May I ask, please, about the questions Jillybean lists below? I have seen similar questions with regard to the sleeve vs. RNY and am having trouble sifting through the quantities of information that come up--forum posts with opinions vs. the objective info I really need to educate myself.

• My starting BMI: 45.2(ish)
• Eating habits: volume and grazing...stress eating, emotional eating, bored eating
• Metabolic conditions: pre-diabetes, history of gestational diabetes, good overall cholesterol but high "bad" cholesterol, large volume of pudge around abdomen (apple shape)
• Difficulty losing weight with only calorie restriction - I need exercise to really make a difference...at the same time, I have arthritis in my knees and pain that restricts what I can do for exercise, take NSAIDS daily for pain management...and at the same time, I AM losing weight with calorie restriction and the exercise I am currently able to do...
• Comorbidities: high blood pressure, mild sleep apnea
• No acid reflux or GERD.
• Commitment to take supplements: absolutely

Is there a series of studies or a fact-based website that would help me weed through what my answers could possibly mean with regard to whether the sleeve or RNY would make more sense for me?

I see my surgeon again on Feb. 15th and will work with him to figure out what's going to be best for me. But I'd really like to feel more comfortable with the options before going in there. Right now I'm leaning heavily toward the sleeve, but am not convinced the RNY wouldn't be a better match.

Thank you for any help anyone can offer!

I chose the RNY because I had two friends that had extreme complications after the DS surgery and the one Dr. that took my insurance in the area did DS or RNY.

Also, I felt I could use the dumping symdrome to help me kick the heavy carb addiction (nothing like feeling like a large pile of garbage when you eat anything high in carbs to make you like grapes!) It worked great! and yes, I would do it again a 100 times!

Angela

voila! your own thread!

you're asking some great Qs, peonies [one of my favorite flowers, BTW]. and one more Q: how old are you? sometimes that plays into the decision as well. i suspect you're fairly young [30-ish?].

your stats fit right into the guidelines for having WLS to start with - so that's one hurdle you won't have to jump. the next Q is what are YOUR goals for the surgery? are you looking to minimize your diabetes risk? or improve management of your cholesterol and blood pressure?

if it's managing your cholesterol and blood pressure, chances are that the weight loss from any form of surgery will help with that. for the diabetes risk, there's evidence that either the RNY or the VSG will help, but the next Q is for how long [and that's where your age comes in].

there's some really good evidence that the VSG offers excellent diabetes control [not sure about data on diabetes prevention, though], without the malabsorption. you can add a malabsorption component to the VSG at a later time if you need it, assuming either you or your insurance company can pay for it [many insurance companies limit WLS coverage to a single surgery in a lifetime].

i'll see if i can find some good review articles or resources out there [i'm going to check the ASMBS website, and AHRQ, cochrane, pubmed, and a few other places], but these are Qs you'll need to discuss with your doctor. but please remember that his answers will largely depend on the surgeries he/she performs and the amount of experience with them.

you're on the right track! don't stop asking Qs!

Oh wow, thank you! I feel so honored.

You gave me some of what I am looking for in your answer (places to go looking for more details -- ASMBS website, and AHRQ, cochrane, pubmed), so thank you for that too!

To answer some of your questions, I'm 45 (single mom, two boys ages 12 and 8). My goal for surgery--in an ideal world--is to get to my goal weight of 115 and use the first year or so after surgery to train my brain to function like a naturally slender, healthy person's brain does--from food choices to portion control to emotional issues to desire for exercise. I want to lower my risk for diabetes, improve my cholesterol ratio, and resolve the high blood pressure and mild apnea. Forever.

Possibly more important to me right now is helping with the pain in my knees from my arthritis/chondromalacia. Hopefully losing weight will help with that. Since it's degenerative, I expect at some point, no matter what I do, it will become more of an issue. Right now I'm taking daily NSAIDS. That's definitely a problem for the RNY. Maybe not so much with the sleeve, but since reflux is possible with the sleeve, it would be better to find an effective alternative for the pain.

I've had previous abdominal surgeries (and lots of scar tissue and adhesions) and that makes me worry about the RNY. I'm uncomfortable with the idea of rerouting my intestines, and with having no valve regulating the flow from stomach to small bowel.

At the same time, I am not in a position to self-pay so must rely on my insurance. They will cover the RNY but not the sleeve. OTOH, my surgeon has done sleeves on four patients with the same insurance I have. Apparently they will approved the procedure for in certain cases. So if we go with the sleeve, I will be relying on my surgeon's experience with getting those four cases approved.

He's part of a Center of Excellence and has done many sleeves, RNYs, and bands, and I'm very comfortable with his skill, his outcomes, AND his wonderful support group.

At this point I am more strongly in favor of the sleeve (for me) than the RNY. I know Medicaid is supposed to be reviewing the sleeve this month and hope that if they approve it, the private insurers will follow. This could be a huge turning point for everyone considering WLS. As long as my surgeon agrees that the sleeve is a least as good (if not better) an option for me than the RNY, that's what I want to do.

Less than 2 weeks now until my appointment. I see the nutritionist for the 2nd time next Wednesday. It feels like FOREVER away but it'll be here before I know it.

Thank you again!!!
Meri

I had the sleeve. I need to be able to take Advil for migraines. With all due respect to Angela not everyone dumps so you can't rely on that and the malabsorption decreases over time. My surgeon said that the long term weight loss for the sleeve is very close to bypass, maybe a difference of 10-20 lbs. I think for the right person the sleeve is just as good a weight loss tool as bypass.

i gotta say, Jen, that if the sleeve had been available 10 years ago, i would have given it some serious consideration. retaining the pyloric valve seems to be very important in this process. who knew????

