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Post by mlharr22 on Sept 27, 2013 1:16:02 GMT -5
I'm scheduled for vsg Oct 23 to remit diabetes. However, just talked to my surgeon who says that there's slim data about the vsg standing the test of time. He says in his clinic he's seeing people not lose enough initially or regain 50 lbs at 18 months. He suggests I should switch to the DS, which I'd rather not do. How has your sleeve worked after a couple of years? What have you heard about other vsger's success over time?
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Post by Deleted on Sept 27, 2013 7:17:42 GMT -5
If you want a permanent solution to your diabetes, you need the DS. Your surgeon has given you excellent advice.
The longer-term stats regarding the maintenance of weight loss with VSG are comparable to RNY, something like 50-75% EWL maintained at 5 years out. You need to decide whether that's good enough for you.
For diabetes remission it's basically a crapshoot. IF you are one of the lucky ones who ONLY needs some weight loss to get diabetes remission, it might work. But a LOT of people need more than that. They need the intestinal bypass provided by the DS. That is what makes the DS so successful with CURING (not just remission of) type II diabetes. The CURE rate with the DS is around 95-98%.
What are you afraid of with the DS?
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Post by angelcake on Sept 27, 2013 12:17:11 GMT -5
Yep, EN's right and there are surgeons out there that have performed the DS without the sleeve for diabetic patients who aren't obese.
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Post by Deleted on Sept 27, 2013 13:13:17 GMT -5
Research the DS and ask questions here where so much of the DS vet knowledge shares. I had the RNY and have done well, however, if I were choosing today to have WLS there would be ONE option....the DS.
I can't provide you with all the statistic links for it but ask and I'm sure others can share the info. Your best bet to cure diabetes is no doubt the DS.
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Post by sheanie on Sept 27, 2013 14:55:13 GMT -5
The sleeve will not get rid of your diabetes. Only the DS can do that. But don't take our word for it, do your own research. Learn about all your options and be comfortable with your decision. Delay your surgery if you have to. Be thankful you have a surgeon who knows about the DS. A lot of WLS surgeons will just slap on whatever fix they know how to do that's easy for them to make money on.
You've found a valuable source of information here in this forum. Make sure you understand how your surgery will re-arrange your insides and what this means. You only want to have surgery once.
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Post by mlharr22 on Sept 27, 2013 14:57:55 GMT -5
I've read a lot of the literature well enough to present to an insurance company and win an appeal to have the DS contrary to their policy. I've also been reading posts on this board for months that indicate many people have significant difficulties with DS maintainence and complications. It was really scary to read what could happen. Also it seems that many people have to work constantly to balance supplements, labs, protein, etc. I know that I'm a "low maintainence" person, so I'm willing to give up some of the DS benefit for the ease of the vsg. I am 235 lbs, so I need to lose maybe 80 lbs. I'm diabetic for 15+ yrs and on insulin, but my a1c is 6 .4 right now, so I'm thinking it's reasonable not to do the DS.
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Post by Deleted on Sept 27, 2013 15:19:16 GMT -5
If you are getting the VSG mainly to get rid of diabetes, you are not going to get any more results with that aspect of your health than you would get with a crap band. It's a restriction-only procedure with no further metabolic benefits attached. The potential appetite reduction from the removal of ghrelin-producing tissue is unlikely to have the slightest impact on metabolism. It is POSSIBLE that you will get a relatively good "remission," but you will NOT be cured, and as soon as you gain any weight back, you will be at extremely high risk of your remission ending. Yes, with the DS you have to pay attention to your nutrition for the rest of your life. If you are not willing to make that commitment, then you are correct, you should not have a DS. (Nor should you have RNY, for that matter, because it, too, brings lifetime malabsorption of essential micronutrients, even long after the minimal caloric malabsorption goes away.) I contest the notion that "many" people have "significant" problems maintaining their nutrition and health with the DS. No Internet community will ever be truly representative of DSers in general. This is true of any WLS, though. People tend to disappear from WLS boards over time and then only return if they develop problems. IMO this board is pretty darned impressive in the number of vets that check in at least semi-regularly, rather above the norm in that regard (though there's no research to back up that assertion--trust me, I've looked, because I'm putting together a study on the subject ). How long have you been on insulin? Oral medications? What has happened with your weight since you went on these meds? Do you have other indications of metabolic issues, such as PCOS? Do you have a history of yo-yoing with your weight? Those are all things that would give information about whether you might need the malabsorption more than you first thought. Weight is a poor indicator of the need of malabsorption to maintain weight loss and diabetes resolution. You'll have to decide for yourself how permanent you want your solution to be and what you're willing to do to get as much permanence as possible. There is always a gamble involved in such decisions. If you know you won't comply with the few but non-negotiable demands the DS makes on a person even in a normal situation, then you're smart to not get a DS. So your gamble will be on whether or not you get the diabetes remission you're looking for. The odds are not wonderful, BUT (and this is important) there just is not much long term information available. One more thought: You can develop deficiencies and problems with a VSG, too, not to mention taking on all the risk of stuff like GERD and the other kinds of troubles that can crop up after any stomach surgery. It's NOT an easier way out.
