More reasons to choose

[dianeseattle]

I had RYGB with an open incision almost 13 years ago (August 20, 2007). The sleeve was not available to me. At that time, here in Seattle, there was one surgeon who was nationally regarded as one of the best bariatric surgeons in the world. He was a surgeon who did many other procedures. His waiting room was always overflowing with people seeking surgical help.

I don't remember how I chose him, but I had been to a few seminars at other medical centers and it didn't look like I was going to be able to qualify for their programs. I looked into university studies as well. Most big cities have a world-class hospital and in Seattle, it's the UW, or yoo-dub, or the University of Washington Medical school, which had campuses all over the city.

I was on Medicaid and Medicare already from a disability, already on SSDI, with limited options. If I wanted to wait a year, the surgery would be fully covered by my insurance at the UW Hospital. But if I could find a way to get that extra 20 percent that wasn't covered, I could have it at Virginia Mason, where this storied surgeon worked. As I was trying to decide, there was a story about him on national news, focusing on the fact that he was enlightening people to his belief that weight-loss surgery was, literally, a cure for diabetes. Doctors are not allowed to use the word "cure" unless they have one. It's malpractice to suggest you can cure anyone of a disease unless you can prove it medically. Fortunately, because he was working on a UW campus, records were being kept on his performance and results.

I then made my decision to see him, and I applied for Charitable Care to the hospital to have the balance covered by them. They accepted me and I never paid a dime for anything I needed, including a year of post-op nutritional follow-up. Because of his successes & his claims of a cure, the UW had also applied for federal money to begin a study called LABS, Longitudinal Assessment of Bariatric Surgery. You can read the results online or in the JAMA. I enrolled in the study and was followed up for 7 years. I'd still be in that program if the feds hadn't cut the funding. It's awesome to have the results, though. Every tiny detail is covered, from my bloodwork to my physical improvements.

I was at low-risk for diabetes based on my bloodwork, but everyone in my family had died with diabetes contributing to their death, as well as cardiovascular disease (stroke, in particular). I had watched it happen in front of my eyes, including with my father, who almost died one day in my car when I was driving us around to the tourist attraction he had created (the landscape of Rocky Reach Dam in Central Washington). He was barely conscious when I took him to the hospital and had almost no blood pressure. A year or two later, he did die, in November 2006. That was the day I decided to find a way to change my health. I loved my dad so much. But as I watched him decline, growing weaker even outside the hospital, having his livelihood taken away (he was a famous landscape gardener and floriculturalist) because he could no longer stand for more than a few minutes, it was a wake -up call. I knew he wouldn't want doctors doing all the things to me that they were doing to him.

In fact, the day he died, I was packing to get on the train to go see him in the hospital. I was also taking a class that was required for the Voc Rehab program I was in. I was told I could not skip the class, even though it was the last one and my mom had phoned a day or so earlier, leaving me a message saying the home-healthcare person had been by and told her my dad didn't have much longer to live, even though he was riding his scooter to McDonald's to meet the guys for coffee and going to his garden every day to do what he could do. Close your eyes while I write the next word: motherfuckers wouldn't let me skip the final class, which wasn't even instructional. It was just a day when all the students presented their work. They didn't need me. I was part of a team. They could get along without me.

So after class I was packing to take the 3 o'clock train when my sister called and said she'd just left the hospital after seeing Dad, but they'd phoned her and told her to come back because he'd had a cardiac event. I could barely breathe. I was just a few hours away from his bedside. But 10 minutes later another sister phoned and told me he didn't make it. The nurses wanted him to get out of bed and take a few steps for the sake of his circulation. He kept saying he couldn't but they insisted. As soon as they got him vertical, he had a massive heart attack and fell to the floor and died.

Didn't intend to go into this, but when she called and told me that, I let out a scream I didn't know I had inside me. I couldn't stop screaming, wailing, crying. Then I got my roommate, who was my exhusband, to take me to find my son at work so I could tell him and bring him back with me so he could also pack for the train, which still had to happen. I could barely walk from the car to the building where he worked. I wanted to die on the spot.

