Weight Loss Surgery - exploring my options- would like others feedback




nurseamber
01-28-2013, 11:17 PM
I know that these are decisions I need to make after serious thought and discussion with my doctor. SO, please don't tell me what I already know. I am only asking for others input and experiences. BECAUSE most of the info I can find is skewed one way or another- I want REAL experiences from others. I am planning on attending a seminar to discuss my options for wls. I have tried to lose on my own for a long time. I do really well on WW- but gain all of the weight (and sometimes more) back as soon as I stop, or slip up. WW has been the ONLY thing I have been able to do that I have had any success with,but like i said- it comes right back. I am morbidly obese. I am 29 years old. I have 2 children, and don't plan on having nay more. I've had my tubes tied. Other than my weight, I am in relatively good health, but obesity related issues run strongly in my family. i.e. DM type II, Hypertension, Heart disease, etc. I HAVE to make a change, and wls seems to be my only option remaining.

What I am asking for, what surgery(ies) did you have? why? why not? I started my research thinking I would go with a lap band, but I seem to be seeing alot of hate for the lap band? why exactly? I also am finding alot of conflicting opinions about the duodenal switch? why? what about mexican bariatric surgery? I'm not sure if my insurance will cover wls, and if it doesn't- it would be alot cheaper on me to do the mexican surgery. Is that a bad decision to make? or a good one?


Zeitgeist
01-29-2013, 05:39 AM
Years ago I took care of the Gastric Bypass patients in ICU and saw things that went really Bad. Enough said!

I was just going to ignore this nonsense and allow Jiffy to deal with it, but had to respond to this statement. I would hope anyone with some sense would realize that yes, if you end up in the ICU, you have some problems. However, not everyone ends up in the ICU! Many morbidly obese patients have other health issues, so surgery can be a risk, however, the complication rate is actually not much higher than the complication rate of gallbladder surgery. You are fear-mongering; many, many WLS patients never end up in the ICU with complications.

To the OP:

When I first started researching WLS, I thought the lapband was the safest choice. However, my high starting weight made it not an option for me. Then I found out that there are a lot of complications associated with it. It is marketed as "least invasive" but it can leave permanent complications like scar tissue and doesn't have the best success rate, especially for the morbidly obese. Plus, while some people can find their "sweet spot" relatively easy, others have to visit their surgical team repeatedly in order to find that fill. With my surgical team being over an hour away, I didn't want the hassle of always having to visit them.

Then I learned about the sleeve. Truthfully, if it was an option for me, I would have had that surgery. But GERD prevented it from being an option.


I am 16 months out from RNY. It is the best decision I've ever made regarding weight loss, but it is not without its drawbacks. My biggest concern is your statement that when you slip up, you gain all your weight back plus more. Believe me, I totally understand this. However, after the "honeymoon period" of weight loss, it is again easy to gain back weight with slip-ups. You probably realize this, although some people hope that regain won't happen to them. Therapy to address the "why" of overeating helps many people avoid or temper regain.

Good luck on your decision. Don't let the fear-mongering of the foolish dissuade you in your hunt for information.

jiffypop
01-29-2013, 09:35 AM
Good grief, Jen, there's NO WAY I'll ever be up before you are!

and now nurse - here we go - I started my research thinking I would go with a lap band, but I seem to be seeing alot of hate for the lap band? why exactly? I also am finding alot of conflicting opinions about the duodenal switch? why? what about mexican bariatric surgery? I'm not sure if my insurance will cover wls, and if it doesn't- it would be alot cheaper on me to do the mexican surgery. Is that a bad decision to make? or a good one?

the lap band is great for some people and really bad for others. I was not a candidate for it because i was so ill going into the surgery that the surgeon said i needed MUCH faster weight loss than the band would give me. Other people love the adjustable feature of it, but, as Jen says, you have to go to the doc for adjustments. Frankly, as I lost weight and started actually living again, the LAST think i wanted to do was to keep running to the doc! OTOH, many people like having the contact.

The RNY and the DS each come with malabsorption, but different vitamins are malabsorbed. With the RNY, it's mostly the water-soluble ones, with DS, it's mostly the fat-soluble ones, which are a little more difficult to keep up with [i think]. Some people report lots of smelly gas with the DS, but others do not.

Folks who've had the DS don't have dumping syndrome like many RNY'ers do, and they don't run into 'pouch filling issues' - as my surgeon calls them. In other words, things don't get STUCK.

DS is becoming more common, but it's still a little hard to find surgeons who are really experienced in it, so if you're interested in it, make sure you can access care readily. As Jen said, if you have to travel a distance to the surgeon, you gotta take that into consideration. The OTHER side of that is that communities that have active WLS programs also tend to have PCPs and other specialists who are familiar with WLS - a huge benefit.

