VSG vs DS for me?

[trace]

Hi. I'll jump right in with the story, especially since it's a long one.

I'm 47, mother of 3 young children who I homeschool, and we recently moved to WA state (Seattle area). Moving to this beautiful part of the country has been a dream of mine for 25+ years, so imagine my disappointment when my long-acting hip pain really became bothersome just after moving here this spring. I need a total hip replacement, however, of the three surgeons I've consulted with so far, none will perform it with my current BMI. I'm 5'9" and 315. BMI of 46'ish?

So here I am in excruciating pain when I take any steps whatsoever, and I've basically been told by the orthopedic surgeons to lay in bed and starve until I can lose enough weight. How much exactly to lose varies, but I have an upcoming appointment in October that I am excited about simply because their standard requirement is a BMI of 40 or less. I have no heart disease, diabetes, or other complicating factors other than a slightly elevated BP that I take lisinopril for. And an allergy to NSAID's, which I'm convinced evolved because of an ortho who put me on a very high dose regimen of it for an extended time.

Since I feel so desperate for resolution of the pain, I took the packet one surgeon handed me for a surgical weight loss group. I really never, ever, ever, ever considered having WLS. I've always been determined to "do it myself." So it was with quite a bit of skepticism that I attended the consultation with the doctor not too long ago. I left there saying, NO WAY! Too risky. Too scary. Too complicated.

As time has progressed, and I continue to be restricted to my home (and even what I can manage within my home), however, I am changing my tune. The statistics are getting to me -- I know the dismal numbers for maintaining long-term weight loss. And even worse, did anyone read the article (in the NYT, I think), describing how screwed up the metabolisms of frequent dieters are? Not that you all didn't know that, but the research outlined how, for example, if I were to get to my goal weight, in order to maintain it, I would have to eat an average of 500 calories/day LESS than a person of similar weight/height who doesn't have my history of dieting. Plus exercise faithfully. That level of rigor and deprivation is so freaking depressing I can't imagine it.

So, here I am really thinking I'm a good candidate for a weight loss surgery. Which one? And could you help me understand why? Thank you!!

 

[Larra]

Well, if you've been reading this site you probably know by now that as a group, we are biased towards the DS, though people with other operations are certainly welcome here as well.
I chose the DS because it has the best statistics of any bariatric surgery for percentage excess weight loss, for MAINTAINING that weight loss, and for resolution of almost all comorbidities. The maintenance part is extremely important, as weight regain is a major problem with other operations.
If, for some reason, I couldn't have the DS, the sleeve would be my second choice, because it would leave me with the option to revise to the DS at a future date relatively easily, unlike gastric bypass, which can be revised but it's a huge deal that few surgeons do, with much higher risks. But the long term results that we know, thus far, for the sleeve as a stand alone do not compare with those for the DS. Short term it works about as well as gastric bypass for weight loss, but not as well for resolution of type 2 diabetes. But long term, the sleeve will inevitably stretch no matter how narrow it starts out, and then you are back where you started with a long term low calorie, low fat, low carb diet and plenty of exercise to keep the weight off. It's a purely restrictive operation, and once you lose most of the restriction, you have nothing helping you. Since morbid obesity is a chronic, life long disease, that doesn't make sense to me. I wanted something that would help me for life, and that's what I have. There will be some people, I don't know what percentage, who will succeed with the sleeve, but they will have to exert a lot more effort and discipline to do it. After many years as a professional dieter, I had had it. I had the DS over 10 years ago and have absolutely no regrets.

 

[trace]

I chose the DS because it has the best statistics of any bariatric surgery for percentage excess weight loss, for MAINTAINING that weight loss, and for resolution of almost all comorbidities. The maintenance part is extremely important, as weight regain is a major problem with other operations.

Yes, yes, yes! I actually badgered the surgeon I met with about this, and he was fairly dodgy on actual numbers. That didn't exactly do much for my confidence. I just found out, though, that they do the sleeve and RNY, which I need to research a whole bunch more. I am not impressed with this office, though, and I just finished filling out the consultation request form for a different office which offers DS.

