Post by nyuboi on Jun 11, 2012 17:26:44 GMT -5
Hi everyone,
OK this post is long-overdue. I have been lurking for a month or so and should not have procrastinated, since as of last week my surgery is now scheduled for two weeks from today – Monday June 25th, 2012. As the subject implies, my BMI is very low for a DS. Weighing in at 212 pounds at 5’9, my BMI is 31.3 – making me what this board calls a “light-weight.” (If only I could be described as such off this forum, ah?) I am 30 years old.
I AM DEPERATE FOR FEEDBACK, AND TIME IS OFF THE ESSENCE. I AM NOT A TYPICAL CASE, EVEN FOR THE MOST AGGRESSIVE OF SURGEONS. All do the DS. My below feedback is NOT to suggest they do NOT like the DS or prefer it to RNY, but rather that most people feel it is aggressive for me. I hate the idea of referencing specific surgeons names. While one is highly active and known on here, the rest I contemplating with mentioning despite most being on vetted lists or mentioned here. But given the seriousness of the surgery, my low BMI, the experience of everyone on here not only with the procedure but the vetted surgeons and two weeks left before d-day, I feel it is best I just honestly disclose my office visits. If I had more time, I would have likely just said the hospitals and implied who each was (anyone knowing I say Lenox Hill will likely assume Roslin, etc.), and then disclosed such in private messages with people. I have seen forum posts of the past get attention, make their way onto search engines, and never fully disappear even when it was attempted. As such, I hope any bariatric surgeons reading this in the future will understand, and not come chasing me with a rubber-hose.
Before starting, please do not be offended, insulted, or feel I am a whiny dramatic pain because of wanting surgery to lose only 50 pounds. I realize this is not typical, and trust me, nothing pisses me off more than hearing some thin person say “I’m so fat, I need to go on a diet” for attention. Everyone is different, and losing the weight is important to me.
------------- BACKGROUND ------------
In August of 2007, I had a lap-band implant with a local hospital here on Long Island, who only does gastric banding. Prior to gaining insurance approval, at my consult in that is, my BMI was 36.6 with a weight of 248. After fasting to prep for surgery, on the date of the operation my weight was 228 with a BMI of 33.7. While 248 was my highest weight and I didn’t come back to it, the lap-band has been a bit of a roller coaster ride. I had many adjustments over the years in an attempt to find my “sweet spot,” which became a non-fixed relative term depending what stress I had going on in my life at any given time. You see, because of the muscles involved near the upper stomach gastric banding, when I was very relaxed it would ease in a sense, and tighten on the opposite. As a result, I rarely could eat during the daytime and yet if it was late at night or I was away on vacation I could tolerate food much better. In the past year or so, I have had to take a benzo (Xanax, Ativan, etc.) in order to relax myself and make it easier to eat when out or enjoying a moderate meal. My band was a 4 CC band, and the amount of saline in it at any given time has ranged from 0 to the mid 3’s or so. While the latter had me at my best success with a weight in the upper 180s, it did not become sustainable to maintain the filling so high due to problems eating – resulting in the band being drained, along with weight gain, and then starting over. The point is my weight has varied from 228 down to 190 or so, up to 202, 204, 208, and three months ago 221. I am currently at 212, which is due mostly to problems eating due to a lap-band complication.
I have been on it all. Xenical/Alli, Phentermine, Meridia, Optifast, Jenny Craig, Weight Watchers, “fat camp” as a kid, etc. All help but temporary. Have been adequate several times in life – at 17 my senior year of high school graduation I went from 230 to 170 for a few months. Three years later I went from 200 or so to 180 when I was placed on Adderall/amphetamines at UNC Chapel Hill and living the dorm life, and that’s about it. Other than that, life has been primarily been spent obese. While I know the flaws in the BMI scaling, to have a normal BMI my max would be 172. This is what I want more than anything – hell 160 would be nice, but it is important to me to weigh in the 170s and something I have wanted for as long as I can remember. I pretty much became fat from 8 years old on and playing the crash diet and fluctuation game my whole life.
History of sleep apnea, and GERD – sometimes severe. While my apnea was in remission when I was last tested at a weight of 190 in June 2009, it is likely it has reappeared since my weight has climbed up a little combined with everyone telling me my snoring is very loud. I have lived on Nexium since 2006, prior to the band placement, having endoscopies before the surgery, a year after the surgery, and two weeks ago. At times it has been as simple as some heartburn, at other times, although rare, it has meant waking up choking as the acid creeps up. For the most part, it is under control when I take proton pump inhibitors. Likely this has been made worse from the lap-band and will be controlled with medication after the band is removed. Light asthma more with the weight gain.
