VSG vs DS for me?

[Spiky Bugger]

My DS was ten years and ten months ago. My sister's VSG was, I think, a little over four years ago. My sister is FAR more disciplined than I.

I lost about 124 pounds. I have maintained a loss of 108-116 for most of eleven years. (I have had a short period when I regained enough that my weight loss was only about 92 pounds...but that was when a non-DS-related disease kept me home with nothing to do and I decided that if I was going to die it was going to be while eating Mint Moosetracks ice cream and brownies. But I didn't die and went back to REASONABLE food, like steak and eggs.)

My sister lost about 120 pounds. She has been regaining at a steady rate and has regained maybe 45-50 of those pounds. She "defends" the VSG, saying that her regain is because of her overeating due to stress...and she really HAS had a lot of stress.

I tell her that I have stress, too, and many, many other health issues that often make it tough to stick to a plan. But I call that "life," and when I STOP eating my way through the crisis du jour, all I have to do is suffer through bacon and eggs and ribeye steaks and it magically makes the scale numbers lower. My sister doesn't have that luxury.

 

[DSRIGGS]

My DS was ten years and ten months ago. My sister's VSG was, I think, a little over four years ago. My sister is FAR more disciplined than I.

I lost about 124 pounds. I have maintained a loss of 108-116 for most of eleven years. (I have had a short period when I regained enough that my weight loss was only about 92 pounds...but that was when a non-DS-related disease kept me home with nothing to do and I decided that if I was going to die it was going to be while eating Mint Moosetracks ice cream and brownies. But I didn't die and went back to REASONABLE food, like steak and eggs.)

My sister lost about 120 pounds. She has been regaining at a steady rate and has regained maybe 45-50 of those pounds. She "defends" the VSG, saying that her regain is because of her overeating due to stress...and she really HAS had a lot of stress.

I tell her that I have stress, too, and many, many other health issues that often make it tough to stick to a plan. But I call that "life," and when I STOP eating my way through the crisis du jour, all I have to do is suffer through bacon and eggs and ribeye steaks and it magically makes the scale numbers lower. My sister doesn't have that luxury.

I love the way you put things! Please don't ever change (I know there isn't a,snowballs chance of you changing but I had to say it)

 

[DSRIGGS]

Thanks for your response! So happy to hear you were able to get everything, well, sorted out!

And, yes, I definitely love to eat! I was just telling my husband that last night -- food used to be an emotional thing for me. I suffered through many, many bouts of starving/binging/purging. I don't do that anymore; I just really like great-tasting food. And because of my hip, I'm pretty immobile.

Is your experience with calories eaten per day and amount of weight lost typical for this procedure? I need to do some more research on what my expectations should be for how much and what I will actually be able to eat long-term post-op.

If you go to DSfacts.com you will find a piece called DS Math that our own @DianaCox wrote. As she will tell you it isn't meant to be used exactly but for illustrative purposes. It is thought that on average that we absorb about 60% of calories we consume. Simple carbs at 100%, protein at roughly 60% and fat at 20%. Again just averages but none of us have the same ds and same bodies so we are all different but it is a good measuring stick if I do absorb 60% and eat 4,000 calories a day that means I absorbing about 2400 calories a day....so you get the idea...it doesn't suck.

Now I had extreme malabsorption so I think I was absorbing more like 40% (just my gut feel) so obviously I can eat more than the average ds. As I tell people, don't go by me beause I am not the typical DS'r.

 

[galaxygrrl]

We have the same article ttp://bariatricfacts.org/threads/ds-math.735/

 

[DianaCox]

So a few more comments about what Mark said, to make it seem like I go around contradicting/rebutting him all the time ...

Men almost ALWAYS outpace women in initial weight loss.