As for Mexico, there are a few people here who've done the surgery there. The key is to find follow-up care at home - and since many surgeons don't want to touch another's surgery, that COULD BE a problem. But since you're a nurse, you might know the lay of the land where you live.

I had RNY - and it's been great for me. Not perfect, but great. And the main reason i had WLS was NOT to lose the weight. It was to give myself the best chance of keeping it off. YES, it's possible to regain - in fact, i've regained about 80 pounds. BUT with following the rules, i've managed to lose more than half of the regain. I don't care how quickly it comes off - as long as it does.

Gotta tell you, though, that if the sleeve had been available all those years ago, I would have seriously considered it.

Keep up with your research - and ask a lot of Qs. And believe me, when [not if] someone wanders in here to tell you not to have surgery, I WILL remove the posts - i'm just not on here 24/7. don't engage with them.


bethFromDayton
01-29-2013, 09:54 AM
I've considered WLS several times and keep coming to the conclusion it's not for me at this point. I thought I'd share my thoughts--but just because it's not for me at this point, that doesn't mean it's not for you.

There are risks to every surgery--we all know that. There are also risks to being obese. We know that too.

I am 5'2" and now weigh 225. That's easily a hundred pounds overweight with a BMI over 40--my cholesterol is high and I have Type II Diabetes.

I know three people reasonably well who have had weight loss surgery. One has had serious complications from the surgery (RNY). She uses a wheelchair or scooter most of the time and is in constant pain. Another had gastic sleeve and is doing great and is so glad she did it. Her experience is what made me look into it again. The third had RNY as well and lost all her excess weight, is much more active, and is much happier.

With my friend who has had complications, I don't know what other factors there might have been--that's a question I haven't felt I could ask.

My personal biggest concern was the restricted eating required--I was afraid I'd find that very hard and was concerned that I'd be one of those who ate too much and stretch her stomach. If I could cut back my eating and increase my exercise, I wouldn't need the surgery.

Even with the diabetes and cholesterol issues, I decided the risks of surgery outweighed the risks for me of not having surgery. Even at 100 pounds overweight, my activities are not really affected by my weight. The research, though, was what pushed me back into a plan for weight loss.

As I understand my reading, many clinics require a 6 month or so weight control program before performing surgery--in 6 months, I could lose enough weight to no longer be in a recommended range for surgery--that was another consideration in me not having it.

On the other hand, my BFF has a BMI of 64 and if she had insurance, I would strongly encourage her to consider (and probably have) the surgery--her risk picture is very different and her weight limits her activities in a way mine does not. (Although her blood sugar and cholesterol are better than mine!)

I hope you get information that helps you weigh your decision. It's a hard one to make--bI'm rooting for you.

jiffypop
01-29-2013, 10:02 AM
I'm inclined to leave Beth's post [above] because she raises the issue that this is a very personal decision that requires everyone to look at their risk picture and diet history.

but if anyone has an issue with leaving it, let me know.

imp
01-30-2013, 09:46 AM
Real experience? You asked, nurseamber :) Here's mine:

I had the mini-gastric bypass on May 17, 2012. I was a 40.5 BMI, 5'4" and 232 pounds the day of surgery. I wore a 16/18 on the bottom and a 1X-2X on top. I had pretty intense diastolic hypertension, severe asthma, GERD, and sleep apnea. I lived on beta blockers, Lasix, albuterol and Pulmicort and Prilosec daily, and ignored my CPAP because it's CPAP, everyone hates that thing. I could not walk a flight of stairs without wheezing. I had written my first novel from my bed because I was too sick to go out much. I'd given up my nursing job years before.

My surgery consists of a 3-6 ounce vertical stomach taken from the lesser curvature, and a bypass of the small intestine. (The bypass can be any length - mine is about six feet. My stomach is about 3 ounces.) There is nothing "mini" about the mini-gastric bypass. On the weight loss and malabsorption scale MGB falls between the RNY and the DS. It has a pretty low complication risk and I was in and out of the hospital in 24 hours with no pain meds and no need for them.

My remaining stomach and small intestine are still alive and attached, just bypassed - so my MGB is revisable and reversible should I need that at any time. The MGB also has a very low rate of regain - about 10-20 pounds in year three, which is generally lost in year four. The vertical stomach doesn't stretch much but the outlet and small intestine can adjust to higher intake, and sometimes people just get happy and eat like crap for awhile - and then they get over it. Even at that the risk of regain is fairly low - under 25%. That's the primary reason I went with MGB.

