Mayastone

Does anyone feel pressured by their surgeon to do the RNY/bypass over the sleeve? Like everyone else, I sat through the initial info session my surgeon offered and I felt like she was really selling the RNY. The whole session was about the RNY, in fact, and how it's the "gold standard" and best procedure. Then, I met with her for my initial appointment. She predictably said I was a better candidate for the RNY. I am 5'2" and weigh 250. Fair enough. I went home and had my mind set on the bypass. But then I started doing my homework and, after much thought, I decided the sleeve may be better for me for many of the same reasons as others who make this decision: I have no comorbidities, research seems to say it's less invasive, no rerouting, no dumping, no vitamin/medicine probs and it would cut out the hunger hormone grehlin. Equally as important it would restrict the amount I can eat and, according to the many pieces of research I read, offer practically the same amount of weight loss as the RNY over the long term, albeit at a slower rate. I am also a cancer survivor and I had concerns about the malabsorption that comes with the RNY and whether or not I could effectively be treated in the future (if needed) if my body would no longer absorb medicines (including oral chemo). That said, I did have a couple of concerns about the sleeve. One, I'm not a necessarily volume eater and this is obviously a purely restrictive procedure. And two, I have a career, a lot of business travel, and a toddler, so I can't commit to constantly exercising like others do. I wondered if I wouldn't lose enough and then regain what I do lose because I won't have that malabsorption so many people benefit from with the RNY. So, I made a second appointment with my surgeon to discuss all of the above and she was still all about the RNY -- which is totally fine. She is the expert and I am turning to her to help me make an informed decision. However, she mentioned several things that were contrary to everything I've read. She said... --Malabsorption only lasts six months at the most for both calories and nutrients/medicine (yet, her required nutrition classes talk about the life long Vitamins, etc???) --People don't lose weight from the RNY because of the malabsorption or restriction; they lose weight because they're bypassing all the hormones in the first part of the small intestine, something you don't get with the sleeve (so malabsorption has very little to do with the weight loss) --The RNY is safer than the sleeve; the sleeve is actually more invasive and dangerous to recover from because it's more prone to leaks due to the length of cut and pressure that builds in the sleeve. --The sleeve causes less weight loss and you will regain more in the long term. I have read that the long term results are VERY similar to the RNY. She says no, long term for RNY is much better. --The least I can ever weigh with the sleeve is 180-190 lbs (currently 5'2" and 250 lbs) and I likely won't get that low. --I can take time release medicines in the future and they will probably work. --The sleeve will rarely be performed five years from now because it's not effective; but I thought the sleeve was becoming the WLS of choice I was confused by what she was saying, so she referred me to the Cleveland Clinic's "Stampede" study, as it compares the RNY to the sleeve. But I read it and it is all about the effects of both surgeries on diabetic patients. I don't have diabetes. Does any of this sound like what you've understood from your surgeons? My surgeon is loved by all. She is smart, has great bedside manner, has been doing this for over ten years and has one of the Bariatric Centers of Excellence. I do trust her, but some of this sounds strange to me. In the end, I want solid info so I can make the decision that's best for me. Any thoughts on why surgeons might try to "sell" the bypass more often? Also, any thoughts on what she said to me when I went in to ask her about doing the RNY vs. the sleeve? Thanks!

Hi Everyone –– I am due to be sleeved this Tuesday on 11/24 and I've been very sick. I've had a very, very high fever that's been difficult to control and a whole host of other issues. The worst has been coughing. I have a very dry cough and I literally have coughing fits where I can't stop. I cough constantly all day and all night. And it's not normal coughing. It's hard, dry coughing -- hacking, really. I cough so much that my abs are killing me and I wouldn't be surprised if they now find a hernia when they operate. The only thing that seems to help at all is constantly sipping Water. I called my surgeons office to reschedule the surgery that they urged me to wait. They said the only reason they can't operate is if I have a fever and that anesthesia would cancel my surgery if I had a fever on the morning I go in. In other words, the only reason to cancel the surgery is if you have a fever -- and none of the other issues matter. Honestly, I'm not so worried about the fever. The fever has almost gone away and I'm sure I'll be fine on Tuesday morning. My concern is the coughing. The coughing is horrible and I can't immagine what it would be like to cough incessantly after having major abdominal surgery. I feel it would just be too painful. I'm also worried about rupturing my newly sleeved stomach. My surgeon isn't worried. He is urging me to come in and go through with the surgery if anesthesia clears me. As a side note, they are booked through the end of the year. So they could not do my surgery until January if I reschedule. The problem is that I have already met my out-of-pocket maximum for this year. It starts over on January 1. So not doing the surgery next week is the difference between paying nothing and paying $3,000. So, I have some incentive for going through with the surgery next week. However, I don't want to do something I will regret. If I'm going to have a horrendous recovery, it can wait -- but I'd love to be in a position to go through with it. Does anyone have experience with coughing after surgery? Please tell me about it... Thanks so much! Maya

