QuietMissB

New to this, and a little lost

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Hello!

I am new to this journey, and have been lurking but finally decided to join in the conversations.

I recently started the journey to WLS after years of failed diets, personal trainers, and attempts at losing weight. I've had initial appointments with doctors and dietitians, have my psych eval scheduled, and am ready to run down this path to hopefully having surgery at the end of the year.

I am struggling, though, in choosing which type of surgery to go with. Although my PCP has admitted that surgery is likely my only option at this point to reach the meaningful weight loss that I need, she is not a huge fan of it. She states her reasons mainly as the vitamin deficiencies and rates of things like osteoporosis in the longterm for RNY patients, and the lack of long term data for VSG on these issues. The PA at the weight management clinic that I am working with, along with the Dr. who will likely be my surgeon, have said that VSG is the only surgery they prefer to do because of the ease of it and fewer complications after, and most of the family/friends that have done either RNY or VSG have said to go with RNY. All of this is to say that I feel so lost.

I am a numbers person, and I can find 5-, 10-, 15- year and beyond data for RNY outcomes and complications, but with VSG a much newer standalone procedure, that data isn't available. All of this to say, I am struggling and a little scared of making the decision. I feel very pressured to make a decision now, and I feel like I am being kind of forced down a road by the clinic without feeling stable in any decision I make.

Any advice?

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Welcome! I think the type of surgery you get is far less important than sticking to the program. You really can be successful with either one. You'll arrive at your own decision for your own reasons. I have murderous monthly cramps, so being able to take NSAIDs was key for me in choosing the sleeve. 

If you have diabetes or acid reflux, gastric bypass is the way to go. 

There are many many threads here you can search for where people explain why they chose the surgery they did. Stick around here, though, and you'll see surgery type will matter far less than your level of dedication. 

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58 minutes ago, QuietMissB said:

Any advice?

Ha ha loads of it. And it's all free, so take it for what it's worth :-)

1. Do not let yourself feel pressured into jumping into a specific decision. Like most things in life, YOU must be your own best advocate. Take the time that you need to research your options and feel comfortable with your decision.

2. Do not even consider the Lap band. That is all.

3. Seriously, you should consider finding a new PCP. If you truly are considering WLS and want to go that path, then you simply MUST have a PCP who is onboard with your decision, and excited for you and supports you. My PCP of 20+ years was so enthusiastic when I sheepishly asked him what he thought of me getting WLS. It was so liberating! Then he retired while I was in the middle of pursuing it, and the new guy was equally as supportive, and he was genuinely happy for me post-op. I believe you really need this kind of support post-op from your primary medical provider.

4. In a short nutshell, my take on the differences between Sleeve and Bypass...

  • Statistically, will lose more, and faster with bypass.
  • Sleeve will definitely compound your existing acid reflux/GERD issues (if you have them), and quite possibly give you those issues if you don't.
  • Bypass will require a more rigorous vitamin regimen, for life. It's quite doable though- some in the morning, some in the evening, some chews in the mid-day. You won't die if you miss a dose or get it wrong early out.
  • Bypass requires that you pay closer attention to not drinking 30 minutes before or after a meal, or during a meal. Bypass removes the valve that your stomach uses to let liquid pass through the stomach but not food. Sleeve does not have this issue since the stomach itself is left intact, just a large part of it removed. Then the remainder gets rolled up like a waffle cone :-)
  • You will no longer be able to take NSAIDs like ibuprofen after bypass. This is generally not an issue with sleeve.
  • Alcohol will hit you a lot harder with bypass.
  • Gastric bypass will usually, almost instantly, normalize your blood sugar and take away your Type 2 diabetes. It's the main reason I went with bypass.

Whichever way you go, I will just add that first and foremost, you should be committed mentally to the new eating style that you will need to adopt post-op. The surgery is only a tool, and like any tool, it can mis-used, or not used at all. It is not a magic bullet and you can only hope to get out of the surgery what you put into it. But this whole forum is a testament to the many many people that have proven that WLS surgery combined with determination and a strong desire to shed the fat, will see you successfully on your way.