The first 5-6 years after my DS, I took VERY few supplements, per the PacLap (Rabkins') practice - calcium citrate twice a day and one prenatal vitamin (and no additional B12); test and see what if anything needs adjusting. I added vitamin C and probiotics just because. And for the first 5 years, except for adding zinc, that is all that I needed. And then over time (the last 8 years), a few levels started to drift downwards - Vitamin D, then iron, then I decided to add Mg to help get my D up and my PTH down a little more (it was OK, but I wanted it better); then K1, then K2, then copper and then vitamin A. But I'm still only taking calcium citrate twice a day, and still manage to only take my supplements twice a day total (I did move my thyroid meds to the middle of the night per many suggestions to do so, but it's a tiny pill I set out before bed and take when I get up to pee). And I still only get tested once a year, unless something is off and I have to change something, and my doctor wants a recheck a couple of months later.

My point being, stuff changes, and unless something is seriously off, bloodwork is not going to be every 3 months except under extreme circumstances.

Regarding testing 30 things - my yearly blood draws are 14-17 tubes, but many of them have multiple tests done (metabolic panel, lipid panel, CBC). I can't imagine why all of them would need to be tested every 3 months. I can imagine the insurance company balking at unnecessary testing.

I'm not quite sure why Mark's doctors are worried about high PTH in the first year after surgery (perhaps there are reasons I am not appreciating having to do with the other issues he has mentioned) - as we lose weight, our magnificently self-tuning bodies notice that our bones do NOT need to be as dense as they were when we weighed 100 lbs more, and the high PTH indicates not insufficient calcium, but rather excess PTH being made to mobilize and remove unnecessary calcium from our bones.

As for that tummy tuck - you are lucky to live in CA where Cox et al. v. HealthNet already ploughed that ground, which was followed by Woelk v. Blue Cross of CA and Gallimore v. Kaiser (and several cases that have since been settled with Larra's and my help at the appeal stage). It won't be so much your charm, as your presentation of your case to Kaiser in the right way (which you can get here) - which may include going out of network to get a second opinion from a reconstructive surgeon who isn't beholden to writing up your case in the least helpful way possible (because Kaiser plastic surgeons ALSO do work on a self-pay basis, which is a cash cow for them and Kaiser).

 

[k9ophile]

@Marquis Mark you are as much entitled to your own opinion and to posting your personal experience as anyone else. My only comment will be that you were very, very fortunate to be with Kaiser in SoCal and not Norcal, because there is no way in hell that NorCal Kaiser would have paid for your revision. @DianaCox and I have fought this fight many, many times. Even if your medical situation had warranted it, they would not have sprung for it. They would have told you your failure to lose enough weight (or to keep it off, depending on the individual) was entirely due to your noncompliance, regardless or the truth of such a position, or lack thereof. You were also fortunate that SoCal Kaiser even had an excellent surgeon to do the revision for you. Not the case in NorCal, by their choice.
And it's not just Kaiser. It is exponentially harder for many people to get coverage for any kind of revision. Of course it shouldn't be that way, and if someone, for whatever reason, wanted to try to succeed with just a sleeve that should be an option. But far too many people find themselves with a failed sleeve (or lap band) and no way to get a revision.

I was going to say something about insurance and revisions, yet now that is not necessary since you've put it much better than I could have.

 

[aaa]

My DS was ten years and ten months ago. My sister's VSG was, I think, a little over four years ago. My sister is FAR more disciplined than I.

I lost about 124 pounds. I have maintained a loss of 108-116 for most of eleven years. (I have had a short period when I regained enough that my weight loss was only about 92 pounds...but that was when a non-DS-related disease kept me home with nothing to do and I decided that if I was going to die it was going to be while eating Mint Moosetracks ice cream and brownies. But I didn't die and went back to REASONABLE food, like steak and eggs.)

My sister lost about 120 pounds. She has been regaining at a steady rate and has regained maybe 45-50 of those pounds. She "defends" the VSG, saying that her regain is because of her overeating due to stress...and she really HAS had a lot of stress.

I tell her that I have stress, too, and many, many other health issues that often make it tough to stick to a plan. But I call that "life," and when I STOP eating my way through the crisis du jour, all I have to do is suffer through bacon and eggs and ribeye steaks and it magically makes the scale numbers lower. My sister doesn't have that luxury.

