My doctor wants me to have this done-->help...questions

[Finding_Stacy 263]

As much as I've prepared myself today in going into my first appointment to meet my surgeon, dietician, nurse practitioner, and psychologist, I still was thrown. I kept telling myself to keep an open mind, knowing the doctor may want a different surgery from what I had my mind set on. I thought I was completely open minded and prepared for whatever happened. I wanted a sleeve and both he, and his nurse practitioner, felt I should have the DS surgery done.

It was like he wanted me to say 'Yes, I agree to the ds.' When, in actuality, he's doing the sleeve first, and in six months to a year, the second part. So why are they trying so hard for me to accept this instead of saying, 'Hey look. It's up to you. If you can't lose more than 75 in one year, let's go ahead with the second part.'

Is it for insurance purposes and are they trying to get an approval for the ds, even though they'll only do the sleeve for now?

But seriously, I just don't know how I feel about the ds. From what I've read it seems extreme. Long term results at two years out show a pretty equal weight loss between the sleeve and the DS, but the side effects with the DS are pretty startling. I trust my doctor since he's done hundreds, if not thousands, of these procedures. I really do. He feels I may not lose more than 75 pounds with the sleeve and I have 190-225 pounds to lose total. Can anyone tell me the best things they've gotten from this procedure and why did you choose this one?

[catwoman7 11,214]

I'm not a DS'er, I had the RNY, but if the DS had been an option for me, I would have seriously considered it. I had over 200 lbs to lose. It's really difficult to lose that much weight and, more importantly, keep it off. Of all the surgeries, the DS has the most success when you're talking that much weight. It's easier to get the weight off, and easier to maintain it. I managed to get it all off with the RNY, but those last 50 lbs or so were really hard work - and I know keeping it all off is going to be a lifetime struggle. But I wanted to lose 100% of my excess weight, and now that I'm there, I want to keep it off. I'm sure it would be easier had I had the DS (but my insurance doesn't cover them - just RNY and sleeve).

[catwoman7 11,214]

p.s. I'm not sure how they can really force you to have something done you don't want. At least they're willing to do it in two stages. If you're happy with the sleeve, you can always tell them no to the DS in a few months. Unless there's something about this that isn't obvious?

[Finding_Stacy 263]

Hey Catwoman, thanks for responding. Congratulations on your weight loss, that's phenomenal.

p.s. I'm not sure how they can really force you to have something done you don't want. At least they're willing to do it in two stages. If you're happy with the sleeve, you can always tell them no to the DS in a few months. Unless there's something about this that isn't obvious?

The reason the doctor said he preferred that for me is because he likes looking at the 10 year numbers. After ten years, I'll have a great chance of staying 180 and less. I guess, my question I should've asked, and will, is why try so hard to talk me into it right now? They're not forcing me, just strongly urging me to see it their way. And he's a very capable doctor, more than capable and I believe him and what he says....but it just terrifies me. And like I said, we're doing the sleeve first anyway, but I'm surprised it wasn't phrased as a 'let's see how you do' instead 'this is what we think you need to do.'

Maybe they bill the insurance at the time of the first surgery as a ds, even if it's a sleeve--I don't know. I'm watching videos on Youtube and the ds'ers look old as hell. I'm 41 with no wrinkles yet. I get told all the time I don't look older than 30. This surgery absolutely has me terrified--between the quickly aged look and the malnutrition aspect. How are you doing with combatting the malabsorption?

I was so excited today over the sleeve, and still am, but this ds makes me nervous. I'm not saying I wouldn't have it, but it's going to take a lot of convincing to get me to see the light with this surgery.

Edited December 22, 2016 by Finding_Stacy

[catwoman7 11,214]

I've aged about 10 years since surgery. I think that has to do with how much you've lost rather than which surgery you went with. I've heard that often your weight shifts around, though, so that you don't continue to look as gaunt. You start to look better after awhile.

re: malabsorption - my lab numbers so far have been very good. Malabsorption is not as extreme with the RNY, though - but I suppose if you really keep on top of your supplements and get regular lab work, you probably be OK. Just keep researching it. I didn't really look very far into the DS because I knew I couldn't have it (because of my insurance - plus, no surgeons around here do that one)

[janedoe92 260]

As much as I've prepared myself today in going into my first appointment to meet my surgeon, dietician, nurse practitioner, and psychologist, I still was thrown. I kept telling myself to keep an open mind, knowing the doctor may want a different surgery from what I had my mind set on. I thought I was completely open minded and prepared for whatever happened. I wanted a sleeve and both he, and his nurse practitioner, felt I should have the DS surgery done.

