Madam Reverie

I'm all for a discussion on politics, not so sure about religion. However and despite my preferences, I would have thought neither of these are appropriate for this type of website. However, nor is, as I have seen and seems fairly prevalent; is individuals dominating forums and engendering a 'them and us' mentality. That is tantamount to bullying - no matter how much alleged 'humour' is deployed as subterfuge or smiley faces to soften the sarcasm. Although it's a subtle and insidious form of bullying, it is still bullying nonetheless. Just a point for consideration, Ed?

You look fabulous! Congratulations

To add to that, here is some GERD specific research... On the basis of the below, I'd be asking your doctor to qualify his remarks on GERD in lapband v's sleeve patients... If anyone has any questions, please do not hesitate to ask. R x Patrice R. Carter, Karl A. LeBlanc, Mark G. Hausmann, Kenneth P. Kleinpeter, Sean N. deBarros, Shannon M. Jones, Association between gastroesophageal reflux disease and laparoscopic sleeve gastrectomy, Surgery for Obesity and Related Diseases, Volume 7, Issue 5, September–October 2011, Pages 569-572, ISSN 1550-7289, http://dx.doi.org/10.1016/j.soard.2011.01.040. Keywords: GERD; Laparoscopic sleeve gastrectomy; Reflux; Obesity Background Gastroesophageal reflux disease (GERD) is a common co-morbidity identified in obese patients. It is well established that patients with GERD and morbid obesity experience a marked improvement in their GERD symptoms after Roux-en-Y gastric bypass. Conflicting data exist for adjustable laparoscopic gastric banding and GERD. Laparoscopic sleeve gastrectomy (LSG) has become a popular adjunct to bariatric surgery in recent years. However, very little data exist concerning LSG and its effect on GERD. Methods A retrospective chart review was performed of 176 LSG patients from January 2006 to August of 2009. The preoperative and postoperative GERD symptoms were evaluated using follow-up surveys and chart review. Results Of the 176 patients, 85.7% of patients were women, with an average age of 45 years (range 22–65). The average preoperative body mass index was 46.6 kg/m2 (range 33.2–79.6). The average excess body weight lost at approximately 6, 12, 24 months was calculated as 54.2%, 60.7%, and 60.3%, respectively. Of the LSG patients, 34.6% had preoperative GERD complaints. Postoperatively, 49% complained of immediate (within 30 d) GERD symptoms, 47.2% had persistent GERD symptoms that lasted >1 month after LSG, and 33.8% of patients were taking medication specifically for GERD after LSG. The most common symptoms were heartburn (46%), followed by heartburn associated with regurgitation (29.2%). Conclusion In the present study, LSG correlated with the persistence of GERD symptoms in patients with GERD preoperatively. Also, patients who did not have GERD preoperatively had an increased risk of postoperative GERD symptoms. Sharon Chiu, Daniel W. Birch, Xinzhe Shi, Arya M. Sharma, Shahzeer Karmali, Effect of sleeve gastrectomy on gastroesophageal reflux disease: a systematic review, Surgery for Obesity and Related Diseases, Volume 7, Issue 4, July–August 2011, Pages 510-515, ISSN 1550-7289, http://dx.doi.org/10.1016/j.soard.2010.09.011. Keywords: Sleeve gastrectomy; Gastroesophageal reflux disease; Systematic review Background Sleeve gastrectomy (SG) has increased in popularity as both a definitive and a staged procedure for morbid obesity. Gastroesophageal reflux disease (GERD) is a common co-morbid disease in bariatric patients. The effect of SG on GERD has not been well studied; thus, the goal of the present systematic data review was to analyze the effect of SG on GERD. Methods A systematic data search was conducted using Medline, EMBASE, the Cochrane Database, Scopus, and the gray literature for the Keywords “sleeve gastrectomy;” “gastroesophageal reflux;” and equivalents. Results A total of 15 reports were retrieved. Two reports analyzed GERD as a primary outcome, and 13 included GERD as a secondary study outcome. Of the 15 studies, 4 showed an increase in GERD after SG, 7 found reduced GERD prevalence after SG, 3 included only the postoperative prevalence of GERD, and 1 did not include data on prevalence of GERD. Conclusion The evidence of the effect of SG on GERD did not consolidate to a consensus. The studies showed differing outcomes. Hence, dedicated studies that objectively evaluate GERD after SG are needed to more clearly define the effect of SG on GERD in bariatric patients.