Congrats on your decision and don't forget we are all here to help you :-)

Edited by Michael_A

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1 hour ago, Michael_A said:

 

3. Seriously, you should consider finding a new PCP. If you truly are considering WLS and want to go that path, then you simply MUST have a PCP who is onboard with your decision, and excited for you and supports you. My PCP of 20+ years was so enthusiastic when I sheepishly asked him what he thought of me getting WLS. It was so liberating! Then he retired while I was in the middle of pursuing it, and the new guy was equally as supportive, and he was genuinely happy for me post-op. I believe you really need this kind of support post-op from your primary medical provider.

 

I guess that I should clarify. My PCP is not an overall fan of surgery for the above stated reasons, but she did state that it is my only really viable option now, and that if I decide to go ahead with surgery, she will support me 100% and do everything to help me be successful.  She recommended that I do consults and gave me information on my options. This is actually the reason why I love my PCP. When I started having clotting issues at 25 (I am now 30), she laid out options for meds and such. I went with an option that was not her top recommendation for me (for a number of reasons) and she helped support me as I navigated its use. I ended up moving later to her top recommendation, and it was much more beneficial to my health and lifestyle. I say this all to say that she is very supportive of patients directing their medical care, and she will do everything she can to help them succeed in whatever route they choose.

I greatly appreciate all of your insight. Many of the facts that you state are why I lean toward the sleeve. I just wish I had numbers. LOL  I also get hesitant when it comes to some of the horror stories I hear about acid reflux/gerd. The minor bouts with heartburn I have experienced in my life are more than enough for me.

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41 minutes ago, QuietMissB said:

I greatly appreciate all of your insight. Many of the facts that you state are why I lean toward the sleeve. I just wish I had numbers. LOL  I also get hesitant when it comes to some of the horror stories I hear about acid reflux/gerd. The minor bouts with heartburn I have experienced in my life are more than enough for me.

Ok, that makes more sense now about your PCP.

Regarding your desires for numbers, I get it. But compared to bypass, the sleeve is still new enough that those long-term numbers aren't there. I will say this though, this forum, I believe, is probably made up now of about half sleeve and half bypass. The VSG is rapidly becoming the WLS of choice among folks that don't have any specific issues, or co-morbiditites, that would make gastric bypass more appropriate from them. Just give it a bit and I'm sure you will get plenty of responses from other sleevers here. I know many of them are several years out post-op and are very successful. I think what @Gretta said is absolutely right- it's less the specific surgery, and more the head issues, that will determine your future success.

I encourage you to read through this forum and all the posts here and you will learn a lot, quickly.. I believe this group of people here. more than any other I found when I was looking for a support forum, definitely preach the "tough love" when you need it and speak the truth to you/us about "real" life in the trenches of the WLS lifestyle.

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If you want data on weight loss surgery, the 1/16/18 issue of JAMA had quite a few interesting articles on large group studies of weight loss surgery.  Although the full texts of the articles are behind a "pay wall", the general summaries are here:

https://jamanetwork.com/journals/jama/fullarticle/2669714

If you go to any of the articles that interest you on line through the above link, you will find some additional study details are provided.

By the way, I have never regretted having a gastric bypass.

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Hi and welcome to the forum .  I had chose the RNY in the beginning, I switched to the sleeve the day I scheduled my surgery because I really felt that I would need medication that I couldn't take with the RNY. I did in fact get acid reflux/Gerd, but medication has taken care of it and I am happy that I switched. That being said,  Gretta is correct either choice you make you must stick with the program in order to make it a success. Its a life change for sure and its worth it.  Good Luck

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Welcome!  You’ve got about 6 month to do your reading:). I had diabetes, high blood pressure, kidney issues and high cholesterol.  I took 18 pills a day, I now take 1 thyroid pill.  I wasn’t really given a choice with the diabetes.  Wls is the best thing I’ve done for myself.  

