Doing the VSG

[multics]

Last year I found a surgeon (DR. Hill www.youtube.com/user/bestbariatricsurgery) who does the Lapband, VSG, RNY, and DS. I was originally targeting the DS and have been going through the bariatric program. Based on some newer information (can help type II) and that the VSG is done as part of the DS I have decided to try the VSG first. My surgery is scheduled for 20 Aug 2014 at Adirondack Medical Center. The bad part is this is a 3 hour drive from me so that is the bad part.

I have gone to the initial meetings of the local surgeons and did not feel comfortable with them. They seemed to do a lot of trust us type hand waving. Dr. Hill seemed to be a lot more upfront about both the surgery risks as well as how the surgery will affect you afterwards. I felt much more comfortable even though this is a much smaller out in the boonies facility. The staff has been very good. One of the instructors had the DS and talks of her experience and that of others and the bad parts, like you don't digest fats, smelly bowel movements, and other things that are now different.

[west4thavenue]

This is a personal decision. I don't know your history, so I can't speak to your choice of sleeve. I can only tell you why I chose DS and how I feel about it now, 5 months out.

I'm 58 years old. I have battled weight all my life. I didn't want gastric bypass because I have known too many people who experienced regain, just as I experienced it so many times when I lost weight. The other procedures, lap band and VSG, weren't good options for me because they don't address the metabolic issues I was having. My health was not good at all (heart attack history, arthritis, clinical depression) and I was literally attempting to SAVE MY LIFE when I went to my surgeon. He does the VSG, too, but after going through my medical history with me, we agreed the results I would get from the DS would be better.

There are "bad parts" to any surgery. First, it is surgery and it is tough. The "bad parts" you mention have been manageable for me and more than worth the result I am getting. The surgeon told me I would have to work really hard to fail, and the stories of the vets here confirm that for me. I will not see significant regain. Perhaps more importantly, I am off a lot of cardiac meds I had to take and I learned last month that I will not have to have a defibrillator implanted in my chest, which we thought was going to have to happen. The cardiologist said this was largely due to my weight loss.

Please read the stories of the people on this board who have had VSG and later had to have an additional surgery to revise to DS. You will not have your metabolic issues addressed with the other surgeries. Only the DS offers the metabolic reset. It also offers the highest percentage of excess weight loss compared to the RNY, VSG and lap band.

I wish you the best in your decision making and in your surgery!

P.S. Lots of us have traveled to have our surgeries. Some have traveled to other continents! My travel time was 2.5 hours.

[Joanne]

Aug 15, 2014 8:03:13 GMT -5 multics said:

Last year I found a surgeon (DR. Hill www.youtube.com/user/bestbariatricsurgery) who does the Lapband, VSG, RNY, and DS. I was originally targeting the DS and have been going through the bariatric program. Based on some newer information (can help type II) and that the VSG is done as part of the DS I have decided to try the VSG first. My surgery is scheduled for 20 Aug 2014 at Adirondack Medical Center. The bad part is this is a 3 hour drive from me so that is the bad part.

I have gone to the initial meetings of the local surgeons and did not feel comfortable with them. They seemed to do a lot of trust us type hand waving. Dr. Hill seemed to be a lot more upfront about both the surgery risks as well as how the surgery will affect you afterwards. I felt much more comfortable even though this is a much smaller out in the boonies facility. The staff has been very good. One of the instructors had the DS and talks of her experience and that of others and the bad parts, like you don't digest fats, smelly bowel movements, and other things that are now different.

You have to pick the right surgery for you. Not everyone wants the DS, and just because it was the right choice for me, doesn't mean it is the right choice for you.

That being said, you should at least make sure you make a very informed decision. Some of the things I would encourage you to think about and research are:

-Living with the DS. Yes, there is a tradeoff. The tradeoff is you have to supplement every day, and you have to monitor your labs. The fact that we dont full absorb fat is a "feature" to many of us, not a down side. We dont need to eat a low fat diet because we dont absorb the calories. The bathroom issues are worse for some than others, but can also be controlled to some degree based on what you eat.

-Starting with a VSG and seeing what happens, knowing that you can revise to a DS: Think carefully about this plan. Just because something is technically possible from a surgical point of view doesnt mean it's practical. What happens to many people who start with this plan is that they find that the insurance doesn't cover the revision to the DS. This can happen for a few reasons - perhaps the insurance company has a "once per lifetime" bariatric clause, perhaps your insurance changes and doesnt cover WLS at all - or very likely that you lose enough weight to no longer qualify, but are still obese. That is what happens to many - you can wind up at a BMI of maybe 35 and be stuck there.

I've seen the VSG work for many people, and I've also seen it work termporarily for many people and see them regain. You have to think about the tradeoffs of the DS and if you think you need the extra metaobolism boost. If your BMI is on the higher side you should even more strongly consider the DS. Only you can decide if that tradeoff makes sense for you - but at least research and think about these things.

