Newbie Researching WLS as much as Possible

[Persephone2015]

Hi all! I am almost 41 years old, weigh 371 pounds and stand 4' 11", making my BMI around 75-ish. I have been researching and thinking about the lifestyle changes required for WLS since 2012. I was scheduled in latter 2012 to beginning 2013 for gastric bypass and gallbladder removal (gallstones) but the anesthesiologist would not touch me due to my high BMI and a history of sleep apnea. In January 2015, I go to a sleep clinic to be evaluated for sleep apnea again. Then, in February, I go to the bariatric clinic for evaluation. I have some health issues: high blood pressure, high cholesterol, vitamin D deficiency (taking 50,000 iu twice per week for a month then maintain), pernicious anemia (sublingual B12 daily), asthma, chronic venous insufficiency resulting in lymphedema in both legs, and Hashimoto's thyroiditis. Oh and bipolar disorder. I am taking medication for everything but the cholesterol and CVI.

I believe WLS could literally save my life (my mom is coming to same conclusion) but I am scared of worsening of the vitamin deficiencies and absorption of my psychiatric meds after surgery. At this point, I am considering the DS and the gastric bypass. I was thinking of the sleeve but the reflux stopped me thinking about that one.

If I choose the DS, I worry about finding a surgeon and the distance to get to them. I am disabled and on a fixed income. I do have Medicaid but I am not sure if they will consider DS in my state of New Mexico since I have looked online and the closest DS surgeon is in Colorado and then Mexico.

I hope to keep searching for the information needed to make an educated decision - one not dictated by $$ by insurance. I plan on surfing through the forums and reading the posts, and possibly ask some questions. I am going in with a clear but open mind as to my options.

Take care and Happy Holidays!

 

[star0210]

I think you're wise to do lots and lots of research. I think with your BMI and health issues, DS is definitely the best option for you to both take the weight off and keep it off and to resolve a lot of your health issues.
Part of the DS is a sleeve, so reflux would still possibly be an issue. Not everybody has an issue with it. I take a Prilosec OTC daily and keep the acid under control. Some days I don't need one at all.
Best of luck to you.

 

[JackieOnLine]

I'm glad you found this place!

 

[Larra]

Hi! You found us!

Regarding the sleeve, with the DS most surgeons do a more generous sleeve for the DS than the really narrow ones being made with the sleeve as a stand alone. The stand alone sleeve relies completely on restriction. When they made the sleeves the same as with the DS back when stand alone sleeves first started gaining popularity, patients regained weight after 2-3 years when the restriction wore off (the sleeve is going to stretch somewhat no matter how narrow it starts out). With the narrower sleeve it may be that this will work better, or it may just postpone the regain as there is no malabsorption and no (or almost no) metabolic changes to help out. Time will tell on that question. I believe there will be some people who will be successful with the sleeve, but they will need to watch their diets very carefully and exercise a good bit. In general, they will also be the people who started out with lower bmi's.
So while we don't know the future of the sleeve as a stand alone, we do know that the narrow sleeves are prone to causing reflux. Generally this is less of an issue with the DS even though we also have a sleeve. For me, I had mild reflux before my DS and I have just a bit more now, easily controlled with one Prilosec daily.

Research carefully! You will also need to learn about the difference between the DS and the SADI, which some surgeons are touting as a variation of the DS, but it's not the same. To the best of my knowledge there is no one doing the classic DS in Colorado. If you are looking at Mexico the only surgeon to consider is Dr. Ungson, and I don't know whether or not he would be an option with your bmi and comorbidities - but it doesn't hurt to ask.

 

[revisionDS]

congrats and welcome, with a bmi of 75 I would think of no surgery besides DS, and for sure not RNY. I think if you get the RNY, you will be back in the OR in 2 years, and RNY to DS is a bear of a conversion.
-with your health issue and BMI you will most likely be a 2 staged DS.
-Your high chol, sleep apnea and BP should be resolved with DS, your chronic venous insufficency and lymphodema also, amongst other health issues you probably have brewing and not know about.
-Vit D def is common in the general public, most people are not tested so they are unaware, before my DS my VitD was about 20. You will have to take dry VitD everyday, but ask yourself would you rather be vitd def and bmi of 75 or vit d def bmi of 30? what kind of quality of life do you have at bmi of 75, you have so much to look forward to, do cut it short.
-Do not worry about medications being malabsorbed, your levels can be titrated to figure out exaclty what you need, I fear for your health and shortened life span with a bmi that high, that is your primary concern, everything after than can be managed.
-I am not sure who would take your insurance, and with a bmi that high you will have to travel to find compentent health care, not many will take a bmi that high. I would suggest Ara Keshishain MD in CA, he is close to you, you would have to check about insurance etc., be careful who you chose.

I hope you find your answers soon, research well, don't wait too long your life really does depend on the correct bariatric surgery.

 

[DianaCox]

"with your health issue and BMI you will most likely be a 2 staged DS." This is not true - it might be for SOME surgeons, but not for the best ones (IMNSHO) - Keshishian and Rabkin almost NEVER do two stage surgeries, and doing it in two stages unnecessarily is more likely to compromise long term weight loss.

Metz (surgeon in Colorado) is NOT to my knowledge doing the DS - he's giving people SADIs. There are no long term results with the SADI, and there is no selective fat malabsorption. In my (educated, but non-physician) opinion, you need the most powerful surgery, which is the DS.

