Surgeon wants VSG vs Roux-en-Y

[aaa]

Welcome.

I'm guessing one of the hospitals you've looked into is the Cleveland Clinic?

 

[Clematis]

First, you don't way how old you are, but I don't think that should be a factor in your decision.

Age is a factor in that at 62 I don;t feel I have 10 years to get it right, or be dealing with revision surgery. The whole point of the surgery is so I can fully enjoy the time I have left and not spend it under the knife again in 7-10 years.

Also, my parents were in assisted living and nursing homes and I watched how the staff struggled to manage the MO or SMO, especially those with dementia. Some aides were frustrated and contemptuous. After vowing to do everything in my power to never be in one of these places, I also became determined to do something to get to normal weight so that I could be managed by caregivers if it ever comes to that. Furthermore, in this light, a procedure that could be managed by an aide if I've lost my marbles would be a plus. I don;t know if a minimum wage aide would want to put the precision into the right kind and portion of food for a golf ball sized RNY.

 

[Clematis]

Welcome.

I'm guessing one of the hospitals you've looked into is the Cleveland Clinic?

Yeppir. That's the Big Brand.

They do not DS on website but people have posted who have gotten one there. But they were SMO so maybe they won;t give a 40 BMI one.

 

[Clematis]

Debbiebobebbie> OMG. How did you survive all that surgery? Poor dear. Glad you've got it right now

 

[Charris]

I think you should get what YOU want and not settle. The only way I would settle is if someone else was going to foot the bill and even then I'd still probably get what I want. I guess I was considered a lightweight. When I got approved for surgery I weighed 203 then gained 24 pounds in the month before surgery. Dr. K. nurse told me I would not be approved because I had to have a bmi under 50.

I know I'm weird buy I had an ERNY so EVERYTHING made me dump. I'm felt that kept me eating decent. Had it not been for dumping I probably would have went back to 350. But I'm so happy I did have the DS.

 

[Clematis]

have a significant pannus

eiyiyi. the damn PANNUS. i have that and I still have the weight - can't imagine how bad it will be after WLS. it was so hot when I got out of the shower yesterday I put a folded up washcloth between the, ahem, lapdog and my pubis to dry it. And forgot it was there. When I changed my underpants this morning it landed on the floor and scared the hell out of me. How does one "lose" a washcloth on one's own skin? I was mortified and no one was even watching.

 

[Munchkin]

Make sure you are talking about the true DS. Not SIPS/SADI.

If I was self pay I would go to Ungson in MX. It's very doable and you could probably do it next month. Self pay is wonderful and you get to call the shots. Yes, I know you are in Cleveland. But you will love the hospital in MX and it's cleaner than what you will get in Cleveland. And you will get better care. And it's cheaper. Lots of people travel for the DS, many to Belgium, Brazil, or Spain. My sister had hers in Spain. You just stay in the hotel for a week or so postop.

Since you have had issues with hydration before, start now. Get used to drinking at least 64oz per day starting today. And start taking at least calcium, D, and a multi every day. Might as well develop some of those good habits now.

It's not just weightloss. It's an adventure!

 

[southernlady]

southernlady> they asked me for three weights, Ideal, Tolerable and Intolerable. I said 120, 130 and 140. They nodded and smiled. And wrote down 157.
5'4" CW 233. Lowest adult weight 111 for a nano-second 24 years ago (scarecrow thin). 125 eighteen years ago. 145 ten and seven years ago. I think I was down to about 180 last fall for an eyeblink. Never held any of these weights more than a few months before rocketing back up.

Okay, question? What if your body no longer wants to go lower than 145? So that would be above intolerable even tho it is a normal BMI for someone 5'4" (and I know cause I am also 5'4")

Goals should be health related. Mine were to beat my insulin pump diabetes into submission. And come off all high cholesterol meds. Also to be more active.

Came off all my cholesterol meds...
The insulin was a bit slower. Took me 10 days to stop wearing my insulin pump after surgery and 11 more days to stop all insulin. My last a1c was still above normal tho (Aug 2015) with a 6.0 BUT my PCP considers for a diabetic, I am doing great. And as we age, they ease the criteria for a1c. As long as it's under a 7, they are happy for those of us who are over 60.

So while losing weight is a very nice benefit, losing the comorbids is the BEST goal of all.

