Question:
I have less to lose than many RNY patients
I am doing the surgery to lose the diabetes. Is the surgery necessarily easier on someone who is not as overweight? I weigh 210, down from 225 in March at the consultation. Any takers on this one, Friends? — SkinnyLynni2B (posted on May 15, 2008)
May 15, 2008
Take this for what it's worth. I am telling you up front that I am NOT an
"Expert" on Weight Loss Surgery. I encourage EVERYONE to
RESEARCH EACH surgical option FOR THEMSELVES! THIS is the information that
I have found in MY research. I have posted it here for people in an effort
to help GUIDE folks and help them START their OWN journey into their OWN
research.
There are a LOT of differences in the different types of surgical
procedures. There are a LOT of differences in different SURGEONS. Some
surgeons require more of their patients than others. Some PROCEDURES
require more of the patient than others. You need to do some research and
find the BEST fit for YOU. I just had a Vertical Sleeve Gastrectomy on
March 1, 2008. My surgeon did NOT require me to lose weight. I had a BMI
of 43.6. Now that isn't NEARLY as bad as many people. Had I been HEAVIER,
he may HAVE required it. I don't know. What I CAN tell you is that I was
having problems with arthritis in my knees and my shoulder. That was
almost three months ago. Now it is GONE. There is just a TWINGE every now
and again but NOTHING NEAR the constant agony that I was in before! I was
also a Diabetic 3 months ago. I have had to DROP all of my diabetes
medications on Easter Day because the ONE glucovance pill that I was taking
caused me to have my blood sugar to DROP to 53 POINTS! My sugars are still
a LITTLE high, but under 150 (usually between 114 to 140 after a meal) and
WITHOUT medication! In a FEW weeks with some MORE weight loss, I figure
that my diabetes will be in COMPLETE remission! I have lost 59 pounds in a
little over 2 MONTHS with my surgery (the VSG) and it was done WITHOUT
feeling HUNGRY!
From what I have learned, your MAIN options are the Lap Band, the Vertical
Banded Gastroplasty, the Gastric Bypass, The Duodenal Switch and the
Vertical Sleeve Gastrectomy. There are other options, I am sure, but these
are the most common that I have found. There are also combinations of
these options ALSO available such as the Banded Duodenal Switch, the Banded
Gastric Bypass, and the Banded Sleeve Gastrectomy. The Banded options are
basically the same as the Regular surgeries but they have a Lap Band added
as additional insurance in case of future need.
The Lap Band: (http://www.obesityhelp.com/content/wlsurgery.html#LapBand)
is well known. It basically squeezes the stomach to make it smaller and
creates a pouch with a restriction at the top of the stomach which fills
quickly and empties slowly. The advantages of this surgery are that it is
reversible if needed and it is adjustable if needed. It is a HIGHLY
flexible procedure. This surgery is well known and excepted by many
insurance companies. It may be best for people who have a history of
cancer either themselves or in their family and may need to take
chemo-therapy and for women in childbearing years who may become pregnant.
There are also other reasons for wanting this type of surgery, but I don't
want to spend ALL day writing this. There is an effective Excess body
weight loss over 3 to 5 years of 50% to 60% noted in some studies. The
PROBLEM with this option is that there are sometimes complications with
this device. Some people have a reaction to the foreign object in their
body. People with immune issues should NOT have this device. Lupus and MS
patients for example, can have a reaction to the foreign body and it may
trigger an immune system response. Other issues with the Lap Band are that
it is common for the band to "Slip" on the stomach and cause the
pouch to enlarge thus causing the person with the device to eat more and
negating the purpose of the surgery. Some surgeons have started stitching
the band to the stomach to prevent this from happening. It would be wise
to ask your surgeon if you are considering this option if he does this.
Other times people have learned to "Eat around the Band" and
force the food PAST the band to fill up the rest of the stomach and thus
defeat the purpose of the band. Actually, this is an issue with ALL weight
loss surgeries. All can be defeated by a patient who is either ignorant or
intent on doing so. It seems to be MORE common with the Banded options,
however. Another issue with Banded options is that occasionally the bands
will erode the outside lining of the stomach causing damage to the stomach
that often needs repairs and calls for a removal of the band and or a
revision to some other type of weight loss option. This happens in about
less than 1% of the Lap Band Surgeries but it IS something that needs to be
taken into consideration.
