Hello from the Delaware Watergap

[Denis Korb]

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.

Lara,
I am happy to take advice, and to do research, and to learn pretty much about anything when its presented in a positive and encouraging way. I give no credit to people who come at me with a superiority complex assuming that just because they read my story that they know exactly who and what I am as a person, we are all complex in one way or another...and I in no way endorse my path as being everybody's path. When I said I developed a back injury, I also pointed out that the one vehicle I had that I could get into no longer worked...the only reason I have ambulance service is that my Insurance is paying for it via my social worker Tom. My insurance is Geisinger, through Geisinger Hospital, so they are pretty insistent I use their services. Can I go out searching for something different, I'm sure I could do so yes, but this is the 3rd time I have begun this Journey and to be honest with you, I'm done going back and forth...I was diagnosed with Right side heart failure and Sleep Apnea back in 2006 and all but pushed on to SSD. I have lived 9 years in a half life watching everyone else around me do my job as a husband and a father. I followed my doctors instructions, and according to the Geisinger Cardiologist, the Right Side heart failure has disappeared. I was Stuck in bed for 5-6 months but through Geisinger I had physical therapists and Nurses come to my house, and now I'm capable of getting up and walking for 6-7 Minuets straight...something I haven't been doing for a very long time, because I followed their instruction. When I came here I asked about the RNY, and the Gastric Sleeve...I was fully aware that they GS was the first stage of the DS, and I already knew that there was the potential that the Surgeon would want me to do the DS...but I haven't spoken to the Surgeon yet so I came here looking for advice...and boy did I get it in a very negative way. I accept that many here are very passionate about their respective surgeries...I find it amazing however that simply because Dr. Cox assumed that I needed a "kick in the ass" others have joined in the negativity.

 

[Denis Korb]

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

Thank you NewA, after all the push on the DS I actually looked him up @ DSfacts and noted his info for my Social worker...keep in mind. I still haven't met my surgeon...for all I know it could be Dr. Bonanni ;-)

 

[Denis Korb]

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.

Bearmom, I will certainly not be getting a lapband ;-)

 

[Denis Korb]

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.

TY More2adore I will keep that in mind

 

[Denis Korb]

"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.

Okay, you focused in on my one incorrect statement...I was referring to the sectioning off of most of the small intestine, even if they reattach it further down the line it still is removed and then reattached. And I give you no credit for inspiring me to do anything other then use you as motivation to achieve my 250 pounds by Christmas goal regardless of how I go about doing it. Your assumption that I may have a problem with intelligence is laughable at best...but if you absolutely need to know my IQ was 143 when last tested. You don't get to turn the fact that you went about responding to my post in a very negative manner on me, as if I were responsible for your vulgar language and choice of tone.

 

[southernlady]

Okay, you focused in on my one incorrect statement...I was referring to the sectioning off of most of the small intestine, even if they reattach it further down the line it still is removed and then reattached. And I give you no credit for inspiring me to do anything other then use you as motivation to achieve my 250 pounds by Christmas goal regardless of how I go about doing it. Your assumption that I may have a problem with intelligence is laughable at best...but if you absolutely need to know my IQ was 143 when last tested. You don't get to turn the fact that you went about responding to my post in a very negative manner on me, as if I were responsible for your vulgar language and choice of tone.

For ME, getting 80% of the stomach removed was a bigger mind hurdle. But honestly my stomach and intestines were doing ME NO FAVORS!!! I could not wait to get rid of stuff keeping me OBESE and diabetic.

 

[Denis Korb]

For ME, getting 80% of the stomach removed was a bigger mind hurdle. But honestly my stomach and intestines were doing ME NO FAVORS!!! I could not wait to get rid of stuff keeping me OBESE and diabetic.

I hear ya...Keep in Mind, I never said that I wouldn't listen to peoples opinions, that was assumed. I simply asked about the Gastric Sleeve and RnY, and explained that I was wary of the DS..and I got blasted ;-)

 

[Denis Korb]

I have been reading the Revision forums on OH as you suggested Lara, and I'm noting while there are some Sleeve patients that get the Gastric Sleeve moving on to the DS, many more are going to the RnY, and Much of the Revisions are from Lap Band to Sleeve. though there are 598 pages of Revisions which is very surprising to me. I did make a post asking for those in my situation to speak up, but in the last 24 hours I have received no reply's on my question.

 

[southernlady]

Denis, this group is passionate about the DS in particular.