Anyway, that's when life as I knew it ended forever. But it was also the moment that turned into my motivation to get healthy, to lose weight, to have RYGB surgery and be there for my child until he was a very old man so he wouldn't have to feel the pain I felt for so much time after Dad died. I mean, it destroyed my family. He was the bridge between us all. We were able to cross over our differences and be civil to each other and socialize and act like human beings. When Dad was gone, everyone lost accountability. They didn't want to please anyone anymore. We each had our demons and we just couldn't care less about the ones that possessed our siblings. I had five sisters and two brothers and a mother who was still alive, but without Dad, I no longer had a family. I felt like I was living in a nest of vipers.

Boy, I hope someone got something out of this story. I took a sharp left turn from what I had intended to write and now am going to take a break to put my emotions back together before I write again. My intention was to talk about sleeve v. RYGB. I'll do that later.

 

[dianeseattle]

IMAGES OF FOUR SURGERY RESULTS

How do you choose the right surgery for your comorbidities?

The three most common and accepted today are a) RYGB (Roux-en-Y Gastric Bypass), b) LAPBAND (rarely used and generally considered unacceptable or banned completely in nations like Canada) and c) VSG (Vertical Sleeve Gastrectomy, performed laparoscopicly) . A fourth technique is still being evaluated (and in long research studies, but seems promising, though risky, as so many intestines are removed) called the Duodenal Switch, or DS.

DUODENAL SWITCH

VSG

LAPBAND, ADJUSTABLE

As near as I can tell, the DS is in a position to overtake RYGB, which is considered the gold standard for bariatric surgery. The VSG is popular and most likely the most performed right now because it is easy for surgeons to perform, hardly invasive, and rarely requires a hospital stay.

Even though the lapband doesn't merit discussion because it is so faulty, I have to include it as a cautionary tale. Many members who've had surgical revisions 20 years after getting a lapband can tell you about the dangers. The band can slip, can become part of your stomach as it shrinks, cause weight gain because it moves and starts causing digestive problems. In some cases it can occlude the pouch it creates to the extent that it screws up eating entirely. It should never be chosen, and it is being phased out of existence in most medical facilities.

VSG is fast and easy. There's very little downtime and because it's done laparoscopically, no big incision. However, the stomach itself is usually removed completely so there's no going back if it fails. Also, because it's fairly vertical, it creates a friendlier environment for reflux. I believe it's actually being pushed by a lot of surgeons because the procedure is so simple and quick that docs can make more money every day. And it does create a pouch, but it's not extremely small and allows a straighter shot to the duodenum, with little digestion. And because they remove the entire old stomach, the appetite-suppressing grehlin hormone is pretty much gone so its warning signals are weaker.

RYGB is the most-performed bariatric surgery historically, though VSG is probably catching up or even overtaking it. Most RYGB has traditionally been done with an incision. It takes longer to heal from the open procedure, but it is a satisfying way for surgeons to see their work so they feel certain they did it right. It is the true bypass, but your stomach is not removed. Because of that, your stomach as an organ is still alive and still secreting grehlin. Recovery feels more normal, though it takes longer. RYGB is now being done laparoscopically, too, which may reduce hospital stay time, though I'm not sure about that yet. Don't be confused if you are looking for RNY surgery and don't find it listed at hospitals. That is an incorrect acronym which uses the "en" as if it were a capital N. "en" is just a conjunction that connects "Roux" to "Y," and can be omitted entirely.

RYGB has beeen most effective at literally curing some types of diabetes. More than anything else, that is the benefit of RYGB surgery. However, even though it's generally been the most efficient and quickest form of weight loss, there's another new technique--the duodenal switch--that looks like it's more beneficial and increases the rapidity of weight loss.

The Duodenal Switch (DS) is laps ahead in the race to cure diabetes. It does require a lot more work and removing intestine, so it might be a risky procedure. It's being written about at all the bariatric sites, such as ASMBS, the American Society for Metabolic and Bariatric Surgery. That organization is pretty much the bible of this type of medical science. However, it doesn't have a support group and American Bariatrics Organization does, right here.