Around February 2012, my band was once again emptied in full due to a lot of vomiting or “lap-band attacks” (pain, etc.) as my fellow banders called it. Knowing I had fluctuated a lot and “never really been happy” with the band, my surgeon agreed to have me see highly experienced surgeons in the city to discuss revisional surgery – which he assumed would, at most, be RNY. He did this for two reasons: 1) On Long Island, he knew most surgeons would not have the flexibility (due to administrative flags) to due this type of surgery on a BMI of less than 35, noting the research hospitals of the city can be more aggressive and 2) Noting “if anyone knew the options out there available to me, it would be [these guys]. He initially gave me two referrals followed by a third one, the last of which was because I had been given highly conflicting recommendations by the first two. I was honestly surprised, since he was conservative about anything besides the band years ago and only performs the band. He was very nice and open minded, though, and said: “It was different years ago, Paul, you had options – now that I feel lap-band and the sleeve are off the table, you only have 1-2 options left if you are concerned about long-term health. Although I want to be sure you are doing it for such and not purely for cosmetic reasons.” He was an AWESOME doctor and often spent an hour with me at each visit, and suggested I see the first 3 highly respects surgeons below. And off we are…
------------- THE DS SURGEONS I MET ------------
MARC BESSLER, NY-Presby/Columbia Univ Med Ctr. February 2012. Dr. Bessler at the time felt a new lap-band would be appropriate, or possibly a sleeve. He felt a DS was crazy on someone of my weight and ruled it out as “out of the question,” and was highly reluctant to even consider RNY. He said, given my BMI, it would only really be justified for him to do RNY if I had diabetes or barrets from my acid reflux disease (which I was negative for). Otherwise he would not be willing to do anything besides a band replacement or possibly a sleeve. While he was aware of the symptoms and the recent emptying of the band, I note he did not order an upper GI and, as such, was NOT aware how serious the dilation was (something I will get to in the next paragraph). Last month he was made aware of such and provided with the upper GI reports and x-rays, and lightly changed his position. He now feels both the sleeve and a lap-band replacement are NOT appropriate procedures and that he would have to “think about” whether or not he would be willing to do a RNY given my BMI of less than 35. He maintains the position of feeling a DS is out of the question for me. While he has a good amount of experience with DS, I did not see his name on the vetted list on these forums and note he generally seems more conservative of the DS surgeons and even made ethical and medical malpractice implications. He would be willing if my BMI was a 35.
MITCHELL ROSLIN, Lenox Hill. March 2012 to Present. In March 2012, I met with Dr. Roslin for a revisional surgery consult (not knowing I had a complication, but rather just because I was dissatisfied with the weight loss). At the time, Dr. Roslin required I had an immediate upper GI performed before he would discuss any revisional options. After doing so, he told me the lap-band had to come out – that such was not even an elective choice but medical necessity. Despite me being completely emptied a month prior on Long Island due to a lot of vomiting or “lap-band attacks” (pain, etc.) as my fellow banders called it, I had extreme dilation of the esophagus. (Not a slipped band, an enlarged esophagus). Dr. Roslin felt this was leading towards a motility disorder known as pesudoachalasia. Although not all surgeons agreed with this strong wording, there was no dispute the lap-band had to come out. Dr. Roslin stated he would not even be willing to do switch the band given my problems and the likely hood of them repeating. While the sleeve would be better than a band, he feels I would only lose another 20 pounds or so from such and that it would not be worth it. Leaving, you guessed it, RNY and DS – both of which he was willing to do. I know the readers of this forum are well educated and informed, so it will not come as a surprise to you to know he suggests the DS given his strong believe that preserving the pyloric valve is the way of the future. While many of you may feel any highly vetted pro-DS surgeon may agree with this, you may be surprised to know Dr. Roslin is alone on this one, but we will get to that. Dr. Roslin had initially stated the disagree would be comparable or better with the DS. At the time, last March, I wasn’t as educated on DS and simply took notes on all this. I felt saying I would make a decision. Of course, him simply removing the band was another option, but he warned I could “blow up.” Later on, after making my mind up on RNY after meeting the next vetted surgeon, he said to me in his office “You don’t want to preserve the pyloric valve?” I found this funny, as most would just say DS – but he assumed, like all of you, I was the “Harvard” of bariatric patients. What a funny thing to say. Lastly, I should note that at my initial consult it came out he had only done 1 DS surgery on somewhat of my weight, although at a subsequent visit he did not recall saying that and seem surprised.