Beauty, I posted this a week ago on another thread and it sounds like you could do with reading it. As the knowledgeable ones above have said; if you're not comfortable, get a second opinion. I have a BMI of nearly 36 and there's no way, given the amount of academic research I've done, I would consider a band. Closer to home, I know a lady who had the band operation, had three corrective surgeries on it and then had to go to sleeve, which due to the scar tissue the band had left, failed, so it had to be revised into a bypass. An absolute mess. This, of course, is an isolated case - but the academic research proves that the band is simply not as effective, you don't lose as much weight, but does, on the plus side, have a lower mortality rate. If you have any queries about the below, please do not hesitate to contact me. All the best, R x "I posted this on another forum and felt it might be useful for other people to have a read of, if like me, you like your scientific facts. Maybe the below will provide a bit of clarity as to the 'nuts and bolts' of some of the bariatric procedures and their long-term (within the limitations of the data) efficacy. This first academic journal quoted was published in May 2013. So, it doesn't get more 'up to date' with regards to evaluating the comparative effectiveness in the three biggest weight loss procedures. I have only reproduced the abstract and have quoted the source below as the abstract covers the salient information we'd be interested in. The second section is all about the metrics, with a snapshot of all the procedures being evaluated in a tabulated form (the table was removed from the cutting and pasting process, so read left to right) and the risks associated with the operations. The primary and secondary sources are also cited. Better to make decisions based on rigorous scientific research, than hearsay and charasmatic sales pitches, I feel... Hope it helps. Article 1: Abstract: Objective: To evaluate the comparative effectiveness of sleeve gastrectomy (SG), laparoscopic gastric bypass (RYGB), and laparoscopic adjustable gastric banding (LAGB) procedures. Background: Citing limitations of published studies, payers have been reluctant to provide routine coverage for SG for the treatment of morbid obesity. Methods: Using data from an externally audited, statewide clinical registry, we matched 2949 SG patients with equal numbers of RYGB and LAGB patients on 23 baseline characteristics. Outcomes assessed included complications occurring within 30 days, and weight loss, quality of life, and comorbidity remission at 1, 2, and 3 years after bariatric surgery. Results: Matching resulted in cohorts of SG, RYGB, and LAGB patients that were well balanced on baseline characteristics. Overall complication rates among patients undergoing SG (6.3%) were significantly lower than for RYGB (10.0%, P < 0.0001) but higher than for LAGB (2.4%, P < 0.0001). Serious complication rates were similar for SG (2.4%) and RYGB (2.5%, P = 0.736) but higher than for LAGB (1.0%, P < 0.0001). Excess body weight loss at 1 year was 13% lower for SG (60%) than for RYGB (69%, P < 0.0001), but was 77% higher for SG than for LAGB (34%, P < 0.0001). SG was similarly closer to RYGB than LAGB with regard to remission of obesity-related comorbidities. Conclusions: With better weight loss than LAGB and lower complication rates than RYGB, SG is a reasonable choice for the treatment of morbid obesity and should be covered by both public and private payers. SOURCE: Carlin A, Zeni T, Birkmeyer N, et al. The comparative effectiveness of sleeve gastrectomy, gastric bypass, and adjustable gastric banding procedures for the treatment of morbid obesity. Annals Of Surgery [serial online]. May 2013;257(5):791-797. Available from: MEDLINE with Full Text, Ipswich, MA. Article 2: September 2012: Morbidity and mortality associated with LRYGB, LSG, and LAGB from the ACS-BSCN dataset LRYGB LSG LAGB 30-d mortality (%) 0.14 0.11 0.05 1-y mortality (%) 0.34 0.21 0.08 30-d morbidity (%) 5.91 5.61 1.44 30-d readmission (%) 6.47 5.40 1.71 30-d reoperation/intervention(%) 5.02 2.97 0.92 SOURCE: Data from Hutter MM, Schirmer BD, Jones DB, et al. First report from the American College of Surgeons Bariatric Surgery Center Network: laparoscopic sleeve gastrectomy has morbidity and effectiveness positioned between the band and the bypass. Ann Surg 2011;254(3):410–20 [discussion: 420–2], in: Timothy D. J, Matthew M. H. Morbidity and Effectiveness of Laparoscopic Sleeve Gastrectomy, Adjustable Gastric Band, and Gastric Bypass for Morbid Obesity. Advances In Surgery [serial online]. n.d.;46(Advances in Surgery):255-268. Available from: ScienceDirect, Ipswich, MA"

I agree, to be honest. I'd opt for chopping off the excess skin, re-plumping (modestly) my bust, but as for the face? I'd leave it fairly untouched I think. Save, perhaps, for a bit of filler here and there!

