Hi all - I've posted a bit about this in another thread but figured I would get everything all organized together here in one place. Hopefully some find this informative/helpful, and hopefully I get some help from others, too!
I also want to add up front that I am not in any way trying to discourage anyone from getting the surgery. I know my circumstances are very rare and just figure it's worth sharing.
So, with that all said...
I had been back and forth about the idea of WLS for around a year - my PCP mentioned that we were getting a new surgeon to our area who was pretty highly regarded. I was honestly kind of leaning towards no surgery, but in 2021 my wife and I welcomed our first child and I had a bit of a Covid-scare a few months later and that was enough to push me towards getting it done. I entered into my hospital's bariatric surgery program in August/September '21 and met with the new surgeon to the area - Dr. Fernando Bonanni. Ultimately after a couple of consults he told me that his recommendation "if I was his brother" would be to do the duodenal switch, with a VSG his second choice. I spent a lot of time going back and forth between the two, but ultimately elected for the DS as I learned in doing my research that it has by far the best long-term outcomes. I am relatively young (30) and am hoping to be here for quite a bit longer, so I wanted something that would work really long-term. My insurance didn't have any minimum waiting periods or pretty much any stipulations at all (didn't have to lose any weight or anything like that) and I was approved fairly quickly, which was really nice. After a bit of discussion with Dr. Bonanni we elected to do a bit longer common channel (150cm) as he told me that's more or less been his 'standard' for the last decade or so and has seen really good outcomes without so much malnutrition troubles.
I went in for my surgery on the morning of January 7, 2022. It was done laparoscopically, robotic-assisted, and by all accounts went very well. Dr. Bonanni reported an enlarged spleen, but otherwise a fairly by-the-book surgery and that all in all everything went about as well as you could hope for. If I remember correctly, I was out of surgery and out of the post-anesthesia unit by mid-afternoon and the plan was to discharge the following afternoon (Jan. 8).
For the most part things were going well. By the evening I was able to get up and walk around without much trouble at all, and was tolerating water no problem. I was getting in a good fluid intake, and didn't have any issues at all with nausea, vomiting, or anything like that. By the following morning I was cleared to be discharged and was told I'd be free to go around noon.
At this point however I was starting to notice a bit more pain and it didn't seem to be managed very well by medication. I also noticed that my abdomen was starting to feel bloated and "tighter," more than what seemed normal from surgical gas. I had also not been able to produce a bowel movement at this point, and could hardly pass gas. I did not feel comfortable with going home at this point and requested to stay at least another night to see if things would start heading the right way. Dr. Bonanni came in for a follow-up consult early in the morning of January 9 as I was still experiencing increasing pain and none of my other symptoms had really shown any positive changes either. It was around this time that they noted my blood pressure had begun dropping while my heart rate was increasing. I don't remember the exact numbers but apparently it was fairly concerning. Some of the medical staff suggested that we run a CT to see if there was a bleed or something somewhere, but ultimately Dr. Bonanni decided that the best course of action would be to head back into surgery and 'explore' that way. To be honest, at the time I was fairly disappointed to hear this (I was hoping to just get a CT!) but ultimately found out that this was the right decision.
This second surgery was also initially performed laparoscopically but quickly I had a large bleed/clot that had formed and had completely obstructed my bowel. As a result this had to be converted to an open surgery. Ultimately the clot they removed was around 2L in volume but was able to get things patched up well and tested for leaks with no issues. As I understand a portion of the blocked intestine pretty much "died" and a small section had to be removed as a result but in the big picture I was given the impression this was not particularly significant. In whatever case, after the fact I was more or less told that if I'd gone home or even taken the time to get a CT scheduled and done that there was a good chance I would not have made it through the night.