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Post by mlharr22 on Sept 27, 2013 16:19:29 GMT -5
"How long have you been on insulin? Oral medications? What has happened with your weight since you went on these meds? Do you have other indications of metabolic issues, such as PCOS? Do you have a history of yo-yoing with your weight? Those are all things that would give information about whether you might need the malabsorption more than" I've been on insulin for maybe 8 yrs and take a couple of types of pills, too. Ive gained maybe 30 lbs since starting insulin. No PCOS. Also no big yo yos. When I have exercised steadily, I firmed up but didn't lose a ton of weight. I really appreciate everyone's time in replying. I certainly don't mean to criticize the board and its members. Overall' I have found the board invaluable, and at the same time it's also been intimidating to hear about everything from daily issues to major hospitalization s. Read more: weightlosssurgery.proboards.com/index.cgi?action=display&board=questions&thread=7509&page=1#ixzz2g876WQvl
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Post by newyorkbitch on Sept 27, 2013 17:40:18 GMT -5
I think you should think long and hard about having a full DS with the gastrectomy. Perhaps just the DS part without the VSG part. Have you discussed that with a surgeon?
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Post by mlharr22 on Sept 27, 2013 21:33:00 GMT -5
No, I've not considered just the intestinal part of the surgery. Why do you suggest this?
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Post by newyorkbitch on Sept 27, 2013 21:35:16 GMT -5
Because you aren't so obese.
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Post by Deleted on Sept 27, 2013 21:41:12 GMT -5
Hmmm. Well, those issues I mentioned are the kind of "typical" things that point to significantly impaired metabolism (though it's by no means an exhaustive list), so your responses to them are heartening.
Weight loss ALWAYS helps T2DM, so you'll have that going for you with the VSG.
I think another thing about which you have to be super honest with yourself is whether or not you can truly live WELL, with good quality of life, on a significantly restricted diet for the rest of your life. If you can handle the kind of choices, portion control etc. that come with the VSG territory, that's a big plus. You won't know till you're well down the road just how much you'll have to "diet" to keep the weight off. Some folks do just fine on 2,000-2,200 calories a day in maintenance, which allows for a lot a leeway in food choices (in VSG sized portions). But if you are one of the unlucky folks who needs to cut back consumption a lot more, say to 1,200 calories or so, that changes your range of choices a LOT.
I know how I'd be if I had to try to live on so few calories, as I've done it several times before. It's definitely something to consider hard.
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Post by mlharr22 on Sept 28, 2013 1:20:33 GMT -5
Thanks so much for all the thoughts and perspectives!
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Post by angelcake on Sept 28, 2013 3:18:40 GMT -5
No, I've not considered just the intestinal part of the surgery. Why do you suggest this? Because... Yep, EN's right and there are surgeons out there that have performed the DS without the sleeve for diabetic patients who aren't obese. It's the intestinal re-sectioning that helps resolve diabetes rather than the weightloss itself, as some patients leave hospital with their diabetes resolved and at that stage it can't really be attributed to losing the weight.
