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

[Finding_Stacy 263]

@@Finding_Stacy

We are close in age, I doubt losing weight will age you. I didn't have any wrinkles before and I don't have any now.

As a person living with a lot of loose skin, it is never too early to start worry about it. Having a plan helps. It is a pain to live with.

I wear a size 10/12 now and I could easily be an 8 or smaller without the skin.

Honestly most people that have the sleeve and RNY that need to lose 200 pounds never get there. It has nothing to do with the tools but a lot to do with the people. People that over weight are food addicts. I was one. Unless people can mentally fix their issues with food, they are going to fail once they heal from the initial surgery, because surgery just doesn't do it all for you. So if someone has 200lbs or more to lose, the sleeve/RNY is probably only going to get 100 pounds off of them in the first 6 to 9 months. Then it is a lot of good old fashioned will power and making the right choices.

If people follow their program and don't advance their stages, you relearn how to eat again like a baby, and you learn to love good healthy food. Most people advance their food stages, reintroduce carbs early and start on sliders ASAP like eat crackers with tuna fish on soft foods . Those people won't hit goal and will start to regain at one year or close after.

My doctor said something similar. He said the average weight loss is only 75 pounds. Of course I'm thinking why? If it can help you lose 75, why not 80, 100, or 150, even? But like you said, I too have read and seen in videos people talking about already eating mashed potatoes three weeks in. I think, and this is just my personal observation, is that many people can find they can still eat the variety of food that always gave them comfort and still lose. The same food that caused them to be in this situation to begin with.

But unfortunately, that positive side effect most likely ends somewhere around the ninth month when the stomach stretches, and instead of eating only a few bites, they now can eat a half a plate, or even a whole plate, several times a day, and that's where the tipping point is for many regainers. Again, just my observation.

I know we're all brainiacs before we are actually thrown into these situations, and I can talk like an expert because I'm not forced into it quite yet. I'm just trying to learn from others, both good and bad. For instance, I'm going to try my damnedest to not stretch my stomach by overeating or drinking, and to keep it 'small' as long as possible. The longest I've ever done low carb was ten months and I got a 100 off. I'm thinking if I can apply that same strategy with this tool, hopefully I'll be ahead of the game, and the longer I can keep it, the sooner new habits will hopefully be retrained into this thick skull of mine. So no mashed potatoes. No candy. No milkshakes (I've seen this one quite a bit and it always shocks me). So, we'll see soon if I can put my money where my mouth is.

One thing I strongly urge people to do, something my mom taught me when I was in Jr. High, is to do your daily neck exercises. Stretch your head back as far as you can then say your vowels in an over exaggerated fashion, stretching your facial and neck muscles in the process. This should help with double chins and tightening up your facial muscles. I always start with fifty a day, but after surgery I'll probably be doing two and three sets of fifty.

[Postop 411]

I am a sleever. I would need to loose 200 pounds to lose all my excess weight. At almost 1.5 years I have lost 175 pounds.

I look solidly 10 to 14 years younger than my age. The men that approach me in public and ask me out are 26 to 30. I had a pretty face before I lost weight and I still have a pretty face.

I think how you eat post op determines if you look healthy or not. A lot of WLS patients stay on low calories forever, slowing down their metabolism and denying themselves essential fats. I eat Keto, and the few other sleevers I know that eat Keto all look younger than their age. Most people that lose weight with keto even without surgery don't age by dropping a lot of weight they look younger. The fat helps with that.

Also upping you calories and keeping them up helps. Calories and Protein should be pegged to your lean muscle mass. People who have been super morbidly obese for a long time have more muscle and denser bones because carrying all that weight changes your body. I have between 100 and 130 grams of Protein a day.

Also what is 100% of excess weight for a morbidly obese person is will be different than a person that was never morbidly obese. I am probably pretty close to 100% right now with my extra muscle and loose skin.