If I'm going to do this, I want to do it right! I, too, have had a lifetime of dieting. Severe restrictions. I think that's why I'm so, so weary of it? Why I just can't imagine putting myself through that torture . . . again? Frankly, I had just made my peace with my size at the start of the summer. I read a whole bunch of HAES literature, and I was growing more and more comfortable with just accepting my situation for what it is. Then my arthritis pain kicked into overdrive, and I'm simply at a loss for how else to deal with it. This all so greatly affects my quality of life. It's absolutely not about my appearance anymore.

 

[Larra]

I don't know where you are in WA, but there is an excellent DS surgeon in Federal Way - Dr. Srikanth. At the least, have a consultation with him before you make this big decision. A surgeon who doesn't do the DS isn't going to recommend it for anyone, and any surgeon who is vague and/or reluctant to give a potential patient the known statistics - well, that doesn't sit well with me. It's your life and your decision, and you have a right to know all there is to know. You are the one who will live with the surgery, not the surgeon.
DS has better long term statistics than gastric bypass, as before, not just for weight loss but also for resolution of comorbidities. It also has no risk of dumping (NOT a weight loss tool, just a potentially very nasty side effect of gastric bypass), no laundry list of foods you are never supposed to ever eat again in your life, you can drink liquids with your meals, NSAIDS can be taken safely (well not you if you're allergic, but for other people that's a big deal). Both operations require lifelong commitment to taking various vitamins and supplements, more for DS than gastric bypass, but the commitment is the same either way.
Keep on reading and learning. Only you can make this decision.

 

[trace]

Oh, good! Dr. Srikanth is who I just submitted my insurance info to! He has an additional location in Kirkland, which is only about 20 miles from me.

For sure, the more I read about DS, the more optimistic I'm feeling about it. But, am I reading correctly that the vit/supp regime is an all day thing? Like at various times? I guess that's not exactly something to complain about considering all the other benefits.

Does anyone know if it's possible to get around the insurance company's "6-months of counseling" requirement??? Time is so critical here -- I can't get the THR until I lose weight, and I'm pretty certain I won't lose weight until I get WLS, and I can't get WLS until I've jumped through all the hoops. GAH!

 

[galaxygrrl]

I'm still a newbie DSer, but besides of the diabetes issue (Major reason for me), the reason I chose the DS is

- it works long term and keeps weight off! And every surgeon who does not do the DS will try to sell you some other type of surgery. I was not convinved any other surgery would be working for me 10 years out
- you don't give up eating forever and I crave fats. People don't talk much about this one in the choices, but I wanted to be able to enjoy food again.
- I wanted to have this be a one and done experience. I did not want to be cut up twice.

And just for laughs, and a bit of a reality check, I read this on another board.

Quick story - when my wife and I were first looking into this WLS (weight loss surgery) thing and going to support groups pre-op (she had a DS 11 years ago, I had a VSG (sleeve) 5 years ago) one of the post op guys was telling how he got into the DS, after going to other surgeons' groups, being told that dumping was the RNY's "gift" to you, etc. he showed up at our doc's group and saw someone eating an In'N'Out burger.

"Have you had this procedure?"

"Yes."

"And you can eat that?"

"Yes."

"Great, this is the place for me!"​

 

[trace]

Thanks for your response, @galaxygrrl. Yes, fat rocks! I'm currently doing a keto diet with my husband in an effort to get my BMI low enough for hip replacement surgery. After years of being vegetarian and vegan, I have to say, I am thoroughly enjoying my high fat meals!

But, really, I just want to feel NORMAL. I'm sure many of you can relate. I could just cry thinking about all the minutes, hours, weeks, years that I've spent obsessing about food -- how much, what kind, when, in what combinations . . . . my head could explode. I'm also the mother of 3 little girls, and I would literally do anything in my power to save them from a lifetime of this struggle. I can only hope that me eating in a somewhat "normal" fashion in front of them, plus being able to take walks and go for hikes, will set a precedent they want to follow. If my daughters NEVER attempt a diet, I'll consider myself a success as a parent.

