Need help deciding - Too soon or too late

[PauliansPG 0]

I am considering sleeve gastrectomy but very unsure whether I should.

I am 43 years old male and have type 2 diabetes for around 8 years. I am 166 cm and 89 kg (BMI = 32). I have always had very good HbA1c (below 6) but have high blood pressure (not too bad), high cholesterol (not too bad), Fatty liver (severe), high uric acid (not too bad).

Perhaps most importantly, I have obsessive compulsive disorder (OCD) which requires me to take high dose antidepressants (Seroxat 75mg). Apparently, Seroxat and most antidepressants work against you when you try to lose weight. I do a lot of emotional eating. I am also very good at finding excuse not to exercise.

I have seen quite a few doctors. The surgeons seems to think it is almost a no brainer to have the surgery while one of the endocrinologist thinks I should try other methods to lose weight first. Having said that, They all agree there is no immediate need for me to do the surgery (primarily due to my good HbA1c numbers).

My thought process - I am not optimistic at all with the possibility of losing sufficient weight on a long term basis through diet alone, especially given my OCD/Seroxat and my very stressful job (my profession has one of the highest divorce and suicide rates....). I want to live long enough to provide for my very young kids (Especially financially) and to watch them grow. While I have very good HbA1C, I am not sure how long that will last and my other weight-related illness have been up and down (blood pressure, chloestrol, fatty liver and uric acid) - basically depending on how much time I have for exercise and how discipline I am in terms of food intake over a given period. On this basis, it seems to be a no brainer.

On the other hand, I am worried about the psychological implication (especially making my OCD worse) and about making such a major change at this point in my life. I am a corporate lawyer and have to meet up with clients for coffees/lunches all the time - it is almost part of the job requirements.

I am a bit lost. Would be most grateful for thoughts and advice.

[New&Improved 1,780]

Sorry I think with your low BMI you will find it hard to get surgery at least from my experience?

Edited July 5, 2020 by MIKEYY84

[ChubRub 1,702]

It sounds like your biggest concerns are related to your mental health. I would talk to your Psych (or whoever is RXing the Seroxat), to discuss any implications the surgery may have on your symptoms, meds, etc.

As far as the business lunches are concerned, I wouldn't even worry about it. You can always just order something light, eat a little bit, and push it around your plate. It's common to be talking so much that even "normal" people don't each much of their meal.

With a 32 BMI, you likely won't get insurance to pay for it, but of course double check with your insurance provider, and you can always look into paying out of pocket. Good luck!!

[catwoman7 11,212]

I don't know about the particular antidepressant you're on, but there are plenty of WLS patients on antidepressants, so that might not be an issue.

[Lanie992 168]

4 hours ago, MIKEYY84 said:

Sorry I think with your low BMI you will find it hard to get surgery at least from my experience?

My BMI was 32 and not only did my surgeon approve it, but my insurance paid for it.

Granted, I have high blood pressure, high cholesterol and high triglycerides... so that helped me get approved.

Edited July 5, 2020 by Lanie992

[mattk53 124]

If you get the Okay from the surgeon and insurance company, go for it. It will eliminate most of your "physical" problems. At least it did with me and I had alot of the same issues.

[rjan 164]

I am a 40 yr old female, starting BMI 35, and I had the sleeve 4 months ago.

I didn't have diabetes yet. But I was clearly on the fast track to get there in a few years. (I also had really bad fatty liver and high triglycerides since my early 20s.) My dad got diabetes at about the age I am now, and he's absolutely miserable now in his mid 60's. I was on metformin, I was hungry all the time even after eating, and my fasting blood sugar had been in the pre-diabetic range for 4 years and was continuing to inch up.

Preventing diabetes was the MAIN reason I went ahead with the surgery. Looking better is nice and all, but I take surgery pretty darn seriously and would have never done it just to lose weight. Back in January, I read some articles about how bariatric surgery cures diabetes about 80% of the time. (It also causes similar significant reductions in long term mortality from other conditions like cancer.) 2 months later I went under the knife. I did self-pay in Mexico - you may also have to do self-pay since your BMI is low.

Surgery certainly comes with risks, so don't let anyone make your decision for you (surgeons always think people should have surgery. 😂) But if I had it to do over again, I would have gotten the surgery about 5 years ago if I had known these facts sooner. Diabetes is a chronic, progressive disease. Even if it's relatively controlled (or even if you're not actually diabetic yet), the fact that your blood sugar and insulin is elevated compared to a normal person is causing damage to your body every single day. The sooner you treat it, the longer you're likely live and the healthier you're going to be while you're alive.

My mom was pretty worried when I told her this plan, especially since I did it in Mexico. But after she talked to my sister-in-law, who is an endocrinologist, my mom felt a lot better. My sister-in-law tends to be the cautious type, but even she told my mom that I was the perfect patient for bariatric surgery, and that earlier was better than later for my long-term health.

I googled around, but couldn't find any specific information about OCD and bariatric surgery. In general, obese people tend to have more psychiatric conditions than the average population, and on average, psychiatric conditions tend to improve a bit after surgery. However, surgery does about double the suicide rate. People also can struggle with their self image changing and things like that. I'd be sure to talk to your psychiatrist/therapist before and often about this, but I wouldn't necessarily let that hold you back.

As far as the eating with clients issues, I think those are manageable long term. Especially if you go with the sleeve over a bypass type surgery, what you can eat won't change too much long term - you'll just eat less. At 4 months out, I'm having steak for dinner and enjoying the heck out of them - just 4 oz instead of 12. Men are less likely to get intrusive comments about their diet and body than women, so hopefully it won't matter much in the long term.