So, I ended up spending the next three or four days in the ICU as my heart rate had remained quite elevated and blood pressure was still fairly low. Additionally I had very high white blood cell and procalcitonin counts which led my medical staff to believe there was perhaps some sort of infection going on. These numbers bounced around a bit for a few days but never really got down low enough for them to be comfortable with moving to a lower level of care. At some point it was suggested that perhaps there could be an infection in the incision that was made for the open portion of the surgery - Dr. Bonanni ended up removing about half of the staples to inspect the wound and found no signs of infection there. Honestly, most of my time in the ICU is fairly foggy. I was on a lot of pain meds and had my own pain pump and feel like the whole time was pretty much a daze. My heart rate was still sitting in the 140's and I was having a hard time getting any good, deep breaths in. I did end up developing some atelectasis and the combination of this plus remaining surgical gas pain and just general discomfort made trying to do the 'deep breathing' exercises really painful. I got stuck and had so many IV's and labs drawn and all kinds of things, to the point that I quickly lost count and they were running out of good usable veins because they'd all been poked about so much.
I do remember getting some sort of "arterial line" or something like that put in and I don't know exactly what it did but I do know it hurt WAY more than a typical stick or IV draw, hahaha. Ultimately after about three days in the ICU I started to show some signs of progress. Maybe TMI, but on day three I kind of accidentally pooped the bed. This was really embarrassing but at the same time really encouraging as it was the first time I'd been able to go since my first surgery and of course I was worried that I had another blockage or something.
At this point I was able to be moved to the "step-down" PCU. Honestly this was probably my least favorite time of my whole stay. I was still in a lot of pain and for some reason the beds in this unit were a lot less comfortable. On top of that pretty much all the nurses that staffed this unit seemed way less interested/involved than the ICU (or the med-surg floor!) ones and I spent a lot of time hitting my call button and just waiting for someone to show up to help me out with this or that. And I had to basically beg to get some simple things like a fan, some sleeping medication, and a heating pad for my back. But oh well. I did end up receiving a transfusion of one unit of blood at this point as my blood levels had still not increased to where they were hoping. As I understand, I was more than one unit "low" but my treatment staff felt that since I was young and had a healthy heart it was 'safer' to go with a smaller transfusion, rather than risk complications with further transfusions (knowing what I know now, I wish I had told them to take the chance and just 'top me off'! ) I do remember feeling really weird while receiving the transfusion, but I guess that could have been any combination of things. It ultimately didn't have any problems and I did feel like this made me look a bit more "alive" finally! So, after about three or four days in the PCU I was cleared to step-down again, back to the medical/surgical floor (this is where I was initially sent after my first surgery).
Being back on the med-surg floor felt like a really big improvement compared to the PCU. I was still extremely sore and had a very hard time getting myself up to go to the bathroom or to try and walk around or anything like that. In addition to the soreness, my heart rate was still pretty elevated and would get worked up really easy with even the smallest activity. But, I was finally able to get some decent rest and we saw most of my numbers heading in the right direction. Ultimately it took about another week until my WBC counts and whatnot had got to a range they were comfortable discharging me with. I ended up having a couple more CT's done to rule out any further bleeds/leaks or anything like pneumonia, and they all came back negative. So, after about two weeks in the hospital I was finally cleared to go home.
Home-care has been mostly uneventful and pretty much the same as my time in the med-surg floor, just without any IV's or lab draws or interruptions every few hours. Pretty much just sleep, go to the bathroom, try to eat, try to walk for a few minutes, and then go back to sleep.
SO, where am I at now?
