Hi all! Working towards DS...

[joben]

Hello!
I'm a 30-y.o. male who is currently coming in around 6'2" and weight has been floating around 380-390.
I met with Dr. Bonanni (I think some of you may be familiar with him; he used to be up in Pennsylvania but recently moved to my area) after my primary doctor suggested bariatric surgery as something to consider and spoke very highly of Dr. Bonanni.

We had our first consult in early August and reviewed potential surgical options. In his words, he said "If you were my own brother I would recommend getting the duodenal switch. But you are kind of right on the line and if you decided you wanted to just get the sleeve done I would happily perform that surgery too and I think that both would give you good results."
Initially I was a bit intimidated by this as it seemed like the most 'involved' or 'extreme' of the surgical options. But, I didn't ask specifically, but I kind of got the impression that Dr. Bonanni specializes in doing the duodenal switch. He told me he has done over 500 now, which made me feel a lot more comfortable. So, that's the direction I'm proceeding in right now. In a couple of days I'll go in for my EGD, then in the coming weeks have a couple of more meetings scheduled with dietitians, psychologists, etc. I'm lucky in that my insurance doesn't require any sort of mandatory waiting period or proof of weight loss to approve for surgery, so the hospital told me their program takes roughly three months. I guess we are closing in on halfway there, then.

I have to admit though the whole proposition still makes me a bit nervous! I've never had ANY sort of surgery done nor ever had to go under anesthesia. And I've watched way too much Grey's for my own good, so I'm frequently finding myself thinking that he'll nick an artery or they won't be able to wake me up or something like that. Not particularly rational, but it is what it is. Beyond that though, I can't help but second-guess a lot. I have to confess that I'm rather indecisive by nature and do frequently second-guess big decisions, but it's just a little weird. I don't really have any major health problems at the moment - just some mild hypertension (like, 130/80 or something close) - but otherwise am doing fairly well and am lucky to be able to say that I'm very happy with my life, all things considered. At the same time I know that my weight will likely lead to more health problems down the road, so I'm ultimately just wanting to get surgery done so that I can hopefully live a bit longer and have more time with my wife and son. Anyways, that said, I can't help but feel sometimes like I'll end up making a big radical change or make myself miserable "just" for a benefit that I won't really see for some time. Not sure if that makes a ton of sense, don't exactly know the best way of saying it...basically, I guess it's like...I just feel like I have a pretty good thing going for me right now and even though it's the right decision long-term it still makes me worry that i'll just end up ruining a good thing, more or less.

Anyways, enough rambling for now. That's kind of where I'm at. I'm definitely a person who likes to be as informed as possible for decision-making so I'm hoping to find some more information, testimonials, etc here that will help me feel more and more confident in my decision(s) going forward.

 

[Munchkin]

30... I wish I had had mine done at 30. Or for that matter, 20 would have been good too. Welcome and you have found the right place. Do a lot of reading here and you will be well informed. I think you are doing the best possible thing for future you. Giving yourself the gift of fitting in a normal size world. You might not see it now but you sure will when you lose the weight. Your life will change for the better.

You need to remember, that sleeve is just another diet with a smaller stomach. If diets have not been great for you, stick with your plan. I have a friend who got that sleeve. She is in a wheelchair and needed to lose weight to get her knees replaced. She never lost enough and has been gaining now. And she is still in a wheelchair. I wish every day that she had had the DS instead. But, she wouldn't listen. You can't find any WLS that works better for losing the weight and keeping it off than the DS. I keep hoping my friend will find a way to get a revision to the DS.

I had my DS almost 20 years ago and I would not trade it for anything else out there. I am a normal looking old bag and I am very healthy. No prescription meds and I can still run and do everything I used to do only better. I am familiar with your doc and there are some of his patients here. He is an experienced DS surgeon.

 

[joben]

Thanks for that, I'm glad to hear it!