 

[Larra]

There is one surgeon at the Cleveland Clinic who has been known to do a DS. I don't know how many he's done, or what his criteria are, or whether or not he has a self-pay plan. These are questions you can ask if you ever get past being put on hold.
Self pay is both a curse and a blessing. The curse part is obvious. The blessing is that you can now choose both your operation of choice and your surgeon. I agree with going to Dr. Ungson in Mexico. He's very experienced, has an excellent reputation, is accustomed to working with people from far out of town, and his hospital gets nothing but rave reviews. There is also a specific hotel where patients stay so they also should be equipped to deal with MO post-ops. I would bet that if you call his office you won't be put on terminal hold and all your questions would be answered by friendly, helpful people.

The surgeon who says dumping is a form of aversion therapy is either misinformed or lying. Honest gastric bypass surgeons, even though they support gastric bypass, will tell their patients that dumping is a potentially very nasty side effect that some but not all patients experience to a mild or severe extent. If that sounds vague, it's because no one knows what percentage of patients dump and because the degree of symptoms is so variable. I've seen reports of 30% dumping all the way to 70%. When you see such an extreme difference in numbers, it tells me that no one really knows.

And don't forget about the NSAIDs. Even if you don't use them now, chances are you will as you get older. They are one of the most commonly prescribed classes of drugs, and also commonly used as OTC drugs. To me, not being able to use NSAIDs would be a very big deal.

Dr. Roslin (now pushing SADI, unfortunately but a very experienced DS surgeon) believes that the future of bariatric surgery will be pylorus sparing. This is a huge change from just a few years ago, when gastric bypass was far and away the most common bariatric operation with everything else at very low percentages. Now, VSG is done much more then even 5 years ago - but as we are seeing, not always with lasting success. I do think VSG is a better choice than gastric bypass because it maintains normal stomach function, avoids dumping, lets people use NSAIDs, no blind stomach, etc. However, the long term results just aren't what was hoped for. And if lap band goes the way of the dodo bird, that would be just fine with me.

You are obviously a very intelligent and thoughtful person who is taking this decision seriously and trying hard to get it right. I wish that were true of everyone. If you are up to learning about the vitamin and protein needs of a DSer - and I am sure you are - and willing to make the crucial but really not difficult commitment to taking those vitamins, eating protein, following your labs, etc - the DS is going to be your best choice for getting to a normal or close to normal weight and STAYING THERE and resolving your comorbidities. And also to avoiding any need for another bariatric operation.

btw, I have a friend who does not post here who had the DS at 62 and has done great with it. So if anyone tells you you're too old, screw them.

 

[Spiky Bugger]

Odd man out here...
•I was a band to DS revision almost ten years ago, at age "almost 59."
•I am not able to take NSAIDs...but that is PROBABLY because of the damage done by the band.
•I just went through hell with an 8mm kidney stone, doctor wouldn't do ESWL this time, had the ureteroscopy (second time) and THAT one hour procedure took three hours because the stone was HUGE. HOWEVER...and this seems counterintuitive...calcium oxalate stones are caused by not absorbing (and/or not sufficiently supplementing) calcium. That can result from any procedure that causes malabsorption...not just dehydration.

So...I never got to a "normal" bmi, but I have kept off well over 100 pounds for almost ten years...and I'll take it.

You pays your money...and you takes your chances. Good luck!

Sue

 

[Spiky Bugger]

The part in bold didn't come out right.

@DianaCox ...or @Larra ...will you fix it, please?

My point was supposed to be that calcium oxalate stones are not caused by dehydration or by too much calcium.

 

[Clematis]

8mm stone? Yikes. Hope you never get another. Last year's stone was unrecovered so wasn't tested as to type. I can't remember what the stone was back in the late 70s but I think calcium which I passed about 48 hours after the howling i-wanna-die pain and vomiting of the attack itself.

Thank you all. DS sounds like what I want - what i need.

I'm going to start a new thread specifically on Mexico.

 

[southernlady]

I'm going to start a new thread specifically on Mexico.

Dr. Ungson is your ONLY option for the DS in Mexico.

The best self pay rate in the US is Dr. Greenbaum in NJ.

 

[Clematis]

Thanks mucho, SL. I'll contact Greenbaum for more info on Tuesday. Staying in US would be more acceptable to husband and PCP.

 

[Spiky Bugger]

The part in bold didn't come out right.

@DianaCox ...or @Larra ...will you fix it, please?

My point was supposed to be that calcium oxalate stones are not caused by dehydration or by too much calcium.

And I still got it wrong.

I am having anemia issues...HGB low...not thinkng well.