You'll want to figure out how you'll deal with it in the first few months though, while your diet is still pretty restricted, and you might be dealing with pain or nausea when you eat. You could certainly tell people you recently had some other type of gastric surgery during this time. In fact, they often repair a hiatial hernia at the same time they do a sleeve, so it wouldn't even be a lie. Gallblader removal is also a common procedure that comes with dietary changes.

[catwoman7 11,212]

8 minutes ago, rjan said:

I am a 40 yr old female, starting BMI 35, and I had the sleeve 4 months ago.

I didn't have diabetes yet. But I was clearly on the fast track to get there in a few years. (I also had really bad fatty liver and high triglycerides since my early 20s.) My dad got diabetes at about the age I am now, and he's absolutely miserable now in his mid 60's. I was on metformin, I was hungry all the time even after eating, and my fasting blood sugar had been in the pre-diabetic range for 4 years and was continuing to inch up.

Preventing diabetes was the MAIN reason I went ahead with the surgery. Looking better is nice and all, but I take surgery pretty darn seriously and would have never done it just to lose weight. Back in January, I read some articles about how bariatric surgery cures diabetes about 80% of the time. (It also causes similar significant reductions in long term mortality from other conditions like cancer.) 2 months late

As far as the eating with clients issues, I think those are manageable long term. Especially if you go with the sleeve over a bypass type surgery, what you can eat won't change too much long term - you'll just eat less.

Slight correction...VSG and RNY diets are exactly the same. Early post op diets are identical. Further out, there are no restrictions as to what you can eat regardless of surgery. I can eat anything....just smaller portions of it, same as you.

[rjan 164]

5 hours ago, catwoman7 said:

Slight correction...VSG and RNY diets are exactly the same. Early post op diets are identical. Further out, there are no restrictions as to what you can eat regardless of surgery. I can eat anything....just smaller portions of it, same as you.

Studies do show you are over 10 times more likely to have dumping syndrome with bypass than sleeve, although it's still fairly infrequent for both.

In LSG group (Group A), only 4 patients (1.49%) reported episodes of DS at M1 and 3 (1.12%) at M6. In Group B (LRYGB with mechanical gastrojejunoanal anastomosis), 41 patients (17.90%) reported episodes of DS at M1 and 43 (18.78%) at M6.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4875983/

[catwoman7 11,212]

22 minutes ago, rjan said:

Studies do show you are over 10 times more likely to have dumping syndrome with bypass than sleeve, although it's still fairly infrequent for both.

In LSG group (Group A), only 4 patients (1.49%) reported episodes of DS at M1 and 3 (1.12%) at M6. In Group B (LRYGB with mechanical gastrojejunoanal anastomosis), 41 patients (17.90%) reported episodes of DS at M1 and 43 (18.78%) at M6.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4875983/

well, yes. About 30% of RNY'ers dump, very few VSG'ers do. But you were saying RNYers have more eating restrictions that VSGers. We don't. Granted, there are always going to be some people who are intolerant of certain foods, for example, some people become lactose intolerant after surgery (and this could be with either surgery), but in general, we can eat the same things. I do a lot of volunteer work at my bariatric clinic. The recommended diets are the same regardless of surgery.

Edited July 7, 2020 by catwoman7

[Mealmighty 1]

I think the fact that you have diabetes is enough for you to have it done it really isn't about weight loss as much as about how your body and lifestyle changes after words. I wont lie to you the recovery and first few days were tough and mind you i chose not to take any pain killers when i left the hospital because of my pain tolerance and past surgical experiences. But I do think that if you have any of the co-morbidities it definitely makes it worth. It definitely can't be about losing weight. That's not enough to get you through. But if you have a lifetime of medications and complications to deal with that would greatly improve with this surgery you should definitely do it.

[rjan 164]

18 hours ago, catwoman7 said:

well, yes. About 30% of RNY'ers dump, very few VSG'ers do. But you were saying RNYers have more eating restrictions that VSGers. We don't. Granted, there are always going to be some people who are intolerant of certain foods, for example, some people become lactose intolerant after surgery (and this could be with either surgery), but in general, we can eat the same things. I do a lot of volunteer work at my bariatric clinic. The recommended diets are the same regardless of surgery.

Sorry for not wording it better - I know the post-op diets are the same. I just meant that bypassers are more likely to end up with certain dietary restrictions if they are one of the unlucky dumpers.

[rbedard43 3]

Hey man I can relate to you I'm 43 I also have type 2 diabetes I know decisions not easy one but for me looking at my weight issues and health issues it outweighed the other decisions. Besides with having the surgery you'll lose pretty much most of your health issues I know I will. There's a huge support system out here further your beer out your weight surgery if you have a Facebook page send me a link I'll add you to the group that I'm involved with.

Sent from my SM-N970U using BariatricPal mobile app

[catwoman7 11,212]

41 minutes ago, rjan said:

Sorry for not wording it better - I know the post-op diets are the same. I just meant that bypassers are more likely to end up with certain dietary restrictions if they are one of the unlucky dumpers.

yes - that's true. They have to severely limit or avoid sugar if they dump. In a way I wish I DID dump so I wouldn't eat it, but....well, it is what it is...

[ms.sss 15,581]

21 hours ago, rjan said:

Sorry for not wording it better - I know the post-op diets are the same. I just meant that bypassers are more likely to end up with certain dietary restrictions if they are one of the unlucky dumpers.

Maybe its not so much bypassers vs. sleevers who have “dietary restrictions”, but dumpers vs. non-dumpers (across ALL surgery types).

I am sleeved and I dump. I know there are other sleevers on here who dump also. It’s just luck of the draw I guess.

With that said, I do on occasion have a dessert anyway (but Im 20+ months out and been in maintenance for over a year). Sometimes I won’t dump, but most times I do. I do find the effects worse when I eat said dessert too fast, or if my stomach is empty when I have it.