nikkilw

Hi! I'm way before pre-op, but I could use some advice!

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Hi! I'm a 31 year old female living in Central California, and I've recently accepted that I need help to fix my lifelong weight issue. At the moment, I need to lose over 250 pounds to be at my goal weight of 180 (I am 6' tall and the rest of the family that I take after is built with very large frames/hips). At the moment, I'm awaiting an appointment with a nutritionist to begin this journey towards surgery, as is required by my insurance. At this point, I am nearly certain that I am going to need bariatric surgery of some kind, and it's now down to trying to figure out how to proceed. I was leaning towards gastric bypass simply because of the sheer amount of weight I need to lose, that seems to be what's recommended from what I read online. However, a friend is having the gastric sleeve surgery next month, and needs to lose more than I do. I'm not particularly fond of the idea of my stomach literally being removed from my body, but this friend also is really trying to talk me out of exploring gastric bypass, citing the extreme nature of it. I'm not opposed to any surgery (except maybe the lap-band - the amount of complications makes me shy away), but I'm really looking for opinions of those who have been through the process. I know I'm a long way away from even having a surgery date, but I really want to make an informed decision about it all. My sister (who knows me better than anyone) thinks that gastric bypass is too extreme and that I'll miss too much of the foods that I won't be able to eat ever again without discomfort. While I see her point, I'm also thinking that maybe that's what I need - to not put food, and eating food in particular, first priority. But, is the exchange worth it? Will there ever be a point post-op where I'm able to eat small amounts of "bad" foods without discomfort? And I say that not because I want to cheat, but because it might help to sway her.

 

Looking for any and all opinions/experiences, any info at all would be helpful! Thanks!

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Hi nikkilw and welcome to Thinner Times. :)

Gastric bypass and vertical sleeve surgery are both pretty extreme in my book. I had to come face to face with the fact that, yes, my weight problem had become so pervasive that I needed a doctor to rewire my insides. But as I've learned here and as I'm learning as I progress with my recovery, both surgeries are only tools. You can succeed with either as long as you're willing to make lifelong lifestyle changes as far as diet and exercise go.

If you "cheat", you're really only cheating yourself, and if you're persistent you can "eat around" either surgery and end up weighing just as much or more than you do now.

I guess what I'm trying to say is that questions such as "which of the two surgeries is right for me?" and "will I be able to eat a small amount of high fat and/or high sugar foods after surgery?" are the wrong questions to be asking yourself.

For example, I asked my surgeon which type of surgery he recommended and I went with his recommendation without hesitation. He's the professional. I was not the professional, neither were my family or my friends. Is the exchange worth it? So far, in my case, it has been. And this is coming from someone who has had nothing but pain since the surgery a couple of short weeks ago, and the majority of my weight loss is pre-op.

Are you willing to sacrifice permanently the physical and emotional solace that food offers in the hopes of something better?

 

Edited by Northchild
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1 hour ago, Northchild said:

Hi nikkilw and welcome to Thinner Times. :)

Gastric bypass and vertical sleeve surgery are both pretty extreme in my book. I had to come face to face with the fact that, yes, my weight problem had become so pervasive that I needed a doctor to rewire my insides. But as I've learned here and as I'm learning as I progress with my recovery, both surgeries are only tools. You can succeed with either as long as you're willing to make lifelong lifestyle changes as far as diet and exercise go.

If you "cheat", you're really only cheating yourself, and if you're persistent you can "eat around" either surgery and end up weighing just as much or more than you do now.

I guess what I'm trying to say is that questions such as "which of the two surgeries is right for me?" and "will I be able to eat a small amount of high fat and/or high sugar foods after surgery?" are the wrong questions to be asking yourself.

For example, I asked my surgeon which type of surgery he recommended and I went with his recommendation without hesitation. He's the professional. I was not the professional, neither were my family or my friends. Is the exchange worth it? So far, in my case, it has been. And this is coming from someone who has had nothing but pain since the surgery a couple of short weeks ago, and the majority of my weight loss is pre-op.