Looking up Mint Moosetracks ice cream...looks good!

 

[CaraOC]

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!!

Hey, I am 8 months post op DS and 80lbs down. I am NOW one week post total hip replacement!!!! I was in your spot exactly pretty much. I think you have come to the same conclusion I came to so just get on with it. The DS is thee most successful WLS available so that's a no brainer. Even 80 lbs down no relief was had with my hip pain so I knew a replacement was going to happen. If you continue at this weight with that hip you are going to end up needing both hips and probably both knees done too. By the time I had my hip replaced my knee on the same leg was in great pain and shooting down my leg. Just go for it. Your alternative is pretty dismal.

 

[galaxygrrl]

Well, and if we are talking about preventing the downside, the co-morbidities (Diabetes, etc) will come carrying that much weight. I wish it was not true.

But the good news is you have started on a path towards some solutions.

 

[trace]

Hey, I am 8 months post op DS and 80lbs down. I am NOW one week post total hip replacement!!!! I was in your spot exactly pretty much. I think you have come to the same conclusion I came to so just get on with it. The DS is thee most successful WLS available so that's a no brainer. Even 80 lbs down no relief was had with my hip pain so I knew a replacement was going to happen. If you continue at this weight with that hip you are going to end up needing both hips and probably both knees done too. By the time I had my hip replaced my knee on the same leg was in great pain and shooting down my leg. Just go for it. Your alternative is pretty dismal.

Oh, wow! Good for you! @CaraOC You must feel like a completely new person. Well, soon you will, I bet.

I just wish I could put this all in motion so. much. sooner. I do already feel pain in my other hip, and occasionally my knee. It's so ridiculous to me that I have to do this 6 months of counseling before WLS, per our insurance company. I truly feel like my complaints about the pain I'm in, plus my crappy quality of life, are falling on deaf ears when I speak to medical practitioners. Did you not have a mandatory wait?

 

[CaraOC]

Oh, wow! Good for you! @CaraOC You must feel like a completely new person. Well, soon you will, I bet.

I just wish I could put this all in motion so. much. sooner. I do already feel pain in my other hip, and occasionally my knee. It's so ridiculous to me that I have to do this 6 months of counseling before WLS, per our insurance company. I truly feel like my complaints about the pain I'm in, plus my crappy quality of life, are falling on deaf ears when I speak to medical practitioners. Did you not have a mandatory wait?

That is a whole other story. My insurance had a an exclusionary clause and wouldn't cover any WLS. I had to have surgery privately and totally out of pocket. I went to Dr Esquerra in Mexicali. You will hear lots about him at this site because he has quite a few grads here. I paid approx $12000. No regrets. So far this hip replacement has had a billing total of $64,000!!! And Cigna tried to get out of that by first denying coverage but my surgeon went to bat and they reconsidered. Insurance companies are tricky sticky bastards.

 

[Marquis Mark]

So a few more comments about what Mark said, to make it seem like I go around contradicting/rebutting him all the time ...

Men almost ALWAYS outpace women in initial weight loss.

The first 5-6 years after my DS, I took VERY few supplements, per the PacLap (Rabkins') practice - calcium citrate twice a day and one prenatal vitamin (and no additional B12); test and see what if anything needs adjusting. I added vitamin C and probiotics just because. And for the first 5 years, except for adding zinc, that is all that I needed. And then over time (the last 8 years), a few levels started to drift downwards - Vitamin D, then iron, then I decided to add Mg to help get my D up and my PTH down a little more (it was OK, but I wanted it better); then K1, then K2, then copper and then vitamin A. But I'm still only taking calcium citrate twice a day, and still manage to only take my supplements twice a day total (I did move my thyroid meds to the middle of the night per many suggestions to do so, but it's a tiny pill I set out before bed and take when I get up to pee). And I still only get tested once a year, unless something is off and I have to change something, and my doctor wants a recheck a couple of months later.

