AstroGuy

Trying to decide between bypass (RNY) and sleeve. I am leaning toward bypass but I am not sure. A little about me. I am 5'7" and my high weight was 265 (BMI of 42) current . Diabetic, HBP, Apnea and high cholesterol. The turning point was when my endo Dr was stumped at why my A1C was still high after all the drugs I was on...."duh, I eat like crap!" I went on a medically supervised weight loss diet for six months (exactly like the pre-op liquid diet) and lost 65 pounds. Transitioned off the diet and gained back 40 (CW is 240lbs). Decided the next step was WLS. My BMI is now 38 with all the same complications. According to charts my weight should be less than 165. From the research I have done I have a 50% chance of reaching: 158lbs with RNY or 170lbs with sleeve. My question is the 12 lbs worth the RNY vs sleeve. I am not sure what the extra "effort" of the bypass is??? Is day to day living different between the two procedures. I am leaning towards RNY for a couple reasons. 1) I have a better chance of getting at least a reasonable weight. There is an 80% chance of being at 190 with RNY two years out vs 208 with sleeve. I like those odds better. 2) Once you have the sleeve done you aren't going to go back and have the RNY done (if that is even possible). I am looking for input from people. What was the logic you used to decide pick the bypass. For the record my doctor has recommended RNY but it seems a lot of people in the support group has sleeves. Thanks in advance. Astro!

I am hoping!!! All paperwork done and my doctor is quick so fingers crossed!

This is the exact thing I am thinking. But I am not sure of the actual day to day differences once you are back to eating solid food. I do have GERD which is probably why the doctor recommends bypass. Although since I lost weight it hasn't been a problem my endoscope showed it was!

Well that is helpful! How bad was the pain at it's worst? I am guessing that 2 weeks minimum for work. A lot of people have expressed frustration with not going for a while but I am not concerned. If nothing is going in, nothing is going out!!!! My biggest fear is what to do with the time I am NOT eating. We are triggered to eat at certain times and used to eating a certain amount. How are you doing with that change?

achappex3 how was the surgery? How not to much of an issue! I am following in your footsteps so I am curious about the process. How are you feeling? Back at work? Hungry, sick, tired? All the usual stuff people ask. By the way awesome progress!!!

I finished my final doctor's exam evaluation today. It was the Pulumonary evaluation and he said I was extremely low risk! Onward and upward! He did say something unusual however. He remarked that he was surprised I was having surgery. My bmi is 38 and I have apnea,diabetes,high BP, high cholesterol and a family history of heart disease. I was kind of surprised by that response. I may not have a bmi of 50 but it is not like I am in the best shape either!

Thanks all. Sounds like Vitamins are more involved than I understand at this point. Great learning. I guess it is better than spending the money on BP, cholesterol and Diabetes meds!

As I approach making a decision one way or another, there are two things that I am concerned with, well actually tons but those can come later. I am a little freaked out about vitamins. I already take a multivitamin and it is no big deal. I buy regular vitamins that deliver 1000% of the daily requirement of everything. My nutrition person says those are fine. I pay like 20 buck for 9 billion pills. I see others talking spend $150 a month for vitamins. Am I missing something? The second question is sort of related. I have to take a medicine that is a horse pill. It is pretty big. I have no issue taking it now but I am worried that I will be able to take it right after the procedure and going forward. It is an anxiety med so, yeah, I'll need it! Thanks, Astro.

I posted this in the pre-op section but I thought it might be better if I ask the question of people that have already been through it? I am considering RNY and am in the last stages of approval. Of course I have questions and am seeking input. I am a male and 53. As a kid I was rail thin (having graduated high school weighing 140 lbs). Over the years the weight slowly accumulated. One year and eight months ago I started on a medically supervised low carb diet and lost 65 pounds in six months. It was Protein shakes and as I transitioned off I gained back about half. I have so many co- morbidities (Diabetes, sleep apnea, high BP, high cholesterol) I feel I have to do something drastic. For me it is a health issue, plain and simple. A family member had great success several years ago (and is still doing great) with a sleeve so I am considering surgery. For me I am pretty much decided on RNY, my logic is that if I get the sleeve and it doesn't get me where I want to be, I can't change it. I have known my medical team (nurses, endocrinologist, nutritionist, exercise person) this entire time. The surgeon and psychologist were just added. They are all very confident that I will be successful....me not so much. My BMI is 38ish so I have some weight to lose (maybe 50 or 60 lbs) which I know is not as much as others. I think I am, at least, a semi intelligent person. I have researched the procedures, the pluses and minus, the risks, and life after surgery. Nothing is like actually having gone through it but at least I think I understand what I am getting into (as best as I can). I guess the question is "WHY IS THIS DIFFERENT"? Let's face it, if I was that good at following a directed diet, I wouldn't be looking at surgery. If I was motivated get up and exercise I would be doing it. So what makes me think that altering by body will change my mind and life. The teams feedback is that because I have lost weight in the past (not just last year but multiple times in my history) that I have proven I can make changes. The surgery will help the changes stick. I am not sure I understand this. The only things I can think of are Volume, Dumping and Relationship. V - I get that I will eat less volume and that makes a difference, but I also know that this alone won't be enough long term. The pouch can stretch and you can sabotage the volume thing with bad choices. I am not to worried about volume but, again, if I was any good at making good choices I wouldn't be here. D - I think dumping can give you immediate feedback when eating the wrong volume or type. I am not sure this is a valid tool but it is there. R - I know that for the first year or so you are not physically hungry. I also know that this disappears and that most of my eating is NOT driven by hunger. I guess my thought is that if I am not driven by hunger for a year I can focus on recognizing and controlling eating for other reasons (boredom being the biggest). The psychologist also mentioned that my energy would be higher and I would be more active, hence less bored. I would appreciate input, not only to the central question, "Why is this different?" but also if you have any insight into my thinking. Is my mind in the right place? Does the VDR logic make sense to those that have gone through it? Really any input would be great.

