Should I get the second step?

[Quillie]

Hello all! I was active on OH several years ago when I received my first step (the vsg) of my DS, I'm so happy to see many of you are still around!

I have so many doubts as to what to do! I researched wls back in 2009 and decided only DS would do, unfortunately in my country there were only two surgeons who had experience. My BMI was just on the edge to qualify so I was very happy when I did! I had the first step done by Dr Himpens in September and lost 100 lbs.

I had no problems maintaining the weight loss at first and kept it off the first four years. I then had my first child, still everything fine. Then my autoimmune disease on my thyroid got a lot worse (12.5 to 100 dosage), not so fine, definitely extra weight. Then I had my second baby which was still soso, I had put on about 30 lbs by this point. The thing that worries me the most that since I haven't lost weight, just put on bit by bit. I'm close to a 45 lbs regain now. I could go on a diet of course, but I've done that so many times unsuccessfully in the past. (lose it but can't keep it off)

Which makes me think about that second step that is still waiting for me (I was approved for a full DS and don't need a certain weight or anything to get it). I'm pretty sure I'm done having babies, I do worry about another surgery.

I'm also very worried about the protein rich diet. I don't like meats at all, I never eat bacon or salami and never want to. I honestly don't think I'd be able to follow the diet now, which makes me doubt I could do it long term. My restriction is still pretty good for being six years out, especially when I eat meat.

If there are others with VSG to DS, I wonder what the recovery after the second part is like? I generally do well after surgery, walking around the same day. I wonder if I would have to miss a lot of work and when I'd be able to care for my children again. (25 lbs)

Any input would be very much appreciated!

 

[newanatomy]

We do know of a couple of vegetarian DS'rs. I assume they are managing. I personally chose this surgery because I would be able to eat meat and fat. How do you currently meet your protein requirements? I realize they are less for you but, still a necessary part of your diet. Protein, after a DS, is non-negotiable. You can supplement but, who wants to live on supplements only. If that was an option, you could lose weight and keep it of by only consuming shakes. See what I am getting at? Not an easy way to lose.

If you are currently only 45 pounds overweight, I doubt a surgeon would agree to the second stage of the operation. Is your BMI at least 40?

 

[Quillie]

No, my BMI was just 40 when I got the first step, it is 30.5 now, but as I said, going upwards. As I said I don't need to reach the BMI 40 qualification because I got approved for the two part DS. They see it as I've only had half of the surgery. Things are a bit different here.

I do eat meat, I just don't eat lots of it. I'm worried about giving up carbs, I kinda feel like if I could do that, I wouldn't have needed WLS to begin with. There must be more people who loved their carbs?

 

[newanatomy]

I think giving up the carbs is very difficult! I bet most of us feel that way. No matter which surgery you choose, there is no free ride. All require sacrifice. You don't have to have zero carbs forever. You will always have to eat protein and watch the carbs.

 

[southernlady]

Welcome @Quillie
As long as you get enough protein in daily, you can do it.
We ALL struggle with carbs....

 

[Kiekerdepiekske]

Hi Quillie! Are you from Belgium or from the Netherlands? My story sort of resembles yours. I had my VSG in 2010 (done by Dr. Himpens as well!). Lost 120 pounds and slowly regained about 50. Had the DS part added in november 2014 after going back and forth on that decision for more than a year. I am very happy that I did. I have completely lost the regained weight at 6 months out and have good hopes to loose more and finally reach a more or less healthy weight (I never went beyond a BMI of 35 with only the sleeve). Not liking meats will make reaching protein goal daily (Himpens advices at least 100 grams of protein daily) more difficult and you will probably have to add additional shakes and bars to your daily diet. Do you like cheese, fish, eggs and dairy and nuts? All these are also sources of protein. Just so you know, there's also a dutch/Belgium duodenal switch group on Facebook where quite a few of Himpens patients come together.

 

[DianaCox]

In the US, you don't qualify for revision surgery with a BMI of 30 - I don't know how the requirements differ where you live. Many DSers don't even get that low - it seems to me that you are (in this case, at this time, with no significant comorbidities like diabetes mentioned) using a bomb to address a problem a BB gun could solve.

