It's been a long time since I've posted something about my own WLS journey, so I figured this is a good opportunity to talk about what's been going on with me.
For those of you who don't know my story (I've reduced the timeline info in my signature to the most recent events only), here it is in a nutshell: I was scheduled for an open RNY at the end of July with Surgeon #1, who cancelled my surgery shortly before the scheduled date, because he abruptly stopped doing RNYs. Having been told that there was no other WLS surgeon in Tucson who was covered by PacifiCare (my insurance carrier), I went through the re-approval process for a laparoscopic RNY with Surgeon #2 in Phoenix (two hours away), waited for an answer from August to the beginning of October, and was then denied on the grounds that Surgeon #2 was outside of my local provider network. As a stroke of good fortune, I learned that my post-cancellation phone call to Surgeon #3's office in July actually resulted in his contracting with PacifiCare for WLS, so I
did have a local option. I decided to go with Surgeon #3 (local) instead of appealing PacifiCare's denial of Surgeon #2 (out-of-town). Are your heads spinning yet?
Surgeon #3 is Dr. Patrick Chiasson at Northwest Medical Center here in Tucson, which has preliminary approval as a Bariatric Center of Excellence and should have a formal designation within a few months. Dr. Chiasson and his partner, Dr. Burpee, specialize in minimally invasive surgery and do all of their procedures laparoscopically. They are also the only surgeons in Arizona who are performing Vertical Sleeve Gastrectomy ("VSG" or "the Sleeve") bariatric procedures. They believe that the VSG will replace the RNY as the gold standard of WLS within a few years, and their surgical practice is now about 55% VSGs. I have spoken with many of their patients in my WLS support group and have been following Teenieleenie's journey here on TT as well, and so far, I've heard overwhelmingly positive comments from people who are anywhere from newly post-op to well over a year out.
While preparing for my required endoscopy recently, I had to go off my twice-daily dose of Diclofenac Sodium (generic form of Voltaren), an anti-inflammatory drug that keeps me functional. I had a huge, excruciating gout flare-up in both feet and ankles, the right knee, and my left hand. I was literally unable to walk and was bedbound, in agony, for a week before my procedure. As soon as the endoscopy was done, I started back on my NSAIDs and got an injection of a corticosteroid from my new rheumatologist. The need to continue taking anti-inflammatories is one of the reasons Dr. Chiasson has urged me to consider having VSG instead of RNY.
Teenieleenie has posted some great links to articles on the VSG in some of her threads, but I'll briefly explain what the VSG entails. The VSG is a strictly restrictive procedure with no bypassing of the intestines. Basically, a significant portion (75% or more, depending on the surgeon) of the lateral stomach is completely removed, leaving a small vertical "sleeve" of a stomach, about the size and shape of a ballpoint pen, which retains its original connections to the esophagus and small intestine, still produces digestive juices (stomach acid), but does not produce gherelin, the "hunger hormone".
Originally, the VSG was used as the first stage in a two-stage WLS process for the "super super obese" (BMIs above 60, like mine was at my highest weight of 540) because it was shorter, simpler, and safer for high risk patients than an RNY. After significant weight loss, VSG patients could then have second stage surgery, a conversion to RNY or Duodenal Switch (DS), to get them to goal. Over time, WLS surgeons performing the VSG found that it was successful also with patients with lower BMIs and could be used alone, without any second stage procedure, to effectively lose excess weight. Weight loss with VSG has been shown in recent studies to be superior to that with the LapBand and comparable to that with RNY.
Because there is no intestinal bypass, however, there is no malabsorbtion of food and thus a much lower risk of malnutrition than with the RNY (on the other hand, there is no "dumping" if sugar is consumed, which could be problematic for those patients who need that extra incentive to avoid sweets). Because there are normal digestive juices and intestinal absorbtion, normal medications, including NSAIDs and other anti-inflammatories, can be taken orally as needed, unlike with the RNY. Unlike the LapBand and RNY, the VSG is completely irreversible, but studies with three years of data are showing that the VSG has far fewer post-op complications, such as strictures and ulcers or uncontrolled weight loss from malnutrition, so reversals would be rarely, if ever, necessary.
Although partial or full gastrectomies have been performed on stomach cancer patients and people with severe bleeding ulcers for over 100 years, the VSG has only been performed as a bariatric procedure for about three years. Because there are no five-year studies of VSG yet, insurance companies consider the procedure "experimental" and normally will not cover it (they are only now starting to cover LapBands, so it could take a while!). The VSG is actually less expensive and time-consuming to perform than the RNY, requires a shorter hospital stay, and will likely result in fewer post-op problems that must be corrected, so insurance companies could save a great deal of money once they start approving the surgery as an alternative to RNY. Dr. Chiasson has been working with the new Medical Director of PacifiCare, providing educational materials, tours, etc., in hopes that PacifiCare will start covering the procedure.
As it stands now, I am waiting for Dr. Chiasson's office to review my now-massive file and determine whether it has everything it needs to submit me for insurance approval - I think everything has been done (and re-done, and done again), so I hope it will be soon. I have authorized Dr. Chiasson to submit me as a VSG to see what happens. I am hopeful (there are a mother and daughter on another forum who have PacifiCare in California, and they got approved for VSGs even though their policies normally excluded that procedure) but realistic - I know PacifiCare will likely deny this "experimental" procedure despite all of Dr. Chiasson's educational efforts.
If PacifiCare denies the VSG, then I will have Dr. Chiasson re-submit me for approval as an RNY and look at options for financing the $18,000.00 cost of self-pay for VSG. It's a tough choice - I have come to believe that the VSG is a better option for me because of the medication and nutrition advantages, but don't know if I can stomach (pardon the pun) financing such a large sum when my insurance will cover the current gold standard of bariatric surgery, a procedure that I've been preparing for for almost a year...
So, that's what's up with Eric!
VSG vs. RNY: What's new with Eric (and, yes, it's long!)
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