Again on the aging, I never had the huge fat neck that some people have I always had a neck and could wear regular chokers even at 370 pounds. People that have a ton of neck and face fat do usually age terrible if they drop a ton of weight because they have loose skin in their face. That is just genetics and weak jaw lines.

If my doctor would have suggested the DS I would have considered. It is extreme but it does work THE BEST. Still I wouldn't want the malabsorption issues, which is why I have worked so hard on my food and eating right. Eating correctly on keto in a way that sustainable to me, that does not feel like a diet has been the key to my weight loss. After 9 months I feel like my weight loss was due to my food and lifestyle, not my sleeve. I decided when I had the sleeve, if I didn't get to a certain weight with it, I would get a revision to the DS. I have been very successful with the sleeve, and no further surgery is needed, except plastics to remove the skin.

If your health is in bad condition and you need to lose weight fast, I wouldn't hesitate to have the DS.

Thanks so much for this. You don't know how reassuring it is to read someone who lost that much weight on a sleeve alone. I weighed in at 371 and want to lose 225 pounds--that's why he suggested the DS. Knock on wood, I've always been very healthy outside my sleep apnea and hypothyroidism--oh yeah, and cancer when I was 26 . I don't have diabetes or high blood pressure, so I guess that's why he said I'm a great candidate, I guess.

He just feels a sleeve can only take me so far and it wouldn't have the lasting results that a ds would have. He hasn't gone into it further yet, but I'm guessing at six months in I'd have the second surgery. Not sure how that works if my bmi drops below 50, or hopefully maybe even 40. How would I qualify then?

I look so young now, not even a single wrinkle on my face at 41, so yeah, I'm nervous. My plan of attack is low carb, high protein with very healthy veggies and berries. I want to work out six days a week to try and combat the loose skin as much as possible with a daily slather of Aquafor (best stuff for healing dry and cracked skin), and as much Water as I physically can get down, even if that means constant sipping all day.

My insurance pays 85% for skin removal if deemed necessary--which they even said on the phone that losing that much weight will more than likely be necessary. I wonder how that works if the insurance covers skin removal but I'd want a lower body lift. I wonder if the surgeon gives an adjusted price for any work done above a skin removal --I know, I know...you don't have to say it. I'm getting my cart ahead of the horses

You're lucky your ins. coverage will cover some skin surgery. Once you begin losing (or even now) start documenting everything with a doctor: rashes, yeast infections, etc. That will help the skin surgery approval process.

As for 'shrinkles', many of us do get them. My face was stretched out much more when I was big. Now it's not. When it was stretched out, some acne scars from my cystic acne (when I was in my 20s) were big and wide. Now, they're much less visible. I'm not terribly wrinkled, but, in my 50s (now); yes, I do have some. I expect it as we all get them as we age. My mother looks great for her age. I use her as my template for what I'll look like. With me, though, health was the most impt. I already had some issues and I knew they were only going to get worse as I grew bigger and older.

Let me give you a great positive: I eat every hour or two. Most of us do. Protein. A lot. I never feel deprived bc I can eat. Steak, hamburgers, chicken, fish, cheeses, cold cuts, nuts, etc., whatever you can think of. DSers don't count calories. Ever. We're only concerned with protein and sugar grams (including simple carbs.). When I'm hungry at 3pm at work, I can go down to McDonalds and get a triple cheeseburger. Do I eat the bread? Generally, no. Because, if I do, I can't get all the burger in and by the time I finish all the meat, I don't want it. Plus, if I want to knock off a pound or two, I'd pass on it.

So while I will never push one WLS over another as I believe they all have tremendous good points, I just didn't want you to focus only on what could happen. I can tell you some of what does happen.

Edited December 24, 2016 by Postop

[janedoe92 260]

I am a sleever. I would need to loose 200 pounds to lose all my excess weight. At almost 1.5 years I have lost 175 pounds.

