Just another Newbie ;)

[RhainyC]

HI there, I'm Rhainy. Just went to the "Seminar" portion of becoming my chosen surgeon's patient...

I really like him...except, right now he is steering me toward a straight sleeve, rather than a D/S... I know there are other surgeons but I really like this doc so far and his staff has been fabulous.
*Sighs*
Malnutrition was one of his concerns...
He didn't say he would not do it, but wanted to see if the sleeve worked before committing to the switch portion of the surgery...he didn't say no...but, the suggestion was sleeve first.

Since my primary insurance has a weightloss exclusion, I am having to go with my Medicare...a lot of surgeons don't take Medicare. I have bad credit, so loans are out, and I am on SSDI so paying cash is out too.



So still trying to figure out what on earth I am going to do...

 

[newanatomy]

Hello and welcome. Hang in there. What is this surgeon's name? Perhaps, someone here knows him and can give you some advice on how to get what you need. If at all possible, you want to have only one surgery. Get it done correctly the first time so you can start living your life. Besides. the sleeve portion and the switch portion work best together.

Good luck and fight hard to get what you need!

 

[RhainyC]

The surgeon I originally was going to go with is Dr. Troy Houseworth, in Federal Way Washington.

 

[Charris]

The sleeve can work if your only issue is portion size. As long as you haven't broken your metabolism and as long as after you loose the weight around year three you will have the discipline to eat appropriate and do your exercise. If he does the DS And that's what you want insist on it and then let him know you may have to choose another surgeon. If you know what you want, if a DS is what you want for sure then get one. Don't make a decision about the rest of your life because you like someone. I have many doctors I like but doesn't mean I'd let them rearrange my inners the way they want instead of what I want or even more so need. We do have some people on the site who have had success with just a sleeve. Talk to then and see do you have what it takes to also be successful. In my mind I would feel like I'd always be on some type a diet once the stomach stretches. Counting calories and measuring portions. I don't know that's why I say talk to the sleevers.

Good luck and welcome!

 

[Larra]

Hi and welcome!

I've seen this surgeon's name as someone doing the DS about once before. My guess, not knowing anything definite, is that he does it rarely and it trying to talk you into an operation that is quicker, easier, and requires less follow-up, with the idea that if it doesn't work out he could "add" the switch. That means YOU get stuck having 2 operations, 2 rounds of general anesthesia, 2 sets of risk, 2 periods of recovery, and perhaps not being able to secure insurance coverage for round 2, which is your problem, not his.
the sleeve does work for some people, at least for awhile. There are a couple people here who are very happy with their sleeves. However, we are seeing more people wanting revision from sleeve to DS all the time because it either didn't work, or worked only temporarily, or wouldn't get them even close to normal weight no matter how faithfully they stuck to the required diet. the DS adds both malabsorption and a metabolic component that the sleeve, and any other purely restrictive operation, does not have. Sleeve, after it stretches (and it will) relies entirely on behavioral change and a careful low calorie, low fat, low carb diet.
If you, like most of us, have dieted your way to morbid obesity and struggle to lose even with strict dieting, the sleeve is unlikely to get you where you need to go. On the other hand, if you have been MO only briefly and can lose weight easily with dieting/exercise and would rather deal with the permanent diet than deal with permanent vitamin and protein requirements, sleeve might work out for you.
In your state Dr. Srikanth is well known as a DS surgeon and has a solid reputation. I don't know whether or not he accepts Medicare, but a phone call would answer that for you. If you believe the DS is right for you, don't let a surgeon with a nice bedside manner and a nice office staff talk you out of it. You are the one who will live with this decision, not them.

 

[DSRIGGS]

Hello and welcome, Rhainy.

Do you have hypertension, Type 2 Diabetes, High Cholesterol or Sleep Apnea? If so the sleeve is not likely to resolve those issues for you. Additionally the VSG requires dieting for the rest of your live. Having the switch portion as a second step is also less effective for EWL than having the complete DS, not to mention why in the world would you want two surgeries (two procedures where you are at risk, two recoveries, two times the cost)?

Additionally, the switch part of the DS is what keeps the weight off long term so with the VSG you may lose initially but there is a chance a good portion of the weight will be gained back if you are not extremely diligent about portion control.