I should add a little bit more context:

I had done a bit of perfunctory research - nothing too much - before my first consult. At that time, it seemed to me like the RNY was considered the "gold standard" surgery, or at least that was my perception. So for one reason or another I had kind of just assumed that this was the type of surgery that would be suggested/offered to me. But, Dr. Bonanni made it sound like unless I had heartburn/reflux (I don't) that he'd rather do the sleeve or DS and that for him the RNY has kind of been a "jack of all trades, master of none" type of thing and he's seen similar regain issues/etc with it as he has with VSG - whereas DS consistently showed the best long-term weight loss and/or least amount of regain. So DS was his first choice, sleeve was second choice, and then he said "If you were really set on RNY I would still be willing to perform that surgery, but it's my opinion that you'll get better results and/or quality of life with one of the other two."

For what it's worth, my insurance does not cover the SADI. Dr. Bonanni did mention that perhaps he would recommend doing a slightly longer common channel, but didn't say specifically. I have to admit that I didn't know there was much debate on the matter until after the fact, so I'm not entirely sure how much longer of a CC he was talking about, I still need to get some clarification on that.

I do also have to say that the idea of having to take so many vitamins a day (for life) is a bit intimidating (at the moment, I take one water pill a day and that's it), but at the same time what I've been telling myself is that I'd rather have to take a handful of vitamins daily than be taking a handful of blood thinners and beta blockers and antidepressants and Lipitor and so on. I can trade some inconveniences now for less REAL problems later on, basically.

 

[southernlady]

He is a well known vetted DS surgeon.
When I had mine in 2011, he only did the DS on a 50 or above BMI unless you were diabetic.
I do have one question? What is his location (and web address) now?

 

[Susan in Tennessee]

I second Munich’s sentiment…if only I could have had my DS at 30! I think you are very lucky to have somehow walked in to a doctors office who knows DS, is experienced, and knows it’s better (for most people) than RNY! Keeping the pyloric valve so you have a normally functioning stomach (just smaller) is a huge plus! I’d have a talk about your channel length soon and get that ironed out. Don’t let him make it overly long.

Welcome!

Susan

 

[Munchkin]

Thanks for that, I'm glad to hear it!

I should add a little bit more context:

I had done a bit of perfunctory research - nothing too much - before my first consult. At that time, it seemed to me like the RNY was considered the "gold standard" surgery, or at least that was my perception. So for one reason or another I had kind of just assumed that this was the type of surgery that would be suggested/offered to me. But, Dr. Bonanni made it sound like unless I had heartburn/reflux (I don't) that he'd rather do the sleeve or DS and that for him the RNY has kind of been a "jack of all trades, master of none" type of thing and he's seen similar regain issues/etc with it as he has with VSG - whereas DS consistently showed the best long-term weight loss and/or least amount of regain. So DS was his first choice, sleeve was second choice, and then he said "If you were really set on RNY I would still be willing to perform that surgery, but it's my opinion that you'll get better results and/or quality of life with one of the other two."

For what it's worth, my insurance does not cover the SADI. Dr. Bonanni did mention that perhaps he would recommend doing a slightly longer common channel, but didn't say specifically. I have to admit that I didn't know there was much debate on the matter until after the fact, so I'm not entirely sure how much longer of a CC he was talking about, I still need to get some clarification on that.

I do also have to say that the idea of having to take so many vitamins a day (for life) is a bit intimidating (at the moment, I take one water pill a day and that's it), but at the same time what I've been telling myself is that I'd rather have to take a handful of vitamins daily than be taking a handful of blood thinners and beta blockers and antidepressants and Lipitor and so on. I can trade some inconveniences now for less REAL problems later on, basically.

Supplements. After a while they become a habit just like anything else you do every day. I portion them out once a week and my total time spent is 10 minutes. I use simple organizers I buy at the dollar store. One for evening and one for morning. When I travel I use snack size ziplock bags. You should know the supplements are not cheap. I am a shopper and I spend about $600 per year.

The shortest CC you can probably get is 100cm. My doc wanted to do 100 and I wanted 50. So we compromised on 75cm. The shortest CC I know of is 40. I do know several successful people who opted for the longer CC, like up to 200. And I know a couple people who did not do so well keeping the weight off. You know you better than anyone else does. Think hard.