Okay, I don't know whether this topic has been covered before. If it has, my sincere apologies. However, there is something I have found on my explorations of all things 'sleeve', that has somewhat resonated with me. And not always in a good way. If you're a bit like me, you've devoured everything available on the big ol' t'internet about the wondrous vertical sleeve gastrectomy. From doctors, to insurance, location, cost, life impact, health implications, surgery competence, surgery complications, long-term outlook, short-term discomforts, scale victories, non-scale victories, psychological wellbeing, psychological hurdles, physiological impediments, familial responsibilities, the Quest for Protein, the quest for Fluid, Protein Bars, protein shakes; which brand is the best, which brand is the worst. The areas for consideration in this matter are endless and, if you're like me, you keep stumbling across extra information which every so often makes you say 'oh no, not another thing to consider'.. Getting to the point, I don't think there is a person amongst us that hasn't trawled the endless YouTube videos and the photos on this website of the dramatic transformations people have achieved. It is almost a voyeuristic pleasure which provides instant gratification and codification as to why you're taking this road. You see people and think 'wow, that could be me'. Whilst clearly, dramatic weight loss will have significantly improved people's health and general wellbeing; reducing or eliminating comorbidities and making their prognosis much better than when they were significantly overweight. There is something that just won't leave me. Have any of you seen photos and videos (and please don't quote specifics) where you've thought either a) you looked better when you were heavier or your weight loss has gone too far, stop, you're looking ill. I don't want to be one of those people that everyone silently thinks 'you looked better before'. However, one only ever knows whether this is the case until you get there and or generally, after the event in question. I guess, fundamentally, I'm questioning whether, in line with some medical publications, some of us are pre-programmed to be portly and we look 'better' portly as a consequence? I know I shouldn't be concerned about this, because health comes first, right? However, when I see people with thinning hair/ no hair, degraded teeth, grey complexions, sunken cheeks, sunken eyes, I sometimes question whether this is the right thing to do, or are people, behind my back (and knowing some of the people I know), to my face, going to be thinking 'crikey, she looks awful'... I have seen, particularly with some photos and videos over a lengthy period of time, people achieve a 'sweet spot' for looking 'well'. However and more often than not, they don't appear to stay at this. Is there a middle ground between meaty and malnourished? Can it realistically be reached and maintained? What are your thoughts, people? Would be good to hear them x

That's really interesting actually, because the people I've met in the flesh, the bypass patients, I hate to say it, looked awful. The VSG 1 year + post op looked better (to varying degrees) And yes, a couple of them did look like they were never meant to be big. They showed me their before photos and it was quite bizarre. They looked like different human beings - literally. I hope I'm blessed to be one of those people. Really...

Thank you

Aint that the truth! Far too much doom and gloom in this world (or do I mean 'room') already!

Hey, if I'm going to get carved up (which is inevitable), I'm going the whole hog. Boobs like Pamela Anderson's and a stomach like Usain Bolt's! Bring it on!

Thanks Coco, it does indeed. To be honest, I share most of my bizarre thoughts, most of the time. Just maybe not ones so personal. After all, how could you even bring in to general conversation 'yes, I have a big belly that hangs like a once pregnant cats and if you stretched it out enough, you could more than likely cover a sofa with it!'. Some segue's are impossible to achieve - even for me! x

Guys, I share your pain. I have ALWAYS had the overhang onto the pubis. Even as a young child. Never tucked in shirts. Wore control briefs to disguise it. Used to kneed and roll it in my hands, pulling it out, wishing I could just cut it off with a bread knife (yeah, that makes me sound psycho). The thing is, I am an apple shape and I have yet to have surgery. Consequently, it scares the bejesus out of me as to how god-awful its going to look after weight loss. I was told years ago by a doctor that no amount of exercise would get rid of it. As much as I've loathed it all my life because its been there forever; its a warming, squidgy and familiar part of me. Like an old friend. That I love and hate at the same time. Its been there that long, it has its own well-worn crease. A cut line, if you will. I don't know about these surgeons. Masters in the craft of surgical medicine - or glorified seamstresses?! My mum would shudder at some of the patchwork quilt jobs I've been seeing on YouTube recently. I could just imagine her saying 'well, that person didn't cut the pattern and tack the garment before sewing very well, did they?!' I don't know why I just told you all that. I should go to bed!

I'm sure they're not. Family tend to give it to you straight.. Its the friends or should I say 'acquaintances' that sometimes don't. I don't think I'm concerned about being 'ugly' per se. More about looking like walking death. Consequently, part of the motivator behind this forum post was whether other people, too, recognise that not everyone looks so well after this surgery?