Are you willing to sacrifice permanently the physical and emotional solace that food offers in the hopes of something better?

 

I completely understand how that may have come off as though that's what I'm thinking about, but it truly isn't. In fact, for the last month and a half, every single thing I eat, I analyze in my head whether or not I could eat this post-op. And I am definitely ready to give up all of that - eating the "bad" foods and everything, truly. I feel as though the weight loss surgery would be my biggest tool in helping me along that journey, because it would not only limit what I intake, but also make what I do intake count for something - not just empty calories. I just brought up the "bad" foods question because it is one that I want to know - I just know that asking a surgeon that question would make it look as though I'm already anticipating cheating, and I'm not. I understand the impact that this would have in my life, and how important it is to make the sacrifices. My sister means a lot to me, though, and that's why I'm asking - I just am asking for help on what to say to her when she brings that part up. I guess ideally I'd like to be able to tell her that although, yes, I can eat very small amounts without pain eventually, I probably won't even want to.

And honestly, even if I really can't ever eat "bad" foods again, this would still be worth it to me, because I know I can't do it on my own. I have a long way to go in this process, but I assure you, every step I've taken, everything that I've looked up, everything I've pinned to my "bariatric" board on Pinterest - none of it has included cheating in that plan for success. The point of this is getting away from the bad foods. She just thinks that I'll miss those kinds of foods too much, and I'll regret it. I just don't think I will. And even if I do miss them, I'll be too busy enjoying being healthy to miss them for long!

Also, I definitely am not limiting myself to just those two surgery options at all. I'm just saying that those two options are the ones that I know the most about, and have actually considered. I'm open to any and all other conversations about other surgeries - that's why I posted this, really. To get some feedback of what everyone else thinks of their experiences through the different kinds of surgeries.

Thank you for replying!

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Both the vertical sleeve and RNY gastric bypass have their own advantages and disadvantages.  Each of them can help you lose weight and get to your goal weight, and then maintain at your goal weight.  As an informed consumer you need to make the weight loss surgery choice that is best for you and your needs. Note that sometimes this choice is mandated by your health insurance company or by your choice of surgeon (not in my case - BCBS of MA let me chose my surgery type, and my surgeon had lots of experience with both procedures).  Also, some people should only have one of these surgeries due to other medical conditions.

I chose gastric bypass for the following reasons (and have never regretted this choice);

1.  Gastric bypass surgery has a higher success rate than the vertical sleeve.  Quite frankly, if I am going to have weight loss surgery, then I want the most effective surgery.

2.  Gastric bypass has been performed for much longer than the vertical sleeve - so the side effects for gastric bypass are better known.

3.  Gastric bypass combines two separate weight loss methods into one surgery (small stomach pouch and malabsorption of calories), while the vertical sleeve has just one (small stomach pouch).  To me, more is better.  I view the malabsorption of gastric bypass to be a major benefit of that surgery.  It means (according to one peer reviewed scientific study that I found) that roughly 18 percent of the calories that you eat are not absorbed by your body after gastric bypass as compared with normal people - which is a huge help both for quick weight loss and for maintaining at your goal weight.  The sleeve does not give you this 18 percent calorie malabsorption benefit.  This is why, as your surgeon may have told you, in general gastric bypass patients lose more weight than sleeve patients.  Of course, everyone's results will differ, and the most important factor for success after weight loss surgery is a long term personal commitment to a healthy lifestyle. 

4.  Nothing is taken out of your body with the gastric bypass surgery, so that it can (in theory) be reversed - this is not true for the vertical sleeve.  More importantly, with gastric bypass (unlike with the vertical sleeve) you retain the rest of your stomach (besides your small pouch) in your body, so that in case of an ulcer or some other problem with your small pouch many years from now (which is not unusual) you will have spare and healthy stomach tissue inside you for a surgeon to use to make a new pouch.