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Post by angelcake on Sept 28, 2013 3:20:03 GMT -5
The DS minus the stomach resection is performed in Europe for cure of diabetes in the NON morbidly obese:
Duodenal Switch without Gastric Resection: Results and Observations after 6 Years
Journal Obesity Surgery Publisher Springer New York ISSN 0960-8923 (Print) 1708-0428 (Online) Issue Volume 14, Number 10 / November, 2004 DOI 10.1381/0960892042583851 Pages 1354-1359 Subject Collection Medicine SpringerLink Date Friday, August 24, 2007 Duodenal Switch without Gastric Resection: Results and Observations after 6 Years
Maria Laura Cossu1, Giuseppe Noya2, Gian Carlo Tonolo3, Stefano Profili4, Giovanni B Meloni5, Matteo Ruggiu6, Patrizia Brizzi7, Franca Cossu8, Luca Pilo9 and Pier Luigi Tilocca10
(1) Centro di Chirurgia Generale e Della Grande Obesita', Policlinico Universitario, Italy (2) Dipartimento di Scienze Chirurgiche, Universita' di Perugia, Italy (3) Servizio di Diabetologia, Istituto Clinica Medica, Italy (4) Istituto di Scienze Radiologiche, Universita' di Sassari, Italy (5) Istituto di Scienze Radiologiche, Universita' di Sassari, Italy (6) Servizio di Diabetologia, Istituto Clinica Medica, Italy (7) Servizio di Diabetologia, Istituto Clinica Medica, Italy (8) Centro di Chirurgia Generale e Della Grande Obesita', Policlinico Universitario, Italy (9) Centro di Chirurgia Generale e Della Grande Obesita', Policlinico Universitario, Italy (10) Centro di Chirurgia Generale e Della Grande Obesita', Policlinico Universitario, Italy Published online: 01 November 2004
Background: The results on metabolic effects of the classical biliopancreatic diversion (BPD) have led us to investigate the operation without gastric resection, thus preserving stomach and pylorus, in patients who are not seriously obese but suffer from hypercholesterolemia, often associated with type 2 diabetes and hypertriglyceridemia. Methods: Between 1996 and 1999, we performed the duodenal switch (DS) without gastric resection on 24 mildly obese patients. Mean preoperative BMI was 36.2 kg/m2. 17 patients (70.8%) suffered from type 1 diabetes, 4 (16.6%) had impaired glucose tolerance, while the remainder had fasting hyperglycemia. In 20 patients (83.3%), hypercholesterolemia and alterations in lipid profile were present. Another 20 patients were taking drugs for arterial hypertension. The pluri-metabolic syndrome was present in 41.6% of patients. Results: Mean follow-up was 4 years. BMI reduction and weight loss were not large. 2 patients who had severe longstanding diabetes type 2 needed a second operation of the classical BPD because of failure in improving diabetes. Another 2 patients were changed to classical BPD because of a relapsing chronic duodeno-ileal ulcer. The incidence of ileal ulcer was 29.1%. Regarding hypercholesterolemia, hypertrigliceri-demia, and type 2 diabetes when there is a good pancreatic "reservoir", the operation seems effective in the long-term. Protein absorption is better than that obtained with the classical BPD. Conclusions: Our long-term results suggest that in carefully selected patients suffering from serious hypercholesterolemia or type 2 diabetes with insulin reserves still at an acceptable level, and with BMI 30-40, DS without gastric resection can be proposed as a surgical treatment for metabolic diseases but not for obesity.
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Post by angelcake on Sept 28, 2013 3:35:03 GMT -5
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Post by Girlrocker on Sept 28, 2013 8:53:37 GMT -5
Hi, I just wanted to say welcome, and glad you found this board and posted. I'm an RNY to DS revision, so I can't speak directly to your question about the VSG. I can share that when I had my revision I was at 240 lbs, so considered a 'light weight'. I revised to the DS because I have major metabolic issues from life-long obesity, since I was 18 (I'm now 52). I topped out at 315 lbs in my 30s. My RNY did not work. But the information provided so far has been great, and not thinking you are critical of this board at all. You see the posts from people who have had complications from their surgeries and are understandably concerned, and you absolutely should take it into consideration. Something to add to your research list is to note when people are posting about complications, if they are virgin surgeries vs. revisions (which are much more complicated). And in the bigger picture, the number of successful virgin DS surgeries far outweighs the percentage of complications. I can't tell you how much I wish I'd had the DS first instead of the RNY, but that's whole nuther long story. And yes, don't take mine or anyone's word for it, keep reading, researching, asking questions. EN is painting a 'bigger picture' scenario in that many of us have been around the bariatric world for a long time, and thus, on assorted support sites throughout the years. While all internet communities have their bonuses and faults, a share of flare-ups, and this one is by all means not excluded from that This is a smaller board but the number of experienced veterans on here is amazing, and a good amount of them stick around or check in. I'm hitting my 2-year anniversary in December, so I'm definitely watching posts now for people who are like me and where they are at in the process. The DS does require a dedication to protein and vitamin supplementation. But the way I look at it, since I already had experience with the RNY, is in the long-run, I could say the same about the lifelong effort involved in maintaining a healthy weight. It has to become a lifestyle, not a diet or a plan - my surgery is a tool that helps get me there. Once through the early recovery stages, really, no one - or even back during my RNY - would know I had surgery from the way I eat. Other than I am health conscious, and now thanks to the DS, I look like I eat Atkins style because of all the protein and full fat. I take the vitamins, it's a part of my day, just like exercising is, eating right, all part of taking care of myself for life. Take your time in making your decision, you really do want to think twice, cut once. I'm grateful for my revision, but wouldn't wish one on anybody. There are many people who convert to a full DS from the sleeve, that isn't considered a revision as much as the second step. And it's a very interesting option available to have the DS component minus the sleeve. Diabetes, metabolism, what you will commit to big picture are all important qualifiers. Again, welcome!
