Just starting the process, had first visit with surgeon

[judanna77 45]

Sorry for how long this is- I know that I always appreciate reading detailed posts about the process, so I’m hoping other will find it helpful.

I’m just starting the process of getting a VSG. I’ve thought about WLS for a long time, but have always been scared off because of the possible complications. I’m not sure what exactly changed, but, about three weeks ago, I was driving to work and the thought of getting the surgery popped into my head and suddenly I knew it was what I needed to do. Looking at the hard road ahead, I wish I had started this journey earlier in life (I’m 37), but I know I wasn’t ready for it until now.

I’m in the DC area, and there are lots of hospitals and surgeons to choose from. I finally settled on Inova Fair Oaks, which is a Bariatric Center of Excellence, has great stats, and has an up-to-date website which let me register for the seminar online. (GWU never contacted me after I filled out their form. Other hospitals had outdated calendars on their websites, or no way to register online, or the websites themselves were unfinished, which I felt didn’t bode well for their programs.)

I went to a seminar about two weeks ago, which was mostly basic stuff that I already knew. I had my first visit with the surgeon a few days after the seminar. The surgeon, Rajev Nain, was the same surgeon who did the seminar. He seemed a bit stiff at first, but after a while he seemed to get more comfortable and I felt like we had a good connection. He definitely didn’t come across as the a**hole surgeon stereotype you hear so much about.

We first talked about my basic health history, medications, that sort of thing. I don’t have many co-morbidities yet- just hypertension and edema in my left leg. We talked about the various surgeries, and he was fine with me getting the VSG, he didn’t push for the RNY. I’m 5’1” and 355lbs. He said that he could get me to around 205 lbs with the sleeve. He was clearly just basing that on the average amount of excess weight lost with the sleeve, not anything specific to me. I would be overjoyed with 205, even though that would still leave me 100 lbs over my ideal weight. However, I also know that each individual is different, and I feel like I have it in me to go lower. I may not make it to 105, but I think I am determined enough to get myself in the mid-100s.

I asked him about his experience- he’s done several hundred VSGs, and even more RNYs. He also has lots of experience with other GI surgeries. While I would have liked him to have done thousands instead of hundreds of VSGs, it is still enough that I feel safe with him. I asked about major complications, and he said that <1% of his VSG patients had had major complications. He has had no mortalities with the VSG, and one mortality with the RNY (the patient died of a pulmonary embolism the day after surgery, even though she was on blood thinners and had had her legs compressed during surgery.)

Having lurked on this board for a while, the variance in different surgeons’ pre-op and post-op diet instructions has been a bit puzzling to me, and the materials from the presentation I attended were very authoritative. I will happily follow rules if I understand the reasoning behind them, but I tend to do my own research and come up with my own rules for myself if I feel like the rules I am given aren’t well supported.

I was nervous to do it (because of that whole surgeon stereotype), but I told this to my surgeon, noted that his post-op diet (2 weeks Clear liquids, 2 weeks full liquids, 2 weeks purees, 2 weeks mushed-up real food, then finally real food 8 weeks after surgery) was one of the more conservative ones that I had seen, and I asked him what research had gone into making it. He laughed at that, and said that the priority for him and the other surgeons in the group was to have consistent instructions that everyone involved in the practice could refer to, so they just flipped a coin when making them. He said that the part he cared about was that he didn’t want patients going to full liquids until after he examined them at the first post-op appointment. Other than that, I could work with the NUT to come up with a post-op diet plan that worked for me.

I then asked him about the 2-week pre-op liquid diet. The pre-op diet that he requires is 900 calories of Protein shakes a day. I told him that I totally understood the reason for the diet (to shrink the liver to make surgery safer), but that I didn’t understand why it had to be all liquid. Why not just 900 calories of low-carb food per day? Again, he laughed and said that there was nothing magical about the liquid part of it, it was just easier for people to stick to the diet when they didn’t have a choice about what to eat. He said that he was fine with me subbing low-carb, high-protein food into the pre-op diet, as long as the NUT approved my substitutions.

He seemed to get a kick out of me and my questions. He said he could tell that I took this very seriously and had done my research. I thanked him for not treating me like an idiot, and not having a “do what I say because I am the surgeon” attitude.

I have to do 6 months of “nutrition classes” to satisfy my insurance requirements, so surgery won’t be until next spring some time. I’m disappointed to have to wait so long, but I am trying to make the best of the time by really making sure I am ready for this change, and by trying to lose as much weight as I can before the surgery. I started myself on a low-carb diet of my own design, and am doing great on it so far. I’ve done low-carb diets before, and it has always been a struggle with craving carbs while on them, but I haven’t had a carb-craving yet on this one. I’ve cut out all grazing and it has helped immensely. I’m eating 1300-1500 calories a day and not feeling hungry. I know it will get harder, but right now, I’m feeling pretty good about myself.

[The Candidate 3,215]

Welcome and congrats on making the decision to have wls. It's clear that you have done your homework, and I'm sure that will bode well for your overall success.

The wait time seems daunting now, but it will pass by quickly. You are wise to make losing weight as a pre op your priority. The more you lose before surgery the better off you will be in the long run.

Good luck and best wishes!