In the Vertical Banded Gastroplasty:
(http://www.obesityhelp.com/content/wlsurgery.html#VBG) (commonly known as
stomach stapling) the surgeon makes a cut into the stomach to create a
pouch. He sews the pouch and places a band at the bottom of the pouch.
This banded option has less chance of the band slipping since the cut in
the stomach holds it into place. It also has the advantage of being
somewhat reversible but is not as easily reversible as the Lap Band. It is
NOT as well known as it's more famous banded cousin, the Lap Band. There
my be difficulties in getting this option with some insurance companies.
It has many of the advantages and disadvantages of the Lap Band surgery
with the exception that the Band does not tend to slip and let the pouch
expand.
The Gastric Bypass: (
http://www.obesityhelp.com/content/wlsurgery.html#RNY) is made when the
surgeon cuts the TOP of the stomach off and creates a pouch. An OLDER
version of this surgery left the stomach intact but had a line of staples
that was used to create the pouch. This method is no longer in use much if
at all. The surgeon then takes a length of intestine and BYPASSES it. He
takes the LOOSE end that is still attached to the intestines and sews it to
the SIDE of the pouch that was created from the TOP of the stomach. The
BYPASSED intestine is then attached to the side of the intestine that was
connected to the pouch so that BILE from the bile duct can empty bile from
the liver into the intestine. This option is often the DARLING of
insurance companies. Many companies that won't pay for any OTHER Weight
Loss Surgeries will pay for THIS one. THAT makes THIS surgery quite
popular for many surgeons! This surgery has the advantage of being a
HIGHLY effective tool in the arsenal of weapons against the foe obesity!
It has an effective rate of weight loss and maintenance of 60 to 80% in
some studies at 1 to 2 years. The DOWNSIDE of this weight loss option is
that there issues of malabsorption of minerals and vitamins due to the
bypassed intestine. This often leaves the patient reliant on his doctor
for the special supplements required to maintain his or her health. Other
issues are dumping, nausea, and vomiting. Dumping is basically when you
have diarrhea that is caused by the intestine's inability to absorb the
food that was eaten. Along with the diarrhea can come intestinal cramping,
sweating, palpitations and other unpleasant side effects. Some people
experience dumping with sweets. Others experience it with fats. Each
person seems to have their own issues but whatever they are, they cause
them to excrete the food that they ate before it was fully digested.
Nausea and vomiting, while experienced by many in ALL weight loss surgeries
is NOT experienced by ALL. It does seem to be MORE PREVALENT in the
GASTRIC BYPASS and DUODENAL SWITCH patients according to the research that
I have seen. The gas and foul smelling stool are also a result of the
shortened digestive process due to the bypassed intestine in both the
Gastric Bypass and the Duodenal Switch.
The Duodenal Switch: (http://www.obesityhelp.com/content/wlsurgery.html#DS
) is the STRONGEST tool in this arsenal of weapons! Many surgeons think it
shouldn't be used lightly and often only recommend the procedure for people
with a body mass index OVER 50! In the Duodenal Switch, the surgeon
REMOVES approximately 85% of the stomach including MOST of the region of
the stomach that produces the hormone grehlin. Grehlin is one of the
hormones that create HUNGER. Removing the section of the stomach that
creates hunger is a HUGE feature of this procedure. The surgeons then sew
the rest of the stomach back together and create a tube shaped stomach that
resists stretching. The stomach varies in size depending on the surgeon
and the patient but can be anywhere from 2 ounces to 6 ounces. Perhaps
more. The next step of this procedure involves bypassing the intestine
just like in the Gastric Bypass. Instead of attaching the intestine to the
SIDE of the stomach, it is attached to the BOTTOM of the stomach where the
intestine used to exit. The bypassed intestine is then sewn at one end
near the liver and the far end of the intestine is sewn to the intestine
that was attached to the stomach to pass bile to the intestines as it does
in the gastric bypass. This procedure is MORE efficient than the Gastric
Bypass in losing weight. This option has an effective rate of weight loss
and maintenance of 70 to 90% in those same studies. The downside when
compared to the Gastric Bypass is that Insurance companies often do not
know of this option and are often reluctant to pay for it. This option has
many of the same issues as the Gastric Bypass. There are some severe
malabsorption issues. There are often issues with dumping, nausea,
vomiting, GERD (acid reflux), gas and foul smelling stools. The Many
surgeons have been reluctant to perform this surgery due to the severity of
the complications that can arise. This is why it is often reserved for
those who are considered severely morbidly obese. Many surgeons had looked
for an alternative to this surgery which lead to what was initially
considered a "Half Duodenal Switch" or as it later became known,
the "Vertical Sleeve Gastrectomy."
