Serious Decison To Make

[ZetaStar 11]

I am currently torn between Gastric Sleeve and Duodenal Switch. I am a 15+ yr. diabetic (currently on metformin pills and long and short acting insulin), have high blood pressure (on 3 different medications), and high cholesterol (on simvastin). My weight at the Nutrition/Orientation was 256 with a BMI of 40.2

In talking with the Dr. at the information seminar, I briefly he said that the DS surgery was the best for someone with my co-morbidities (especially diabetes); but I want the GS. My reasons for wanting GS is because I'm afraid of the possible Vitamin deficiency, dehydration, and malnutrition, and other complications that aren't associated with the GS. I have my first consultation with him tomorrow. My question is: If a surgeon says that the DS is the best surgery for you, but you want the GS, can the surgeon refuse to do the surgery that you want? If so, do I comply with his suggestion or try to find another surgeon?

[James Marusek 5,244]

You might listen to the reasons why he/she made the recommendation before you leap. In my case in addition to high blood pressure and diabetes and sleep apnea and other co-morbidities, I also had severe acid reflux (GERD). RNY was my surgeons choice and it was also mine. There were several individuals on this board that also had GERD but went with the sleeve and had to have a revision to RNY because of incompatibility with GERD.

Some doctors are just comfortable with a certain type of surgery. It is their expertise. It is their preference. But there are also medical conditions that drive a specific type of surgery.

After all do you really want to undergo the knife twice when once will suffice?

[animallover1247 249]

Hi ZetaStar

I'll let you know my experience. I have been diabetic for about 12 years (insulin dependent), and I also have high blood pressure and moderate sleep apnea. I had done a lot of research before I went to my consult. My surgeon told me gastric bypass was the gold standard for diabetes. I told him I was aware of this fact but I did not want to have bypass surgery for many reasons. some of which you listed l. I told him I wanted the sleeve and he did not have a problem with it.

As a general rule, I would say go with what your surgeon recommends and if you have questions or doubts about it, then talk to him/her. Yes, I'm sure a surgeon can refuse to do a certain procedure on you. If that happens, you could seek out another surgeon but keep in mind they may tell you the same thing.

Let us know how your consult goes!

[CowgirlJane 14,259]

I would say "fact based decision"

Your BMI is not at the higher end, so I am guessing it is your # of comorbitities that is pointing the surgeon toward the DS?

The latest studies indicate that the bypass has a better track record than the sleeve for "curing" diabetes - what do the facts say about the DS?

I was more obese (my BMI was over 50 when I was sleeved) so it was a tough decision.

i had band induced reflux (but it went away when band was removed) and luckily have been fine since being sleeved.

One thing I found out when I was researching plastic surgery... I went on multiple consults. I heard from TWO plastic surgeons that the only serious complications they had were both DS patients post massive weight loss. Truth of the matter is that all of us that were morbidly obese have some level of permanent damange/change to our bodies. The DS is a bigger surgery, bigger risks, more malabsorption and I believe very good results. If I was alot heavier/higher BMI I would have definately considered it, in spite of the bigger risks. Frankly, it remains my backup plan that I hope to never have to exercise!

I have had tremendous success with my sleeve - lost 150# and maintaining for a few years now - so far so good.

[DivaSoBlessed 97]

Hello and welcome @@ZetaStar!

I am at the beginning of my journey as well and it looks like you have some pretty good advice from those who have gone before us and have already had their WLS. It is a tough decision to make but ultimately the decision is up to you. Your surgeon will make the best recommendation that they feel will help you in the long run but you still have a choice. I will also say that so far from what I have been reading on this forum it appears that none of these surgeries come without a lack of Vitamin deficiency, dehydration, and malnutrition. No matter what you choose there is a likelihood of experiencing some or all of these side affects. Keep in mind that there are risks associated with any of these surgeries but chances are greater that your surgery will be a successful one. As far as your reflux here is what the surgeon at my information session explained to us. If you tell him during your consult that you have acid reflux he won't do the sleeve period because it will only make your symptoms worse. My husband has GERD and is a type II diabetic, with hypertension and what I witness him go through I couldn't imagine how much worse it could get. Listen to your doctor and if you are still feeling differently consult with another surgeon to see what their thoughts are. Finally asks as many questions as possible and do some more research before making your decision. I am wishing you the very best. please keep us posted.

Edited December 2, 2015 by DivaSoBlessed

[ZetaStar 11]

Thank you all for your advice! I appreciate it so much.

Cowgirl Jane: In the information seminar, the Dr. did say that the DS surgery is the one that is best for resolving/curing diabetes and the one they usually use for insulin dependent diabetics. That's me...

animallover1247: I like that you told your surgeon what you preferred and he didn't have a problem with it. I may try it and see what happens.

James Marusek: You are ab-so-lute-ly right!!! I do not want to go under the knife twice when once will suffice! I will be listening to reason. There's a reason why they are Drs.