As @Charris said, it would be a mistake to pick your surgeon because you like him. You are his customer and if he won't give you the product that you have determined that YOU NEED then tell him you will take your business to somebody who will listen to you and do what you want.

That would be my advice to you.

 

[RhainyC]

Thank you all~

Hello and welcome, Rhainy.

Do you have hypertension, Type 2 Diabetes, High Cholesterol or Sleep Apnea? If so the sleeve is not likely to resolve those issues for you. Additionally the VSG requires dieting for the rest of your live. Having the switch portion as a second step is also less effective for EWL than having the complete DS, not to mention why in the world would you want two surgeries (two procedures where you are at risk, two recoveries, two times the cost)?

Additionally, the switch part of the DS is what keeps the weight off long term so with the VSG you may lose initially but there is a chance a good portion of the weight will be gained back if you are not extremely diligent about portion control.

As @Charris said, it would be a mistake to pick your surgeon because you like him. You are his customer and if he won't give you the product that you have determined that YOU NEED then tell him you will take your business to somebody who will listen to you and do what you want.

That would be my advice to you.

DSRIGGS,
Yes, No, Yes but only Triglicerides, and yes, Moderate to Severe Obstructive Sleep Apnea.

Everyone:
I have extreme mobility issues due to Lumbar and Cervical Spinal Surgeries, needed due to extreme stenosis...I will be in a wheelchair in a few years, so the DS (Hess method) is what I NEED, not just want.

Edited to add: I have a BMI of 57.5 at this time am 5'6" and 355 pounds.

 

[DSRIGGS]

Thank you all~



DSRIGGS,
Yes, No, Yes but only Triglicerides, and yes, Moderate to Severe Obstructive Sleep Apnea.

Everyone:
I have extreme mobility issues due to Lumbar and Cervical Spinal Surgeries, needed due to extreme stenosis...I will be in a wheelchair in a few years, so the DS (Hess method) is what I NEED, not just want.

Then under no circumstances should you even consider the VSG. As Larra mentioned, there is a good DS surgeon in your state so I would definitely call and check on insurance.

BTW I have spinal stenosis and had an ACDF on C4-C6 (believe it was that level. I also have degenerative spinal column issues. The DS and losing weight will help alleviate strain and give you the best chance at staying out of a wheel chair.

good luck.

 

[Pattycake813]

Welcome, Rainy.

If that's what you want find a way to get it... if it means a different surgeon, calls to medicaid/medicare, whatever. Remember whatever is done you will be living with the rest of your life (or facing dangerous revision with more downtime/recovery.)

Now is not a time to settle for just anything.

 

[southernlady]

Since my primary insurance has a weightloss exclusion, I am having to go with my Medicare...a lot of surgeons don't take Medicare. I have bad credit, so loans are out, and I am on SSDI so paying cash is out too.



So still trying to figure out what on earth I am going to do...

While it's true many don't take Medicare, enough do that you can find a surgeon who will give you a DS. Be warned tho, with straight Medicare, you will still have a 20% copay. Now, if you have a Medicare Advantage policy as your secondary, the 20% either mostly or completely disappears. I had NO copay with my Medicare Advantage BCBSTN policy. And mine was secondary as well. I didn't met the 5 years of morbid obesity my primary called for. However, it still had to be subitted to my primaary before the secondary picked it up.

You may have to travel but it will be worth it.

Start by calling the closest DS surgeons to you and ask if they accept Medicare.

IF you do not have a Medicare Advantage policy, the best thing would be to wait til open enrollment in October and get one and make sure your surgery is next year. I know it seems a long way off but it would be worth the wait.

 

[RhainyC]

While it's true many don't take Medicare, enough do that you can find a surgeon who will give you a DS. Be warned tho, with straight Medicare, you will still have a 20% copay. Now, if you have a Medicare Advantage policy as your secondary, the 20% either mostly or completely disappears. I had NO copay with my Medicare Advantage BCBSTN policy. And mine was secondary as well. I didn't met the 5 years of morbid obesity my primary called for. However, it still had to be subitted to my primaary before the secondary picked it up.

You may have to travel but it will be worth it.

Start by calling the closest DS surgeons to you and ask if they accept Medicare.