The switch is complex and not in wide usage yet, though it's probably the future of bariatric surgery if doctors and insurance companies can work it out so both benefit from it (not to mention the patient). If I were having WLS today, I think I'd ask for the switch.

If you query surgery subjects of the last 40 or 50 years, you'll find a lot of necessary surgical revisions. In order to have a revision if your surgery has stopped working or has presented a new challenge, you need some lengths of digestive organs to rebuild. Read that twice. You can't grow your intestines or your stomach or your esophagus back.

Because of that and that alone, I will always get behind the RYGB. Of course, that's what I have. And I'm going on 13 years with this digestive revision. The weight loss was rapid, though I did plateau for about six months. I am not a patient woman and I wanted to be thin tomorrow! My entire journey took 14 months and of course, that's the amount of weight I could have lost without surgery over the same period of time. But I couldn't. I tried 100 times. I couldn't stick to a diet where I'd only lose a pound or two a week if my life depended on it, and it did! I didn't take the easy way out. I took the hard way! Weight loss surgery is not a teeth-cleaning or knee surgery or a few stitches when you cut your finger in the kitchen. It is a profound revision to your digestive system, but it's not designed to zoom you down to a naturally healthy weight.

The reason it takes time is because we have to relearn how to eat. We have to deal with our demons. We are constantly feeling humiliated in public. We don't think we deserve to be healthy or thin. Our heads are still fully captured by our eating disorders and there's a lot of the Familiar to surrender to the Unfamiliar. Many people agonize over the entire period, whether its a year or two or three on a post-operative journey. We don't realize how much time and effort we put into gaining 100 pounds. That's not easy. You have to work on it hard for a long time. Virtually no one is born obese, or with an eating disorder. We are brainwashed for years, decades, even past middle-age, before we can see clearly. Most people don't try for WLS until a doctor says they're developing diabetes, their cholesterol is high, and the plaque in their arteries is slowing blood flow to the heart and brain.

Maybe it won't matter what surgery you choose. Like Strother Martin's character famously declared repeatedly in Cool Hand Luke, "What we've got here is a failure to communicate!" It's kind of eerie how well that movie parallels the struggles and obstacles obese people face in the world. Thank God we have the option of WLS. Nothing else will ever work. Bust out of prison and find asylum in your surgeon's office, where you can find real freedom.

And don't ever let anyone take your inventory. Make the right choice for you and do not allow negative comments to become part of your self-esteem.

I hope this is helpful and that I didn't make too many errors in my interpretations. Feel free to correct me if you know I made a mistake. It's super-important to get this right. The best thing you can do if you need to research surgery types is go to a great medical center with a bariatrics program. Most introductions to WLS are free of charge, done in groups with PowerPoint presentations. Then, you can decide.

Use your gut for instinct, not for overeating.

 

[catwoman7]

DS is actually a fairly old surgery. It's a complicated surgery, not commonly done, and not many surgeons do it. It's very effective but has the highest risk of all the currently-done surgeries. And RNY is almost always done laproscopically these days - the only people who've had open ones that I know about had them many years ago.

I had RNY and stayed in the hospital two nights, but it seems like a lot of the recent patients at my clinic stay one night. VSG is typically one night. Recovery on both is about the same.

Basically, if you have GERD prior to surgery, go with the RNY as it often improves if not cures it. If you don't have GERD, it really comes down to personal preference.

 

[WazzuCoug]

The image you have for DS isn't quite right. It has been around for a long time, and a VSG the first step of the process of getting a DS. They noticed people were having success with just the VSG, so there was a move away from DS since it is a major rerouting of the intestines and has way more complications than the RNYGB or VSG. It is usually only presented as an option for extreme morbid obesity, and even then not often recommended from what I understand. I've known plenty of people who have had success with VSG and RNYGB. I chose VSG because I preferred to keep my GI tract in-tact vs. re-routing. It just felt a little more straight forward, so to speak. I wouldn't steer anyone away from a RNYGB, but it just wasn't my preference. I think if people commit to change, either method will provide incredible results.

I'm off all diabetes medication and 2 of 4 blood pressure meds, and expect to get rid of all of them before too long. I'm currently 12 days post-op.