....and I got virtually no support and he and I didn't exactly "click"....his surgical skills are excellent...his personality not so much.

When looking for a surgeon, while bedside manner is nice, I prefer surgical skill. You do need to feel support in your journey from a surgeon cause you are making a decision that is very important. But support after is not as critical, esp after the first year. A good PCP willing to listen and help is far more valuable moving forward.

My husband and I are both DS'ers and were having issues this year getting our PCP to continue pulling our labs. He wanted us to see a bariatric surgeon...okay, we booked an appt with the one locally (I had also heard rumors he was doing the DS and this gave me a chance to find out). Turns out that yes, he does KNOW what the DS is but chooses to not perform the surgery. But he also made a comment very telling. He called the VSG a "sleeve them and leave them" surgery as vitamin compliance is not critical like it is with the DS. BTW, the surgeon sent our PCP a followup and told him to continue pulling labs for us.

 

[DSRIGGS]

Southern Lady, is this due to the villi growing more plentiful to enable more absorption? Does this NOT happen in a DS, or rather I'll ask, what exactly is the difference in the DS that makes it work? The sleeved stomach eventually enlarges some (and that is intended?) so restriction isn't the forever answer. Hubby has been quizzing me and need help giving right answers.

The RnY pouch will stretch up to 30 oz volume the sleeve 8-10

 

[Munchkin]

Best of luck to you! I hope you find what you are looking for.

 

[Larra]

If you need NSAIDs, gastric bypass isn't going to work out for you (unless you WANT to take narcotics!). Now, I don't know where Scott got those numbers about the pouch stretching to 30oz and the sleeve 8 - 10, but bottom line, it doesn't matter. People can, and do, easily eat around either, with slider foods or by eating frequently. And with the RNY pouch, the size of the pouch is actually less important than the size of the stoma. If the stoma stretches out, whatever you eat just falls out of the pouch straight into the small intestine, the pouch is almost constantly empty, and people experience frequent hunger and possibly dumping and possibly reactive hypoglycemia.
If you were to decide on RNY (which seems less likely now that we know about the NSAIDs issue) you will almost certainly be saddled with a proximal RNY, partly because that's the industry standard, and partly because a lot of insurers will only pay for proximal and not distal and certainly not ERNY.
Last thought - before you decide whether or not to battle insurance, you need to know what your policy does and doesn't cover and what appeals rights you have, if any. So request a copy of your EOC - evidence of coverage - which is a lengthy document, like 80-100 pages, not the little summary of benefits. Maybe you would be able to get a DS fairly easily, maybe not, and knowing could help you determine whether or not you want to consider self-pay seriously, start making arrangements, etc.