Question from my wife

[jim1969]

The sleeve alone will not do anything for diabetes. The diabetes resolution has nothing to do with the weight loss. My diabetes went in to immediate remission 3 days after my DS and I was still 335 pounds. It isn't losing the weight that made my diabetes go away, it was the switch.

Regarding GERD. A VSG has a smaller sleeve type Cally than a DS and it can cause GERD issues. Note I had GERD before my DS and it did not get any worse and it may have improved a bit.

Good to know!

 

[southernlady]

Jim, I was not able to self pay. Thankfully my BMI (at 35.2) was barely high enough to have Medicare pay for mine.

As far as the GERD, small sleeves do not help that. And a VSG usually has a super tiny sleeve. My sleeve was made tiny to offset a fairly long common channel (175 cm). IF I could have a do over, I would have either just have the switch OR had a much larger sleeve to a much shorter common channel...something like a 75.

My GERD is better but not resolved. AND my longer common channel or the fact that I have been diabetic for years before my DS may be a the bottom of my noting being totally resolved now. BUT I control it with diet and exercise.

I don't know how tall your wife is but for me to get from a 35.2 to a 32.2 only took about 15 lbs.

 

[DBmom23]

Jim, I had the DS with a BMI of 30. I have struggled with my weight my whole life and knew there was no end in site. I have had no regrets at all and am at my goal weight after 9 months. My CC is 100cm and I have no issues with diarrhea etc. I also know I won't lose excessively because I have had a couple of weeks where I have eaten more carbs and my weight goes up. I also have stopped losing at least over the last 6 weeks or so on a very healthy low carb, high protein routine of ~150 grams protein daily.

 

[Spiky Bugger]

I guess this answers my question to DianaCox.

Yeah, but...it (the paper) is a dozen years old and @DianaCox will yell at us about that.

 

[Larra]

Jim, this is a difficult area because we (and the bariatric surgery community, and the insurance companies...) have traditionally reserved "weight loss surgery" for the people with the most weight to lose. However, we really should call it bariatric surgery because so much of the benefits derive from metabolic alterations rather than from weight loss, at least for the operations that work best. When gastric bypass was first developed, it was thought that it would work by forcing people to eat less, i.e. by restriction. Certainly that plays a role, but then docs noticed that their patients' diabetes was gone by the time they left the hospital, long before any significant weight loss had happened. In reality the effects of bariatric operations are far more complex than restriction and even than malabsorption, so for someone like your wife, with a serious metabolic illness (type 2 diabetes) bariatric surgery could be very beneficial. As others have already pointed out, the "switch" part of the DS is already being done in many countries for people who are not MO for exactly this reason, with about 90% resolution of diabetes.
You already know Dr. Esquerra. There would be no harm in at least asking him if he does bariatric surgery for someone in your wife's condition, and if so what operation would he recommend. My understanding is that doing the switch alone doesn't lead to a huge amount of weight loss, maybe 35 lb or so, so I don't think excessive weight loss would be a big worry. Resolution of type 2 diabetes with lap band is almost nil, and with VSG better but still poor, so even though those operations might sound like they would be more suitable for a "lightweight" like your wife, they really aren't. Again, it's not all about bmi and numbers on the scale, no matter what insurance bean counters ordain.
Of course there is risk with any major surgery, so your wife and her potential surgeon would need to balance the risk of surgery vs the potential benefits to her, which will also depend on how bad her diabetes is and possibly other individual factors.

 

[Munchkin]

Late to the party!

If I was in your wife's position, I would not stop till I was switched. Diabetes is progressive and she will just have more problems as she ages. Read the thread I posted about H's surgery. http://bariatricfacts.org/threads/ds-for-diabetes-dans-story.355/ With all due respect to Larra, I disagree. When people are diagnosed type 2, schedule surgery. There is a cure, we should use it! The current treatments for type 2 are like putting a very expensive bandaid on a broken leg.

If her BMI is 32, she should probably just get the whole thing. Again, as you age, weight tends to become more and more of a problem.

 

[Larra]

@Munchkin Believe me, I take diabetes as seriously as anyone. I've seen far too many people with terrible complications that destroy their lives. However, all medical care should be individualized. There are some people who are able to achieve excellent control with little or no medication. I can't see why these people should undergo the risks of major surgery, as well as the nutritional risks of living with malabsorption. Of course, if their situation changes down the line, having surgery sooner while they are still healthy rather than later after they are in dire straits would make sense. And then, there are the people who are already too far gone to benefit. I hope we'll see less of this if/when this surgery becomes available in the USA, and if/when we also develop better nonoperative tools.
From what I've read, including a recent article, it's surprising (to me, anyway) how little type 2 diabetes shortens life expectancy. The big issue is quality of life, because diabetes significantly lowers good quality of life years. So please understand that I am not at all opposed to this surgery for people with type 2 diabetes, and to the full DS for those who are both diabetic and obese. Just that, as always, there are risks both with and without surgery and the patient's individual situation, and what that person wants out of life, has to be taken into account.

 

[jim1969]

Jim, I had the DS with a BMI of 30. I have struggled with my weight my whole life and knew there was no end in site. I have had no regrets at all and am at my goal weight after 9 months. My CC is 100cm and I have no issues with diarrhea etc. I also know I won't lose excessively because I have had a couple of weeks where I have eaten more carbs and my weight goes up. I also have stopped losing at least over the last 6 weeks or so on a very healthy low carb, high protein routine of ~150 grams protein daily.

Very encouraging news from someone with a lower BMI.

 

[jim1969]

Late to the party!

If I was in your wife's position, I would not stop till I was switched. Diabetes is progressive and she will just have more problems as she ages. Read the thread I posted about H's surgery. http://bariatricfacts.org/threads/ds-for-diabetes-dans-story.355/ With all due respect to Larra, I disagree. When people are diagnosed type 2, schedule surgery. There is a cure, we should use it! The current treatments for type 2 are like putting a very expensive bandaid on a broken leg.

If her BMI is 32, she should probably just get the whole thing. Again, as you age, weight tends to become more and more of a problem.

Thank You for sharing your husbands story and for your input!

 

[jim1969]

@Munchkin Believe me, I take diabetes as seriously as anyone. I've seen far too many people with terrible complications that destroy their lives. However, all medical care should be individualized. There are some people who are able to achieve excellent control with little or no medication. I can't see why these people should undergo the risks of major surgery, as well as the nutritional risks of living with malabsorption. Of course, if their situation changes down the line, having surgery sooner while they are still healthy rather than later after they are in dire straits would make sense. And then, there are the people who are already too far gone to benefit. I hope we'll see less of this if/when this surgery becomes available in the USA, and if/when we also develop better nonoperative tools.
From what I've read, including a recent article, it's surprising (to me, anyway) how little type 2 diabetes shortens life expectancy. The big issue is quality of life, because diabetes significantly lowers good quality of life years. So please understand that I am not at all opposed to this surgery for people with type 2 diabetes, and to the full DS for those who are both diabetic and obese. Just that, as always, there are risks both with and without surgery and the patient's individual situation, and what that person wants out of life, has to be taken into account.

Thank You for your input!