I'm with Jiff, I only had the two choices, I made the right choice for me with what I had.

True Jen, not everyone dumps, but I try and find the positive in everything...even dumping.

I'm so glad I'm here.....

I recently made the decision that I wanted WLS.

First step was orientation - which I went to - and I've had my first appt with the surgeon I've chosen. He's great! I knew after orientation that the lap band was not for me - as I am diabetic, have high blood pressure and high cholesterol - I hate being on these meds! I want my diabetes reversed!

So, when I met my surgeon, he and I discussed either the sleeve or the bypass. He is the surgeon who brought the sleeve surgery to California - which makes me feel very good about his ability. He has done all three WLS - He said that because of my size, the bypass would have more chance of complications... explaining that the weight of my intestines attached to the tiny pouch of a stomach, could pull at the staples and cause a leak or infection..... Anywhoos.... the fact that there's no re-routing.... a lower chance of malnutrition, etc.... he sold me on getting the sleeve.

So, now, all of the tests begin..... I've got to do an Upper GI on Thursday morning... ugh! Never had that done before.... I've actually NEVER had surgery before so all of this is both exciting - I cant wait for my new life to begin - but also terrifying.

My surgeon has told me that he wants me to lose about 40-50 pounds before surgery.... also, told me to cut out my carbs now. I'm a diabetic - on oral meds, and started cutting out carbs..... which lowered my sugars a little fast - so I've stopped taking my meds. I dont want to have a low. That's scary!

So, right now, I'm panicking a little bit - with all the classes / support groups/ dr appts / Tests - EKG - Bloodwork - Upper GI - Chest Xray, etc that I need to do - I commute an hour each way to work everyday - depending on traffic - sometimes it's more like 90 minutes.... I have a special needs son, that needs a lot of care - I'm just trying to juggle everything!

I've been putting myself last for the past 15 years - I'm 40 now. I'm doing this for me. I'm doing this for my son, because I need to be here for as long as possible to help him.... and I know this is important. It's just so mind-blowing at this point....

Now, if only I could figure out how to turn my brain off at night, so I can sleep!!!! LOL

Sorry for rambling - so happy to be here... I've been reading up on all of your posts.... and they are very helpful and so motivational. Seeing all of your successes makes me even more excited for my own.

Will be back nightly to read up on more posts.... and chat with ya'll

Julie

Julie -

I'm so glad you found us! and congratulations on making a decision. I gotta tell you, though, that one sentence in your post - in particular - raised a flag with me:

My surgeon has told me that he wants me to lose about 40-50 pounds before surgery.... also, told me to cut out my carbs now. I'm a diabetic - on oral meds, and started cutting out carbs..... which lowered my sugars a little fast - so I've stopped taking my meds. I dont want to have a low.

see that part in there about stopping your meds? DO NOT DO THIS WITHOUT WORKING WITH YOUR DIABETES DOC!!!!!! of course you want to avoid the lows, but you also want to avoid a roller coaster. you might need more frequent monitoring, or a DECREASED dose or something, but that's something you REALLY need to discuss with the doc who's handling your diabetes.

and just an FYI, i had my RNY at about the same weight you are now - and i had NO complications, so it's possible that your surgeon may be steering you to the sleeve for a different reason.

don't get me wrong - if it had been available when i had my surgery, i would have given it VERY serious consideration - there's a lot of GOOD in the sleeve surgery. but the weight of the intestines pulling at the pouch? i'm not so sure about that ... but then again, i'm just a single case, and i'm sure your surgeon has his reasons for saying that. just be sure that it's a real reason and not an excuse.

sounds like you're really off and running on this adventure? your son will thank you [well, at least until he realizes that the fact that you can keep up with him will mean that he can't get away with quite as much!! LOL!!!! sorry - couldn't resist.

I second this!

Different oral meds for diabetes work in different ways. For example, metformin works by improving insulin sensitivity and by helping to control glucose being released by the liver, so it wouldn't typically cause a low because it's not forcing your body to produce more insulin. Definitely work with your doc when adjusting meds.

I agree with Jiffy and Jill; stopping medication cold without monitoring seems a bit scary.

While I had the RNY, I recognize there are issues that this surgery has, such as Reactive Hypoglycemia, that do not occur with the VSG. (I wasn't a candidate for the sleeve because of GERD issues, but I seriously considered it.) However, I have never heard of the weight of intestines pulling on the pouch as a reason to avoid the RNY. Seems a bit fishy to me.

Hi again

I emailed my doc and told her what the surgeon wanted me to do - so with her blessing, I'm checking my sugars all the friggen time- I've only stopped taking my glipizide if I go completely without carbs - but I'm still taking the metformin, as I knew it wouldn't cause a low with me. But I'm monitoring it very closely - and I'm making sure to keep my doctor in the loop!

My momma didn't raise no dummay lol

Julie

thank you, Julie! i hoped something like this would happen - sounds like you have one smart doc [goes well with you - since your momma didn't raise no dummy!!! )

and yes, it's a royal PIA to check your sugars all the time, but over the long haul, you'll be in the best possible shape for your surgery and for living a healthier life.

Hi, can someone please explain what does this actually means. Keep reading about it, but dont know what it means in practise