Unfortunately I have not seen a ton of progress in the weeks since being discharged. Or, at least...it's been very slow. I am still tired all the time and fatigue extremely easily. I do just fine with my fluid intake, but have had a hard time getting in enough food intake. Often times it seems like a debate between 1.) stay in bed and get rest but don't eat or 2.) get up out of bed and fix something to eat but get less rest and I'm so tired all the time that (1) often seems to win out. Things have been slowly improving in that regard, but I do definitely feel like I'm struggling to get in enough nutrition, and stuff like protein shakes that I used to drink with no problem seem to be a bit tougher to stomach now. That coupled with the fact that I rarely have any appetite has made things pretty tough. I'm doing pretty good with my vitamins, though I am thinking I am going to try supplementing some additional Iron and perhaps some B12. I have not had follow-up labs done yet but I do remember seeing one of my hospital lab records saying it looked like I potentially had low iron and I can only assume that's gotten worse in the time since then. I must confess that I just went with the hospital-recommended vitamin plan which is pretty much just a high-ADEK multivitamin w/ Iron (2x daily) and some calcium citrate chewables (6x daily) and I'm suspecting it's simply not enough. Plus, they kinda taste gross, so I'm looking to transition to something more similar to the Vitalady DS plan or the like. I figure that knowing I was a bit anemic when leaving the hospital, perhaps some additional iron supplementation would help out, but maybe I am off base on that.
Still the worst part is just the fatigue and how easily I get worn out. Pre-surgery my average resting heart rate for 2021 was about 68-72bpm. Post-op - for the last month or so - it has been around 95bpm. Even simple things like just walking short distances feel like a full-blown workout - just yesterday morning I walked from my car into church and by the time I got to my seat my heart rate was reading at nearly 150bpm. Even just sitting upright tends to keep it fairly elevated, like the mid 110s to 120s range. That has been really tough, and I haven't seen a ton of improvement in that regard and am not really sure what more I can do. I know that with a lower blood volume your heart simply has to pump more quickly to circulate it the same, but it's been six weeks since surgery with very little improvement. I guess I am hoping that adding in more iron will help increase my RBC counts too, but I'm not really sure at this point. It's very limiting and truthfully a bit discouraging. On the plus side, I've lost about 50lbs since surgery and a whole 100lbs since beginning with the surgical program (397 when I started the program in August/Sept '21; 347 day of surgery; 297 today) but I feel so much less healthy than I did 100lbs ago, which seems like a pretty weird thing to say, lol.
So, do I regret having the DS done? Honestly, at the moment, I kind of do. I know my particular circumstances are pretty rare (Dr. Bonanni told me he'd only seen this happen one other time in his career), but it's hard to not feel like I wouldn't have had so many problems if I'd went with the 'simpler' VSG procedure (and maybe a DS at some later point down the road). I know it is still relatively early, but as of yet I've not really seen any benefits for me, either. Yes, I've lost a lot of weight, but as above, I feel a lot less healthy than I did when I was heavier and definitely haven't got any new-found energy or anything like that either. I hardly have an appetite and hate having to wait a long time after eating to be able to take a drink. I haven't found any foods that I absolutely cannot tolerate (thankfully, I've still not had anything make me particularly nauseous or make me vomit or anything like that), but at the same time pretty much everything feels like it sits "heavy" and it seems like it takes me nearly an hour to eat something like 2oz of deli turkey without feeling "heavy" or bloated or something. I am really limited in what I can help out with around the house and can't even pick up my 11-mo old son, which is really tough given that my wife is currently ~20 weeks pregnant herself and has spent the past week battling a rough bout of covid, too. It's been a really rough time, to say the least. I had a lot of worries/concerns about surgery in the first place, and I hate to say it but pretty much all of my fears ended up coming true (well, with the exception of dying on the table, thankfully, haha!), so it's really hard to not "i told you so" to myself. BUT, like I said, I know these circumstances are very rare, and I'm still holding onto hope that someday soon I will turn a corner and things will get a little more "normal" and I'll start feeling myself again. But with how slow things have been going, it's just awfully discouraging still. But I still believe I will see those 'benefits' someday. Just feels a lot further off than I had initially expected.
Well, that's pretty much all I've got at the moment. My regards if you made it all the way through to the end. Like I said at the start, I'm not trying to talk anyone out of getting the surgery - just wanted to offer my perspective. And I hope it doesn't come off as me trying to get a pity-party either; that's not my intent but I guess just kinda wanted to vent a little bit and get everything out there to help process the last ~6 weeks or so a bit better for myself. Again, kudos if you made it all the way to the end!