I have been reading the Revision forums on OH as you suggested Lara, and I'm noting while there are some Sleeve patients that get the Gastric Sleeve moving on to the DS, many more are going to the RnY, and Much of the Revisions are from Lap Band to Sleeve. though there are 598 pages of Revisions which is very surprising to me. I did make a post asking for those in my situation to speak up, but in the last 24 hours I have received no reply's on my question.

The reason many sleeves revise to the RNY is that they go to surgeons who do not know HOW to do the DS.

I looked at your hospital's web site...they only offer the Sleeve, RNY and BPD (WHICH isn't supposedly done any more and is NOT covered by any insurance) I'm wondering if they meant to put the BPD/DS and whoever IT person who put it on there screwed up. Before getting any surgery, ASK for drawings...make sure you understand what you need.

Also if you are on NSAIDS for your back, remember that RNY'ers can not EVER have NSAIDS again. The sleeve and the DS are allowed NSAIDS after healing and in very moderate amounts, always with food.

 

[Larra]

@Denis Korb I was going to tell you this but @southernlady beat me to it - revision from sleeve to RNY actually makes no sense because it requires more work on the stomach, whereas revising from sleeve to DS just means adding the "switch" part to an already sleeved stomach. But many of these patients have never ever heard of the DS because surgeons who don't offer it don't mention it, not wanting to lose paying customers, they just go ahead and do what they already know how to do, regardless of whether or not it's the best of even most logical choice for the patient. We see this all the time.
did you notice on the revision forum that you didn't see a lot of DS patients wanting/needing revision? Did you see ANY??
Those of us who have been around the DS community for awhile know who the players are and where they are. If we tell you there aren't any at your beloved clinic, we know what we're talking about. Now, if there is someone starting to do the DS there, that would be great. We would love to see more bariatric surgeons doing this operation. But I doubt that this is the case - if I am wrong please feel free to correct me and I will gladly learn of another DS surgeon. But I doubt it.
It is clear that the people at this clinic have helped you. That's great. But that doesn't mean they are the best choice for your bariatric surgery.

And btw, with all your knee and back problems, do you take NSAIDs? Think you might need them in the future, as many people do with or without being MO? With RNY they are contraindicated for the rest of your life. With DS you can taken them, in proper doses of course. This turns out to be a big problem for a lot of people with RNY who either don't realize that they take NSAIDs (there are so many on the market and often with multiple names) or who have some future injury or arthritis and then learn they are screwed out of one of the most effective classes of medication available and stuck choosing between Tylenol and narcotics..

 

[Denis Korb]

No, I'm not taking any NSAID's...they had me taking some pain killers and other muscle relaxer as needed, but I simply stopped taking them because they weren't helping. I did look into the surgeon at Geisinger based out of their Danville clinic, but today is a Sunday so I know very little about what they do as of yet. The Directors name is Dr. Christopher Doubet Still and from what I can see he started practicing in the early 1990's. as I said I haven't met him yet, but I will ask the pertinent questions when I do meet him. I know I was given the original choice between a DS and a RNY and I asked about the Gastric Sleeve, but I by no means have made up my mind as of yet...though I have to admit you have brought up some excellent points that I will have to consider.

 

[Whit]

I am always torn as to what to write when new comers or anyone for that matter ask for opinions and then immediately become offended when confronted with the unpleasant facts. While your situation is personal to you it is not one we have not heard before.

Admittley I stopped reading when the IQ was posted. I am of average intelligence and hormones have me seriously wondering what has happened to my cognitive functions. My attention span is also questionable long posts and I are a no go.

I revised from RNY to DS and it's no joke. I was half the weight you are and never got close to a normal BMI. It is not the best surgery period. IMO you should not consider it. You will need a second surgery. If sleeve or RNY are your only options then sleeve. But you will still need a second surgery.

Support, advice, and compassion are given freely on this site. Nothing is sugar coated here.
this board is what you make it I wish you luck.

 

[JackieOnLine]

Hi Denis, welcome to the board.

there is a ton of info on this thread, I hope you can benefit from it. there is no point in being offended by anything said: if you don't like someone's post, ignore it and them.

and do we have a sticky thread about why it's better to keep your pyloric valve? I'm not seeing it right off.

< here is me, waving hello!

 

[JackieOnLine]

I'd like to add that everyone , even doctors have an anti-weightloss surgery bias because our whole society does.

do it the "right" way, diet and exercise! will power! commitment! as though surgery was for people not strong enough: this is all bullshit.

if you can lose weight and keep it off without surgery? good for you. most can't.

 

[JackieOnLine]

Admittley I stopped reading when the IQ was posted. I am of average intelligence and hormones have me seriously wondering what has happened to my cognitive functions. My attention span is also questionable long posts and I are a no go.

Whit? I love you.