Update on my status

[JenKapNC]

So my initial consult was for SIPS with Dr. Enochs (Cary, NC) in late April. I was 3/4 of the way through pre-op when BCBS stopped covering SIPS. Enochs has offered to do a DS with a long common channel like he does for his SIPS patients, but that seems odd. After some soul-searching and tons of research I've come to the decision to have the DS with Dr. Sudan in Durham, NC (if he'll take me). I have a consult 7/29 (it's the earliest they could get me in). My BMI floats somewhere between 40 and 41 and I know some Drs. like to reserve the DS for 50+ers. Keeping my fingers crossed that Sudan approves me and we can get moving.

My GI recommended an endoscopy given my desire to have a VSG-type procedure performed and Dr. Enochs confirmed that he would recommend as well given my history of reflux and heital hernia. They just want to double-check for Barrett's Syndrome. Anyone else have the endoscopy done as part of your GI pre-op? Thoughts?

Did any of you have a sleep study done as part of your required pre-op procedures?

I'm a little frustrated that my process has been stalled, but hopefully Sudan accepts my other pre-op procedures and we can get a surgery date scheduled sooner rather than later.

I know Enochs puts his patients on a liver-reduction diet with SIPS. Did you guys have that with your DSs?

Thanks all in advance and keep your fingers crossed for me that all goes well with Sudan.

 

[DianaCox]

You can get a tailored DS with your lower BMI - larger sleeve, longer CC. You'll do fine with that, and have a higher likelihood of long-term success, along with the ability to eat high fat (which the SIPS/SADI will NOT provide).

 

[Larra]

Dr. Sudan has an excellent reputation, and as far as I know he doesn't "reserve" the DS for people with higher bmi's. Whatever testing you've already done should be transferable to your new surgeon.

 

[newanatomy]

I am sorry for the delay in your treatment. I know how frustrating it is to have to wait.

Most of us had to do some type of pre-op diet to "shrink the liver". Not fun! Again, lots of people have had a sleep study done. I never had to have that one. I had to meet with a nutritionist and a psychiatrist. They did some pre-op blood work at the hospital the day before my surgery. That's about it. Good luck with the endo.

 

[DBmom23]

i will add in my own experience. just had the DS with a BMI of 35 at the beginning of the eval and 34 (33.8) at the time of surgery. i received a 4oz sleeve which is considered large and a 150cc common channel which is considered relatively long. The good thing with the larger sleeve is that i have had no trouble at all with hydration from POD#1. Still working on food intake, but liquids in regular sips throughout the day are a breeze.
Good luck! I so remember the feeling of impatience about having the surgery done as quickly as possible, but you are making the right decision to find the best surgeon available to you.

 

[hilary1617]

I had a sleep study as part of pre-op and was diagnosed with severe sleep apnea. It was something I swore at the time I could not have because my third superpower (after floating and static electricity) was sleeping on demand. I could sleep anytime, anywhere - plus I just didn't "feel" tired. Got on a CPAP and after a LONG adjustment period (5 weeks - can't remember exactly) began having real sleep and realized how exhausted I really was.

I also had to go for an endoscopy. My doctor recommended I ask for a "double dip" as it were to be added to a colonoscopy which was also required (due to admitting to gi bleeding I had long ignored which turned out to be polyps).

Also had psych, nutrition, heart clearance.

All worth it in the end!

Best wishes!

 

[southernlady]

I was a 35.2 BMI when I had my DS. Was TOLD I had a 4 oz sleeve but saw the operative report and IT says a 32 bougie which is actually rather small. My common channel is 175. LOST all my excess weight. I can't eat much at one sitting but I eat all the time.

 

[OldBroad]

My surgeon required quite a long list of pre-op procedures. I was able to skip the colonoscopy because I had one less than 10 years prior (and there were no polyps). I also got to skip the sleep study because I was already using a CPAP after a diagnosis of severe sleep apnea. I did have to have an endoscopy, cardiac stress test, blood work, bone-density (DEXA) scan and psychiatric clearance.

 

[Elizabeth N.]

I came to the WLS process with ten years of CPAP use under my belt, and I still had to have an updated sleep study done . Also had a "top and bottom" (endoscopy and colonoscopy) done as part of the pile of medical tests and clearances.

 

[southernlady]

I went thru the WLS process with only an endoscopy as my colonoscopy was also less than 5 years before. (I was on a 5 year schedule due to family history). No sleep study required even tho I had documented sleep apnea...BUT I had also had the UPPP to correct it. My surgeon didn't require an updated study and I had a whopper of a comorbid anyway...insulin pump dependent type 2 diabetes. Only other testing I had to have done was a cardiac clearance.

