Don't squeeze the Charmin, Mr. Whipple

[HoleyBaymax 1]

Sorry if the lede was misleading--long intro thread, unrelated to the surgeon in GA, a former poster in the Lap-Band forum, or a grocer who sold toilet tissue. Also not a BM discussion, although I gather those are popular 'round these parts.

Hello, all. Apologies for the length; maybe the info or discussions will help some in the future.

Like many here, I’ve battled obesity my entire life, from Husky-sized jeans to a HW of 453 in 2017. Through a counselor, I connected with a weight loss PCP, and by working with him and a NUT have lost 130 lbs in 2 years. I was content with this method and pace, but circumstances had other plans.

This past summer, I presented with symptoms consistent with gallstones. After an external ultrasound showed nothing, PCP ordered an EUS. Surprise, pancreatic neuroendocrine tumor (PNET), on my birthday, no less! Consults with surgical and medical oncologists ensued, and while I have the kind of cancer that killed Steve Jobs, as long as I don’t treat it with carrot juice and happy thoughts, it probably won’t kill me tomorrow. That’s good, since as a husband and father, I want to stick around.

The (hopefully not) killer, though, is that my cancer doesn’t show up on bloodwork or CT, and only marginally on PET. Med and surg onc, per secondary and tertiary opinions, concur that the best treatment plan is to cut it out.

What has this to do with WLS, you ask?

As I wrote above, I was happy to keep losing my 5 lbs/month, see where I landed, and make further lifestyle changes when I plateaued. However, the cancer I have, according to World-Class Oncologists ™, can flip a switch any time and go from not-a-problem to Patrick Swayze-level, and nobody understands exactly why or how.

WLS enters the picture as a catalyst to accelerate treatment. The thinking is that VSG (my recommended procedure, based on my initial consult with Dr. Hussain and the bariatric team at UC) will drastically en-rapidate my weight loss, possibly helping me drop as much as 70-90% of my excess body weight in the next 9-12 months. In that way, the surg onc should be able to operate on a healthier patient with fewer complications, especially if, as seems likely, he has to pivot to what would be, at worst, a laparoscopic Whipple procedure.

Being a lesser man at the time of that surgery should make the whole process less risky overall, but that’s just one of the questions for the surgical team that I’ll begin to firm up once I start the formal pre-op process. I’ve been assessed as a near-ideal bariatric candidate by psych based on my previous work, and by NUT based on the low-carb high-protein changes we’ve institutionalized in our family lifestyle. We even gave the NUT two recipes she said she’d share with her patients! I have concerns in both areas, though, that I’m working to get a handle on—psych, given my history with depression, and nutrition, since some of the strategies I’ve used to be successful up to now might not be compatible with VSG.

Anyway, thanks for letting me introduce myself and overshare. If you have any relevant thoughts or experience on the above, especially if you have had, or know anyone who has had, a Whipple procedure after a VSG, I’d REALLY like to hear from you, since there’s not much in the open literature on it. I’ll maybe post more details, questions, etc., in the relevant sub-forums if I can’t find something through search, but again, thanks for letting me vent and share.

[Sweettoothless 100]

Would pancreatic surgery at a weight of 320ish be all that more dangerous than if you were at 180, assuming you aren't 4'6"? I would do a consult with a bariatric surgeon (keeping in mind they want you to be their client most likely) to see if it would complicate a treatment/surgery protocol for cancer. I've had a couple of health issues pop up just after surgery (not related to surgery) and I find that non-bariatric medical folks are unclear about the new way my body works. Such as drinking a big-to-me bottle of contrast dye before a ct scan etc. Or not producing a big cup of urine on demand for testing. That being said I have some wonky boobs that may or may not decide to go cancer that I have to have scanned every 6 months and those folks totally encouraged me to have the fastest weight loss possible to make detection and treatment easier. (And they weren't ginormous to begin with.)

[HoleyBaymax 1]

As the three surg oncs I consulted explained to me, my BMI and excess adipose tissue make robotic laparoscopic techniques more difficult and riskier. Some CYA for liability purposes perhaps, but also realistic risk assessment that the data support.

The bariatric surgeon with whom I’ve initially consulted also has surg onc training, but we haven’t discussed enough specifics for me to be completely comfortable, other than to reco VSG over RnY or DS because of the residual structures. He also concurs with the surg oncs that I should have a WLS procedure first, heal and get results to reduce risk, then schedule the cancer bit.

One issue I plan to raise at the next consult: since these dudes teach at the same hospital and see patients literally doors down from each other, how unreasonable is it for one of the surg oncs to observe or assist with the VSG? Onc can get the lay of the land, familiarize him/herself with the plumbing, maybe even snake the camera around and get a look at the little bugger on a fact-finding recon operation. We’ll see.

[Sweettoothless 100]

Sounds like you have a good team! Especially the bariatric surgeon having oncology experience.