It was like he wanted me to say 'Yes, I agree to the ds.' When, in actuality, he's doing the sleeve first, and in six months to a year, the second part. So why are they trying so hard for me to accept this instead of saying, 'Hey look. It's up to you. If you can't lose more than 75 in one year, let's go ahead with the second part.'

Is it for insurance purposes and are they trying to get an approval for the ds, even though they'll only do the sleeve for now?

But seriously, I just don't know how I feel about the ds. From what I've read it seems extreme. Long term results at two years out show a pretty equal weight loss between the sleeve and the DS, but the side effects with the DS are pretty startling. I trust my doctor since he's done hundreds, if not thousands, of these procedures. I really do. He feels I may not lose more than 75 pounds with the sleeve and I have 190-225 pounds to lose total. Can anyone tell me the best things they've gotten from this procedure and why did you choose this one?

I haven't had surgery yet, but I too was ready to get the sleeve and didn't even think about RNY or DS until I met with my surgeon. He goes over all the types he does and I knew rny would have been better because I have so much excess to loose, but I was pulling toward the sleeve. Then he told me at the DS. They do a modified version of it known as SIPS. He said there aren't the same amount of complications as regular DS. My surgeon even told me not to go home and google it because it brings up the normal way of DS and that will scare me out of doing it. He said if I looked up the modified version I would find better information. I decided that I want DS because it's not like the regular one and I will be able to lose all my excess weight. Though I also have to annually check up with my surgeon and take Vitamins for life I say it's a great trade in for a healthy longer life. In terms of malabsorption my PA said they recommend the Vitamin patch because it makes it easier and then I can just take a B complex Vitamin. Another huge factor that locked me into getting DS is my surgeon said he was seeing some patients getting the sleeve and they wouldn't lose as much weight as they wanted due to their metabolism being slow. My surgeon's office does a BMR test that tells if your metabolism is slow which is mostly attributed to genetics and isn't too much to do about it (per my PA). When I took my test I had a pretty slow metabolism, so that alone just confirmed me wanting DS.

Do you know if your surgeon does the regular switch or modified one? And why he wants to split it in two separate surgeries?

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[Finding_Stacy 263]

Ooh, good question. I know he likes to break it up into two procedures for the safety of the patient, since the risk of blood clots are higher the longer you're under general anesthesia. There's another big reason too, but my brain is playing peekaboo with my brain cells right now. I do know Dr. Alverdy was one of the first doctors, I believe, to ever do this procedure laparoscopically so this is his wheel house.

I did see today that my insurance wants to be billed for one procedure even though it's two surgeries, hence the reason I'll have to make a decision soon even though I'll only have the sleeve done for now. He prefers this surgery since it has a 90% ten year success rate of keeping off 90% + of extra weight, unlike the other surgeries.

I guess my biggest concern are the Vitamins. His nurse practitioner said the ds only has two more pills than the sleeve, but I've noticed people generally looked good on the sleeve after the weight loss. I do like that Vitamin patch you mentioned. I'd be all about that. I'm going to have to ask them about that--thanks for that little piece of info!!

So, are you definitely leaning towards the ds? Have they told you what else they still need you to do before getting it sent off to insurance for approval?

[janedoe92 260]

Ooh, good question. I know he likes to break it up into two procedures for the safety of the patient, since the risk of blood clots are higher the longer you're under general anesthesia. There's another big reason too, but my brain is playing peekaboo with my brain cells right now. I do know Dr. Alverdy was one of the first doctors, I believe, to ever do this procedure laparoscopically so this is his wheel house.

I did see today that my insurance wants to be billed for one procedure even though it's two surgeries, hence the reason I'll have to make a decision soon even though I'll only have the sleeve done for now. He prefers this surgery since it has a 90% ten year success rate of keeping off 90% + of extra weight, unlike the other surgeries.

I guess my biggest concern are the Vitamins. His nurse practitioner said the ds only has two more pills than the sleeve, but I've noticed people generally looked good on the sleeve after the weight loss. I do like that Vitamin patch you mentioned. I'd be all about that. I'm going to have to ask them about that--thanks for that little piece of info!!