ALFONS POMP, NY-Presby/Weill Cornell Med Ctr. May 2012. Now, here is someone that was on one of your vetted lists, and also on the Castle Connolly Top Doctors list. The director of bariatric surgery at Columbia, I met with his resident and him. In summary, he was willing to do a sleeve or a RNY. The sleeve, his resident noted, could be more problematic given the area of my band the scar tissue from such, in addition to making my acid reflux worse. RNY, what he wanted to do, he liked best because it would cure my heartburn while still being effective. I was surprised he was even willing to do RNY frankly (because the other previous Columbia surgeon was not). He noted how they lead the studies on doing RNY on low-BMI patients who have diabetes, how it puts them into remission, etc., and that he had a lot of experience doing RNY on people of my weight. I believe he said maybe he did 1 DS on someone of my weight. Now, before continuing, I must note he has significant DS experience, and I know he has been performing the procedure longer than Dr. Roslin. Now, here comes what would later become the scariest part of me considering the DS. “Paul, you’re a young guy, do you want to be going to the bathroom 9 times a day?” He went on to explain that, easily, my bowel movement would triple. He explained I would have “room-clearing” gas, and reference one patient who had been evicted from an apartment because of the landlords dissatisfaction with the foul-smelling odors of their bowel movements coming through the floors. Obviously, I realize this is extreme, and I went on to mention I would want it more conservatively done, and that Dr. Roslin had noted that he would not be as aggressive as more severely overweight patients, and that he could control it a lot in how much be bypasses. Dr. Pomp said back to me that there were no real studies distinguishing long limb versus short limb patients in terms of side effects and success. This had be wondering: The Lenox Hill patient handbook boasting 85% weight loss at 3 years with DS (versus 60% with RNY): was it skewed if history had more severely obese getting the procedure until recently? His resident said they often have patients go on Xenical/Alli to get an idea what it will be like, etc. I have years and years of experience with such, but unlike DS, I can stop taking Xenical on the weekends! In summary, Dr. Pomp was NOT willing to perform the DS on me. He concluded with “Don’t get me wrong Paul, the DS is a great procedure – fun to do and I do it all the time, but it’s NOT for you!” I should note he spent more time with me than any other surgeon.
And, finally…..
WILLIAM INABNET, Mount Sinai Med Ctr. June 2012. He believes very much in the DS and preserving the p-valve, and seems closest to Roslin in terms of aggressively believing in the DS. However, he did NOT suggest such for me. Unlike most former, he actually suggested the sleeve. For one he felt it would provide me with adequate weight loss since with the lap-band I did “well” with only a restrictive procedure. Second, he noted that this would allow me to easily add on the d-switch portion and in a sense help me do the DS switch in stages if I was not happy with the sleeve alone. (Although I disagree feeling the DS would be even less justified 20 pounds lighter, and that, like Dr. Roslin said, I will have moderate weight loss with such). I explained I wish I had been more aggressive five years ago and that I am worried if I only do the sleeve now I will be back in having surgery again. He reminded me I have my whole life ahead of me. In addition, he also prefers to do an RNY over DS on me. He said it is a major major surgery especially for someone of my weight and even noted “And I am a very pro DS surgeon so that can show you how aggressive I think it is for you.” Having said that, unlike everyone but Dr. Roslin, HE IS willing to do it on me. He would prefer it be done in stages as a plan, but is willing to do which ever option I want. I asked him about the diarrhea and nausea concerns of mine. He said it should not a be a problem, noting what he would do doing would be known as a “modified duodenal switch.” I asked if that meant leaving more common channel, and he said “exactly – leaving 150cm.” This is exactly what I was going to ask Dr. Roslin. Although the idea of a conservative DS sounds like a paradox, lol. In any event, I get it and do feel I need not be as aggressive as others – especially given diarrhea is my #1 concern. I explained I can’t be on trial as a future attorney and have to run out of court and he said “you should be fine.” He explained I may have 2-3 bowel movements a day (I do already) or that I may get loose stools, but that full fledge diarrhea would not be the issue I thought it would be. As he rushed out the room, I said “Will I be able to stay on fire island, a beach resort here on the Island, out on the weekend and have tortilla chips and Mexican food, and not be rushing to the bathroom with chronic diarrhea? (I remember an ALLI/XENICAL experience there years ago after such…) He said “You’ll be fine.” He had to run on me to start seeing other patients before I even broke out my very technical questions.