I look solidly 10 to 14 years younger than my age. The men that approach me in public and ask me out are 26 to 30. I had a pretty face before I lost weight and I still have a pretty face.

I think how you eat post op determines if you look healthy or not. A lot of WLS patients stay on low calories forever, slowing down their metabolism and denying themselves essential fats. I eat Keto, and the few other sleevers I know that eat Keto all look younger than their age. Most people that lose weight with keto even without surgery don't age by dropping a lot of weight they look younger. The fat helps with that.

Also upping you calories and keeping them up helps. Calories and Protein should be pegged to your lean muscle mass. People who have been super morbidly obese for a long time have more muscle and denser bones because carrying all that weight changes your body. I have between 100 and 130 grams of Protein a day.

Also what is 100% of excess weight for a morbidly obese person is will be different than a person that was never morbidly obese. I am probably pretty close to 100% right now with my extra muscle and loose skin.

Again on the aging, I never had the huge fat neck that some people have I always had a neck and could wear regular chokers even at 370 pounds. People that have a ton of neck and face fat do usually age terrible if they drop a ton of weight because they have loose skin in their face. That is just genetics and weak jaw lines.

If my doctor would have suggested the DS I would have considered. It is extreme but it does work THE BEST. Still I wouldn't want the malabsorption issues, which is why I have worked so hard on my food and eating right. Eating correctly on keto in a way that sustainable to me, that does not feel like a diet has been the key to my weight loss. After 9 months I feel like my weight loss was due to my food and lifestyle, not my sleeve. I decided when I had the sleeve, if I didn't get to a certain weight with it, I would get a revision to the DS. I have been very successful with the sleeve, and no further surgery is needed, except plastics to remove the skin.

If your health is in bad condition and you need to lose weight fast, I wouldn't hesitate to have the DS.

What is keto?

Sent from my iPhone using the BariatricPal App

[Postop 411]

Very low carb.

[janedoe92 260]

I've heard of people doing Keto, never knew what it was, I'm going to look into that because I feel like I'm a carb junky.

Sent from my iPhone using the BariatricPal App

[OutsideMatchInside 10,166]

@@Finding_Stacy

We are close in age, I doubt losing weight will age you. I didn't have any wrinkles before and I don't have any now.

As a person living with a lot of loose skin, it is never too early to start worry about it. Having a plan helps. It is a pain to live with.

I wear a size 10/12 now and I could easily be an 8 or smaller without the skin.

Honestly most people that have the sleeve and RNY that need to lose 200 pounds never get there. It has nothing to do with the tools but a lot to do with the people. People that over weight are food addicts. I was one. Unless people can mentally fix their issues with food, they are going to fail once they heal from the initial surgery, because surgery just doesn't do it all for you. So if someone has 200lbs or more to lose, the sleeve/RNY is probably only going to get 100 pounds off of them in the first 6 to 9 months. Then it is a lot of good old fashioned will power and making the right choices.

If people follow their program and don't advance their stages, you relearn how to eat again like a baby, and you learn to love good healthy food. Most people advance their food stages, reintroduce carbs early and start on sliders ASAP like eat crackers with tuna fish on soft foods . Those people won't hit goal and will start to regain at one year or close after.

My doctor said something similar. He said the average weight loss is only 75 pounds. Of course I'm thinking why? If it can help you lose 75, why not 80, 100, or 150, even? But like you said, I too have read and seen in videos people talking about already eating mashed potatoes three weeks in. I think, and this is just my personal observation, is that many people can find they can still eat the variety of food that always gave them comfort and still lose. The same food that caused them to be in this situation to begin with.

But unfortunately, that positive side effect most likely ends somewhere around the ninth month when the stomach stretches, and instead of eating only a few bites, they now can eat a half a plate, or even a whole plate, several times a day, and that's where the tipping point is for many regainers. Again, just my observation.