 

[galaxygrrl]

Actually, I'm only 2.5 weeks out of surgery, so, I can't talk more than that, but I've yoyoed my whole life, I would wake up every day and think about everything I could eat that day and at the same time think, "how am I ever going to get thin" I would describe the drive to eat as voices in my head that said, eat, eat, those seem to be gone and people who are further down the road than me say that those voices are gone.

As far as I can tell, surgery gets the weight loss and food craving monkey off your back. And the reason I choose the DS, is it seemed to give someone the most normal life. And with WLS you should be able to hike, bike, etc again

Hope this helps.

 

[Marquis Mark]

Well, I had a sleeve for 6 years before getting it revised to a DS. My sleeve stretched and, as a result I only ended up keeping off about 25% of my excess weight. Although, in fairness, I think most people (on average) do a bit better. 50% EWL at 7 years out is what I've heard ( If you're 315, that would take you down to about 220 - if you're average). I think the original surgeon left mine too large because people that were much more compulsive/stuffers than me did better and my weight loss stopped at 8 months out.

Since getting the DS, I have now lost 70% of my excess weight and I'm still losing.

When it comes to weight loss, there is no question the DS is the best. However, and it may be an unpopular opinion here, I don't see anything wrong with trying a sleeve first. The sleeve is a very simple operation with few complications and it doesn't require much in the way of supplements/labs. You're basically as you were with just a smaller, but functioning as it was, stomach. That surgery has been done for ulcers and cancer for 100 years now.

Since getting the DS, I've struggled with constipation (and an anal fissure as a result), an incisional hernia (unlikely if yours is done purely laparoscopic) and I'm now getting iron infusions. I also have a new PT job of dealing with vitamins and an expense of about $70/month. God help me if I ever lost my insurance and had to pay for labs and other follow up on my own. I'm still a bit anxious about what will happen when/if I'm in my 80s with this surgery. But, from the little bit I've gathered, most people seem to be fine. Although if they were dead how would I know?

Having said that, I don't regret the DS. My complications, bad as they sound, are relatively minor and manageable.

Being overweight was the bane of my existence. I'm sure it was for most of us or we wouldn't even contemplate such a draconian solution. But now with the DS, I simply don't worry anymore about what I eat (other than taking it easy on sugar and getting enough protein. Most days I can manage that).

I look pretty sexy, if I do say so myself and I can tell my ex has thoughts about me (but those only go one way ;-).

For the first time in my life I'm normal. I raised the white flag and it feels soooo good.

Do your homework. Seek out honest opinions. No surgery is all good or bad. But you do have some viable options. Welcome.

Mark

 

[galaxygrrl]

And even worse, did anyone read the article (in the NYT, I think), describing how screwed up the metabolisms of frequent dieters are? Not that you all didn't know that, but the research outlined how, for example, if I were to get to my goal weight, in order to maintain it, I would have to eat an average of 500 calories/day LESS than a person of similar weight/height who doesn't have my history of dieting. Plus exercise faithfully. That level of rigor and deprivation is so freaking depressing I can't imagine it.

We all read that article and in fact, the article says, surgery does work. Btw, the guy who was metabolism was down so much, he burned 800 calories less a day, actually had the DS and has been on this board. After the DW, his metabolism when back up some. Hope that is true for everyone here

When it comes to weight loss, there is no question the DS is the best. However, and it may be an unpopular opinion here, I don't see anything wrong with trying a sleeve first. The sleeve is a very simple operation with few complications and it doesn't require much in the way of supplements/labs. You're basically as you were with just with a smaller, but functioning as it was, stomach.

I thought about this too. And think it's a very reasonable approach, but I just wanted to be done with my weight issues. I have to get blood work once a year for a thyroid issue, so I figured, a blood panel is not a big deal too.