------------- WHY, PAUL, WHY? ------------
Well I mentioned the co-morbidities before, but let’s be honest – they are not really on my mind right now and in remission. Will my weight come on if I remove the band? Likely. Will the co-morbidities then follow? Likely. Having said, I do believe I am capable of not getting heavier than I am now with decent dedication to not going over-board with my eating. I have been used to this from the lap-band. When my friends eat at the restaurants and all, I am usually wrapping my dinner – sometimes taking 3 more sittings to finish it. Eating is definitely hard work and a chore sometimes. Although the sudden removal of such – it would take a lot of discipline to not become a kid in a candy store. (Buffet celebration!!!) J/K. Anyway, as for losing more weight, I think with moderate eating I can probably keep myself below 200. I think with a significant dedication and commitment (dieting, working out, etc.) I can even get myself down to 190. Every pounds beneath that would take extreme dedication, and unless I was working as a personal trainer in a gym for a living, I just don’t know if it’s realistic, especially when I begin law school or a tough career. I do NOT believe I will ever truly be at a normal weight or thin without something as aggressive as RNY or DS. I am confident I will come damn close or hit goal with the DS. (As I write this, damn do I want a cigarette as a break between sections – but I had to quit today to be ready for surgery in 14 days).
I don’t have to tell you being thin has been a life-long dream. You all know what it’s like. I have a friend 300 pounds who eats like I do. Some of us just get a rotten card in terms of genes. I know a lot of you have it far worse than me so please don’t take my writing as me being a wining bitch. I come from a family history of obesity – not morbidly but still. I hate ignorant people with their naive statements: “Just join a gym, go on a diet.” (I want to say “Really? You mean that helps with weight loss? No shit? Who knew?) I see friends eat three times what I do and weigh less. If I meet someone who has lost all the weight and kept it off long-term, I will listen. Otherwise shut up. ? Naturally the people that weigh 210, 220, 240 and say to me “I lost a ton of weight and was thin when I just…” Keyword WAS. Anyone can lose weight, keeping it off is the hard part and how many really do? I mean, if someone is saying “was” or “was thin when I,” it translates to me as they inevitably gained all of it back, thus I care less for their opinion on how to crash diet it off. My uncle has said “well when I did it,” and my mom “well when I got down to a size four.” While I love them, neither maintained it. I have yo-yoed as much as the next person, but I don’t want to do this the rest of my life. Being prone to obesity since child hood, I just don’t feel it’s realistic to maintain a normal BMI without something as drastic as surgery.
Being the Pisces water lover I am, I used to frequent the beach – till I was 10-11 or so. Then, I could no longer take my shirt off comfortably as the weight got worse and worse. Many said “so take your shirt off, look at others” -- but I do not see a lot of youth take their shirt off like that. Certainly my teenage days and 20s I was not comfortable to do so. While I may care less in the future, it is something I just can’t bring myself to do at a crowded beach or environment. If you go to LI’s top “Jones Beach,” it is just packed and packed with people, the majority of which I would say don’t look bad – especially in the young adults.
I spent high school being tortured and made fun of, particularly in the locker room with “Paul has breasts.” I realize this is the nature of high school. Ironically, half of these people I now see on facebook have gained weight, some are flat-out fat, including a kid that made fun of me going to fat camp. My high school nemesis, a girl, would tell me that there’s no way I could be related to my brother, who was thin and even resorted to weight gain shakes when he was in high school and college. Don’t get me wrong, I am not doing this surgery for psychological scars. It just goes to the long history of wanting it so bad. My senior year, I had extreme motivation with a “deal” with a teacher to give me a credit needed for graduation if I reached below 180. I hit 170 over many months, but had extreme motivation of that plus not wanting to graduate 230. I was eating veggie burgers and protein every day, and worked out at 5am before school and often after school. Some say “well see you did it,” but I was also 17. I have never again come as close, although was able to maintain 190s my first two years of college, while on and off of Meridia, which I had also used my senior year of high school. I was a clean-cut kid: No smoking, no drinking, no drugs. Food was my drug back then. (After lap-band I started smoking, one addiction for another!)