IF you do not have a Medicare Advantage policy, the best thing would be to wait til open enrollment in October and get one and make sure your surgery is next year. I know it seems a long way off but it would be worth the wait.

Southern Lady,

Thank you for that info. I will look into the Medicare Advantage programs as I don't have any Supplemental right now. Medicare confuses the heck outta me, so this will be fun...only NOT!

Oh and meeting a 5 year will Not be a problem with me....*Sighs*

 

[southernlady]

Oh and meeting a 5 year will Not be a problem with me....*Sighs*

My husband had no issue either. But I floated between 195-205 many of those 5 years. Any time I got below 202 (I think it was, it kicked that year out.

 

[Larra]

@RhainyC now that we know more about you, it seems clear to me that the DS is far and away your best option. You need to get as much excess weight off your bad spine (not to mention your other weight bearing joints) as you possibly can, and there is no question that the DS has the best statistics of any bariatric surgery for percentage excess weight loss, as well as for the all important maintenance of that weight loss. Also, while it works great for the lightweights of the bariatric surgery world, it is especially useful for people with higher bmi's who have the most weight to lose. It really saddens and angers me that, given your personal circumstances, a bariatric surgeon would try to steer you away from the most appropriate operation for you.
The DS also has the best rate of resolution of almost all comorbidities, and in particular in your case, for sleep apnea. there is of course no guarantee that any surgery would cure that (even some skinny people have sleep apnea) but it's your best bet. If nothing else, the more weight you lose, the more your sleep apnea is likely to improve, and you'll get the most weight loss with the DS.

Your instincts were sound. You knew what would be best for you. Don't let anyone talk you out of what you know to be in your best interests. If things don't work out with anyone local, keep in mind that Dr. Keshishian in CA does accept Medicare. That means travel, which is a relatively minor and temporary inconvenience compared to living the rest of your life with the medical problems you have now.

 

[hilary1617]

Hi and welcome Rhainey! I agree with the others that given your size and comorbitities, DS would be the most promising surgery for you, so long as you are prepared to supplement properly with protein and special vitamins for the rest of your lifetime. This can seem daunting, but actually becomes second nature very readily. All the best!

 

[DSRIGGS]

@RhainyC now that we know more about you, it seems clear to me that the DS is far and away your best option. You need to get as much excess weight off your bad spine (not to mention your other weight bearing joints) as you possibly can, and there is no question that the DS has the best statistics of any bariatric surgery for percentage excess weight loss, as well as for the all important maintenance of that weight loss. Also, while it works great for the lightweights of the bariatric surgery world, it is especially useful for people with higher bmi's who have the most weight to lose. It really saddens and angers me that, given your personal circumstances, a bariatric surgeon would try to steer you away from the most appropriate operation for you.
The DS also has the best rate of resolution of almost all comorbidities, and in particular in your case, for sleep apnea. there is of course no guarantee that any surgery would cure that (even some skinny people have sleep apnea) but it's your best bet. If nothing else, the more weight you lose, the more your sleep apnea is likely to improve, and you'll get the most weight loss with the DS.

Your instincts were sound. You knew what would be best for you. Don't let anyone talk you out of what you know to be in your best interests. If things don't work out with anyone local, keep in mind that Dr. Keshishian in CA does accept Medicare. That means travel, which is a relatively minor and temporary inconvenience compared to living the rest of your life with the medical problems you have now.

I live in the Peoria, IL area and last August I traveled to see Dr K in Glendale (LA) where he gave me a revision due to my extreme malabsorption caused from my original DS. My son who was 21 at the time of his surgery also traveled to see Dr K to fix his severe gastroparesis.

There is NO BETTER BARIATRIC SURGEON in the world than Dr K, not to mention he is the most incredible Dr you will ever meet as he has a great sense of humor and an unwavering passion for providing his patients with the BEST possible care. I can't tell you how many times we have traded emails over the last year. He is absolutely worth the travel and in fact, as soon as approval comes through I will be heading out to see him to fix a hernia and hopefully have a procedure that greatly diminishes the chance of a 5th hernia (I have had two internal and ventral hernias in the last 18 months).

So this will be three times I have flown out to see Dr K for surgery for my family in the last year. Which reminds me I forgot to ask him for the frequent flyer discount.