I know we're all brainiacs before we are actually thrown into these situations, and I can talk like an expert because I'm not forced into it quite yet. I'm just trying to learn from others, both good and bad. For instance, I'm going to try my damnedest to not stretch my stomach by overeating or drinking, and to keep it 'small' as long as possible. The longest I've ever done low carb was ten months and I got a 100 off. I'm thinking if I can apply that same strategy with this tool, hopefully I'll be ahead of the game, and the longer I can keep it, the sooner new habits will hopefully be retrained into this thick skull of mine. So no mashed potatoes. No candy. No milkshakes (I've seen this one quite a bit and it always shocks me). So, we'll see soon if I can put my money where my mouth is.

One thing I strongly urge people to do, something my mom taught me when I was in Jr. High, is to do your daily neck exercises. Stretch your head back as far as you can then say your vowels in an over exaggerated fashion, stretching your facial and neck muscles in the process. This should help with double chins and tightening up your facial muscles. I always start with fifty a day, but after surgery I'll probably be doing two and three sets of fifty.

You can't stretch a properly formed sleeve. I feel like I have to say this every week around here.

Sleeves do not stretch. They do heal. The restriction that people have right after surgery is healing, not true restriction. Once your stomach is fully healed at 6 months, that is your truest restriction.

Read back what you wrote about. People start eating SLIDERS in the first month, and continue eating them all along. At first people can only have two or three tablespoons of mashed potatoes, at 6 months they can probably have a whole cup. They claim their sleeve has stretched but in reality, they aren't even invoking restriction because they don't eat dense Protein.

Once they heal and have their normal sleeve capacity they can eat more sliders, possibly infinite amount of sliders because their stomach is not swollen or inflamed anymore.

pizza toppings for me, offer no restriction, I could eat the toppings off a whole large pizza or at least a whole frozen one, they do nothing for me. So I don't eat toppings off pizza. salad greens are a slider for me also, but a whole bag of salad greens from the grocery store is 20 calories, so I can eat a whole bag of salad if I want and burn more calories eating it than the veggies even cost. So when I want to munch on something in the afternoon I have baby spinach.

Sleeves don't stretch, people eat sliders. They drink their calories, they self sabotage.

[OutsideMatchInside 10,166]

I am a sleever. I would need to loose 200 pounds to lose all my excess weight. At almost 1.5 years I have lost 175 pounds.

I look solidly 10 to 14 years younger than my age. The men that approach me in public and ask me out are 26 to 30. I had a pretty face before I lost weight and I still have a pretty face.

I think how you eat post op determines if you look healthy or not. A lot of WLS patients stay on low calories forever, slowing down their metabolism and denying themselves essential fats. I eat Keto, and the few other sleevers I know that eat Keto all look younger than their age. Most people that lose weight with keto even without surgery don't age by dropping a lot of weight they look younger. The fat helps with that.

Also upping you calories and keeping them up helps. Calories and Protein should be pegged to your lean muscle mass. People who have been super morbidly obese for a long time have more muscle and denser bones because carrying all that weight changes your body. I have between 100 and 130 grams of Protein a day.

Also what is 100% of excess weight for a morbidly obese person is will be different than a person that was never morbidly obese. I am probably pretty close to 100% right now with my extra muscle and loose skin.

Again on the aging, I never had the huge fat neck that some people have I always had a neck and could wear regular chokers even at 370 pounds. People that have a ton of neck and face fat do usually age terrible if they drop a ton of weight because they have loose skin in their face. That is just genetics and weak jaw lines.

If my doctor would have suggested the DS I would have considered. It is extreme but it does work THE BEST. Still I wouldn't want the malabsorption issues, which is why I have worked so hard on my food and eating right. Eating correctly on keto in a way that sustainable to me, that does not feel like a diet has been the key to my weight loss. After 9 months I feel like my weight loss was due to my food and lifestyle, not my sleeve. I decided when I had the sleeve, if I didn't get to a certain weight with it, I would get a revision to the DS. I have been very successful with the sleeve, and no further surgery is needed, except plastics to remove the skin.