So, are you definitely leaning towards the ds? Have they told you what else they still need you to do before getting it sent off to insurance for approval?

Yes I got my stuff sent off earlier this week and I put that I wanted DS. I liked that I have a chance to lose 100% of excess weight and the long term go keep it off. All my requirements per my insurance was to sign up for their bariatric program, do 6 months of supervised weight loss program which I was able to do with my pcp, of course bmi over I believe 30 and co morbidity but my bmi alone was enough, and 5 year history of being obese. I also was recommended to get tested for sleep apnea. I recently met with a dr about that and scheduled my test. He said bariatric surgeons recommend it because people with untreated sleep apnea have more chance of post surgery complications, so I'm happy I'm getting tested, but they're so backed up it won't be until after surgery:/

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[Finding_Stacy 263]

Oh, good for you! It's so nice to go through this together and be able to come together here and compare notes :-)

I looked up that modified ds procedure. That sounds like something I'd be more interested in, but something tells me my doctor doesn't do it. I could be wrong, and I'll definitely ask, but thank you for mentioning that. I learned two things from you now--Vitamin patch and a modified ds surgery.

My insurance doesn't require a supervised weight loss, just the bmi and my two co-morbidities--sleep apnea and hypothyroidism. I had a sleep study done in June, before I ever seriously considered a wls, but I'm so glad I did. I no longer have headaches in the middle of the night and I'm not as tired during the day. Before the cpap, I used to take a nap daily. It's a great, great little machine.

My doctor said I'll get a letter from them after the first of the year saying what they'll still need, if anything. My bp and lab work was good and the ultrasound showed a bad gallbladder with gallstones that he said they'll remove. Sadly, my doctor is booked till February so that's the soonest it can happen.

But...I think I may have shot myself in the foot with the nurse practitioner. I told her I wanted to have this procedure done in February, if possible, because we're going on a cruise April 2nd. She seriously did a double take, then said 'A what?'

Hey, I booked it in August--what can I say? I got a great deal for the four of us ????

But, she said I would need at least 6 weeks to heal to make sure there are no blood clots, so if I can't get in for surgery until the end of February, they'll have to put it off until afterwards. I was completely deflated, so I asked, 'Do you know how much damage I could do?' Hoping that would sway her to my devious side, but she simply replied, 'you won't.'

Hmmm, that didn't go as planned ????

[janedoe92 260]

Oh, good for you! It's so nice to go through this together and be able to come together here and compare notes :-)

I looked up that modified ds procedure. That sounds like something I'd be more interested in, but something tells me my doctor doesn't do it. I could be wrong, and I'll definitely ask, but thank you for mentioning that. I learned two things from you now--Vitamin patch and a modified ds surgery.

My insurance doesn't require a supervised weight loss, just the bmi and my two co-morbidities--sleep apnea and hypothyroidism. I had a sleep study done in June, before I ever seriously considered a wls, but I'm so glad I did. I no longer have headaches in the middle of the night and I'm not as tired during the day. Before the cpap, I used to take a nap daily. It's a great, great little machine.

My doctor said I'll get a letter from them after the first of the year saying what they'll still need, if anything. My bp and lab work was good and the ultrasound showed a bad gallbladder with gallstones that he said they'll remove. Sadly, my doctor is booked till February so that's the soonest it can happen.

But...I think I may have shot myself in the foot with the nurse practitioner. I told her I wanted to have this procedure done in February, if possible, because we're going on a cruise April 2nd. She seriously did a double take, then said 'A what?'

Hey, I booked it in August--what can I say? I got a great deal for the four of us

But, she said I would need at least 6 weeks to heal to make sure there are no blood clots, so if I can't get in for surgery until the end of February, they'll have to put it off until afterwards. I was completely deflated, so I asked, 'Do you know how much damage I could do?' Hoping that would sway her to my devious side, but she simply replied, 'you won't.'

Hmmm, that didn't go as planned

Yeah this is a great forum to gain more information I love it!

And I'm excited for the test, I'm almost positive I have sleep apnea I'm always fatigued no matter the amount of sleep, and wake up sometimes choking trying to catch my breath, so it'd be great to get some good sleep.

