VSG vs. DS (Sydney, Aus.)

[more2adore]

I'm just going to blatantly copy this from my intro post. This was way too many questions to ask in the intro thread, so I'm going to repost it here so hopefully you lovely vets can help me wrap my brain around all this.

Hi everyone - I'm more2adore. I'm 525 pounds today, down from my peak weight of what I believe was over 600 pounds in December of last year. I haven't been dieting or anything, but I moved to Sydney, Australia and got married to a man who fortunately is an excellent (and healthy) cook, and I've been doing a lot of walking around to get to know my new home (I'm originally from Virginia in the US). My weight loss has stalled, though, and I had said that when it stalled again I would seriously look into WLS of some type. We very much want to have kids in a couple of years, and I'm already 35 - so I feel as though my best chance for kids is going to be serious weight loss between now and then. Also, I want to be able to do more outdoor adventure type things with hubby. He sails regularly - I'd love to be able to join him!

The issue for me I think is going to be a surgeon because of where I live. I'm currently deciding between the VSG and the DS, but it seems as though the DS is SO much more suited to someone as large as I am. But I read somewhere (couldn't tell you where now... been on a LOT of sites doing research today) that many surgeons try to get you to have the VSG first and lose as much weight as possible and then do the DS later. Supposedly it's safer? But I read - maybe on DSfacts.org? - that more DSers think it's better to do both components together at once. However, the only surgeon I found listed on dsfacts.org is one who is several hours away from here, and hubby has no vacation time left at work to be able to take time off and come with me that far. I would really prefer to do it in Sydney, but finding an experienced surgeon is proving challenging. I have an info seminar with a surgeon my GP recommended next week, but from his website it looks as though he just does band, RNY and VSG.

Thoughts? Input? Experience? Thanks SO much in advance!

 

[DianaCox]

There are very few DS surgeons in Oz - Nottle is the ONLY one we have heard good things about recently. This is your LIFE - convenience be damned. If you had cancer or a heart condition, would your husband have any hesitation about accompanying you to have surgery and taking off of work? In the US, the Family Medical Leave Act (FMLA) protects the jobs of people who need to take off work for a period of up to three months for their own illness or to care for a seriously ill family member. I imagine that Oz has similar rules - look into it.

 

[hilary1617]

Welcome, More2Adore! I personally believe the DS is the best choice for anyone who is morbidly or super morbidly obese AND medically able AND willing (1) to be compliant with nutrition, particularly protein, and daily supplementation of specialty vitamins for the remainder of his/her lifetime post-op and (2) willing to self-educate and self-advocate with medical professionals who may not fully be aware of the needs described in (1). Otherwise, the VSG would be a good choice, though it will involve more work to lose and keep off the weight - it can be converted to a DS later, insurance/cost/risk willing, and importantly, it keeps the pyloric valve intact. You may need to travel out of country, even, to get the best surgeon for you, but a great surgeon is a medical necessity.

 

[more2adore]

@hilary1617 I don't think compliance will be an issue for me. I've always been 100% compliant with every other medical treatment I've ever had in my life (other than starvation dieting... heh) ... CPAP, compression stockings, other pills/medications I take, etc. And I already just naturally emphasize protein in what I eat simply because a nutritionist I worked with for a while told me I wasn't getting NEARLY enough for my size. So I think I'm just naturally well-suited to DS.

You're totally right, @DianaCox. I know so little about the Aussie healthcare system at present (just learning since I've only been here since early this year), I'll need to find out exactly how I go about seeing a doc in another state. All the docs I've seen so far have required referrals from another doc, even with private pay, and I think I heard something about in-state-only referrals. Nottle is out of state. Hoping maybe @Parousia and @K-J can let me know if it's possible?

Also, Blamey is listed on dsfacts.org - though there's a note saying he no longer advertises the DS, but still we do it. Nothing good recently about him?

I was thinking there were bound to be other DS surgeons who were "acceptable," just that Nottle and Blamey were the best - but if these guys are (or if Nottle is) the only doctor(s) I should be trusting with my surgery, I'll make it happen and hubby will find a way to take off. He's behind me 100%... I just didn't get (until reading more threads here) just how important specific surgeons were. I'm on it now.