I also want to add up front that I am not in any way trying to discourage anyone from getting the surgery. I know my circumstances are very rare and just figure it's worth sharing.
So, with that all said...
I had been back and forth about the idea of WLS for around a year - my PCP mentioned that we were getting a new surgeon to our area who was pretty highly regarded. I was honestly kind of leaning towards no surgery, but in 2021 my wife and I welcomed our first child and I had a bit of a Covid-scare a few months later and that was enough to push me towards getting it done. I entered into my hospital's bariatric surgery program in August/September '21 and met with the new surgeon to the area - Dr. Fernando Bonanni. Ultimately after a couple of consults he told me that his recommendation "if I was his brother" would be to do the duodenal switch, with a VSG his second choice. I spent a lot of time going back and forth between the two, but ultimately elected for the DS as I learned in doing my research that it has by far the best long-term outcomes. I am relatively young (30) and am hoping to be here for quite a bit longer, so I wanted something that would work really long-term. My insurance didn't have any minimum waiting periods or pretty much any stipulations at all (didn't have to lose any weight or anything like that) and I was approved fairly quickly, which was really nice. After a bit of discussion with Dr. Bonanni we elected to do a bit longer common channel (150cm) as he told me that's more or less been his 'standard' for the last decade or so and has seen really good outcomes without so much malnutrition troubles.
I went in for my surgery on the morning of January 7, 2022. It was done laparoscopically, robotic-assisted, and by all accounts went very well. Dr. Bonanni reported an enlarged spleen, but otherwise a fairly by-the-book surgery and that all in all everything went about as well as you could hope for. If I remember correctly, I was out of surgery and out of the post-anesthesia unit by mid-afternoon and the plan was to discharge the following afternoon (Jan. 8).
For the most part things were going well. By the evening I was able to get up and walk around without much trouble at all, and was tolerating water no problem. I was getting in a good fluid intake, and didn't have any issues at all with nausea, vomiting, or anything like that. By the following morning I was cleared to be discharged and was told I'd be free to go around noon.
At this point however I was starting to notice a bit more pain and it didn't seem to be managed very well by medication. I also noticed that my abdomen was starting to feel bloated and "tighter," more than what seemed normal from surgical gas. I had also not been able to produce a bowel movement at this point, and could hardly pass gas. I did not feel comfortable with going home at this point and requested to stay at least another night to see if things would start heading the right way. Dr. Bonanni came in for a follow-up consult early in the morning of January 9 as I was still experiencing increasing pain and none of my other symptoms had really shown any positive changes either. It was around this time that they noted my blood pressure had begun dropping while my heart rate was increasing. I don't remember the exact numbers but apparently it was fairly concerning. Some of the medical staff suggested that we run a CT to see if there was a bleed or something somewhere, but ultimately Dr. Bonanni decided that the best course of action would be to head back into surgery and 'explore' that way. To be honest, at the time I was fairly disappointed to hear this (I was hoping to just get a CT!) but ultimately found out that this was the right decision.
This second surgery was also initially performed laparoscopically but quickly I had a large bleed/clot that had formed and had completely obstructed my bowel. As a result this had to be converted to an open surgery. Ultimately the clot they removed was around 2L in volume but was able to get things patched up well and tested for leaks with no issues. As I understand a portion of the blocked intestine pretty much "died" and a small section had to be removed as a result but in the big picture I was given the impression this was not particularly significant. In whatever case, after the fact I was more or less told that if I'd gone home or even taken the time to get a CT scheduled and done that there was a good chance I would not have made it through the night.