Okay, I don't know whether this topic has been covered before. If it has, my sincere apologies. However, there is something I have found on my explorations of all things 'sleeve', that has somewhat resonated with me. And not always in a good way. If you're a bit like me, you've devoured everything available on the big ol' t'internet about the wondrous vertical sleeve gastrectomy. From doctors, to insurance, location, cost, life impact, health implications, surgery competence, surgery complications, long-term outlook, short-term discomforts, scale victories, non-scale victories, psychological wellbeing, psychological hurdles, physiological impediments, familial responsibilities, the Quest for Protein, the quest for Fluid, Protein Bars, protein shakes; which brand is the best, which brand is the worst. The areas for consideration in this matter are endless and, if you're like me, you keep stumbling across extra information which every so often makes you say 'oh no, not another thing to consider'.. Getting to the point, I don't think there is a person amongst us that hasn't trawled the endless YouTube videos and the photos on this website of the dramatic transformations people have achieved. It is almost a voyeuristic pleasure which provides instant gratification and codification as to why you're taking this road. You see people and think 'wow, that could be me'. Whilst clearly, dramatic weight loss will have significantly improved people's health and general wellbeing; reducing or eliminating comorbidities and making their prognosis much better than when they were significantly overweight. There is something that just won't leave me. Have any of you seen photos and videos (and please don't quote specifics) where you've thought either a) you looked better when you were heavier or your weight loss has gone too far, stop, you're looking ill. I don't want to be one of those people that everyone silently thinks 'you looked better before'. However, one only ever knows whether this is the case until you get there and or generally, after the event in question. I guess, fundamentally, I'm questioning whether, in line with some medical publications, some of us are pre-programmed to be portly and we look 'better' portly as a consequence? I know I shouldn't be concerned about this, because health comes first, right? However, when I see people with thinning hair/ no hair, degraded teeth, grey complexions, sunken cheeks, sunken eyes, I sometimes question whether this is the right thing to do, or are people, behind my back (and knowing some of the people I know), to my face, going to be thinking 'crikey, she looks awful'... I have seen, particularly with some photos and videos over a lengthy period of time, people achieve a 'sweet spot' for looking 'well'. However and more often than not, they don't appear to stay at this. Is there a middle ground between meaty and malnourished? Can it realistically be reached and maintained? What are your thoughts, people? Would be good to hear them x

Yeah, the tracking thing.. I don't think I'd have the patience for that. I know I'll probably have to in the start, but i'm kinda hoping that if I follow the rules; protein, veg, carbs and no drinking during meals, that I'll be okay and will relax into it.. Although I'm also worried if I relax too much, I'll be stuffing pizza in no time!

Hehe, bless you. If it would make you feel more comfortable, I could always adopt; txt spk wit no gramor & spelin mistaks so wot i am sayin can be underztood? That's crazy. It actually took me time to be able to write that! Okay, better stop, else I'll be vilified for mocking the afflicted :|

I'm 36 and in my head, even at my weight, I look like Venus De Milo, what are you on about?! LOL (kidding ) I totally agree with you on the thin face thing. It's not a good look. I don't know how tall you are, but 165 would be perfect for me, too. Do you have any suggestions on how to maintain calorie intake in the first couple of months?

That's really good. Congratulations on your success. Have you any suggestions for upping the calorie intake in the first two months? I have visions of my being so worried about the calorie crash, that I'll be tempted to sip double cream or something?!

That's excellent advice indeed. May I ask how you got those 1200 calories and above in, in the end and what prevented you from being able to do that for the first 6 months?

LOL guys, that's too funny. I have made a boo-boo, by posting this thread twice. Most comments are on the other one under 'general'. If you wouldn't mind posting your views on there? 'blinded by the lack of spelling errors'.. I just burst out laughing at that one! x

Thank you so much, that's truly very kind of you. You've hit in on the head - the sickly look. With so many different opinions on what is right and what is insufficient across the board, it is easy to get very confused. I guess we can blame the lack of long-term medical research on this issue being as to why it's so difficult to get a cohesive and collective response from all those in the business of providing this surgery. Consequently, people are left trying to find their own answers and through trial and error, finding what's right for them. I'm wondering whether there will ever be a definitive stance on the issue? Or, we all make a 'best guess'. I love your statement about hoping to recognise perfection. I'm hoping to recognise when I'm losing too much because I do not want to look ill. If I do, be assured, I shall be promptly heading for my favourite restaurant for a creme brulee (or three)!

TOTALLY! People also seem to gasp for breath while they're talking for what appears the first 6 months, along with the burp-stifling! Oh, and mental confusion seems apparent, too. It is concerning. In addition to these things, what I have also observed, is that there is a bit of a change in personality,too, as the videos go on. People start out fairly balanced, contemplative, reserved, grateful for small milestones, to then changing in line with their weight, to on occasion, becoming quite arrogant and demanding. Why is this? Maybe that's another question for another forum topic

Hehe, like your style! Self body-image is such a big thing, isn't it? I, too, am proportioned. I, too, don't want to lose my healthy facial coverage either. Has anyone got any answers for this one?! How do we prevent looking gaunt?!

That's a healthy attitude. Do you think you'll know when 'enough is enough' though? How will you gauge it? By clothes? Comments? Looks? It's a great achievement so far, I wish you all the best in finding your sweet spot

You're right on that one; one mans Water is another mans champagne. But no, the 'mis-proportioned' thing is not really what I'm talking about. It's the gaunt, drawn, malnourished look. Generally looking like walking death. Then, the question - when is enough, simply, enough?