With either surgery, you will get what you put into it.  You can defeat either surgery one bite at a time...good luck!

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On 4/11/2018 at 9:55 PM, Gretta said:

If you have diabetes or acid reflux, gastric bypass is the way to go. 

There are many many threads here you can search for where people explain why they chose the surgery they did. Stick around here, though, and you'll see surgery type will matter far less than your level of dedication. 

I have been working for the last couple of years to change habits, and although my habits around food have gotten better, I know I have a lot of work to do yet. I know that surgery isn't a fix-all, and that I need to fix my thoughts and habits about food to be successful, and I know that sometimes that is easier said than done, which is why, when I saw how supportive this community is, I had to join in.

I never used to have issues with acid reflux, and so that was not really part of the discussion, but as I refine my diet in some ways, I am starting to get really bad heartburn somewhat often. I am hoping that once I am able to fully give up the caffeine (my biggest weakness) and high citrus fruits, it will subside. Definitely going to have to bring this up with my doctor, though, as it has become a big concern.

I guess my biggest stressor right now is my doctors making me feel like I should have already decided on a surgery, and feeling pressured to choose one over the other. Even if the sleeve ends up being the right choice, I still don't like feeling pressured. Does that make sense?

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Resist the pressure. There's no reason to have already decided.

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@QuietMissB You want numbers? You need the wisdom of Ms. @Jen581791 . She’s the stats MVP of the forum. :)

Welcome and best of luck to you which ever way you decide to go. 

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Hello. I had WLS about a month ago. Like you, I was very torn between the two surgeries. I researched both and reflected ad nauseum. I had my surgeon going crazy and at my final preop appointment, I made my final decision (and hoped it was the right one.)

What i can say is this; I believe it was the right one FOR ME. My surgeon told me he had never had an appointment last that long. I didn’t care. He answered all my questions and we listed all the pros, cons, and differences. Like you, I found more research on bypass. 

My advice to you is to make the best decision for you. The surgeons do this all day, every day but this is your one and only! If you feel pressured and uncomfortable, find a new surgeon. It is your body and your life. Whichever option you chooose should be an educated one that feels right FOR YOU and not them.

You will come to a decision that suits you and it will be the best decision that you ever made. I know, so far, that I made the best choice and couldnt be happier!

Good luck.

 

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@Michael_A and @Gretta + the rest of the group covered most of it. I will add if you are a drinker and you don't want to give it up completely, educate yourself on the effects of alcohol when you have a by-pass. 

 

 

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On 4/17/2018 at 6:42 PM, NerdyToothpick said:

You want numbers? You need the wisdom of Ms. @Jen581791 . She’s the stats MVP of the forum. :)

Word.

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On 4/12/2018 at 6:10 AM, QuietMissB said:

I am a numbers person, and I can find 5-, 10-, 15- year and beyond data for RNY outcomes and complications, but with VSG a much newer standalone procedure, that data isn't available. All of this to say, I am struggling and a little scared of making the decision. I feel very pressured to make a decision now, and I feel like I am being kind of forced down a road by the clinic without feeling stable in any decision I make.

 

On 4/18/2018 at 6:42 AM, NerdyToothpick said:

You want numbers?

Ooh, I didn't ever reply to this! 

I think the suggestion to look at the most recent issue of JAMA is a good one. The most up-to-date info you'll find is there, and there are quite a few interesting studies. RNY has great stats, but it seems to be looking more like VSG is accumulating some really good stats, too, despite the fact that it's newer so hasn't been studied for as long. 

I know this is a huge concern for someone choosing to do WLS, but as soon as my decision was made, I was happy with it, and I think most people are happy with their procedures. It seems like this huge fork in the road where you have to pick which way you're going to move ahead, but I think that it's actually more like two roads running parallel to each other - they'll both get you to about the same place, just with slightly different scenery along the way.

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