 

[Kate]

Welcome! So glad to see another Washingtonian here! Dr. Srikanth was my surgeon and I adore the man and hope that you get a chance to meet with him. I watched both my parents struggle with hip pain leading to both hips being replaced so I can empathize with that pain. And I definitely understand the wish to be NORMAL. While I do not have children of my own, I have small children in my life, and would do anything so that they don't grow up feeling like I did...a large hippo in a family of svelte gazelles. The supplements really aren't that big of a deal and if the trade off is that my nieces and nephews get to hang out with me and run around with me instead of me watching while they do it? Totally worth it.

 

[DianaCox]

However, and it may be an unpopular opinion here, I don't see anything wrong with trying a sleeve first. The sleeve is a very simple operation with few complications and it doesn't require much in the way of supplements/labs. You're basically as you were with just a smaller, but functioning as it was, stomach. That surgery has been done for ulcers and cancer for 100 years now.

Since getting the DS, I've struggled with constipation (and an anal fissure as a result), an incisional hernia (unlikely if yours is done purely laparoscopic) and I'm now getting iron infusions. I also have a new PT job of dealing with vitamins and an expense of about $70/month. God help me if I ever lost my insurance and had to pay for labs and other follow up on my own. I'm still a bit anxious about what will happen when/if I'm in my 80s with this surgery.

OK, my rebuttal:

• This is what's wrong with trying the sleeve first:
  • It's likely to fail anyway - why put yourself through the drama of failure, to say nothing of doubling surgical risks, pain, recovery time, lost work, increased costs, etc.?
  • Revision surgeries are less likely, on average, to be as successful as a one step DS
    • First, you lose the synergistic effect of the stomach portion with the metabolic effects of the intestinal rearrangement.
    • Second, if your sleeve stretches out too much after doing the sleeve only, you may need to have a revision to your stomach as well, which is riskier than the original sleeve with respect to possible leaks and strictures due to the fact that the tissue of the stomach has been stretched and thinned, and having to operate over the prior staple line.
    • Third, you have further damaged your metabolism with the VSG procedure/diet - and lowered your basal metabolic rate even further, making it harder to get the full benefit of the DS.
• Struggling with constipation:
  • Some VSGers struggle with constipation too - probably about the same percentage
  • If anything, more DSers worry about their stools being too loose
  • There are many ways of dealing with constipation with a DS - including eating more fat, taking fiber supplements, miralax, etc.
  • If you are constipated, follow some simple rules, including DON'T STRAIN, and don't pull your asscheeks apart on the toilet! The best way to fix an anal fissure is not to do the things that promote them.
  • Incisional hernias are LESS likely with lap surgery (and most DS surgeons do the procedure lap - and by the way, more revisions are done open because of previous scar tissue from the first procedure - another reason to not do the VSG first), but they are by no means unlikely. I have one from a less than 1" lap port (it showed up years later).
  • Iron infusions are not that big of a deal, and - the good news is, if you need them, you can STOP trying to take sufficient oral iron, which is - SURPRISE! - constipating and gut-churning. I'm happy to have an infusion every 18 months to 3+ years, and never have to buy or take iron pills anymore.
• Part time job taking vitamins? Nope - it takes me about 30 min every four weeks to set out my pills for the next four weeks - I take my vitamins twice a day, though some people do take them more often. $70/month is about right - I buy in batches - 6-12+ months worth at a time, and shop online for some of them, or at Costco.
• Once you have ANY bariatric surgery, you are medicalized for life, and you should not lose your insurance - good thing there is the ACA, right? But of course, if you DON'T have bariatric surgery, you WILL get diabetes, hyperlipidemia, heart disease, hypertension, kidney failure, and - um - shouldn't lose your insurance.
• When you are in your 80s (which you are UNLIKELY to have lived to, without bariatric surgery), you will plan ahead and tell the people who are helping to care for you what you needs are, and if you have planned carefully and your kids don't hate you, you should be fine.