5.  The people that I knew who had the gastric bypass lost all the weight that they needed to lose and got to their goal weight - while many of the people that I know that had the sleeve did not make it to their goal weight - or got to their goal weight and then regained a lot of weight.

6.  The major downsides of gastric bypass - having to take vitamins the rest of my life, a longer surgical procedure, and facing the possibility of dumping - were acceptable risks to me.  Taking vitamins is no big deal (and since I buy them at CVS on sale, it is not a major expense), since I was knocked out for my surgery I did not care that it took longer to perform the surgery, and I only dump about once every six months (any only after I do something "stupid" like eating a big bowl of ice cream).

I fully respect people who get the vertical sleeve, but I love my life with gastric bypass ).

Edited by Res Ipsa

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In addition to what I just posted on surgery choices, it might be helpful for you (even through you are at a very preliminary stage as far as weight loss surgery goes) to understand what are the key things to remember in order to be successful with weight loss after a gastric bypass.  This is what I have posted in the past on this topic:

1.  Follow the diet plan from your surgeon.  Most people find it helpful (at least at first) to write down everything that they eat.  Measure all of your food, especially right after surgery.  Note also that your diet after surgery will be very high in lean protein and low in carbs.  You will need to drink protein shakes, at least for the first few months, in order to get enough protein.  Find foods that you can eat on your diet and like, and make these items the cornerstones of your daily food intake.  

2.  Take your vitamins on the proper schedule and in the right amounts.  This obligation will continue for the rest of your life and is not optional if you want to be healthy after a gastric bypass. You do not need "bariatric" vitamins; the ones from Costco, Walgreens, etc are fine, but be sure that your calcium pills are calcium citrate not calcium carbonate.

3.  Drink lots and lots of no calorie (or very low calorie) liquids - but nothing with carbonation.  You really can't drink too much liquids. You will have to give up all caffeine and alcohol at least for a few months after surgery (more on alcohol below).

4.  Get some exercise every day.  I like long walks, but other people prefer to go to the gym. Just as importantly, try to adopt an active lifestyle (which will be much easier after you lose some weight).  Although exercise probably will not have a major role in your weight loss, it will have a major role in making you feel more healthy and alive, and will help your body adjust better to the rapid weight loss. 

5.  Be sure to have regular checkups and blood tests after your surgery. Also, if you currently take medicine, the dosages probably will change as you lose a lot of weight. Indeed, most of us find that we no longer need almost all of our prescription medicines after we reach our goal weights. But obviously follow your doctors' advice on this. 

6.  Rapid weight loss and not using unhealthy food as a form of comfort can cause some mental health issues to get worse - so if you have mental health issues be sure to watch for this. Seek help if you need it.

7.  If you do go back to drinking alcohol at some point after a gastric bypass be aware that it will hit you much faster and harder than before. It will also be much more addictive (as many members of this forum can confirm).  Moreover, you cannot have a drink and drive, as just one drink will impair your ability to drive.  Finally, remember that alcohol is empty calories that will hurt your ability to lose weight and keep it off.

8.  You need to accept that everyone's weight loss journey is different.  Some people can tolerate artificial sweeteners, and some cannot.  Some people "dump" after consuming just a little sugar, and other people dump rarely or never.  Some people lose the weight quickly, and other people lose slowly or with frequent stalls.  Some people can eat a lot more calories at goal than other people.  In addition, some people have medical complications and/or significant excess skin problems.  

9.  Most people after gastric bypass do not reach their goal weight or reach their goal weight and then regain some (or even a lot of) weight.  However, many of us do reach our goal weight and then maintain that weight long term. The key to success is simple - remember that gastric bypass surgery is a powerful weight loss tool, but long term success will be based on developing a healthy relationship with food (which is much easier to do with the small stomach and limited diet that you will have after surgery) and on following the other rules on this list. You can become skinny and healthy, and stay at your goal weight for the rest of your life, but you will have to work on it every day - it does not come automatically with the surgery. 