And I'm glad I can give you some information:) definitely see if your dr does sips.

I also have gallstones but my PA said they don't usually take gallbladders out anymore I can't remember why, but I'm going to double check with my surgeon because I'd like to avoid any episodes and a second surgery if possible, and those months will fly by. I remember thinking the six month nutrition requirement was going to be forever, but that flashed by I hardly remember it.

And is the only reason they don't want you going on the cruise is because of the fear of blood clots??

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[Finding_Stacy 263]

She only mentioned the blood clots and that I need a six week recovery time before getting on a plane. I thought the restrictive eating on a cruise is nice too. It will be a week where I don't have to rack my brain in finding new ways to get my Protein and exercise in.

i never did ask, what city are you doing your surgery in? It would be so neat if our surgieries are semi close together. I am surprised how many on here have the same surgery dates.

[janedoe92 260]

She only mentioned the blood clots and that I need a six week recovery time before getting on a plane. I thought the restrictive eating on a cruise is nice too. It will be a week where I don't have to rack my brain in finding new ways to get my Protein and exercise in.

i never did ask, what city are you doing your surgery in? It would be so neat if our surgieries are semi close together. I am surprised how many on here have the same surgery dates.

Oh okay that makes sense. And I'm getting mine in Amarillo, Tx. My insurance requires I get it done at a center of excellence, and that's the closest one to me. And yeah it's crazy so many people have the same surgery dates, but good because they're able to go through it together. Hopefully l will be able to have surgery the end of January, but we'll see, waiting on insurance right now.

What about you, where are you getting yours done?

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[Finding_Stacy 263]

I was hoping for the end of January, but don't get me wrong, I'll take February too.

Im getting mine done at the University of Chicago. I live in Indiana, but I feel lucky that I live 40 minutes away from such an excellent place to have my surgery.

[janedoe92 260]

Yeah I know what you mean, I feel like I was in a rush because my deductible is all paid so it would've been basically free this year, but no such luck:/

And that's great! 40 min isn't too bad

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[Postop 411]

Hi. I'm 11+ years out from a full DS.

I've heard of doctors mentioning the DS (as the second procedure) as something to think about if you don't do well enough with the sleeve (and keep it off) but yours does seems a bit more insistent. I guess he really thinks it will be necessary in your case given what you want to lose. But remember, the decision is ultimately yours. You'll do what your comfortable with. As for the insurance, I know many DSers who want to have that 2nd stage of the surgery within about 6 mos. The reason being is they may lose enough weight that their ins. co. might balk at another procedure & that sleever wants the switch to add the lifetime malabsorptive component.

Today most DSers have it done in 2 steps. Especially if you have a high BMI, it's just safer to keep you on the operating table for a shorter period of time. I'd ask the doctor what length he makes the common channel. Does he use a standard length of: 75, 100, 150? Or does he measure each patient individually? The length will also determine what (if any) types of side effects you may experience.

The DS is more extreme. There is potential for more side effects. Most are manageable if you're careful about what you eat and when. That doesn't mean I don't eat junk. I just had half a brownie. I'm at home now as I wouldn't eat something like that in public. I don't want to deal with the gas and/or stool issues that might occur.

But...there is also the benefit of your odds regarding losing & keeping it off.

As for Vitamins, I don't know many DSers who have luck with the Patches. It's just something I want you to think about. You must be committed to a lifetime of Vitamins (I take 40+ per day) and blood tests (every 6 mos. or yearly depending on your surgeon). You should also probably have a Dexa Bone Scan (preop) so you'll have a baseline to be compared to as you age and as your malabsorption kicks in.

While the amount of my vit/minerals may have shocked you (others do take fewer, but we all take a good amount) there's no diabetes issues, cholesterol issues, CPAP, etc. You might want to make a pros/cons list to figure out what you can live with and what you can't.

Look, I didn't run to the DS. I was told in 2003, I had to have WLS. I ignored that for 1 year. I told no one. Then in 2004, I realized I had to do something (as my cholesterol was 302 and everyone in my family dies of heart issues). I was also a touch below diabetic. I went to 3 hospital programs and at one of them, I learned about the DS. Once I realized I just couldn't lose/keep the weight off on my own; I decided the DS was probably the right one for me. It's a very personal decision as all of the WLS have good & bad points.

Edited December 23, 2016 by Postop