Last, a story. 10 people in my office had WLS about 20 years ago. 1 DS, me. 1 band. And 8 RNY. Fast forward. The band person never lost an ounce. One of the RNY people and 1 DS person, me, are still relatively 'normal'. The other 7 RNY people are all bigger than they were when they had surgery. Why? When you alter your anatomy to lose weight, your body adapts. It wants to get back to fat. The standard RNY bypasses so little that by the 2 year mark, your body has adapted. And that's when many start the regain. The DS bypasses so much your body can't adapt. JMHO, the RNY is cruel.

 

[joben]

He is a well known vetted DS surgeon.
When I had mine in 2011, he only did the DS on a 50 or above BMI unless you were diabetic.
I do have one question? What is his location (and web address) now?

Hmm, I am not sure what has changed. I'm not diabetic, but I am right on that line. At our first appointment, my BMI was at 49.7, so I don't know...maybe he just called it 'close enough.'

Here is where he's currently located (link to hospital directory page, I don't know of any website beyond that - he works for the big hospital in my town.)

 

[Munchkin]

Hmm, I am not sure what has changed. I'm not diabetic, but I am right on that line. At our first appointment, my BMI was at 49.7, so I don't know...maybe he just called it 'close enough.'

Here is where he's currently located (link to hospital directory page, I don't know of any website beyond that - he works for the big hospital in my town.)

It is worth it just to avoid the diabetes right around the corner. Promise! They started doing the DS decades ago in Europe to cure type 2 diabetes.

 

[joben]

Supplements. After a while they become a habit just like anything else you do every day. I portion them out once a week and my total time spent is 10 minutes. I use simple organizers I buy at the dollar store. One for evening and one for morning. When I travel I use snack size ziplock bags. You should know the supplements are not cheap. I am a shopper and I spend about $600 per year.

The shortest CC you can probably get is 100cm. My doc wanted to do 100 and I wanted 50. So we compromised on 75cm. The shortest CC I know of is 40. I do know several successful people who opted for the longer CC, like up to 200. And I know a couple people who did not do so well keeping the weight off. You know you better than anyone else does. Think hard.

Last, a story. 10 people in my office had WLS about 20 years ago. 1 DS, me. 1 band. And 8 RNY. Fast forward. The band person never lost an ounce. One of the RNY people and 1 DS person, me, are still relatively 'normal'. The other 7 RNY people are all bigger than they were when they had surgery. Why? When you alter your anatomy to lose weight, your body adapts. It wants to get back to fat. The standard RNY bypasses so little that by the 2 year mark, your body has adapted. And that's when many start the regain. The DS bypasses so much your body can't adapt. JMHO, the RNY is cruel.

That's actually not so bad as I would have thought! I was expecting/budgeting for more like twice that...

Maybe I'm imagining it but I thought perhaps he had mentioned something like 100-150cm channel. BUT at the same time it was such an overload of information all at once that I may well be remembering it wrong or perhaps just making that up in my head entirely...haha. Yeah, definitely gonna want to get that clarified.

 

[southernlady]

Hmm, I am not sure what has changed. I'm not diabetic, but I am right on that line. At our first appointment, my BMI was at 49.7, so I don't know...maybe he just called it 'close enough.'

Here is where he's currently located (link to hospital directory page, I don't know of any website beyond that - he works for the big hospital in my town.)

If you round up, it’s 50. Thanks for the link.

 

[Larra]

Welcome!
As others have said, you are very fortunate to find a DS surgeon without even knowing you were looking for one. The DS has the best statistics of any bariratric surgery not just for percentage excess weight loss, but for maintenance of that weight loss and also for resolution of almost all comorbidities, with the exception being reflux.
As far as your age is concerned, better now than after you experience all the miserable comorbidities that are almost certainly in your future if you do nothing now. If anything, the trend in bariatric surgery these days (well, before Covid hit, at least) is to operate at younger ages before these problems arise and damage is done. I wish I had had the DS at a younger age for sure.