My point being, stuff changes, and unless something is seriously off, bloodwork is not going to be every 3 months except under extreme circumstances.

Regarding testing 30 things - my yearly blood draws are 14-17 tubes, but many of them have multiple tests done (metabolic panel, lipid panel, CBC). I can't imagine why all of them would need to be tested every 3 months. I can imagine the insurance company balking at unnecessary testing.

I'm not quite sure why Mark's doctors are worried about high PTH in the first year after surgery (perhaps there are reasons I am not appreciating having to do with the other issues he has mentioned) - as we lose weight, our magnificently self-tuning bodies notice that our bones do NOT need to be as dense as they were when we weighed 100 lbs more, and the high PTH indicates not insufficient calcium, but rather excess PTH being made to mobilize and remove unnecessary calcium from our bones.

As for that tummy tuck - you are lucky to live in CA where Cox et al. v. HealthNet already ploughed that ground, which was followed by Woelk v. Blue Cross of CA and Gallimore v. Kaiser (and several cases that have since been settled with Larra's and my help at the appeal stage). It won't be so much your charm, as your presentation of your case to Kaiser in the right way (which you can get here) - which may include going out of network to get a second opinion from a reconstructive surgeon who isn't beholden to writing up your case in the least helpful way possible (because Kaiser plastic surgeons ALSO do work on a self-pay basis, which is a cash cow for them and Kaiser).

Diane, it's all good. I love and respect your knowledge and willingness to help. Just wanted to make sure the Trace understood there are many different experiences. I've seen people who've had smooth sailing and others like Scott who have been through the wringer.

When I was researching the DS, I read some horror stories and some fairy tales and everything in between. I threw out the high and low scores and aggregated the rest and reached the conclusion that the DS was the best option. I'm pretty sure anyone who does a fair amount of reading will come to the same conclusion.

Believe it or not, I may have charmed (and by charmed I mean got lucky again) my way into a Kaiser TT, but there's a big caveat that goes with that. I'll PM you and Larra about that when I get a little more info as I may need your advice on this one.

 

[Munchkin]

Got the name of the doc at Mayo for you. Kevin Perry. Call! Maybe they can at least recommend a doc in your area.

More info...he does anterior on his larger patients as well. My friend's BMI was @45 and hers was anterior. Faster healing, less painful!

 

[DianaCox]

By TT do you mean abdominoplasty with muscle tightening, and not just a panniculectomy? BIIIIG difference.

I got our not-covered-by-the-DMHC BCBS plan to cover my husband's abdominoplasty (he was not a bariatric patient, though he had lost about 80 lbs over his highest weight 11 years previously), by arguing that his diastasis recti (separation of the abdominal muscles, which was from probably congenital poor fascia, and worsened by his previous central weight gain) would complicate the repair of his umbilical hernia, and that he wanted to avoid mesh, since he'd had difficulty with mesh repairs to an inguinal hernia. I wrote the outlines of the requests for precertification for both the general surgeon and plastic surgeon - to my pleasant surprise, BCBS approved it (though they waited until 36 hours before the scheduled procedure to do so).

Since the CPT code for an abdominoplasty essentially covers THREE procedures (plication of the rectus abdominal muscles, lipo and excess skin removal), he got a bonus minor FUPA lift thrown in (his weight loss did not improve that poofy area, which he was really uncomfortable with). Oh, and he had a repair of a previous inguinal hernia repair and a new repair of a new inguinal hernia on the other side done at the same time. Recovery was not easy - abdominoplasty involves a hip-to-hip incision, and stripping the skin from the abdominal wall, for starters, to say nothing of the plication of the muscles.

 

[DSRIGGS]

Yep my fupa is the only thing that really bothers me. That being said, it seems to be less poofy since my double inguinal repair. The hernias must have been causing some of it.

Btw I wouldn't even know that there was mesh used had the surgeon not told me. It has only been 2.5 months so hopefully that doesn't change.