 

[Marquis Mark]

OK, my rebuttal:

• This is what's wrong with trying the sleeve first:
  • It's likely to fail anyway - why put yourself through the drama of failure, to say nothing of doubling surgical risks, pain, recovery time, lost work, increased costs, etc.?
  • Revision surgeries are less likely, on average, to be as successful as a one step DS
    • First, you lose the synergistic effect of the stomach portion with the metabolic effects of the intestinal rearrangement.
    • Second, if your sleeve stretches out too much after doing the sleeve only, you may need to have a revision to your stomach as well, which is riskier than the original sleeve with respect to possible leaks and strictures due to the fact that the tissue of the stomach has been stretched and thinned, and having to operate over the prior staple line.
    • Third, you have further damaged your metabolism with the VSG procedure/diet - and lowered your basal metabolic rate even further, making it harder to get the full benefit of the DS.
• Struggling with constipation:
  • Some VSGers struggle with constipation too - probably about the same percentage
  • If anything, more DSers worry about their stools being too loose
  • There are many ways of dealing with constipation with a DS - including eating more fat, taking fiber supplements, miralax, etc.
  • If you are constipated, follow some simple rules, including DON'T STRAIN, and don't pull your asscheeks apart on the toilet! The best way to fix an anal fissure is not to do the things that promote them.
  • Incisional hernias are LESS likely with lap surgery (and most DS surgeons do the procedure lap - and by the way, more revisions are done open because of previous scar tissue from the first procedure - another reason to not do the VSG first), but they are by no means unlikely. I have one from a less than 1" lap port (it showed up years later).
  • Iron infusions are not that big of a deal, and - the good news is, if you need them, you can STOP trying to take sufficient oral iron, which is - SURPRISE! - constipating and gut-churning. I'm happy to have an infusion every 18 months to 3+ years, and never have to buy or take iron pills anymore.
• Part time job taking vitamins? Nope - it takes me about 30 min every four weeks to set out my pills for the next four weeks - I take my vitamins twice a day, though some people do take them more often. $70/month is about right - I buy in batches - 6-12+ months worth at a time, and shop online for some of them, or at Costco.
• Once you have ANY bariatric surgery, you are medicalized for life, and you should not lose your insurance - good thing there is the ACA, right? But of course, if you DON'T have bariatric surgery, you WILL get diabetes, hyperlipidemia, heart disease, hypertension, kidney failure, and - um - shouldn't lose your insurance.
• When you are in your 80s (which you are UNLIKELY to have lived to, without bariatric surgery), you will plan ahead and tell the people who are helping to care for you what you needs are, and if you have planned carefully and your kids don't hate you, you should be fine.

Other than the revision being less effective, not sure such a rebuttal is necessary as I was mostly sharing my experience/opinions and only speaking for myself.

 

[DSRIGGS]

I had the DS 3 years ago in 13 days. I have had a rough time if you have seen any of my posts but I would never have any other WLS than the DS even with my struggles. My issue was a bad DS procedure where the surgeon made my alimentary limb too short which caused severe malnutrition because I wasn't absorbing anywhere near what I should have. A year ago Dr Keshishian, the best DS surgeon in the world, fixed that for me. BTW he makes patients who he can't convince to get the DS instead of a sleeve, sign a paper stating basically that he told them the sleeve will ultimately end up being the first step of the ds when you come back in two years because you didn't lose the weight you wanted and your diabetes comes back. The data just simply shows the VSG doesn't work like the DS and regain is very cimmon. The other part is if you like to eat and not starve yourself like the sleeve requires the DS is the only answer. I eat close to 4,000 calories a day and I am 6'2 and weighed 175 this morning.....I need to gain 20 pounds but it is very hard for me to gain.

Anyway best of luck and please do yourself a favor and get the DS. You will not regret it.

 

[trace]

For the first time in my life I'm normal. I raised the white flag and it feels soooo good.

Do your homework. Seek out honest opinions. No surgery is all good or bad. But you do have some viable options. Welcome.

Mark

Well, that just sums it up right there. I really want to be able to say the same thing. Thank you for the welcome -- I truly appreciate everyone sharing their experiences.