 

[brooklyngirl]

I know, firsthand, how frustrating setbacks can be, I had a bunch, but Dr. Sudan has a great reputation (he mentored my surgeon, as well) so you'll be in good hands. I also had an endoscopy and a sleep study, along with a stress test, psych clearance, endocrinologist clearance, and some sonograms and doppler scans. Maybe more that I'm forgetting. The hoops they make you jump through can be super frustrating at the time, but will be worth it eventually!

 

[DSRIGGS]

I had to have a psyche evaluation, stupid 6 month diet (3 month for Marshall, but 6 for insurance), mandatory support group once a month until surgery and then 5 day clear liquid diet (liver shrinkage)...No Sleep study but did have standard chest xray and ekg the day of surgery to make sure ticker and lungs were good.

and yes I feel you on the delays. It was 12 months after I decided I wanted the DS before it finally happened, but when I look back on it now, I honestly really don't even remember. You have made your decision (a great decision IMO) and your day will come sooner than you think, so hang in there and it WILL HAPPEN.

 

[Will2014]

So my initial consult was for SIPS with Dr. Enochs (Cary, NC) in late April. I was 3/4 of the way through pre-op when BCBS stopped covering SIPS. Enochs has offered to do a DS with a long common channel like he does for his SIPS patients, but that seems odd. After some soul-searching and tons of research I've come to the decision to have the DS with Dr. Sudan in Durham, NC (if he'll take me). I have a consult 7/29 (it's the earliest they could get me in). My BMI floats somewhere between 40 and 41 and I know some Drs. like to reserve the DS for 50+ers. Keeping my fingers crossed that Sudan approves me and we can get moving.

My GI recommended an endoscopy given my desire to have a VSG-type procedure performed and Dr. Enochs confirmed that he would recommend as well given my history of reflux and heital hernia. They just want to double-check for Barrett's Syndrome. Anyone else have the endoscopy done as part of your GI pre-op? Thoughts?

Did any of you have a sleep study done as part of your required pre-op procedures?

I'm a little frustrated that my process has been stalled, but hopefully Sudan accepts my other pre-op procedures and we can get a surgery date scheduled sooner rather than later.

I know Enochs puts his patients on a liver-reduction diet with SIPS. Did you guys have that with your DSs?

Thanks all in advance and keep your fingers crossed for me that all goes well with Sudan.

Yes most doctors require a liquid diet for final 2-3 weeks pre op to shrink the liver, and with damn good reason. The livers of morbidly obese folks are HUGE and need to be physically moved and pushed around during the procedure. A fatty liver is a sick liver, and they frequently hemorrhage just by being handled...because they have a vasculature that forms around them to feed the fatty areas. Reducing the livers size is critical to a successful outcome IMO. I also like the sound of the longer common channel with your BMI. The greater absorption this will allow could well benefit you enormously, while still allowing you to lose the needed weight. Liz has done quite well with a 175 CC for instance. I wish mine were longer than the 110CC I have, because I've lost too much and it's hard to maintain my weight. I wish had a 160CC but I had no idea at the time that this would be an issue. And yes, the endoscopy is required for ALL patients having bariatric surgery. Best of luck going forward my friend! I'm excited to think of the new you that's just around the corner. Please keep us updated.

 

[GirlFriday]

I didn't really have an insurance approval process. They looked at medical records and were like, "Yep, you're fat. You better have this done. Oh...get some counseling, too."
So I did that and had the standard pre-op bloodwork, chest x-rays, EKG, upper GI, and all that. Nothing special, no colonoscopies, no pap smears, no stress tests. Most importantly, no pre-op liquid diet!

I had some major delays because the tests came back and showed that I had elevated levels of nicotine in my system, which was silly because I hadn't smoked in over a year at the time of the tests, and I had to have some other follow up tests. Those delayed me getting a surgery date by two months. I was so completely frustrated by the time the surgeon approved me, that I almost threw in the towel. Then I realized how miserable I was being so heavy and pushed on.

So don't give up. It can be frustrating, but it is worth it. So completely worth it. I am ten weeks out and I have lost 57 pounds and I already feel so much better.

 

[Larra]

@Will2014 I believe you are generalizing too much. My surgeon did not require a pre-op endoscopy and I didn't have one. He also didn't require a pre-op "liver shrinking" diet. Just clears the day before, and of course nothing after midnight the night before (very important to have an empty stomach to prevent aspiration of stomach contents into the lungs during induction of anesthesia for any surgery, not just bariatric). And while MO people do generally have a fatty, enlarged liver, the amount of variable and there is no special vasculature around the liver. The liver texture is more fragile and more, as you pointed out, harder to get out of the way, so some (not all!) surgeons want it shrunk pre-op.
My surgery went without complication without these measures. I did have a very experienced surgeon who does the DS all the time, and this probably makes a difference. However, if someone's surgeon does request this diet, you are pretty much stuck with it.