Your current diet and food aversions are incompatible with a DS. You MUST be able to eat meat, and lots of it. Based on what you said, I suspect your current diet is way too carb heavy, and THAT is the reason you are having issues with weight creeping back on. You should post a few days of food logs to enlighten us as to non-surgical suggestions for making what you have work for you.

 

[Larra]

Hi Quilllie! I'm happy to see you here.
While I think it will be harder to get in enough protein if you don't eat meat, it can be done. It will require more diligence and a willingness to eat fish, eggs, cheese, nuts, soy, and hopefully some meat as well. You don't say that you're a vegetarian, just that you don't prefer meat, but hopefully you would be willing to eat some to maintain good health. Do you eat chicken? Turkey? Meat doesn't always mean just beef and pork. And while many people here love bacon, there is no requirement to eat it, or any other one specific food. There are lots of protein choices available, it's just easier for people who like meat because meat is so rich in protein.

As far as whether you should go ahead of not, you are the one experiencing the regain and you can see where the trend is going. If you are ok where you are, that's great, but if you are continuing to gain with no end in sight, having the switch done seems to me like a good idea. Your surgeon can make the common channel a little longer than usual if you or he is concerned about losing too much.

 

[DBmom23]

I agree that a BMI of 30.5 does not warrant surgery, particularly given your dietary preferences. Have you tried other weight loss approaches recently?

I am only 5 weeks out but am a vegetarian (eat fish, dairy, eggs). It is not hard to get to my current goal of ~70 grams protein/day most of the time. I lost my taste for eggs for now but am drinking a protein shake with peanut butter added for breakfast, snacking on almonds and sunflower seeds, Indian paneer with small amount vegetable like spinach for lunch, lots of cheese and fish for dinner. It works for me and I'm sure you could find a way but I wouldn't jump in so quickly.

 

[newanatomy]

I agree that a BMI of 30.5 does not warrant surgery, particularly given your dietary preferences. Have you tried other weight loss approaches recently?

I am only 5 weeks out but am a vegetarian (eat fish, dairy, eggs). It is not hard to get to my current goal of ~70 grams protein/day most of the time. I lost my taste for eggs for now but am drinking a protein shake with peanut butter added for breakfast, snacking on almonds and sunflower seeds, Indian paneer with small amount vegetable like spinach for lunch, lots of cheese and fish for dinner. It works for me and I'm sure you could find a way but I wouldn't jump in so quickly.

I couldn't eat eggs for a long time post-op. Then I slowly got my taste back for them. Now, I want an egg on everything!

 

[Quillie]

Hi kiekerdepiekske, I am from Belgium. I'm surprised to hear you lost so much weight with the second step. I've read that it would be more for maintenance. I'm mostly worried about the steady gain, as I know where this is going. How was your recovery from the second step?

@DianaCox It's not a revision, I signed up for the DS in the first place. I do realise that a BMI of 30 seems low for people from the US, but I'm the only obese person at work (80+ people) and definitely the fat one wherever I go over here. Keeping a food log is a great idea, though I don't eat too much I do prefer carbs. I usually don't have breakfast (start 6am and can not eat for hour after taking medicine) have a salad at lunch (this does have some added protein, chicken, cheese or quinoa). In the afternoon I usually snack on fruit, this would have to change I suppose. For dinner we are very much meat/veggies/starch people, once a week we'll have spaghetti, every two weeks french fries. When it's warm like now we'll have an ice cream once a week in the evening and when co-workers bring something in I'll have a bite. I think especially for those 'bites' a food log will be helpful. I do think eating differently will really feel like a diet, as I feel I already make sacrifices. (no bread, no crisps/cookies/candy etc) The annoying thing is that husband eats the same, only about four times as much, and has a BMI of 20.3.