The Vertical Sleeve Gastrectomy:
(http://www.obesityhelp.com/content/wlsurgery.html#VSG) (if you get the
same picture as the Vertical Banded Gastroplasty, just scroll UP) is a
GREAT tool to use in the fight against obesity. While not QUITE as
effective as the Duodenal Switch, it is often JUST as effective as the
Gastric Bypass without the severity of the side effects of EITHER of those
two options. The Vertical Sleeve Gastrectomy initially started as an
attempt to create a safer Duodenal Switch alternative. While early
attempts were not as successful in weight loss reduction, this was mainly
due to the fact that the surgeons were relying on the larger size stomach
often used for the Duodenal Switch patients who often rely on the
"Switch" part of the surgery for some of the weight loss. Once
the surgeons started reducing the size of the STOMACH, the Vertical Sleeve
Gastrectomy became a much more effective tool at helping the patient loose
weight. In the Vertical Sleeve Gastrectomy, the stomach is cut and
approximately 85% of it is removed. Just like the Duodenal Switch, most of
the cells that produce the hormone grehlin are removed. This eliminates
most of the hunger that the patient used to have, if not all of it. The
stomach that is made from what is left is turned into a tube that is
resistant to stretching. This tube is often designed to hold from 2 to 4
ounces of food or liquid. At this point the surgery is complete. The
surgeons just need to close up and the patient needs to recover. The
upside to this surgery is that it is simple and has one of the LOWEST rates
of complications of all the weight loss surgeries. It also has one of the
HIGHEST rates of excess weight loss with one study in California coming in
starting at 58% to 77.9% loss in a ONE to TWO year study and one doctor in
England reporting that 100% of his patients had a weight loss and
maintenance OVER 70% at 6 YEARS of living with the Sleeve. He also
reported that patients with hypertension, diabetes, impaired glucose
tolerance, obstructive sleep apnea, asthma, or arthritis were all cured or
improved after surgery. It has also been said that this is the ONLY
recommended option for people with immune system problems. People with
diseases like Lupus or MS can have this procedure because there is NO
foreign object placed in their body. This also is one of the few
recommended options for people with organ transplants. People with
transplants need their intestines to metabolize their anti rejection
medications. There are possible issues with GERD in this surgery as there
are with the Duodenal Switch There are NO malabsorption issues with this
surgery. There are NO additional foul odors. There is NO additional
intestinal gas. While nausea and vomiting is common in ALL weight loss
surgeries, it is NO MORE PREVALENT in the Vertical Sleeve Gastrectomy than
in most of the other options. If needed, the Vertical Sleeve Gastrectomy
can be easily converted to a Duodenal Switch should additional Weight Loss
measures need to be taken at a later date. This act is called a
"Revision." Having your Vertical Sleeve Gastrectomy converted to
a Duodenal Switch would be said to be having a, "Revision of your
Vertical Sleeve Gastrectomy to a Duodenal Switch."
The Biggest DOWNSIDE to the Vertical Sleeve Gastrectomy is that it is
considered "Experimental" by many insurance companies. While it
has not been practiced HERE in the US as a weight loss option for very long
(about 5 years or so) it has been done for QUITE a while in Central and
South America and in Europe for quite some time. The surgery has been used
HERE in the US for OTHER reasons for QUITE a while. It has been used QUITE
effectively to treat stomach cancers and ulcers with good effect. These
treatments have been done in the US for quite some time.