LGBT: If you are highly conservative or offended by alternate lifestyles, please skip this paragraph –Y seriously. Now, if you are not familiar or have friends in such a scene, you may not know how tough looks are in such – especially in youth. Unfortunately, a lot of the stereo types become such for a reason. Too much of an emphasis is placed, initially at least, on sex and looks. I never had the chance to tell people “Hey I went to NYU, have a degree in finance, I have XYZ going for me” because most of the time I wouldn’t be given the time of day to get that far. Everyone wears tight clothing, and I would say the pressure of being thin is far worse than in the “straight” scene. Abercrombie, Hollister, Armani Exchange, etc. – dreams to me. I used to have a joke with my uncle that if I walked into an Abercrombie & Fitch, they would think “you must be here for the cologne,” as it was no secret there was not an item in the store I could buy or fit into. The stereotype of them dressing well and all need not apply to me. I’m sure everyone here can understand the difficult in shopping for clothes as an overweight individual. It has gotten better since lap-band, but by no means do I have any business wearing tight-fitting clothes or anything like that to blend-in at clubs, bars, fire island, etc. Now, the truth is that scene tends to gradually die out from 30 on. That is, it is less important now and will become more and more so over the years. The truth is if I could go back ten years to 20, there would be nothing to think about – I would have done this surgery in a heartbeat, hell even at 25 when I had the lap-band. Now, as I inevitably will settle down, it will matter less. However, I am afraid if I get less severe of a surgery (sleeve, etc.), I will be looking back at 35 or 40 saying I wish I had done it when I was 30. People my age are slowly looking to settle, and I feel I will be years behind because I have not “sowed my wild oats.” This does not mean I am looking to go out and live it up but, rather, I would enjoy a summer or two of wearing tight clothes and being free and confident. On the other side of relationships, I cannot tell you how many times I have been turned down by people more on “my level” in terms of ambition and all, hell even others at the other end. I have had moments in life that will stay with me forever. Imagine talking to someone online and then when meeting them having an emergency call to work before they even got out of their car, or speeding off while you go into a convenience store, or them “not looking for a relationship” and being exclusive with someone two weeks later. Now imagine each happening several times. I am not naive, I realize rejection is part of life and it happens to all. I just feel in the lifestyle, the requirements per say are most stringent. You might as well be in L.A. in the entertainment industry. When I went to school down in North Carolina at UNC Chapel Hill for a year, I did not have one single lead for a relationship. Then, when I transferred and finishing undergrad at NYU over three semesters – also not one relationship or any real luck of any sort. Hell, one or two people befriended me for the purpose of trying to meet my roommate, a 10 in terms of intellect combined with looks. Now, you must understand this is one of the most “open-minded” LGBT-friendly campuses in the country. Located in the village, it does not get more accepting than that. Despite such, nothing. At the time I was 235 pounds or so – even on Adderall (amphetamine) for ADD which in the past (at UNC) accelerated weight loss. Now as for the LGBT, I realize I will not get those years back. But this just makes me more prone to being interested in weight loss – age is already starting to work against me for younger people, and the weight just exponentially makes it worse. Having said that, I know these shallow people should not matter and will seriously become less important as I die more and more out of the scene. (If I am out now once a week that is rare, compared with three times a week eleven years ago). I know this surgery has to be done for me, not them, and I feel like if anything goes wrong during the surgery or I die, I will have let that world gotten the best of me. One last note, with more graphic implications (skip rest if offended). Without spelling it out for you, I lack lots of specific sexual experience. There is stuff I have never done, mostly because I am OCD, find it weird and gross at times, and am not comfortable with my body to even take my shirt off. Having said that, there is a certain inevitable type of activity that I can’t help wonder might be of high concern with the DS. I can’t imagine the embarrassment or increased potential for something to go terribly wrong in that specific manner. (I do not mean something extremely gross or graphic, rather the normal way one who is.. would… ca pisch?) I hope this last part doesn’t stop people from giving me good feedback or replies.
------- RISK VERSUS REWARD & CONCERNS -----
The reality is neither RNY nor DS are truly really medically justified in my case. I do NOT have diabetes or other things to even make me one of the new RNY populations. Hell, if I drop another 2 points on the BMI, I won’t even qualify for obesity medication. It is no secret 35 is the minimum for co-morbidities, and I am a 31. (I am not even referring to insurance coverage because somehow I have been approved given I met the criteria at the time of my lap-band and have a major complication from such). The point is, most doctors would not be willing to touch me for this reason. For the aggressive few, they would be more comfortable with RNY than DS, which is probably even less justified. The reality is Dr. Roslin seems to be the only one who, based on his recent presentation and Q&A on here, feels that if someone is a candidate for RNY weight wise they are also a DS candidate. Typically other surgeons, even vetted pro-DS ones, seem to feel it is a highly aggressive surgery for someone of my weight.