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Post by Deleted on Sept 28, 2013 9:07:22 GMT -5
With 80 pounds to lose, I wouldn't get the DS without the gastric sleeve. You're morbidly obese. Doing that would give you all the stuff you're afraid of getting from the DS without anything remotely resembling adequate weight loss. *eyeroll*
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sgee
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Post by sgee on Sept 29, 2013 20:41:19 GMT -5
If you want a permanent solution to your diabetes, you need the DS. Your surgeon has given you excellent advice. The longer-term stats regarding the maintenance of weight loss with VSG are comparable to RNY, something like 50-75% EWL maintained at 5 years out. You need to decide whether that's good enough for you. For diabetes remission it's basically a crapshoot. IF you are one of the lucky ones who ONLY needs some weight loss to get diabetes remission, it might work. But a LOT of people need more than that. They need the intestinal bypass provided by the DS. That is what makes the DS so successful with CURING (not just remission of) type II diabetes. The CURE rate with the DS is around 95-98%. What are you afraid of with the DS? Wish there was a 'like' button. What Elizabeth said...
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Post by sheanie on Sept 29, 2013 22:41:42 GMT -5
Look at my stats. You are where I was pre-op. I'm not a college graduate, I'm not a nutritionist or anything special. I maintain perfectly well with no struggle at all at my current weight of 121. I've not had any rehospitalizations or scares. No leaks. Didn't lose my hair. I have a very small, tight sleeve as well. I am glad that I do.
I would not ever consider the sleeve. I have 5 girlfriends now who wanted my results but only opted for the sleeve (for your exact reasoning) who are now pissed they have regained most of their weight. One lost all her hair (so much for opting for the sleeve) and also had her gallbladder go septic two months post-op.
Choose your surgeon wisely. That's where most of your risk is, IMHO. Do your research. Finally, FEEL COMFORTABLE with your decision. Because it's not us who will have to live with it, it's you.
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Post by Deleted on Sept 30, 2013 15:06:49 GMT -5
First, welcome to the board.
Second, I am a lightweight. I had 63 lbs to lose to get to a normal BMI. I opted for the DS because of my diabetes and I didn't want to diet the rest of my life.
I was an insulin pump dependent type 2 diabetic. I started insulin in 2003. Prior to insulin, I had been on 4 diabetes medications. I had to remain on metformin as I also have PCOS.
I had the DS on the 24th of Jan 2011. Stayed on the insulin pump til the 1st of Feb. Stayed on insulin another 11 days. Stayed on metformin but at 500 mgs a day (was 2000 mgs a day pre-op) til April 2011. Pre-op a1c ON insulin and metformin was 8.2.
I just had an a1c, have not been on ANY diabetes medications since April 2011. This a1c was 5.8. And I eat like a normal person with emphasis on protein and fat. But once I get in my protein, if I want a sweet, I have one.
ONLY time I was hospitalized due to anything to do with my DS was for my gallbladder to be removed 6 months after my DS. IF my surgeon had removed that during the DS,, that would not have happened.