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Hello and welcome. I also started this journey with over 200 pounds to lose. I fully believe it is possible to achieve that goal and had some family to convince. It took finally telling mother I needed to lose more than she had ever weighed and taking her to the informational seminar for her to see how necessary this is for me. Now, she is one of my biggest supporters.

You also sound exactly as I did. For months pre-op my husband and I discussed our meals comparing it to what it would be like post op. I went with the sleeve. I know I am losing pretty slowly (just my experience, not everyone does) but my shot at lifetime maintenance is what I need. Also, I can revise down the road if needed. I can eat almost all foods now but it's my choices that are different. I eat according to my goals and have found delicious ways to do that. Please feel free to message me if you have more specific questions!

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If you're leaning toward sleeve, chances are it's a good choice for you. I did not want gastric bypass, but from hanging around here, I've learned that some of my concerns with it become somewhat mitigated over time. I wanted to have the freedom to eat whatever I chose and not dump. I've learned that only a minority of RNY patients dump and that among those who do, dumping often goes away over time. I didn't want malabsorption. I've learned that the small intestine will grow more villa over time to improve absorption (not enough to eliminate the need for lifelong vitamin supplementation, but enough that more calories are absorbed over time). I've also learned that lifelong vitamin supplementation is necessary for sleeve, as I now produce insufficient intrinsic factor to absorb adequate B12 through my gut. I had a hang up with the physical removal of 80% of my stomach from my body. I got over it by watching videos of sleeve surgeries and reassuring myself that if something truly went wrong (such as intractable GERD), I could convert to bypass.

I also know myself. I had no concerns about my ability to lose 100% of my excess weight (I'd already done so on three prior occasions), nor was I concerned about how fast I would lose it (easy for me to say; I am and always have been a fast loser). My eye is on maintenance. Having a snowball's chance of maintaining my fourth massive weight loss for the rest of my life is why I did this.

As for successful sleevers, I've lost almost 200#. Jolls has lost almost 200#. PapaG has lost over 200#. Srattee has lost almost 200#. Srattee is converting to bypass due to complications with his sleeve. It's also possible to convert to bypass or duodenal switch down the road in case of inadequate weight loss with sleeve.

In the end, a pouch or sleeve is just a tool, a very powerful tool, but a tool nonetheless. What matters is your preferences, your expectations, and your willingness and commitment to doing your part to create and maintain your own success.

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While I certain am more preferential to sleeve (obviously since I had it) I would never try and talk people out of bypass.  We have these options for a reason -   because one surgery is "better" for that individual person for health or personal or both reasons.   You have to pick the surgery you think will be best for you is the bottom line. 

I also had 250+ pounds to lose and when I went to my first consult I thought for sure the surgeon would tell me I should do bypass because of my sheer starting BMI - but when he asked and I said I wanted sleeve all he said was "excellent choice".   I lost 237lbs at my lowest which still left me technically about 30lbs more to lose to be a "normal" BMI.   I did not lose the additional 30 and I have since gained almost 50lb back.  This is not the sleeves fault.  I still have the sleeve, it still gives restriction -  I don't do my part with eating and making proper choices.   I would still choose the sleeve even after all this.  It very simply is just the better fit for me.    If you feel bypass is the better option for you then that is what you need to do despite what others might say.  You have to be comfortable in your own decision as this is truely a LIFElong journey you are about to partake on.   WLS gets you so far -  then it is alllllllllllllllll up to you to maintain or continue on in the future.

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I will be a week out tomorrow! I wanted the sleeve because I did not want my intestines touched because of my own medical problems. I felt that other than that it didn't matter what I chose to do because it is only a tool! I would need to put in the work with either sleeve or bypass!