 

[bearmom]

Everyone has made such great points, but there are a few things I'd like to add.

My surgeon makes his sleeves with the DS the same as his stand alone sleeves, and I did have a problem with reflux prior to my DS, and haven't had a single episode since. Many surgeons may also address a hernia contributing to ruflux, but mine was 100% from my extra weight. That said, I know it goes both ways - some get relief just from weight loss, and some have more reflux after. That would be something to ask the surgeon, and if he makes a smaller sleeve, ask if it can be made slightly larger. I'd err on the safe side if reflux has been a real issue for you.

Another thing, and you don't need to tell me this because it's no ones business but yours, but I'm putting it out there as something to think about. I know folks with and without surgery on psych meds, and while I don't know any post op that has absorption issues with their meds that they weren't able to adjust accordingly (not that there aren't any, but just no one I know, or have read from) I HAVE seen some med issues with them just not taking them, for a variety of bad reasons.

The other thing I'm seeing is a frightening number of post ops saying they have not been taking their vitamins, and there can be logical reasons like being broke (cost and budgeting are considerations) but it can be for stupid things like they finally felt normal, or they just don't know why missing supplements one day, turned into a week, month, etc., but NO reason is acceptable, as it can do permanent damage, or be life threatening to not maintain correct levels.

The reason I throw this out there is because I'm aware that some had issues quitting meds previously, and now they have had issues quitting vitamin routines (at least for a time). Of course this is just based on a limited number of people I know, and info from more online groups that share but don't know of any research from larger groups. So, getting our vitamins and protein is our one, most important job post op, so if consistency with stuff you take has ever been an issue, think about it.

I really do like the sleeve, but especially with your BMI, Hashimotos and cholesterol, the DS makes so much sense.

I had a laundry list of metabolic issues, but PCOS and 1 diagnosis of Hashimoto's, are so far, completely resolved since my DS almost 6 years ago. My surgeon never mentioned that the DS could help with any of my issues, but I've read since that I'm not the only one. What a huge perk.

One last thing - I was a self pay and had to travel for surgery, and although I traveled much further than I should have (India, from Seattle), I would do it again in a heartbeat. The travel seemed like such an inconvenience (even an impossibility, at times) and I still think how grateful I am every, single, day that it did it. You WILL have to travel, but there are some very do-able DS surgeons that you could get to.

 

[revisionDS]

"with your health issue and BMI you will most likely be a 2 staged DS." This is not true - it might be for SOME surgeons, but not for the best ones (IMNSHO) - Keshishian and Rabkin almost NEVER do two stage surgeries, and doing it in two stages unnecessarily is more likely to compromise long term weight loss.

Metz (surgeon in Colorado) is NOT to my knowledge doing the DS - he's giving people SADIs. There are no long term results with the SADI, and there is no selective fat malabsorption. In my (educated, but non-physician) opinion, you need the most powerful surgery, which is the DS.

A friend of mine from Finland had a very difficult time finding a vetted surgeon to take her as a patinet with a bmi of 68 and co-morbs, to do a DS in one stage, she eventually traveled to Dr K. The reason I suggested Dr K is because he takes the most difficult, sickest patients, he would do a one stage DS. Finding a surgeon to do a one stage DS with a bmi of 75+ with those co-morbs, will be the exception not the norm.

 

[JackieOnLine]

I had a laundry list of metabolic issues, but PCOS and 1 diagnosis of Hashimoto's, are so far, completely resolved since my DS almost 6 years ago. My surgeon never mentioned that the DS could help with any of my issues, but I've read since that I'm not the only one. What a huge perk.

if I ever knew this, Bearmom, I had forgotten. I wish more people knew things like this - most excellent!!

 

[revisionDS]

if I ever knew this, Bearmom, I had forgotten. I wish more people knew things like this - most excellent!!

yes excellent indeed MO really messes with our hormones, I am very glad the comorb resolved. My friend got down to a bmi of 32 and maintains, she feels wonderful, she can sit in a normal chair, she can fly and sit in a regular flight seat, no more HBP medication, no more diabetes, no more c-pap, but it did take 9 months to find DS surgeons that would even take her on as a consult forget about operating on her, one stage DS and she would travel anywhere in the world for her DS, I know I helped her try to find surgeons as I currently live in the USA. I had to fly for my DS and I will have to fly 3,000 miles for my DS revision, traveling to get a DS is more common than people think, no one wants to travel, heck I would love my surgeon to be in my back yard. I have asked him to move near me but he is not going for that, so I will go to him. Some people just need a very very experienced (revision) surgeon for various reasons, either difficult revision, complicaitons, conversion, etc.

 

[southernlady]

Welcome, @Persephone2015

 

[aaa]

Welcome.

 

[Spiky Bugger]

Maybe he was the only one, but I have met a Keshishian Two-Stager.

 

[Persephone2015]

Hi! You found us!

I sure did! Thanks for suggesting it to me. I love your avatar of a sweet looking cat wearing a bow tie.

 

[Larra]

EN gets credit for finding the tuxedo kittie for me and explaining how to make it my avatar. Your "Doberman" is great too.

this site has an amazing group of well informed people who graciously (well usually) give of their time and knowledge. I think you and our other newbies will find so much more info here.