Initial Visit With Pa This Morning

[Sphinx 22]

At my appointment this morning the PA suggested I research the sleeve gastrectomy. She really just said that the weight loss is greater than the band, faster, and no foreign bodies/need for frequent visits (fills). The thought of having such a large part of my stomach literally cut out makes me nervous, but as someone with RA on meds that lower my immunity, I have to wonder if it would be better NOT to have a foreign body. Does anyone having any thoughts on pros and cons of the two (generally, I know it's different for everybody).

[Jean McMillan 2,973]

Autoimmune disorders like RA are considered a contraindication for the adjustable gastric band.

I had 5 happy years with my band before having it removed in April 2012 (due to stenosis from 20+ years of silent reflux). I had the vertical sleeve gastrectomy in August 2012. I'm having a hard time adjusting to my sleeve, but I'll to list the pros and cons as objectively as I can.

THE BAND

Pros:

Adjustable

Reversible

Reduces hunger & appetite

Provides early and prolonged satiety

No malabsorption of macro or micronutrients

Cons:

Slower weight loss (average 1-2 lbs/week)

Small, gradual fills can delay weight loss until enough saline is put in to create optimal restriction

Contraindicated for people with autoimmune disorders

Risk of esophageal and/or stomach dilation, slippage, and erosion

Risk of reflux, especially if the band is too tight

Need for frequent aftercare visits (fills, unfills, checkups)

Certain foods can be difficult to eat

SLEEVE GASTRECTOMY

Pros:

Faster weight loss

Greater weight loss (but it's really too soon to trust the stats on that)

Reduced need for aftercare visits

Supposedly eliminates hunger (due to reduced production of grehlin, the hunger hormone), which has not been the case with me

Supposedly makes it easier to eat a wide range of foods (again, not the case with me)

Cons:

Not adjustable

Permanent - not reversible

Can cause malabsorption of miconutrients (vitamins & minerals, especially Iron, folic acid, B12)

Reflux is so common that PPI's are routinely prescribed to sleeve patients (and long term use of PPI's can also cause anemia)

Risk of dumping syndrome (from rapid gastric emptying)

Risk of staple line leaks (very painful, can be life-threatening)

The good news about my sleeve surgery is that I've lost 20 of the 30 lbs I regained from losing my band. The bad news is that since surgery, I experience extreme spikes and dives in my blood sugar, which is apparently the cause of the ferocious hunger I experience about one hour after I eat, no matter what or how much I eat. So far no one has been able to fully explain or resolve that problem, and it makes my daily life a misery. Also, I experience dumping when I eat anything with more than 5 or so grams of sugar in it. I've become very anemic and have to take an Iron supplement every day. A hemoccult test showed that I have some kind of a gastric bleed, so tomorrow I'm seeing my gastroenterologist in the effort to find out if the anemia is caused by the PPI I'm on (omeprazole) or the gastric bleed (from ulcers, a perforation, or something else). I can't take it lightly because my mom had colon cancer, so I'll probably have to have a colonoscopy to identify the source of the bleed.

Now, having said all that (and clearly not being a happy camper), I do know many people who've been sleeved and are delighted with their weight loss and the lack of side effects and complications. I just wish I was a member of that club.

Jean

[Sphinx 22]

I've never actually heard about RA being a contraindication until you posted that. I know I've read on here about at least one person who had a band even though they have lupus. When I went to my seminar I specifically asked and was not told I couldn't have it. The PA I saw was aware I have RA as well. (Of course that could be why she made sure to tell me to research the sleeve. I also have to get clearance from my rheumatologist, which I haven't even talked to him about yet.

I did do a google search for contraindications, and they do say autoimmune connective tissue disease, but I wonder if thats a CYA disclaimer?

The idea of the sleeve just makes me nervous, there's no going back or changing my mind once I get it. That freaks me out a little!

I guess I'll be calling and asking about this sooner rather than later.

Thanks for your help, and I'm sorry you're having problems! I hope its possible to sort it all out