@Larra, thanks again for pointing me in this direction! I do eat meat, I just don't prefer it. I don't like most dairy or eggs either, but I do like greek yoghurt and fish. I think I've just grown up with the idea meat=bad which makes it hard to turn of. I only started really eating it when I met hubby. I'm so used of thinking about the antibiotics, diseases, how bad for environment etc etc that I feel guilty just looking at it which makes it hard to enjoy. I think I'll make a appointment with my surgeon and get his input on the regain.

@DBmom23 I've lost four pounds eating extremely clean for a few weeks recently, but honestly I can't live that way forever. I stopped because I didn't feel like another couple of years of yoyoing would do me any good, then I thought about getting the second step. I'm just trying to get a feel of the pros and cons it's not an easy decision. I'm glad to read you make it work as a vegetarian.

 

[DianaCox]

"I do realise that a BMI of 30 seems low for people from the US, but I'm the only obese person at work (80+ people) and definitely the fat one wherever I go over here."

I don't mean to sound like I'm ragging on you, exactly, but that does seem to be an attitude and self-esteem problem more than a health problem. I get that dieting all the time SUCKS (which is why I wanted a DS, and why even so, my BMI is about 33 - but I'm almost 62), and I would be pissed if I originally expected and was promised a DS and ended up struggling with just a sleeve, but - a BMI of 30 is just not that fat, especially if you are currently healthy otherwise. You will be trading becoming much more medicalized for the rest of your life for about 25 lbs more weight loss.

"I feel I already make sacrifices. (no bread, no crisps/cookies/candy etc)" - most of that will stay pretty much the same post-DS, you know, or you will get stinky gas - and I do mean STINKY - as well as risk regain. Keep in mind that the DS is not a free pass to carbs anyway, so your diet will HAVE to change from sugar/starch-heavy anyway.

If you plan to have more children, I would hold off until you do - having a DS will complicate the pregnancy, and you will likely gain some more weight anyway. Perhaps after you have completed your family, and/or have put on another 25-40 lbs for other reasons (yeah, it sucks, but it will likely happen), getting the switch will be more appropriate AND provide you a longer-lasting benefit. Something else to think about.

This reminds me of what my husband is going through with his knees. He put off doing ANYTHING about it for years and years, because he was told to wait as long as possible before getting them replaced. When he was finally ready to do it, he found out that his knees were not as bad as he thought, and he could have (and should have had, much sooner) arthroscopic surgery to fix some fixable things, and now he walks with much less pain. BUT - it is not "fixed" - his knees are fragile, and he has to be careful to not damage them further, both because it would hurt, and because he wants to delay for as long as possible needing the real BIG knee replacement surgery - both to avoid the pain, and in the hope that the surgery becomes better the longer he waits - but in the meantime, he's not really "fixed" and he can't do what he MIGHT be doing if it was a year or so AFTER his knee replacement. So he waits, and tries to figure out how long he can hold out.

There's no magic formula for what's right for you, if having the surgery is simply a matter of you getting to say you want it.

 

[brooklyngirl]

I agree that a BMI of 30.5 does not warrant surgery, particularly given your dietary preferences. Have you tried other weight loss approaches recently?

I am only 5 weeks out but am a vegetarian (eat fish, dairy, eggs). It is not hard to get to my current goal of ~70 grams protein/day most of the time. I lost my taste for eggs for now but am drinking a protein shake with peanut butter added for breakfast, snacking on almonds and sunflower seeds, Indian paneer with small amount vegetable like spinach for lunch, lots of cheese and fish for dinner. It works for me and I'm sure you could find a way but I wouldn't jump in so quickly.

You do know that, long term, your goal should most likely be 120+, right?

 

[DBmom23]

Yes but I still can't eat very much at one sitting being 5 weeks out. I think once I can up the quantity, it won't be too hard to up the protein.

 

[Quillie]

I just wanted to let you all know I've taken what has been said to heart. I've decided that the cons outweigh the pros for now for a second step. I do worry because I'm gaining with all the restrictions at the moment. I've decided to work with a dietician with experience after wls and start up some exercise that will get me some peace of mind. Life has been hectic lately and I think focusing on my weight might have been a way to feel in control.

Thanks all for the advice!