So sorry to hear that! As for me, I went in at 5am on the morning of my surgery and they canceled me on the spot. I found out when I went to my PCP later that day that my white count was 20,000, so it's a good thing we canceled. However, the actual reason they canceled was that I had taken Advil in the week prior to my surgery, which is a blood thinner. I had a fever of 104 two days in a row and was unable to bring it down with Tylenol, so I had to take Advil. My surgeon called me personally that afternoon to touch base. He said he is going to try to squeeze me in before the end of the year so I don't have to start from zero with my out-of-pocket maximum in January -- so far, however, his scheduler is telling me it'll have to be January. So, things are still in limbo for the moment, but at least I'll be healthy when this happens.

I'm so sorry to hear that. Aside from those issues, were you successful in your weight loss? Personally, that's my biggest concern.

I hear you on the GERD. I guess I just feel like that you can always move to the RNY from the sleeve, but there's not much that can be done if you start with the RNY and it doesn't work out. Anyway, I don't have GERD or any comorbidities, so I think I'm probably a good candidate for the sleeve -- though, I am concerned I'll lose less weight. I have about 120 lbs to lose.

Thanks -- I get all that. ). My point was that being irreversible isn't as big of a deal as it sounds. In the end, even if you don't lose much or regain what you did lose, the fact that the sleeve is irreversible doesn't really matter. Effectiveness aside, I can't imagine a situation where someone with a goal of losing weight would ever say they wish they had a larger stomach. I can, however, imagine someone wishing they hadn't rerouted their digestive system. I just meant that saying the sleeve is irreversible isn't actually as scary as it sounds. It just means you'll never have a large stomach. In my world, that's a good thing' Needless to say, I have changed my mind and am now scheduled for the sleeve. I let my surgeon talk me into the bypass twice -- but every time I left her office and started to think about it, I kept coming back to the sleeve. In the end, I consulted another surgeon and he confirmed everything I was feeling on my own -- so I made the switch. Sorry! That was supposed to be a smiley face above!

But why would having a smaller stomach ever be a bad thing? Even if it didn't work well for weight loss in the long run, what's the problem with having a smaller stomach? I can see why rerouting your digestive system would be a concern or why putting a foreign body in your body might be a concern -- but why is having a smaller stomach a concern? No, you can't get the portion of your stomach they removed back -- but why is this not good?