If your health is in bad condition and you need to lose weight fast, I wouldn't hesitate to have the DS.

What is keto?

Sent from my iPhone using the BariatricPal App

Keto is high fat, low carb moderate protein.

My daily macros look kind of like this...

25 g Carbs (9%, 100 kcal) 110 g Protein (41%, 440 kcal) 59

g Fat (50%, 528 kcal)

I don't usually get that much fat in but I try, I always hit my protein goal. I very rarely have more than 15 net carbs in a day. I find is almost impossible to get a lot of carbs in, veggies don't really have them, and I don't eat other things, just meat and veggies.

[OutsideMatchInside 10,166]

@@Finding_Stacy

Did your Dr really explain why you have to have your surgery in 2 parts? The only people that usually have the DS in 2 parts are people that are in the 500-600 range. At 371, you should be able to have the entire surgery at one time.

[Postop 411]

No longer. Many want to do the DS in 2 parts unless you're a super lightweight. The single part DS is generally 4 hours. Some maybe a bit less. Others more, depending what they find.

[catwoman7 11,212]

re: insurance - it'll sometimes cover the panniculectomy part (removing the extra skin on the abs) if you have documented proof that you've had complications from it (e.g., chronic rashes), but it would be unusual for them to cover an entire lower body lift. Usually the way it works is if they agree to cover the panniculectomy part, you just pay the difference (if you want the whole shebang)

I wouldn't worry about excess or wrinkly skin. I worried about it all the time when i was pre-surgery and early post-surgery, but now that I'm normal weight, I could give a flip about my excess skin. I'd take it *any day* over weighing 373 lbs (my highest weight). I may eventually have it removed, but right now, I just wear elbow-length sleeves (or longer), a good bra, and I tuck my stomach into my pants. The only person who knows it's there is me (well, also my husband and my doctor). It's been very easy to hide.

[catwoman7 11,212]

p.s. I think people stop short of their goal and/or gain weight for several reasons: they let bad habits slip back in, they stop weighing/measuring/logging their food and have "portion creep" (may not be as much of an issue with the DS since you guys can have a lot more calories than the rest of us), they relied too much on the surgery to do the work and really didn't work at it themselves, diet fatigue, they stop monitoring their weight, etc. I got down to 200 lbs pretty easily and could probably maintain that fairly easily - but I wanted to be a normal BMI. *That* takes work. I've read somewhere that only about 10% of former super morbidly obese patients make it there - although there are some of us around so it's certainly possible. But again, you'll have better odds of getting there with the DS.

[Aggiemae 739]

I felt I was being pressured to do what I felt was more restrictive and invasive WLS.

The surgeon hit home when she told my that the average weight loss with the sleeve for a person of my age and weight was 30-40 pounds the first 6 months and another 30 pounds he next year. So a total of 70-80 pounds in 18 months. She then ran through the much better statistics for DS and RNY.

I have an advanced nursing degree and was probably better informed that the average WLS patient but I burst into tears. Having major surgery to lose 70 pounds? At 200 pounds I would still be obese. I told her I was too upset to make a decision and would call the next day.

got home, calmed down and could think clearly I considered what she said carefully and pt coming back to the word AVERAGE. My goal weight was 170, technically "over weight" but a weight that in the past I has been able to maintain without struggling. That's just 30 pounds less that the anticipates "average" expected lose for my age/weight...

In the end I decided to have the sleeve and NOT be "average".

I am (almost) 8 weeks post op and have lost nearly 35 pounds, the "average" expected at 6 months...

My thoughts about why surgeons push people? The more weight we lose, the better their outcome statistics.

[OutsideMatchInside 10,166]

@@Aggiemae

Because medicine in America is a for profit business.

