Peggy D

I clearly said "revision of the sleeve & SA-DS" so, yes, the surgeon "touched" the sleeve. Considering I suffered with chronic constipation for 60+ years, "the bathroom" as not returned to "normal," whatever that is. The diarrhea is not occasional, it's several times a week &, usually, I cannot pinpoint a trigger. It's something I deal with & wish I didn't have to. I have not had any vitamin deficiencies. I do take 2 multivitamins, 4 calcium citrate & 50 mg zinc a day as well as additional vitamin A & D every other day. And I am certainly not actively posting.

I am 3 years 8 months out from revision of the sleeve & SA-DS & still wish I could have done it sooner - actually about 30 years sooner! I did, finally, hit my lowest adult weight of 162.8 a few weeks ago and generally stay about 165. About a year ago I did regain 25 lbs or so but then lost it, losing 13.6 lbs during a trip to Europe, the rest has just gradually come off. Of course, being older, the distribution of weight is a lot different than it was 40+ years ago. The only way I'm going to get rid of the stubborn fat on my abdomen & thighs is with liposuction. My co-morbidities did finally resolve for a couple of years after the revision but the diabetes & hypertension have returned. They are no where near what they were, though. I do still get episodes of diarrhea & have to be very careful about what I eat. All that being said, I would not have had the revision if I hadn't still had the co-morbidities.

Since the sleeve does not alter your intestines there is not likely to be much change in your bowel habits. If anything you may be more constipated. Any surgery that results in malabsorption is very likely to cause "unexpected bowel movements." Things move through quickly since the intestinal tract is shortened considerably. The shorter the common channel the more likely this will happen. The saying "never trust a fart" very much applies.

My ferritin levels have always been elevated, long before I started taking iron. The LFTs have only been elevated for the last 4-6 months. I did have an abdominal ultrasound that showed minimal fatty liver (probably much improved from before WLS). I did have labs checked every 3 months for the first year after my SA-DS. My gastroenterologist wants the LFTs re-checked in 3 months to see if the Vitamin E helps. If not, he will decide what the next step will be when I see him in May. I have no idea why my surgeon had me get iron infusions before my initial sleeve 4 years ago. I could understand having them after my panniculectomy 2 years ago as I had had a huge blood clot under the incision that had to be evacuated surgically the next day. My hemoglobin & hematocrit dropped dramatically.

Your Vitamin regimen should be determined by lab results. I had the single-anastomosis duodenal switch with a 300 cm common channel & I take considerably less Vitamins & mineral that most who had the same surgery do. It seems that I absorb very well. I take: 1 senior Multivitamin twice a day 2 Calcium citrate with Vitamin D twice a day Vitamin A 8000 IU every other day Vitamin D 5000 IU every other day zinc 50 mg once a day Vitamin E 400 IU twice a day (this dose was prescribed by my gastroenterologist because I have elevated liver function tests) I do not take any Iron supplements as my iron levels are high & may be contributing to the elevated LFTs.

Generally, insurance will use your first visit weight or, if there is documentation, your highest weight. They do not go by your weight at the time of submission for insurance approval.

You are more likely to have issues with diarrhea & foul-smelling gas & stools with the DS but it does get better over time. The DS has much better long-term weight loss than the sleeve and better resolution of co-morbidities. Your higher starting weight with, I assume, a BMI over 50, is a reason to consider the DS over the sleeve. My highest weight was 314 lbs with a BMI of 50.7. I had a sleeve gastrectomy in August 2013 because, as a nurse, I wasn't comfortable with the amount of malabsorption of the DS. At that time, there was only the classic DS with a 50-100 cm common channel. Two plus years later I was down about 100 lbs but my co-morbidities were not significantly improved. I was still on 4 insulin injections a day plus Metformin for type 2 diabetes, three meds (one was a combo) for high blood pressure & medication for high cholesterol. As a matter of fact, my cholesterol med had been changed to a stronger one & then that dose was increased. I decided something more had to be done so, in December 2015, I had a revision of the sleeve & conversion to a single-anastomosis duodenal switch (loop DS AKA SIPS or SA-DS) with a 300 cm common channel. The first 2-3 months were a bit rough with the intestinal issues but, by 6 months out I was completely off all of the medications & by 9 months my PCP has removed the diagnoses of diabetes, hypertension & hyperlipidemia. So, my personal opinion is go for the SA-DS in the first place.

I have a single-anastomosis duodenal switch with a 300 cm common channel. Even with that I had severe problems with explosive diarrhea & odor for the first 2-3 of months. Of course, my surgeon has a very strict post-op diet regimen that was only Clear liquids for week 1, clear liquids plus 5 (yes, 5!) Protein shakes for weeks 2-4, puree for weeks 5 & 6, soft for weeks 7 & 8, then regular foods starting with week 9. A lot of problems with foul-smelling gas & stool is related to how much fat you eat. Because the fat is poorly absorbed & passes through undigested, it causes the odors. Try eating less fat & see if that decreases the frequency of stools. Still, my gas & stools have always been less "fragrant" than my husband's & he has never had bariatric surgery!

The sleeve can stretch. Mine did although it still only held about 4 ounces. I had a "pouch test" x-ray where I ate a measured amount of food with radio-opaque material added. Even though the vast majority of the stretchable portion of your stomach is removed in a sleeve gastrectomy, there still is some left.

My surgeon has the same pre- & post-op instructions for all surgeries whether is a sleeve, gastric bypass, traditional DS or single-anastomosis DS. pre-op: 2 weeks Clear liquids with 3-4 30-gram Protein shakes. Shakes must be made with powdered protein, no pre-made shakes ever. post-op: week 1, clear liquids only weeks 2 - 4 clear liquids plus Protein Shakes (sleeve 3 shakes/day, DS & bypass 5 shakes/day) weeks 5 & 6 puree weeks 7 & 8 soft foods week 9 start introduction of regular foods I think I've seen only one other person post that a surgeon with a similar severely restrictive program.

That's the description of the gastric bypass. A gastric sleeve, with or without a duodenal switch, removes 85% or so of your stomach but leaves the pyloric valve totally functional (the outlet from the stomach to the intestine).

My surgeon only takes out the gallbladder if there are gallstones present. I was glad when we finally got the results of my abdominal ultrasound & it showed I did have gallstones. It took three months & multiple calls to get the report. I had no symptoms but my gallbladder was so enlarged & adhered to the surrounding tissues that it took longer to get it out than it did to do the sleeve. But my insurance does routinely cover gallbaldder removal at the time of WLS whether or not it is symptomatic.

I had a panniculectomy almost 2 years ago & I still wear a shapewear garment every day. I wore an abdominal binder day & night for the first three months or so. I continue to wear a Cupid garment I bought at Walmart & modified to go from right below my bra to cover my butt. I cut off the straps because they just don't fit right & I've tried several brands. I wear it because I still feel the pulling of the tissues that were stitched together where my 15 pounds of pannus was removed & it's just more comfortable with the garment.

At 5' 6" & 300 lbs your BMI is 48.4. Well over the BMI insurance requires for coverage without co-morbidities. You do need to check with your insurance carrier, giving them your policy number, to be sure that WLS is covered. It all depends on the specific policy. Employer-provided policies may have exclusions as do most individual policies. You won't know until to talk to them. When you speak to them ask them for a copy of their criteria for coverage of WLS. That will specify exactly what you need to do.

As I've posted in the "Official: FitBit thread" I do not like FitBits nor Jawbone UP Move. Both under-report my daily steps by 20-30% or more. I recently tried a Misfit Shine & Misfit Flash & am very happy with them. They tend to be within 2-4% of actual, counted, steps.