DivaSoBlessed: I forgot to mention that I have acid reflux and take Walmart OTC meds for that. Since you said that, I now remember that they did say that Gastric Sleeve could possibly/will make acid reflux worse. I know that I am leaning more to the Sleeve because that's the one my Son had 1&1/2 yr. ago. He and his girlfriend had the sleeve. He looks wonderful and lost quite a lot of weight (over 100 lbs), but he still has to take insulin for his diabetes. Personally, I don't want to have to take insulin or have the complications that come with diabetes. I'm already experiencing neuropathy and diabetic nerve pain in my feet and hands.

I am so glad that I happened to stumble across this website!!! I <3 it!!

Again, thank you all so much!!

Smooches

[DivaSoBlessed 97]

@@ZetaStar my husband was taken off of insulin and started back on the pills. I know exactly what you are experiencing because my husband has everything you mentioned and including fatty liver disease, and non-alcoholic pancreatitis the neuropathy is the worst of it all. He wakes up in the middle of the night in lots of pain and sometimes can't get back to sleep for hours. He now works out 5 times a week during his lunch at the company gym and has lost over 100 lbs. If there is a possibility that going with the sleeve won't resolve these issues I would think long and hard before making your choice. I am sure that you will make the best decision for you. I am happy that you found the website. I stumbled upon it too.

[Pinkgirl1234 761]

Listen to your doctor.I had the option of lapband or bypass back in 2004.My doctor saw that I insisted on the less"invasive " surgery...I went with the lapband.BIGGEST MISTAKE!I have had nonstop problems...looking back I wish my doctor would have given me the advice ...now I am seeking a revision to bypass....Get the most effective surgery.My friend has the sleeve and she has malabsorption as well..vitamin up!!!

Go with your doctors advice.

[MichiganChic 3,262]

You might want to do some research. You might also want a second opinion. If I were in your shoes, I'd be doing those things, and also considering RNY as a viable solution.

I had a high BMI, and probably should have had RNY, but I didn't want all the malabsorption. I don't think I would have considered the DS. For me, the long term risks and unpleasant side effects weren't worth it. I didn't have comorbidities, so that factored into my decision to go with the sleeve. I've been pleased with the outcome.

You do have a lot to consider! Remember that physicians opinions are that - opinions. Not that they are not valuable and based on knowledge, but sometimes it's a good idea to consult more than one.

[Sajijoma 1,324]

my surgeon doesn't even offer the DS. He says that it's a highly risky surgery and the complications outweighs the benefits so he doesn't do them. I ended up with RNY and although so am just over 3wks out, I am seeing HUGE differences in my weight especially when I look at my face. I didn't have any co morbidities to speak of, but I do carry a high BMI. I'm losing top down so I have a very thin face now and unfortunately still a lot of junk around my trunk! ???? listen to your surgeon and ask a lot of questions and then together make the choice you both feel will be the best decision. Don't rule out RNY. Malabsorption isn't all bad. It also means you aren't absorbing all the calories and fat you take in which help with weight loss and when they make your pouch, they don't cut out the excess stomach. It remains inside producing hormones so if God forbid you did have a serious complication like esophageal erosion so bad that it needed repair or cancer, they can use that stomach lining to build you a new one. It's always better to graft from 1 body if possible. With sleeve there's nothing left to work with, and I don't know much about DS but I assume it's the same since I believe I was told the sleeve actually was a stage one of making DS.

[ZetaStar 11]

Well... my consultation with the surgeon went well. He recommended DS as I thought he would. I told him I thought I'd rather have the sleeve and he explained that with my A1c being 13.1, that my diabetes was way out-of-control and that it needed to be brought in control and the DS surgery has proven to be the best for that. Plus with me having been diabetic for over 15 yrs. and insulin dependent as well as pills for about 10 yrs. DS was best for resolving diabetes. Then when you add in my other co-morbidities, and he really took time to explain to me the effects and how the DS surgery can help resolve/improve these issues,I felt better. I also expressed my concerns and his explanations helped calm those to the point where I felt a lot better about the DS surgery. I also went to a support group of Protein Tasting at the Center and the Mentors (those who've had the WLS) were there to talk to and answer questions. There was a lady there that I had talked to before who'd had the DS surgery. Of course, I talked to her again tonight and she was very supportive and told me more about how she's being 2 yrs. post-op. So, I guess I said all that to say I'm ok, even though a lil nervous about surgery, but I'm listening to my Dr. and ready to commit. I'm sure I'll be calling on y'all's advice, & prayers,and I'll be devouring everything I can find on DS surgery. Again, Thanks so much!!!! Love to you all!!!!!! MUAH!!

[DivaSoBlessed 97]

You can do this @@ZetaStar and you'll be a better you post-op. Imagine not having to take any medications again. I'm rooting for you and wishing you the very best.

[JengaBee 38]

I don't have diabetes but the history of acid reflux was enough for my surgeon to immediately steer me away from the sleeve. He suggested the mini gastric bypass. It's just as effective as the gastric bypass, but a lot safer. And it is outlasts the sleeve in long term effectiveness.

I really wanted to stick with the sleeve but after a ton of research and a little trust in his knowledge, I'm going with his recommendation.

[Pinkgirl1234 761]

Mini bypass?

[JengaBee 38]

Mini bypass?

It's a simpler safer gastric bypass. Check it out in YouTube!