My Dr only does the sleeve because it is fast and he does 10 in a day. I am under no illusions about what he is doing. I got in right before it turned into a surgery mill.

A lot of doctors are pushing what is most profitable for them.

People need to think about that when considering surgery.

Edited December 24, 2016 by OutsideMatchInside

[shedo82773 1,236]

re: insurance - it'll sometimes cover the panniculectomy part (removing the extra skin on the abs) if you have documented proof that you've had complications from it (e.g., chronic rashes), but it would be unusual for them to cover an entire lower body lift. Usually the way it works is if they agree to cover the panniculectomy part, you just pay the difference (if you want the whole shebang)

I wouldn't worry about excess or wrinkly skin. I worried about it all the time when i was pre-surgery and early post-surgery, but now that I'm normal weight, I could give a flip about my excess skin. I'd take it *any day* over weighing 373 lbs (my highest weight). I may eventually have it removed, but right now, I just wear elbow-length sleeves (or longer), a good bra, and I tuck my stomach into my pants. The only person who knows it's there is me (well, also my husband and my doctor). It's been very easy to hide.

re: insurance - it'll sometimes cover the panniculectomy part (removing the extra skin on the abs) if you have documented proof that you've had complications from it (e.g., chronic rashes), but it would be unusual for them to cover an entire lower body lift. Usually the way it works is if they agree to cover the panniculectomy part, you just pay the difference (if you want the whole shebang)

I wouldn't worry about excess or wrinkly skin. I worried about it all the time when i was pre-surgery and early post-surgery, but now that I'm normal weight, I could give a flip about my excess skin. I'd take it *any day* over weighing 373 lbs (my highest weight). I may eventually have it removed, but right now, I just wear elbow-length sleeves (or longer), a good bra, and I tuck my stomach into my pants. The only person who knows it's there is me (well, also my husband and my doctor). It's been very easy to hide.

catwoman. I think you might have said the wrong thing about the Panni. I had one Sept of 2015. It isn't removed from your abs, it is the lower skin that hangs in the fashion called an apron. The lower skin hangs down towards the "KittyCat" as we call it. LOL If I had it to do over I would pay the extra to have a Tummy Tuck with muscle repair. Like you said most insureance's pay for the Panni but it is very hard to get the upper stomach done by them. Yes by all means document every skin issue. Myself I documented my issues with my Suregon, my PCP, and my Dermatologoist. And I took pictures of my skin issues on my phone. Which I really never needed. I lost 132#'s in 6 months so I did have lots of skin issues like I got yeast all the time. Oh yes I also kept my receipts for my medication. I didn't have much trouble getting my Panni.

[shedo82773 1,236]

I felt I was being pressured to do what I felt was more restrictive and invasive WLS.

The surgeon hit home when she told my that the average weight loss with the sleeve for a person of my age and weight was 30-40 pounds the first 6 months and another 30 pounds he next year. So a total of 70-80 pounds in 18 months. She then ran through the much better statistics for DS and RNY.

I have an advanced nursing degree and was probably better informed that the average WLS patient but I burst into tears. Having major surgery to lose 70 pounds? At 200 pounds I would still be obese. I told her I was too upset to make a decision and would call the next day.

got home, calmed down and could think clearly I considered what she said carefully and pt coming back to the word AVERAGE. My goal weight was 170, technically "over weight" but a weight that in the past I has been able to maintain without struggling. That's just 30 pounds less that the anticipates "average" expected lose for my age/weight...

In the end I decided to have the sleeve and NOT be "average".

I am (almost) 8 weeks post op and have lost nearly 35 pounds, the "average" expected at 6 months...

My thoughts about why surgeons push people? The more weight we lose, the better their outcome statistics.

EXACTLY!!! I had a Surgeon who has the BARIATRIC EXCELLENCE AWARD as does the Hospital that he practices in. When I first started going to him he wants his patients to sign a contract to follow your weight loss success for 5 years.