My answer, and I am a male, is that we are just not that smart. The cartoons about us and squirrels or boobs are exactly right. We are just not that deep. He thinks Valentines day = buy a gift, looks around and sees a box of something red and heart shaped and BOOM, done. Don't be too hard on him. I would remind him again and move on! Take pity on us. Astro

I am considering RNY and am in the last stages of approval. Of course I have questions and am seeking input. I am a male and 53. As a kid I was rail thin (having graduated high school weighing 140 lbs). Over the years the weight slowly accumulated. One year and eight months ago I started on a medically supervised low carb diet and lost 65 pounds in six months. It was protein shakes and as I transitioned off I gained back about half. I have so many co- morbidities (Diabetes, sleep apnea, high BP, high cholesterol) I feel I have to do something drastic. For me it is a health issue, plain and simple. A family member had great success several years ago (and is still doing great) with a sleeve so I am considering surgery. For me I am pretty much decided on RNY, my logic is that if I get the sleeve and it doesn't get me where I want to be, I can't change it. I have known my medical team (nurses, endocrinologist, nutritionist, exercise person) this entire time. The surgeon and psychologist were just added. They are all very confident that I will be successful....me not so much. My BMI is 38ish so I have some weight to lose (maybe 50 or 60 lbs) which I know is not as much as others. I think I am, at least, a semi intelligent person. I have researched the procedures, the pluses and minus, the risks, and life after surgery. Nothing is like actually having gone through it but at least I think I understand what I am getting into (as best as I can). I guess the question is "WHY IS THIS DIFFERENT"? Let's face it, if I was that good at following a directed diet, I wouldn't be looking at surgery. If I was motivated get up and exercise I would be doing it. So what makes me think that altering by body will change my mind and life. The teams feedback is that because I have lost weight in the past (not just last year but multiple times in my history) that I have proven I can make changes. The surgery will help the changes stick. I am not sure I understand this. The only things I can think of are Volume, Dumping and Relationship. V - I get that I will eat less volume and that makes a difference, but I also know that this alone won't be enough long term. The pouch can stretch and you can sabotage the volume thing with bad choices. I am not to worried about volume but, again, if I was any good at making good choices I wouldn't be here. D - I think dumping can give you immediate feedback when eating the wrong volume or type. I am not sure this is a valid tool but it is there. R - I know that for the first year or so you are not physically hungry. I also know that this disappears and that most of my eating is NOT driven by hunger. I guess my thought is that if I am not driven by hunger for a year I can focus on recognizing and controlling eating for other reasons (boredom being the biggest). The psychologist also mentioned that my energy would be higher and I would be more active, hence less bored. I would appreciate input, not only to the central question, "Why is this different?" but also if you have any insight into my thinking. Is my mind in the right place? Does the VDR logic make sense to those that have gone through it? Really any input would be great.

I want to go with RNY. My logic is that if I get a sleeve and I don't lose enough I can't go back and get the bypass. If I lose too much from the bypass (I don't even know that is possible) I can modify my diet. In terms of risk, although there is a difference, in the big picture the risks are about the same. My sister had the sleeve specifically to avoid dumping but for me, I see dumping as a plus as I have a horrible sweet tooth. Hopefully, it will motivate me to avoid those foods.

I have this same concern. I don't want to tell anyone anything. My wife has convinced me I should tell my immediate family (kids, sisters, dad, etc) but I really don't think it is anyone else's business. What I've told my boss is that I am dealing with a medical issue and I will have a few doctors appts in the next few weeks. We are pretty relaxed about that and I am salaried so that makes it easier. When it is time for surgery I will just say that I have to have surgery and I would rather not discuss it. That is it. Same thing for co-workers and the people that I supervise. After the surgery and I am losing weight and looking incredible I will just say I am on a low carb diet. I lost a bunch of weight last year and that is what I said so it will be easier this time.

