Post by Carolyn H. on Jan 24, 2012 21:32:01 GMT -5
I have been pretty open about my WLS, and I have fielded a number of questions at work over the last year re: why I went VSG rather than LAGB. I go through the lengthy list, and splain my undying love for my pyloric valve, etc.
I was asked by a MO co-worker who is considering WLS and has done some research as to why I chose VSG. I splained her why I chose VSG over RNY & LAGB, and I suggested she should consider DS due to her being pre-diabetic (really, right on the cusp of full-blown diabetes). Her BMI is borderline for coverage, but I splained the appeals process, etc.
Not to make this a magnum opus post, it was a long conversation and she asked about 2 stage DS, or more preceisly, seeing if stand-alone VSG would work for her as it had (so far) for me but having the possibilty of revision in the future.
I told her a) don't plan for failure/hedge. If you doubt you can do it with VSG alone, go with a virgin DS. b) Doing the switch later is less effective than the 'all in one' approach, c) blood sugar was not really my problem, so I didn't need to resolve it as she does. My highest pre-op A1C was 5.9 which is barely pre-diabetic (ish), and d) there's a possibility that the revision to DS (i.e., switch) would have to be done 'open' rather than laprascopically unlike a virgin DS.
She was curious about the less effective in two parts issue. I'm trying to get a better explanation for her, if there is one. My understanding is that after being on reduced calorie, low-carb diet the reduction in basal metabolic rate makes 'switching' less effective (i.e., you get more bang for your malabsorption buck when your metabolism is still going full out, early on). Better explanation than that?
Also, while RNY to DS is generally done open, would VSG-DS need to be done open? I thought about it afterward, and it seems like it should be able to be done lap if a full DS is done lap? Correct me if I'm wrong, please.
I promised to get back to her ASAP as she's wants to start the process. Thanks in advance for help.
Just as a note, my DH is still on the fence about a switch without sleeve for his diabetes. His docs changed up his meds, recently and he's doing pretty well right now. We'll see. I told him another trip to the ER with blood sugar of 600, and I'm going to do the surgery on him myself with a butter-knife.
I was asked by a MO co-worker who is considering WLS and has done some research as to why I chose VSG. I splained her why I chose VSG over RNY & LAGB, and I suggested she should consider DS due to her being pre-diabetic (really, right on the cusp of full-blown diabetes). Her BMI is borderline for coverage, but I splained the appeals process, etc.
Not to make this a magnum opus post, it was a long conversation and she asked about 2 stage DS, or more preceisly, seeing if stand-alone VSG would work for her as it had (so far) for me but having the possibilty of revision in the future.
I told her a) don't plan for failure/hedge. If you doubt you can do it with VSG alone, go with a virgin DS. b) Doing the switch later is less effective than the 'all in one' approach, c) blood sugar was not really my problem, so I didn't need to resolve it as she does. My highest pre-op A1C was 5.9 which is barely pre-diabetic (ish), and d) there's a possibility that the revision to DS (i.e., switch) would have to be done 'open' rather than laprascopically unlike a virgin DS.
She was curious about the less effective in two parts issue. I'm trying to get a better explanation for her, if there is one. My understanding is that after being on reduced calorie, low-carb diet the reduction in basal metabolic rate makes 'switching' less effective (i.e., you get more bang for your malabsorption buck when your metabolism is still going full out, early on). Better explanation than that?
Also, while RNY to DS is generally done open, would VSG-DS need to be done open? I thought about it afterward, and it seems like it should be able to be done lap if a full DS is done lap? Correct me if I'm wrong, please.
I promised to get back to her ASAP as she's wants to start the process. Thanks in advance for help.
Just as a note, my DH is still on the fence about a switch without sleeve for his diabetes. His docs changed up his meds, recently and he's doing pretty well right now. We'll see. I told him another trip to the ER with blood sugar of 600, and I'm going to do the surgery on him myself with a butter-knife.