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20 hours ago, Jolls said:

While I certain am more preferential to sleeve (obviously since I had it) I would never try and talk people out of bypass.  We have these options for a reason -   because one surgery is "better" for that individual person for health or personal or both reasons.   You have to pick the surgery you think will be best for you is the bottom line. 

I also had 250+ pounds to lose and when I went to my first consult I thought for sure the surgeon would tell me I should do bypass because of my sheer starting BMI - but when he asked and I said I wanted sleeve all he said was "excellent choice".   I lost 237lbs at my lowest which still left me technically about 30lbs more to lose to be a "normal" BMI.   I did not lose the additional 30 and I have since gained almost 50lb back.  This is not the sleeves fault.  I still have the sleeve, it still gives restriction -  I don't do my part with eating and making proper choices.   I would still choose the sleeve even after all this.  It very simply is just the better fit for me.    If you feel bypass is the better option for you then that is what you need to do despite what others might say.  You have to be comfortable in your own decision as this is truely a LIFElong journey you are about to partake on.   WLS gets you so far -  then it is alllllllllllllllll up to you to maintain or continue on in the future.

I totally agree with Jolls that the choice of which surgery to have is a personal one that each person has to make in consultation with their surgeon.  There is no universal right or wrong choice on which surgery to have as every overweight person and their health issues and needs are different.  The important thing is to make the choice in an informed manner and not based on limited research into the relative benefits to you of the two types of weight loss surgery.

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research go to the meetings and ask questions and it's a personal decision. I had the sleeve and I lost 100% of my excess weight. and I still have restriction in amount of food I can eat and no adverse medical issues due to malabsorbtion.  I chose the sleeve because during my research I have found that cancer patients that had stomach cancer had large portions of stomach removed and had weight loss and this has been going on for many years. was it a sleeve per se no but same  basic surgery. I love my sleeve. but both surgeries are going to change your food relationship so the surgery choice is yours and yours alone 

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Marcia, I keep forgetting about the long history of partial and full gastrectomies in the treatment of stomach cancer. My uncle had a full gastrectomy after being diagnosed with stage IV stomach cancer, and he had a full gastrectomy. He's been cancer (and stomach) free for more than a decade and a half. 

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The first surgeon I consulted with asked me what procedure I felt was right, then told me he likes to let the patient choose if there are not other factors that really suggest one particular one is a better choice.  He said it is because he feels if it's the patient's choice, they're more willing to work with it and make it work for them. 

The sleeve was right for me.  I don't regret my choice.  I think you'll find that people are generally happy with the decision they made for them - I'm sure all of us here did pretty extensive research before selecting our procedures.  Some people are in the camp of being skeeved out at the thought of 80% of their stomachs being gone forever.  Others are in the camp of not wanting rerouting and malabsorption.  And there's nothing wrong with either camp, you just have to figure out which works best for you.  

The question about cheating is difficult.  I understand where you're coming from.  I think a better approach would be to help educate your sister more as you learn, what the procedure involves, how you get and stay healthy, etc.  It's not a diet.  There is no cheating.  It's a new lifestyle and it's all about choices.  If you make a bad choice, you may not feel very well.  You may regain weight.  But that's life in general - it's about choices and consequences, right?  Can she come with you to the information session?  Or a nutrition class?  Learn together.  

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First, HUGE thank you to all the feedback!! I definitely appreciate all the conversations about it I can get, I really want to make an educated decision about all of it. I do have a few questions to throw out there that anyone can answer!

First, with the hypothetical gastric bypass, were I to have it - the multivitamins. I know I have seen a LOT of people talking about the sales at CVS and how wonderful they are, and since I go to CVS for my regular prescriptions, it would be perfect to be able to get my vitamins there, too. How much does each usually cost, ballpark, with these sales? I've heard of some BOGO deals? How often are the sales?