Erin and Shar, thanks a ton. Everyone's advice and comments really helped. I was at a support group meeting last night and they said the same thing. This has really made a difference. I know people say that all the time but it is true. Thanks. Ed

From my understanding, the pre-op diet is to remove fat from the liver so that the surgery is easier for the surgeon. I wouldn't worry about it. I would be proud of the 14 pounds in 10 days!!!!!

That would be awesome. I have a bad sweet tooth and that would be welcome!! Is this a normal thing?

J16 totally agree and your results are amazing! For me I have discovered that there is 4 types of eating drivers. Having an appetite (craving something to eat) and grazing (mindless eating). With the recent weight loss I learned that you can control the carb cravings by really limiting them. I was on a ketogenic diet (>50 g a day) and after a few days didn't crave carbs at all (and I have/had a huge sweet tooth) so I think I can control that. At this point I really don't consume "any" carbs. What I mean by that is that I don't eat things that are heavy carbs (e.g. Pasta, bread, chips, etc). I really don't have a desire. I still have a little bit of a sweet tooth and added chocolate back in (those mini bars) which is not good! (and of course I am not so good on volume) Low energy (like a low blood sugar). The low energy happened a lot while I was an active type 2 diabetic due to injected insulin but still happens now while not taking any insulin. This is planning. I just can't skip meals or at least at the first sign of a problem, correct it by eating something small. If I waited until I was really in hypoglycemic mode it was panic time. This doesn't happen much now. Hungry (physically empty stomach), The other two is where I THINK the surgery can help. Again asking for a reality check here! By drastically changing my stomach and hormones the physically empty part is supposed to be less, at least initially. The second one on grazing should also be limited due to the restriction. Right now I have a habit of eating until full (which is actual over full). The expectation is that is limited by the surgery and the desire to grave will be reduced and the volume that can be graved is also reduced. So my hope is that during the Honeymoon period I can get exercising at least a little more then I am now and ingrain it into my life and get a better relationship with food and eating. I always make the analogy that I want food to be like mowing my lawn, yeah have to do it but I don't wake up everyday preoccupied by it. It is just a think that has to be done.

I also have United Healthcare and I also have the "six month waiting period". The insurance person at the Dr. Office told me they never have to wait the six months especially if you have a documented history of a medically supervised diet program. With your post I am getting nervous. I have one more requirement to get (pulmonary eval) and that happens next week. The way she explained it to me is that if the insurance balks at the approval, the doctor mentions something along the lines of "Fine but if the patient keels over from a heart attack they are coming after you!" She said that usually solves it. Also remember that the doctor and hospital are very motivated to do the surgery, e.g. $$$. Now I am not saying the doctor would recommend a surgery of this magnitude just to get the money but the once he says it is a good fit and you pass all the medical requirements the hospital wants it done as soon as possible. Use them to get it approved faster. My hospital has a "patient advocate" department. You might contact them.

I suppose it depends on your work coverage. I've checked with mine and it just says we are covered for any medical procedure but it must be approved. I would think that if the insurance is paying for the procedure STD would cover it. I know they can't disclose to your company or boss why you are taking STD (not even HR).

I "just" lost 65lbs and wasn't able to keep it off so I did get to feel the of being thinner but it was 100% lost on a medical program using low carb Protein shakes. I did three shacks a day every day for six months. I was personally OK with continuing with the shake program but they wanted me to transition off because you can't live on shakes for ever. When I transitioned off the shakes that is when I had a problem. It wasn't drastic, 1 or 2 pounds a week but I couldn't stop it unless I was VERY careful with my food. As we all know "diets" fail so I don't think looking at this as a diet the right way. I mean I get that I can't eat two bowls of ice cream or a whole pizza, but I also know that I can't eat carrot sticks for ever. Again, if I could have done it, I would have. My hope is that the restriction reminds me to stop eating before it gets out of hand and the dumping reminds me not to eat crap. The surgery is a BIG deal. No going back and a major mutilation of internal organs. I don't want to go through the surgery, the recovery, the adjustments and the side effects for life without having a good chance of success. This is one point I am fixated on. Fortunately I have time to work though it in my mind! So thanks for the input!!!! Keep it coming!

Thanks all. I have pretty sure that I will go with the working on my portion and exercise.

Thanks for the advice. I've heard of the set point theory but I don't know much about it. More research!

For my evaluation she was trying to determine if I understood the implications of the surgery. Things like permanence, forced change in volume, consequence of not following plan. She also wanted to understand motivation. If I was doing it to lose weight to just look better or if I was motivated by health concerns or mobility. We spend alot of time on support system and if I was committed. I had to have two, one hour sessions. I will probably go back for further appointments however. The test was to give her insight to my personality. Mine was 165 questions long!