There is a NEW option that is being explored for people that have had the
RNY that may be expanded to include OTHER weight loss surgical options and
possibly be used to REPLACE them in the future if it becomes approved for
that use. This new option is called stomaphyX. The stomaphyX surgery
basically takes a post down the INSIDE of the stomach and then FOLDS the
stomach in upon ITSELF and makes the available volume INSIDE the stomach
SMALLER. There is NO CUTTING on the abdomen or anywhere ELSE. All of the
surgery is done through the esophagus. None of the stomach is removed or
cut. At the moment, from what I have been able to find according to MY
research, the device is only approved for use with Gastric Bypass patients
to help make their existing pouches smaller. Permission is being sought to
expand the device's use to other types of weight loss surgeries and for use
on patients that have NOT had weight loss surgery but to be used in PLACE
of traditional weight loss surgery. From what I have been able to find,
this device has not been approved for this use yet. To find out MORE about
this option go to this link:
http://www.themorbidme.com/2007/09/stomaphyx-incis.html .
Options for getting surgeries that are not paid for by insurance can be
found if you are persistent. You can sometimes petition the company and
get them to reconsider with a doctor's explanation. You can also self pay
or take out a loan. Many times, the surgeries are cheaper in Mexico or
other central or South American countries. Do some research to find your
options.
Not every surgery is going to be right for every person. Frankly, for ME,
if I were an obese male with a BMI under 50 (which I am) or an obese woman
NOT of child bearing age, I would choose the Vertical Sleeve Gastrectomy
(which I DID). If I were an obese male with a BMI OVER 50, I would get the
Duodenal Switch. If my insurance company would not COVER it, I would get
the Sleeve. If not THAT, then the Gastric Bypass. I would keep working my
way down the list until I found SOMETHING that I could get. If the
insurance company wouldn't pay, I would try to take out a LOAN (this is
actually what my wife did for me). If I were a WOMAN of child bearing
years or a person facing the possibility of chemotherapy or some other
health issues that would require periods when I would NEED more sustenance,
I would want the flexibility of the Lap Band. The short of it is, Do YOUR
RESEARCH and CHOOSE the right surgical option for YOU! If you can't get
ONE option for a reason, at least get another! For the sake of yourself
and the ones you love, do SOMETHING to fix the problem before it is too
late. If you die due to health problems caused by obesity, it is TOO
LATE!
Whatever surgical option you choose, for whatever REASON you choose, we are
ALL here for the same reason. We are here to HELP and BE HELPED. Please,
let's respect each other. There are those on the OH boards that consider
themselves to be "Experts." Most of these folks do not have any
medical experience. They are patients just like me. It is best to take
any advice you get on the OH boards with a grain of salt (if not the whole
cellar). Some folks have a severe bias towards or against certain
surgeries. There are folks who will TELL you that the surgery you are
considering is WRONG and is BOUND to fail! IGNORE these people. Not every
surgery is right for every person! DO YOUR OWN RESEARCH and and CONSULT
with your PHYSICIAN or your SURGEON! I cannot stress the importance of
doing your own research enough.
There is a revised version of this post at my profile page. I have added
some links to some web sites that have some interviews with some surgeons
that perform weight loss surgeries and have videos that actually SHOW the
surgeries. You can watch the surgeries being performed and get many of
your questions answered by the surgeons as they explain what they are
doing. They explain the positives and negatives of each procedure. My
Profile page can be found HERE:
http://www.obesityhelp.com/member/hubarlow/ . Look for a post called
Surgical Comparisons. If you can't find the post on the profile page, look
for the post in the March Archives.
I hope this helps
Hugh.
— hubarlow
May 15, 2008
Who can out do Hugh? Wah! At any rate, it is easier for the surgeons to
do a surgery on someone who is not as overweight, it is easier for you to
move if you are not as overweight, but, your reaction to the surgery,
anesthesia, pain etc. is all individual to you and probably will not be
effected by losing 15 pounds. The healthier you are the better. That said,
any weight off is weight you don't need to lose later. Seems there are
very good results in the reversals of diabetes. This is very exciting! I
hope you do well! :))
— waterlover
May 15, 2008
I doubt it is easier, but no one can really predict it anway...but the
weight loss might be slower since you don't need to lose a whole of of
weight...The body is an amazing machine and it fights hard to survive,
especially when it thinks you are starving it. There is a lightweight
forum...You might find more answers there....I'm a heavyweight, myself! :)
BUT...your diabetes will be gone! AND lemme tell ya...that was a relief to
me! You will probably be a cute itty bitty person when all is said and
done.
— .Anita R.
