I had my meeting with the surgeon- but now I'm on the fence again.

I had my mind made up before I went in that I wanted DS. When I called the office they told me he generally doesn't do DS on people with a BMI under 50 so I went in expecting him to flat out tell me no. 

He was so nice about it. He didn't try to talk me out of it. He answered all of my questions and spent about 40 minutes with me. 

So here's what has me anxious. 

1. He said that many DS patients have issues with nausea for about 3 months or so. (Would I still be able to work, etc?)

2. He said that he might be a little biased but he has a lot of patients who had DS longer than 10 years ago (done by a surgeon who was there before him) who didn't have issues with malnutrition until many years out. He said it kind of creeps up on you. So my response to that was-- you can fix that by taking vitamins and supplements, right?? He said not always. Some people have to have iron infusions, etc. He said the other big thing is problems getting DSers to get in enough calcium long term to avoid osteopenia and osteoporosis. He said some of his DSers who had it done a long time ago have had a lot of issues with that. 

He said , even with the DM and HTN they are relatively well controlled now. Is it worth the extra risk to lose an extra 10 -15% percent weight? He said because my DM isn't severe now he feels like if I can maintain my weight after RNY my diabetes likely would not come back.... 

I asked him if I was his sister what surgery he would recommend and he said RNY....

He said that he would do the DS if thats what I really wanted... but I still got the impression that he didn't think it was a good idea. 

Now I'm feeling anxious about my decision. 

I am worried if I have DS something really bad is going to happen.... LOL.... But then again, I am a worrier. 

I think the other big thing is that I am the bread winner. My husband only works part time so if I were unable to work we would be in trouble. :(

You're letting the cons out way the pros. A point to think about is affordability. Can you afford the vitamins required of the DS? Can you afford dealing with diabetes when it comes back after having the RNY?  Can you deal with the regain that happens many times with the RNY? I drew up a pros and cons list and it helped my support my decision. Wishing you all the best regardless of your decision.

--gina

Yes, I can afford the DS vitamins- at least as long I as I am still working. LOL. 

I asked about the regain in RNY-- he said about 15 %, 

I don't know about all of this. I just did some looking on line. Looks like RNY folks are at risk for metabolic bone disease too.... 

All of this has me just scratching my head....

I hate to assume that the worst will happen, but I don't want to be kicking myself 15 years down the road if it does and be regretting my decision. 

Oh, and I forgot, he said he also has to do a couple of reversals a year as well for severe malnutrition. 

He was telling you the bad stuff not the good. My surgeon's stats for RNY are 20-25% late (2-3 years) weight regain of 20 - 30% of the pounds lost. 60-65% of excess weight lost. 1-2% malnutrition and vitamin deficiency. Failures are converted to DS or are revised to reduce pouch stretch or anastomotic stretch.

DS: high success rate (80-90%). 70-75% excess weight loss in 1 st year and 80-90% at 2-3 years. [heavy weight stats]. Low failure rate with long term follow-up required. 5-7% malnutrition & vitamin deficiency [we know what causes that now]. No mention of failures converting to anything...no mention of failures at all.

--gina

I had a similar experience with a surgeon who kept telling me the DS was too much risk for the gain of losing another 10-15% of my weight.  I went home and did more research.  I lurked and read what everyone posted about complications and health concerns, and finally... finally.... I asked myself which surgery really fit me, the way I like to live, the way I have always eaten, and how I took care of my medical issues.

1.  Some new people have reoccurring nausea until their doctor finds the right meds for them.  We also will have a bit at the beginning as we learn what to eat and what doesn't agree with our stomachs - and that comes with every WLS.  IMO, he has exaggerated the nausea issue

2.  10 years ago I bet those DS patients were given terrible, wrong nutritional guidance.  Heck, I have a hard time finding a nutritionist who knows what they are talking about now!  So for years those DS patients were not taking the right vitamins, taking vitamins in oil, or eating the wrong foods – Of course they are going to have osteo issues 10 years later.   I say I wished I had gotten it 10 years earlier... but I'm glad I did it last year because the information available to me now is probably 20 times better than it was back then.

Secondly, my mother and 5 aunts had osteo issues and none of them ever had the DS.  If you don’t stay on top of your vitamins and labs, you will have problems later on.  Just like every other woman who is aging.

3.  Diabetes maintenance:  Check your facts on this.  Laura could speak to the percentages of reoccurring Diabetes for both surgeries.