 

[joben]

Welcome!
As others have said, you are very fortunate to find a DS surgeon without even knowing you were looking for one. The DS has the best statistics of any bariratric surgery not just for percentage excess weight loss, but for maintenance of that weight loss and also for resolution of almost all comorbidities, with the exception being reflux.
As far as your age is concerned, better now than after you experience all the miserable comorbidities that are almost certainly in your future if you do nothing now. If anything, the trend in bariatric surgery these days (well, before Covid hit, at least) is to operate at younger ages before these problems arise and damage is done. I wish I had had the DS at a younger age for sure.

Yeah. That's more or less what I've been trying to remind myself. But still, sometimes it's hard to not feel like I won't be creating more problems short-term, if that makes sense! Not a dealbreaker, but just makes it a little scary is all.

 

[Susan in Tennessee]

That's actually not so bad as I would have thought! I was expecting/budgeting for more like twice that...

Maybe I'm imagining it but I thought perhaps he had mentioned something like 100-150cm channel. BUT at the same time it was such an overload of information all at once that I may well be remembering it wrong or perhaps just making that up in my head entirely...haha. Yeah, definitely gonna want to get that clarified.

I spend a lot more than that, so please don’t think that’s the norm. Yes, sometimes taking the handful of pills ( 4 times a day for me) gets old but it does become habit, as was mentioned. I just remind myself I take the vitamins and then I go have a delicious, satisfying meal, and snacks, and then go do what I need and want to do without feeling winded and tired, while wearing clothes that I purchased ANYWHERE, not from a special Dept or special mail order book!

 

[JackieOnLine]

Hi & Welcome!

I have to admit though the whole proposition still makes me a bit nervous! I've never had ANY sort of surgery done nor ever had to go under anesthesia.

it's normal to be nervous since there are risks - but keep reminding yourself of the risks of not getting surgery.

 

[Georgepds]

Well.. DS is a wonderful operation for the obese. The co morbidities it resolves are remarkable ( sleep apnea, T2, diabetes, hypertension, hypercholesterolemia...etc) If you are young and obese , you may not have these problems.. if you are old and obese .. they are very likely. So avoid them before they get bad. T2 Diabetes, for example, leads to neuropathy ( as well as nephropathy).. and once the nerves degenerate in your feet.. they are gone.. literally a life long pain in the foot

I was about your size, BMI~50, when I got VSG, then a year later, DS. Two years later my BMI~25, the myriad comorbidities are resolved, but the foot neuropathy remains. My recommendation is lose the weight before you get old enough to have the problems. There are metabolically healthy young obese people, but when you get old, if you are obese, the metabolic problems multiply.

You seem worried about taking vitamins. Really, it's not a big deal. Anyone modestly organized can handle it. How can you tell if you are modestly organized? Can you hold a job? Can you maintain a relationship? If so, you are modestly organized, so the worry about taking vitamins is misplaced. Don't get me wrong, you have to take them, and if you don't, you will develop malnutrition and associated problems, but they are avoidable problems... just take the vitamins

You also seem worried about surgery. Morbidity and complications of DS are way down, compared to 20 years ago. And, as others have pointed out, you have found a good experienced DS surgeon, which stacks odd in your favor.

Now for the part you can't control well post DS: craping and farting. Some people develop constipation others diarrhea, still others UBM ( urgent bowel movements..if you've ever crapped your pants or the floor on the way to the toilet, or , poor you, far from a toilet, that's an UBM ). The farting is almost completely unbelievable. I'm talking about stinkers that will clear a room, and make your sweet spouse re think if, on the whole, you are worth the stink. Few talk about it because it is embarrassing, but it is a literal pain in the butt... and it does not get any better, or at least, not for some of us.

Not that BMI~50 itself is without butt problems. At that BMI you have probably learned some dance to clean your butt. Once you loose the weight, you can forget the toilet dance.. you can clean your butt sitting on the bowl and lifting a haunch, just like you could when you were a kid


Compared to the eventual metabolic problems of obesity (heart disease, dialysis, neuropathy, foot amputation) craping and farting are a walk in the park.. but they are still problems post DS

If anyone knows how to mitigate that downside, I'm all ears