My dad had the same surgery a few months before I did. He, at a year out, has lost about 75 pounds and is at his goal weight. His stomach is larger than mine, and less sensitive - he can eat just about whatever he wants. He is a former Type II diabetic and was very hypertensive. He is down to one medication, from the eleven he was taking. He gets cranky because I've lost more weight, but really he is a very good example of a 67-year-old man being able to lose 65-75% of his excess weight and still eat fairly normally.

I have lost somewhere in the area of 100 pounds. I ditched my scale so I'm not sure :) I am on NO meds. I am no longer hypertensive. My asthma and sleep apnea are completely resolved. I have no more acid reflux. Bonus, I wear size 3/4 pants and a size small top. Even my feet shrunk a full size.

My stomach happens to be twitchy, and has been since the recovery room. That's not usual with my surgery - I have probably the worst food intolerances of anyone on my surgeon's forum, and my doc would agree with that. So with me you get best case (yay losing 90% of excess weight, heck yeah) and worst case (oops my stomach hates everything) all at once.

With MGB the rules are a little different. You don't drink water right after surgery - you live on G2, V-8, broth, yogurt (unless you're me and can't handle yogurt) and goldfish crackers for two weeks. Then you phase to soft foods - refried beans, mashed potatoes, soups - for a week (if you're my dad) or a month (if you're me). Then you can add foods, one at a time, and see what works. High protein - 60g minimum (80 if you're me) a day is standard. MGBers need salt and potassium in higher doses. We also need vitamins at three times the normal adult dose. Other than that, we can kinda eat what we want. Carbs are not off limits, but some people dump on sugar and others (me) can't get in their protein if they fill up on carbs.

Hair loss is an issue. My dad has a bald spot now he didn't have before. I have lost a ridiculous amount of hair, way more than normal for my surgery. So I have to take 200 mg zinc, plus my iron, plus higher protein, to keep my hair in my head. We are seeing some regrowth at 8 months out, so it is working, but be ready for some hair loss with any surgery. I bought a wig, but I don't wear it - I just cut it short until the regrowth catches up, and people seem to like it that way.

Loose skin is an issue depending on how much you have to lose. I haven't had a huge problem with it, but I do have some. If it really starts to bug me I'll do something about it later.

My stomach hates eggs, lactose, chicken, ground beef, and pork. It hates soy milk and rice milk, too. It also hates chocolate and bread and cake. This is not normal, but it's my stomach. You can imagine how much fun it is to find things to eat :) Pretty much I have adapted. I don't eat much junk, although my primary carb is the occasional cracker or potato, or taco shell. Oddly, I can eat popcorn. I dunno, my stomach is weird. Coffee, black teas, and soda are off limits for MGB patients but most of us cheat on one or more of those. I love my coffee, but I don't drink soda. My surgeon is mad about the coffee right now so I'm working on it.

Mostly, I live on steak, cheese, crab legs, shrimp, nuts, and protein shakes. There is one protein bar I like, so I use that as well. You do have to get creative and learn what works for your body after surgery. I do not have to do a lot of exercise -what I get at work and the running around I do on days off is enough for me at this point. My surgeon and I may revise that later if my weight loss stabilizes.

Alcoholism is a big issue for any bariatric procedure. If you have a bypass and also drink you are at risk for alcohol addiction because of the way we metabolize - drunk fast, sober fast. So that's something to be aware of in advance, and alcohol is best avoided or used in very strict moderation following any bariatric surgery where a bypass is involved. I like sake. I can't have hard alcohol or beer at all, or red wine, but a little white wine is okay for me once in awhile.

In short, I'd do it again tomorrow. My life is not a cakewalk, but I am healthier, happier now. I love to go shopping and I can shop anywhere I want. I can climb stairs. I can deadlift my patient. I can live my life now. It's pretty cool.

imp
01-30-2013, 10:11 AM
Oh, nurseamber - if you choose to go to Mexico for surgery, do be sure you are clear on exactly which procedure you are getting. I know several people who had great experiences there, and if I do plastics I'll do them there. I'll probably import my own Vicodin, but still :)

I also know a few people who are accidental MGB patients. They went to Mexico for RNY and came back with MGB, because it is easier to perform and surgeons there really like the procedure for its low complication rate - they can get you in and out fast and you get the results, so. Do read your paperwork and be clear in advance.

One woman I know couldn't figure out why the RNY rules were not working for her and why her labs were jacked up, so she went through her stuff, found out she'd gotten MGB in Mexico (and had signed off on it!), and then had to learn about the procedure after the fact. She's happy with it now - hit goal 9 months postop, has maintained it for seven years - but she was pretty shocked to find she didn't have a RNY.

On the other hand if you want MGB that's a great way to get it. I spent about 18K of my dad's money on mine, including preop tests and the hospital.