Keep on reading and thinking about it.  Ask your surgeon why there is such a high rate of failure for the RNY, and what causes those failures.  That should give you a good idea if you can be successful at an RNY.  When I asked my surgeon, his answers showed me that I would have a better chance of keeping 100 lbs off 10 years from now using the DS.

Good luck.  Only you can make the right decision for you.

Another thing to remember, we have our levels tested so we know when we are low on calcium, D,  whatever.  But guess what, a huge percentage of the general public has this issue as they age and they never had WLS.  They just don't find out about the problem as soon as we do.

Some people do have the issues your doc described.  But most don't.  Some people do fine with the RNY.  Others are sick all the time and many gain the weight back as soon as the effects of the malabsorbtion disappear.  Sad, but the five RNY people I know are as heavy or heavier than they were before the surgery.  One kept the weight off for 6 years and the others gained it back faster.

Diabetes...ask any expert, it only gets worse as you age.  Me personally, I would take 3 months of nausea over going blind or having my feet amputated.  And diabetes is the leading cause of blindness and amputations in adults.  My H had the DS for diabetes in Spain because his feet kept getting worse even though his HA1c came back normal because he controlled his diabetes with passion.  He had retinopathy as well and it completely resolved post DS.  He was seeing his future as blind and in a wheelchair.  He took the chance and the last 10 years of his life were good.  He could eat and live like a normal person.  No more worrying about the diabetes.  It was gone.

You know you.  Part of this is leap of faith.  You just take your chance and do it.  We take  chances every day and the truth is, you can get waxed going out to check the mail.  It's all about risk VS benefit.

There are some who have kept weigh off and had long term success with RNY surgery  I was not one of them. I had surgery 11 years ago and gained almost all of my weight back. It took awhile but it came back. I recently had revision surgery to DS. I agree with the posters above me. Only you can weigh the risks vs. benefits and determine what is best for you. 

Think twice cut once...

Best

Whit

Personally I would have fired him and gone with another surgeon.  My surgeon had absolutely no issue with doing a virgin DS on me with less than 100 lbs to lose.  He had stringent pre-surgical hoops, but the hoops were the same for the DS or the RnY.

I wouldn't wish and RnY on my wosrst enemy much less my sister.

You listed a lot of possible maybes of problems with the DS.  What about the absolute problems you will have for the rest of your life without a pyloric valve.

I would ONLY let a surgeon cut on me who was on board with the DS 110%.

~Becky

I think he gave you some good things to think of.

But as somebody who has been on OH since 1998 or 1999, I can tell you that I've seen SOOOOOO many RNYs up for revisions.  Soooo so many.  Sooooo many Lap-Bands. (Basically every Lap-Bander from when I was banded has had one.)  I am seeing a lot of my fellow VSGers having revisions.

I have seen a few DSers with issues.  I remember one woman who kind of forgot about her blood work and vitamins for years, and then came on complaining that she was having problems.

I know there was the person on here a few weeks ago who had issues with A, needed A injections, but that they are not available right now for love or money.

I know of one DSer who had the DS portion reversed in Spain.

I do know quite a few who have had iron infusions... and some who have struggled with their calcium.

But, even with that, I know far far more non-DSers who have needed revisions.   Far far more who have gained all or most of their weight back (or even gone above their pre-surgery weight).  Far far more who thought their diabetes was "gone for good" only to see it return.

I've had two bariatric operations and am looking at my third. I do not wish that on anyone. :)

If you can't "commit" to the DS, then get a VSG.  At least then, your revision to a DS will be easy.  Revisions from RNYs, are serious business.

Sonya, you've already gotten a lot of good info and opinions, so let me just add a little to your two points of concern:

1 Nausea, yeah, you might have a little problem but if you do it will wax an wane.  Not like when you're pregnant and find yourself running to the bathroom to throw up.  Meds help a lot, as does ginger or peppermint.  Will you be able to work?  Yes,  think of it like being able to work despite having a slight headache.

2  Malnutrition.   I want you to know that since I have been on this board, the info on nutrition has greatly improved.  So I am sure that these older patients did not have the information they needed to take care of their nutrition.  You have to have some "smarts" to have the DS, and I think you do.  You will have to have your labs done regularly and then adjust your vites as you labs indicate.  It's not difficult, it just takes a little bit of time and that's well worth it.  This board will be a great source of information for you, far better that what your surgeon will give you.

Oh, and as far as being the bread winner, think of how important it is for you to get rid of the diabetes and improve your health!

Glad to see your are thinking this through.  Ask again if more questions come up.  :o)