So, I ended up spending the next three or four days in the ICU as my heart rate had remained quite elevated and blood pressure was still fairly low. Additionally I had very high white blood cell and procalcitonin counts which led my medical staff to believe there was perhaps some sort of infection going on. These numbers bounced around a bit for a few days but never really got down low enough for them to be comfortable with moving to a lower level of care. At some point it was suggested that perhaps there could be an infection in the incision that was made for the open portion of the surgery - Dr. Bonanni ended up removing about half of the staples to inspect the wound and found no signs of infection there. Honestly, most of my time in the ICU is fairly foggy. I was on a lot of pain meds and had my own pain pump and feel like the whole time was pretty much a daze. My heart rate was still sitting in the 140's and I was having a hard time getting any good, deep breaths in. I did end up developing some atelectasis and the combination of this plus remaining surgical gas pain and just general discomfort made trying to do the 'deep breathing' exercises really painful. I got stuck and had so many IV's and labs drawn and all kinds of things, to the point that I quickly lost count and they were running out of good usable veins because they'd all been poked about so much.
I do remember getting some sort of "arterial line" or something like that put in and I don't know exactly what it did but I do know it hurt WAY more than a typical stick or IV draw, hahaha. Ultimately after about three days in the ICU I started to show some signs of progress. Maybe TMI, but on day three I kind of accidentally pooped the bed. This was really embarrassing but at the same time really encouraging as it was the first time I'd been able to go since my first surgery and of course I was worried that I had another blockage or something. At this point I was able to be moved to the "step-down" PCU. Honestly this was probably my least favorite time of my whole stay. I was still in a lot of pain and for some reason the beds in this unit were a lot less comfortable. On top of that pretty much all the nurses that staffed this unit seemed way less interested/involved than the ICU (or the med-surg floor!) ones and I spent a lot of time hitting my call button and just waiting for someone to show up to help me out with this or that. And I had to basically beg to get some simple things like a fan, some sleeping medication, and a heating pad for my back. But oh well. I did end up receiving a transfusion of one unit of blood at this point as my blood levels had still not increased to where they were hoping. As I understand, I was more than one unit "low" but my treatment staff felt that since I was young and had a healthy heart it was 'safer' to go with a smaller transfusion, rather than risk complications with further transfusions (knowing what I know now, I wish I had told them to take the chance and just 'top me off'!
) I do remember feeling really weird while receiving the transfusion, but I guess that could have been any combination of things. It ultimately didn't have any problems and I did feel like this made me look a bit more "alive" finally! So, after about three or four days in the PCU I was cleared to step-down again, back to the medical/surgical floor (this is where I was initially sent after my first surgery). Being back on the med-surg floor felt like a really big improvement compared to the PCU. I was still extremely sore and had a very hard time getting myself up to go to the bathroom or to try and walk around or anything like that. In addition to the soreness, my heart rate was still pretty elevated and would get worked up really easy with even the smallest activity. But, I was finally able to get some decent rest and we saw most of my numbers heading in the right direction. Ultimately it took about another week until my WBC counts and whatnot had got to a range they were comfortable discharging me with. I ended up having a couple more CT's done to rule out any further bleeds/leaks or anything like pneumonia, and they all came back negative. So, after about two weeks in the hospital I was finally cleared to go home.
Home-care has been mostly uneventful and pretty much the same as my time in the med-surg floor, just without any IV's or lab draws or interruptions every few hours. Pretty much just sleep, go to the bathroom, try to eat, try to walk for a few minutes, and then go back to sleep.
SO, where am I at now?