 

[DianaCox]

"I just didn't get (until reading more threads here) just how important specific surgeons were. I'm on it now. "

I'm glad to hear this - because ESPECIALLY at your size (didn't I read somewhere your BMI is 96?), you are very very high risk. You may in fact be safer as a two parter for the averagely- skilled surgeon. If you were in the US, I'd recommend Keshishian or Rabkin, as they have the skills and tools to do supersupersupersuperobese people in one step, but even then, I'm not sure (that's why they don't let me in the OR ... )

 

[more2adore]

Hmmm... well, maybe I should be looking at the VSG, then. Yes, that is my BMI. I was actually at 101 at one point. A bit confused now - is Dr. Nottle considered skilled enough to do the DS directly on me, or do I need to just go with the VSG as US surgeons aren't an option anymore? And if I do the VSG, do I still need Dr. Nottle?

 

[DianaCox]

Well, you're right there - "anyone" can do a sleeve - it's the switch that is the hard part. Perhaps you should consider getting the sleeve locally, but contact Nottle NOW about the fact that you want to go to him in a few months or perhaps a year, after you have lost a substantial amount of weight, to finish the job.

But - I would ask Nottle FIRST (1) does he feel comfortable doing a one-step DS, which would be preferable if possible; and (2) whom would he recommend to do your sleeve locally. He may have a well-founded opinion on that topic.

 

[more2adore]

Perfect - Diana, you have been SUCH a help!

 

[Larra]

Hi again! Glad you found your way here.

Yes, Dr. Nottle was the one I was thinking of, I just couldn't recall his name.

Now that I know your bmi, I agree with Diana that a 2-stage DS might be the safest way to go, given that the surgeons available to you don't do the DS very often and probably won't be experienced with doing it on someone your size. But yes, check with Dr. Nottle first before you make your move.
I also feel all the more strongly that the DS is far and away your best choice. While the VSG might (hopefully) help you with some initial weight loss to get you to where the "switch" part can be done more safely, it is very unlikely to be sufficient to get you even close to a normal weight, and less likely to resolve your comorbidities as well. So one way or another, the DS is the way to go. Not you just have the difficult task of making it happen, but it CAN be done.

 

[more2adore]

Thanks Larra for confirming that! And thanks for referring me here. Okay, I'll start with the VSG. I'm actually excited. Ready for the next phase of my life.

 

[hilary1617]

@more2adore - Glad you're committed to compliance because the DS really has great long term results. Please keep us posted on your plans - excited for you!

 

[more2adore]

Thanks hilary!

Just curious - what kind of testing do they usually do before surgeries? I suspect I might have a hernia from a fall I took (missed the last step - doh) a couple of months ago. I realize things may vary from doctor to doctor, but is it typical for them to determine if you might have hernias prior? What about your heart - I had some brief-but-scary episodes when my levothyroxine dose was too high but they mostly stopped once it was brought down (pretty much nonexistent now). Will they do an EKG or something?

 

[DianaCox]

I would presume there would be EXTENSIVE pre-op testing for you, in particular your heart, especially given your size and probably risky health. Just keeping you on the OR table is going to require special considerations. EKG and chest Xray, as well as extensive lab work are required pre-op for any anesthesia. You will almost certainly be required to have a stress test, possibly echocardiogram, and if your EKG is abnormal (which it very well may be, just because of the fat in the way), you may require angiography as well. Many of us were required to have a pre-op EGD and colonoscopy as well. I would be concerned if these are NOT required.

 

[Larra]

Even the healthiest, youngest, bariatric surgery patient has a chest x-ray and ekg, along with various blood tests. And I agree with Diana, you may need further testing because you are higher risk than average.

My only other caution with a VSG is to make sure that this is a PLANNED 2-stage DS, not just a planned VSG. In the event that for whatever reason you decide not to do the second stage, that's fine, no one is going to force you to do it. But you don't want to find yourself going through a second approval process for a "revision" from your VSG.

 

[Charris]

More2adore listen to these ladies they know their sh**! I was trying to have a revision with my initial dr because it would have been free versus 4000. They assured me the results would not be good. Thank God I listened because with all the complications I had im sure I would have died.