Just posted this in the gastric bypass forum, as well. Does anyone feel pressured by their surgeon to do the RNY/bypass over the sleeve? Like everyone else, I sat through the initial info session my surgeon offered and I felt like she was really selling the RNY. The whole session was about the RNY, in fact, and how it's the "gold standard" and best procedure. Then, I met with her for my initial appointment. She predictably said I was a better candidate for the RNY. I am 5'2" and weigh 250. Fair enough. I went home and had my mind set on the bypass. But then I started doing my homework and, after much thought, I decided the sleeve may be better for me for many of the same reasons as others who make this decision: I have no comorbidities, research seems to say it's less invasive, no rerouting, no dumping, no vitamin/medicine probs and it would cut out the hunger hormone grehlin. Equally as important it would restrict the amount I can eat and, according to the many pieces of research I read, offer practically the same amount of weight loss as the RNY over the long term, albeit at a slower rate. I am also a cancer survivor and I had concerns about the malabsorption that comes with the RNY and whether or not I could effectively be treated in the future (if needed) if my body would no longer absorb medicines (including oral chemo). That said, I did have a couple of concerns about the sleeve. One, I'm not a necessarily volume eater and this is obviously a purely restrictive procedure. And two, I have a career, a lot of business travel, and a toddler, so I can't commit to constantly exercising like others do. I wondered if I wouldn't lose enough and then regain what I do lose because I won't have that malabsorption so many people benefit from with the RNY. So, I made a second appointment with my surgeon to discuss all of the above and she was still all about the RNY -- which is totally fine. She is the expert and I am turning to her to help me make an informed decision. However, she mentioned several things that were contrary to everything I've read. She said... --Malabsorption only lasts six months at the most for both calories and nutrients/medicine (yet, her required nutrition classes talk about the life long Vitamins, etc???) --People don't lose weight from the RNY because of the malabsorption or restriction; they lose weight because they're bypassing all the hormones in the first part of the small intestine, something you don't get with the sleeve (so malabsorption has very little to do with the weight loss) --The RNY is safer than the sleeve; the sleeve is actually more invasive and dangerous to recover from because it's more prone to leaks due to the length of cut and pressure that builds in the sleeve. --The sleeve causes less weight loss and you will regain more in the long term. I have read that the long term results are VERY similar to the RNY. She says no, long term for RNY is much better. --The least I can ever weigh with the sleeve is 180-190 lbs (currently 5'2" and 250 lbs) and I likely won't get that low. --I can take time release medicines in the future and they will probably work. --The sleeve will rarely be performed five years from now because it's not effective; but I thought the sleeve was becoming the WLS of choice I was confused by what she was saying, so she referred me to the Cleveland Clinic's "Stampede" study, as it compares the RNY to the sleeve. But I read it and it is all about the effects of both surgeries on diabetic patients. I don't have diabetes. Does any of this sound like what you've understood from your surgeons? My surgeon is loved by all. She is smart, has great bedside manner, has been doing this for over ten years and has one of the Bariatric Centers of Excellence. I do trust her, but some of this sounds strange to me. In the end, I want solid info so I can make the decision that's best for me. Any thoughts on why surgeons might try to "sell" the bypass more often? Also, any thoughts on what she said to me when I went in to ask her about doing the RNY vs. the sleeve? Thanks!

Hmmm...that's basically the way I felt about the RNY. Just seems so invasive when you can simply (haha) have most of your stomach excised. But it just doesn't sound like any of my doctors have much faith in the sleeve -- not my surgeon, not my PCP, not my oncologist, no one. I finally just decided I should do the RNY.

I'm so sorry to hear that! Just curious, but why does your surgeon not do the RNY any longer? I mean, since it's billed as the "gold standard" and all...

Well, I made a decision and we submitted my packet to my insurance company yesterday. I'm opting for the bypass. I had a long talk with my PCP and he felt that the sleeve wasn't a good option for me because my issues are more metabolic. If I were more of a volume eater, he said he could see it -- but since my metabolism is a problem, he thinks I would only benefit from the bypass because it helps reset your metabolism. I'm not excited about the prospect of dealing with dumping, but it looks like this isbwhat I'm going to do...

I posted this elsewhere, too... Thank you so much, everyone, for your feedback. This helps a lot. I'm still very conflicted. I went back to my surgeon today and one of her staff members told me they don't even normally do the sleeve for people of my weight because they just don't see the results they need. All that said, they agreed to do the sleeve for me if I want to go that route. Honestly, I have a friend who weighed around 350 and she lost over 100 lbs -- so she has been successful, but she is having trouble losing the rest of her excess weight. So, I'm still really confused -- and I'm not sure how much of it is because my surgeon and her office are encouraging me to do the bypass or what I have seen with my friend and her sleeve. Also, I spoke with my oncologist and he said that if I were to ever need treatment in the future, I could be treated if I have the bypass or the sleeve.

I posted this elsewhere, too... Thank you so much, everyone, for your feedback. This helps a lot. I'm still very conflicted. I went back to my surgeon today and one of her staff members told me they don't even normally do the sleeve for people of my weight because they just don't see the results they need. All that said, they agreed to do the sleeve for me if I want to go that route. Honestly, I have a friend who weighed around 350 and she lost over 100 lbs -- so she has been successful, but she is having trouble losing the rest of her excess weight. So, I'm still really confused -- and I'm not sure how much of it is because my surgeon and her office are encouraging me to do the bypass or what I have seen with my friend and her sleeve. Also, I spoke with my oncologist and he said that if I were to ever need treatment in the future, I could be treated if I have the bypass or the sleeve.