Unfortunately I have not seen a ton of progress in the weeks since being discharged. Or, at least...it's been very slow. I am still tired all the time and fatigue extremely easily. I do just fine with my fluid intake, but have had a hard time getting in enough food intake. Often times it seems like a debate between 1.) stay in bed and get rest but don't eat or 2.) get up out of bed and fix something to eat but get less rest and I'm so tired all the time that (1) often seems to win out. Things have been slowly improving in that regard, but I do definitely feel like I'm struggling to get in enough nutrition, and stuff like protein shakes that I used to drink with no problem seem to be a bit tougher to stomach now. That coupled with the fact that I rarely have any appetite has made things pretty tough. I'm doing pretty good with my vitamins, though I am thinking I am going to try supplementing some additional Iron and perhaps some B12. I have not had follow-up labs done yet but I do remember seeing one of my hospital lab records saying it looked like I potentially had low iron and I can only assume that's gotten worse in the time since then. I must confess that I just went with the hospital-recommended vitamin plan which is pretty much just a high-ADEK multivitamin w/ Iron (2x daily) and some calcium citrate chewables (6x daily) and I'm suspecting it's simply not enough. Plus, they kinda taste gross, so I'm looking to transition to something more similar to the Vitalady DS plan or the like. I figure that knowing I was a bit anemic when leaving the hospital, perhaps some additional iron supplementation would help out, but maybe I am off base on that.
Still the worst part is just the fatigue and how easily I get worn out. Pre-surgery my average resting heart rate for 2021 was about 68-72bpm. Post-op - for the last month or so - it has been around 95bpm. Even simple things like just walking short distances feel like a full-blown workout - just yesterday morning I walked from my car into church and by the time I got to my seat my heart rate was reading at nearly 150bpm. Even just sitting upright tends to keep it fairly elevated, like the mid 110s to 120s range. That has been really tough, and I haven't seen a ton of improvement in that regard and am not really sure what more I can do. I know that with a lower blood volume your heart simply has to pump more quickly to circulate it the same, but it's been six weeks since surgery with very little improvement. I guess I am hoping that adding in more iron will help increase my RBC counts too, but I'm not really sure at this point. It's very limiting and truthfully a bit discouraging. On the plus side, I've lost about 50lbs since surgery and a whole 100lbs since beginning with the surgical program (397 when I started the program in August/Sept '21; 347 day of surgery; 297 today) but I feel so much less healthy than I did 100lbs ago, which seems like a pretty weird thing to say, lol.
So, do I regret having the DS done? Honestly, at the moment, I kind of do. I know my particular circumstances are pretty rare (Dr. Bonanni told me he'd only seen this happen one other time in his career), but it's hard to not feel like I wouldn't have had so many problems if I'd went with the 'simpler' VSG procedure (and maybe a DS at some later point down the road). I know it is still relatively early, but as of yet I've not really seen any benefits for me, either. Yes, I've lost a lot of weight, but as above, I feel a lot less healthy than I did when I was heavier and definitely haven't got any new-found energy or anything like that either. I hardly have an appetite and hate having to wait a long time after eating to be able to take a drink. I haven't found any foods that I absolutely cannot tolerate (thankfully, I've still not had anything make me particularly nauseous or make me vomit or anything like that), but at the same time pretty much everything feels like it sits "heavy" and it seems like it takes me nearly an hour to eat something like 2oz of deli turkey without feeling "heavy" or bloated or something. I am really limited in what I can help out with around the house and can't even pick up my 11-mo old son, which is really tough given that my wife is currently ~20 weeks pregnant herself and has spent the past week battling a rough bout of covid, too. It's been a really rough time, to say the least. I had a lot of worries/concerns about surgery in the first place, and I hate to say it but pretty much all of my fears ended up coming true (well, with the exception of dying on the table, thankfully, haha!), so it's really hard to not "i told you so" to myself. BUT, like I said, I know these circumstances are very rare, and I'm still holding onto hope that someday soon I will turn a corner and things will get a little more "normal" and I'll start feeling myself again. But with how slow things have been going, it's just awfully discouraging still. But I still believe I will see those 'benefits' someday. Just feels a lot further off than I had initially expected.
Well, that's pretty much all I've got at the moment. My regards if you made it all the way through to the end. Like I said at the start, I'm not trying to talk anyone out of getting the surgery - just wanted to offer my perspective. And I hope it doesn't come off as me trying to get a pity-party either; that's not my intent but I guess just kinda wanted to vent a little bit and get everything out there to help process the last ~6 weeks or so a bit better for myself. Again, kudos if you made it all the way to the end!