[illinids2]

Echo what Joanne and Monica have said. I will add that if you want the surgery with the statically documented highest 5 year EWL and diabetes resolution, the DS is the only choice.

Two other personal realities for me:
The bathroom issues are a myth (for me). Yes I go several times daily but that is no big deal.

Why would I want to have to diet the rest of my life (which you will with VSG) and have two surgeries, time off work and the physical and mental recoveries?

I am very biased when it comes to WLS so take that into account ..I would never consider anything other than the DS as nothing else works.

[multics]

I've been researching this for over 5 years. My Endocrinologist has been pushing me for surgery for longer. I finally selected the VSG as it is done as part of the DS anyway. Dr. Hill did mention that he has in the past had DS patients that were not healthy enough for the full DS and had to do just the VSG part to get them to a safer operating weight.

One of the Bariatric nurses who teaches some of the required training/orientation classes had the DS. I've been to the two local to me Bariatric initial meetings but they only do the lapband, VSG, and RNY. None of them do the switch. I found I wasn't comfortable with them at the end of the initial meeting as they seemed to do a lot of 'TRUST ME" things without a lot of detail. I called a couple other surgeons and hospitals closer and found none of them did the DS and a couple of them tried to really discourage me looking into the DS. Dr. Hill was very open about the 4 different surgeries, the success/failure rates and surgical risks. He was also open about the diet changes and cost of the vitamins and minerals required by the various surgeries as well as the side effects.

I had the surgery Aug 20th. I was released from the hospital Aug 22nd. I've had no pain issue worth mentioning. I never felt a need or desire for any pain meds. I've driven myself to/from the pharmacy today to get the new meds.

I will be 60 in September. I never smoked or drank or did illegal drugs. I was diagnosed as diabetic type II when I was 39. My biggest health problem is my weight and the problems it is causing on my knees, hips, back followed by the type II. I'm down almost 20 lbs as of today, most from the pre-op diet. I passed all the tests wither perfectly fine or close enough (they did a heart catherterization to check all the heart arteries). They discovered one of them had just a small narrowing worthy of meds, but not worth a stent and no reason to oppose surgery.

The worst part so far is the Adirondack Medical Center where Dr. Hill practices is about a 3 hour drive each way. Other then required checkups, I'm going to have to find a more local support group. I don't want to be driving that far, particularly in the winter unless they are willing to allow attendance via skype or other electronic means. I've been in several hospitals locally for diabetes related problems. This was the best hospital experience I've had as a patient in a hospital.

[goodkel]

Congratulations on a successful surgery!

I wish you luck with it!

[multics]

I had a total of 6 incisions. This picture was taken 2 days after the surgery.

They've allowed me to proceed to stage IV and try well chewed solid food, but no beef or pork. My new stomach is still settling in and adjusting so I have to be very careful about what and how fast. So far the chicken salad has worked best, but I think the egg and tuna problems are I don't like the store bought ones. Tomorrow I'm thinking of going out with friends and very carefully trying some moist Tandori chicken (maybe 1 thigh) and maybe a little chicken tika masala.

[illinids2]

Aug 29, 2014 9:27:24 GMT -5 multics said:

I had a total of 6 incisions. This picture was taken 2 days after the surgery.

They've allowed me to proceed to stage IV and try well chewed solid food, but no beef or pork. My new stomach is still settling in and adjusting so I have to be very careful about what and how fast. So far the chicken salad has worked best, but I think the egg and tuna problems are I don't like the store bought ones. Tomorrow I'm thinking of going out with friends and very carefully trying some moist Tandori chicken (maybe 1 thigh) and maybe a little chicken tika masala.

You had surgery on August, 20 and are eating meat already???  Be very careful about going to fast.  As I understand it you just did the sleeve part but that is still major surgery and your new stomach is healing.

[goodkel]

Well, if his surgeon gave his approval and she chews it to a pulp, he'll probably be fine. He did say that he was having moist chicken.

Buffalo chicken wings slow cooked in barbeque sauce sat easily with me from early out.

My mushy food included Wendy's chili that has beans and hamburger in it.

It IS just his stomach that he has to consider.

[goodkel]

Aug 29, 2014 9:27:24 GMT -5 multics said:

I had a total of 6 incisions. This picture was taken 2 days after the surgery.

They've allowed me to proceed to stage IV and try well chewed solid food, but no beef or pork. My new stomach is still settling in and adjusting so I have to be very careful about what and how fast. So far the chicken salad has worked best, but I think the egg and tuna problems are I don't like the store bought ones. Tomorrow I'm thinking of going out with friends and very carefully trying some moist Tandori chicken (maybe 1 thigh) and maybe a little chicken tika masala.

Congratulations!
You seem to be doing great!