Oh, and I currently weigh 143 which is a perfectly normal BMI. (I got down to 121 for 10 mins and bounced back to a comfortable weight).
Liz
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Post by kennyk on Dec 16, 2013 2:57:54 GMT -5
Wow, awesome thread everyone. I have already bookmarked it since I have often been part of this conversation with people. MlHarr22 a lot of us get here in different ways. Curious, who was your surgeon? Hats off to him(?)
Many years ago I found I had testicular cancer. I was 365 pounds. Double rounds of radiation with 6 months nonstop vomiting followed by 6 months of intermittent vomiting started me on my way to weight loss. Mind you I have dieted and lost well over 100 lbs several times on everything from over eaters anonymous, to weight watchers, think thin, and getting into the marines by eating NOTHING but tuna with mustard, lettuce, and egg whites.
During my follow up I was diagnosed as pre diabetic. I laughed at it and did not care after cancer. For the most part I was very non compliment. Years later my weights were between 235 and 300 with negligible effects on my sugar levels. Neuropathy and family history made it clear that I would most likely lose a foot one day. It scared the shit out of me, just not enough to keep my sugars together. I first only heard of the DS when my sister in law, a 5 dose a day, insulin diabetic traveled from Connecticut to use Dr. Sudan in N.C. 3 weeks after her surgery she was off insulin. On her doctors recommendation she stayed on metaformin for a few months for reasons having nothing to do with diabetes. I was intrigued. I decided to watch how she did for the next year. I contacted Dr. Sudan's office for a NY referral. The doctor was not on my plan and I used another in his practice at Mount Sinai. Dr. Kini was a true professional. He and his support team were not big big DS fans. Even though I went specificly for a DS he mad many other suggestions including starting with a VSG and possible DS down the line.
When asked about best overall results for my diabetes he said hands down it was the DS, and agreed to do it. I am now 8 months post op. My sugars are under 4.0 (possibly a little low due to some pre existing anemia?) I am for all practical purposes at goal. Recovery came without complications but was still a long road. As far as my surgeon, I have the utmost respect. He is not necessarily a big advocate of the DS, but feeling that I had a competent understanding of the follow up he gave me the surgery I wanted NOT THE ONE THAT BEST SUITED HIM AND HIS PRACTICE.
I can not begin to tell you the gratitude I feel both to him and the people on this board who have made this all possible.
As for my sister in law? She lost a lot of her weight, at 6 months had a setback with her foot stopped all exercise AND BECAME a carb and protein junkie. She stopped losing weight, has not gained in 2 years and still has very stable sugars. She does not visit the board. When I send her things that are a little scary to read she responds why do you read that crap? Easy answer. It is the information that will keep me alive and healthy.
You have a lot of choice and decisions to make. Good luck with what ever you decide on but I will say this was one of the best things I ever did for myself Kenny
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Post by duodenalswitcharoo on Jan 23, 2014 9:46:57 GMT -5
Not sure if this thread is still relevant but I shall tell you what happened with me.
I was 600lbs+ and had T2DM, not insulin dependent yet, only on metformin. Post VSG my diabetes resolved itself...whilst still in hospital. YAY! That's what you wanted to hear right? It's true....BUT, your question is about after year 2. I am 3.5 years post VSG and for the past 6 months I have had all the signs and symptoms of diabetes coming back at me full force. So whilst the VSG sent my 'betes' runnin for the hills, it did not keep it away. Also, I have continued to lose throughout that time, so it's not weight gain causing the 'betes' monster. I am now scheduled for my DS in Feb. I understand the fears of what CAN go wrong...as I am repeating them in my head hourly at the moment as I prepare for my time....but the fact is, if you eat right and take all your vites as recommended by the vets, the chances are well in your favour. Shit still can go wrong, even if you are perfect, but if you think about it, everytime you leave your house you are risking being hit by a bus, crashing your car, losing life and limb...but we don't obsess over that because the chances are small and the payoff for leaving our house is well worth it.
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Post by kennyk on Jan 24, 2014 0:53:14 GMT -5
Not sure if this thread is still relevant but I shall tell you what happened with me. great post and i believe this type post is ALWAYS relevant! the thought of no more diabetes makes all the sides seem so very worthwhile. kenny
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Post by Girlrocker on Jan 24, 2014 9:40:34 GMT -5
Agreed, I have it bookmarked and it was nice to see it again!
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