I know that everything I've ever read on carbonated drinks says they're not allowed, and I'm willing to accept that, but I'm just curious why? Is it because it forms gas in your stomach and makes you feel fuller than you are? Or because the carbonation is actually damaging somehow?

Also, I did a few different online seminars for a few different bariatric surgery centers around me, and this popped out at me. I have pretty severe acid reflux. I have to take Omeprazole daily or I will be in so much pain. This being said, I read that the sleeve actually gives some people acid reflux? And makes it much worse in those people who already have it? Is this credible? Because if so that definitely takes me out of the running for the sleeve!

As for my sister, she already has assured me that she'll support me no matter what I choose, she is just wanting to make sure that I can live with my decision. I have a bad habit of rushing into things and regretting it later lol so she's just looking out for me. But I know she'll be the one taking care of me after surgery, if it happens, so she'll definitely learn everything she needs to know about it. 

I also wanted to ask, when it comes to anti-depressants, how does that work exactly? Are there liquid forms of most of them?

Again, thank you SO much to everyone who replied!! I read every word and appreciate it so much.

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I buy my vitamins from Amazon, Vitamin Shoppe, and Walmart. Vitamin Shoppe has a semi-annual buy one get one 50% off sale, when I stock up on B12. Links below. I also take omeprazole every day (Walmart brand, extended release capsules), although I think I could discontinue that one at this point. Pre-op I was concerned about whether I could have VSG because of GERD. I chose to risk the possibility of exacerbating my silent GERD, because I was also getting a hiatal hernia repaired. I've been fine.

I also take an antidepressant (bupropion extended release). My doctor had no concerns with either the drug or the form (extended release tablets). 

Two multivitamins per day  https://www.amazon.com/gp/aw/d/B002RL8FCU/ref=mp_s_a_1_1_a_it?qid=1466493346&sr=8-1&keywords=kirkland+multivitamin&pi=SY200_QL40

Vitamin D3 1000 (one drop) per day  http://m.vitaminshoppe.com/m/p/vitamin-d3-5000-iu-1-fl-oz/vs-2714

B12 1000 mcg lozenge  http://m.vitaminshoppe.com/m/p/b12-methylcobalamin-1000-mcg-120-lozenges/vs-1730

Calcium citrate  http://www.walmart.com/ip/Equate-Calcium-Citrate-plus-D3-Maximum-Calcium-Supplement-Coated-Tablets-180-count/36169187

I choose to also take 

Fish oil https://www.amazon.com/gp/aw/d/B002CQU55K/ref=sxl1_a_it?qid=1466493780&sr=1

Probiotics  https://www.amazon.com/gp/aw/d/B00MXDEFYO/ref=sxl1_a_it?qid=1466493875&sr=1

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My doctor signed me up for auto mail of vitamin B12 shots and all the other vitamins you need after surgery. I have so many bottles I don't know what to do with them. I purchased gummies as they are easier to digest for me. The ones I get are chewable and I am not fond of them. If anyone is interested in buying them off me let me know. I have plenty. 

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many surgeons do not allow gummies. I guess they are afraid they will get stuck or something. The other reason is that 99% of gummy multivitamins do not contain iron which is an important mineral especially for bypasses.

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My programme excludes gummy multivitamins.  And most aren't comprehensive and don't meet the asmbs.org recommendation of 100% RDA for VSG/gastric band or 200% RDA for gastric bypass patients.

On the iron thing, I prefer to use an iron free multivitamin because it allows me to take calcium citrate at one and the same time.  I take my iron (with a vitamin C supplement) about an hour before bed so that it has all night to do it's thing.

 

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I go to costco and get gummies. trying out bariatric advantage now that I got at my surgeons office. aS to the acid reflux question everyone is different. I was on omeprazole like you I had horrible acid reflux before my sleeve. I've never had another problem with reflux since surgery. but each person is differentirely with either surgery ive heard from others you could still have some reflux.  and as for the price at CVS anywhere from 5.99 and up for vitamins. 

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