May 16, 2008
Wow, we have an aspiring novel writer here. Sounds like you are already
heading the right direction since you've dropped 15 lbs. What are you doing
that's giving this amazing success? If it's weight loss you're after, it
looks like you've found a way!
— Ruth Shapovalov
May 16, 2008
Wow, what turned on Hugh!
Yes, any surgery is easier on less overweight people then the very fat
ones. However, talk with the doctor you are going to use and listen to
what he has to tell you. RNY will cure your Dibities Type II. Best of
success to you.
— William (Bill) wmil
May 16, 2008
Hi Lyn, easier how? I am not sure what you are asking. Some people lose
weight prior to surgery and it slows down their weight loss after surgery,
some don't. Some people lose their diabetes after surgery and some done.
I am sure you are not nearly as casual as you sound in your question, but
this is not a casual surgery, and you are doing really well on your own.
Any chance of continuing to lose weight on your own and skipping the
surgery? Losing the weight will change your diabetes as well, even without
surgery. Surgery is big and recovery is big for anyone, no matter how much
you need to lose. Be careful, and best to you. Take care. Patricia P.
— Patricia P
May 16, 2008
Well, I am 39, had 100 pounds to loose and am 1 year out and at goal. I had
the RNY. It was laproscopic and for *me* it was an extrememly easy surgery.
Easier than my c-section and easier than an open abdominal surg I had for a
prior colon cancer. It IS an easier surgery on a smaller person. That is
why I wish the insurance companies would be reigned in: if the obesity
could be restrained BEFORE people got to 500 pounds they would have a
better / safer outcome. I am VERY happy with my decision. My blood
pressure is down. My kidney labs are better now. I just could NOT get off
the sugar on my own, even after the cancer, so I chose the RNY. I am very
pleased. Who knows how big I would have got as I got older? Anyway, I
researched it; started out thinking I would go with LapBand since I
"only" had 100 pounds to loose. Then after going to the seminars
chose the RNY instead due to my sugar addiction (and good luck getting
insurance to pay for ANOTHER surg if the 1st one doesn't work & is not
the surgeon's fault.) I think THAT is they key; figure out what will work
for YOU and go into that decision with confidence. That is part of the
reason there are people who are so militant that their decision is the only
right decision; because it WAS the right decision - for THEM. That is where
you need to be. Do enough research to be SURE. :-D We wish you the best!!!
— MAG
May 16, 2008
I weighed 204 at surgery (5'3") and just barely met the Medicare
requirements of a BMI of 35. (I am 66.) I had RNY and it was a piece of
cake. Had it done on Monday, released from the hospital the next evening
and never had hardly any discomfort. My main reason was also to get rid of
my diabetes. I was released from the hospital off of all diabetic
medications. My sugars for the first month were bouncing right around 100.
After that they were elevated some and my internist says he may have to
put me of a very low dose of something. I won't mind that at all. The
main thing is I feel so good! I have energy that I haven't had in years!
I have lost 29 pounds in 7 weeks!
— ShirleyF
May 16, 2008
This is a good question. I'm in the same situation. My opinion is go for
the surgery that will best help you reach your goal of weight loss and help
with the fiight against diabetes. The insurance would not approve you, if
you didn't need the surgery. It is one thing to lose the weight, and
another thing to keep it off. Don't miss this chance to get medical help.
Joining this website as given me alot of important information about the
different procedures available to me. The doctor told me that the lapband
would not work for me because of the sweet/crabs and medical issues.
— Toby2
May 17, 2008
Easier??!!! No surgery is easy because of the risk!. All surgery is risky.
My suggestion to you is to go to as many seminars and research, research,
research! Everyone is different and never compare yourself to anyone else.
Talk to your PCP, surgeon and go to the local seminars. Find the answers
you need directly. Much success to you!
— notjus4fun
May 18, 2008
At first, I was convinced that the lapband was the surgery for me. After
going to the doctor and telling him about my sweet habit, and other junk
foods. He suggested the RNY for me. I am a diabetic, and have other
health issues. All surgery is risky, please don't pick a procedure just
because you want to feel safe. Remember, anytime you are put to sleep,
than you are looking at major surgery regardless of the procedure.l I
maybe wrong, but thats what I was told. Correction....
— Toby2
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