[multics]

So far so good. I've mostly been eating atkins shakes, sliced deli chicken and turkey, eggs (scrambled/omelets), and chicken salad.

So far, eating "too" fast seems to cause the most problems, but some things tend to not work as well. Seafood salad seems to work in small quantities. I've eaten out at a local Chinese favorite, but all I had was eggdrop and miso soup and tea. I've also eaten at a local favorite diner and just did the swiss cheese omelet taking about half home for a second meal.

Some things that worked during the preop high protein/low cal diet now taste terrible so back to carefully testing new high protein foods. Carefully well chewed/nibbled high protein bars have so far worked ok.

I'm now down to 346.0 from around 375 before the preop diet. I've reduced my insulin pump basal from 2.3 before the preop diet to 1.9 for preop diet to 1.30 unit/hour. My bsg's have now been running between 70 and 130 with most in the 100 to 120 range. I expect my next A1C to be much better.

So far I'm pretty happy. This weekend I'm going to try some tendori chicken very carefully.

The surgeon has stated that he has done several VSG to full DS surgeries as well as RNY to DS. I'm hoping the VSG will continue to work and get better.

[multics]

I've had some problems, but I'm not sure if they are related to the surgery or were developing independently. I had the surgery Aug 20, 2014. Around mid/late Oct I was starting to have pain sitting.

In November they diagnosed me with a right peritoneum abscess and did emergency surgery the Saturday after thanksgiving to start draining it (done by colo-rectal surgeon). They added some additional prostrate meds as one of the problems I'd seen my PCP for was trouble peeing. When they did the surgery they also added a catheter.

About 2 weeks later after my aid helped me undress (I'm not flexible enough for compression stockings) I stood up, grabbed my towel and passed out as I got to my bedroom door heading to the bathroom to shower. I was only out for about 2 or 3 seconds according to my aid. Fortunately all I did was scrap my forehead and arm. However my aid and I determined that due to the lack of room, my weight, my position, we needed more help to get me up. We called 911 and when EMT arrived they insisted on taking me to the closest hospital due to my passing out.

They evaluated me and kept me for observation. Monday and Tuesday I was seen by a couple heart surgeons who reviewed my meds and basically determined I was on too many meds with a warning about blood preassure dropping when standing so they took me off all the meds with those warnings. The general surgeon (no colo-rectal at this hospital) looked and was not pleased with the drainage. I had 3 additional surgeries (debredements?) to better clear drain the wound including adding drains the last time. These were done about one a week. I then spent 2.5 months at a nursing/rehab to get the nursing needed to keep the wound clean and get enough rehab to be able to walk again due to the length of the hospital stays as well as the nursing stay before they started rehab. I went into nursing/rehab Dec 31 2014 and wasn't released until mid March 2015.

Everything seemed fine and the abscess was fully healed. Around early May I started feeling week and having trouble walking. Back to my PCP who started doing tests. Bye the end of May I was in constant pain and again transported to a larger local hospital. It took them 2 weeks to diagnose the problem as they had to find an MRI I would fit in, I did not fit in theirs. Pain was very bad, running around 8 to 9 on the 10 scale. Hydrocodone 10-325 didn't really work, Morphine didn't really work well either. Valium helped better then those. They determined I had a serious bacterial infection of my T4 and T5 vertebreas that basically destroyed them. June 15th I had back surgery and had 2 titanium alloy rods and screws inserted to replace my damaged T4 and T5. I spent 2 weeks recovering in the hospital before they felt I was well enough for nursing/rehab facility.

I spent 2 months there and was discharged Aug 31, 2015. Large hi-res JPG of my back scar and graphic pdf's of the last 3 visits to the surgeon for follow up are in sgeinc.com/~multics/pics/x-rays/ for the curious.

The good news out of all of this is I'm down about 125 lbs despite the nursing/rehab facilities not understanding Hi-protein/lo-carb diets. They did manage to give me the highest A1c's I've ever had. Now I'm struggling to get back on diet.

The big question is where did the infection come from?
The VSG surgery is now where near the rectal infection.
The rectal infection is not near the back infection.

[OnMyWay2Thin]

Multics,

You should start a new thread if you are looking for advice. Many will not look at threads this old unless they are doing research. I'm sorry I don't have answers to your questions, but it's very concerning. I'm fairly new, too, having had surgery in July, 2014. I wish you luck in getting answers but suggest putting this as a new thread so people know to look at it.

Kelly

[multics]

Just a quick update.
I'm down to 271 lbs for a loss of about 125lbs. The bariatric people think I'm doing very well. After the one year lab workup they told me to increase calcium and D3. I feel much better and am much more mobile now. Another local hospital (St. Peters) has added a bariatric unit, but they don't do the DS.

[misskate]

I am a little late to the game but new to the forum. How has your experience with the sleeve been? I am trying to get approval through Kaiser but it hasn't been easy.