The posts about hospitals not being familiar with DS are scary in the event of an emergency. I imagine nowadays most are familiar with RNY, but to try and explain DS at a crucial time… I recall in 2008 having a major lap-band attack where I needed to have it loosened (saline removed) to let stuck food pass through as my vomiting would not stop. At the E.R., granted a bad hospital, they did not know what to do and wanted to give me something to induce vomiting, something that could make the lap-band slip. I had to explain to them to take a syringe needle where my port was and pull saline out. They had to page my surgeon and be walked through it. I can only imagine with DS… I might as well bring a DS for dummies book to all hospital emergencies.
I am not going to lie, the small chance of mortality scares me. According to national statistics, the risk of death is 2/200 with RNY and DS, and 1/100 (doubled) with revisional surgery. All but Dr. Roslin felt this was significant, not from a death perspective but a complication one, as they have to cut through a lot of scar tissues. Although Dr. Pomp stated it is more like 1/500 for their hospital, and Dr. Inabnet felt the revisional surgery mortality rates have come way down. Dr. Bessler felt the chances of post-op complications in the first 30 days were very increased, and did not justify the surgery with my BMI. He did feel the complications risks could be the same with RNY on me, though. The blood clot thing from the longer DS is a little scary, although Dr. Roslin says “don’t worry we will load you full of blood thinners and have a guy like you walking around the same day.”
Now, as you know most posted mortality rates reflect only 30 days post-op, so now let’s talk about beyond 30 days… Long term the biggest risk, according to Dr. Inabnet, is that of malabsorption. While the vitamin requirements are also there with RNY, I imagine far worse with duodenal switch. Reading the posts on here, it seems inevitable that at one point or another the blood work will not be great. I am told long term if this becomes serious they can reverse the small intestinal bypass portion of the surgery, although even more dangerous than the original procedure. Although this seems to be a main concern for the surgeons, the things I am worried about lay more with the non-serious day-to-day living aspects of either procedure.
With the DS, I am VERY concerned about diarrhea. I have read some of your stories and even if rare, not exactly a good for a social life. I may be able to manage if it’s highly rare, but if we are talking on a weekly basis I am troubled. One female posted saying it’s only bad when she over-eats fat on the weekends. Saturday night is when I would be going out to dinner! Am I to assume any time I eat a normal meal at a Chinese buffet, even if rare, troubled times will follow? Ironically, the weekend when out having fun is the most inconvenient time to have bathroom problems, since I will be out socializing. Traditionally I haven’t minded Alli/Xenical at home, but it’s a bitch to deal with sometimes on the weekends. The few horror stories make me say at the time “why am I doing this to myself?” Am I going to be having a monthly nightmare (or more) where I say “What the hell did I do to myself?” I read one persons post about Starbucks – imagine if that were a date? A friend or partner would understand, but imagine someone you barely know. As explained in detail above, I have received conflicting information here. Dr. Roslin compared DS to RNY in this regard. Dr. Pomp flat-out disagreed. Reading published material I do not see how Lenox Hill can even compare the two. Dr. Inabnet is the only one who made me feel a little better saying I will be fine. He also said I could take Imodium and other things when I need to. On his Q&A on here, Dr. Roslin references non-informed doctors speaking of the diarrhea horror stories – but those are extreme examples. What about the day to day living? Am I looking at this being weekly? Is this ever uncontrollable? Does gas turn into an emergency incontrollable bowel movement? On that note, I imagine I would be carrying around Febreeze anytime I use a public rest-room? And the gas is as bad as everyone says? I may be able to live with the latter two, but diarrhea is – completely a major concern for me. A surgeon called this very rare in RNY patients.
Second to that, my other big concern is nausea. Dr. Inanbent said this can occur in about 5-7% of DS patients. I can tolerate pain or a lot of things in my life – but nausea makes me a baby. I cannot work or do anything easily with nausea. I have been prone to it these past few years with the lap-band, especially when I could not eat during the day, and it is not pleasant. I will often take Nauzene chewable tablets that have a mixture of stuff. Again, is this better with RYX? With DS, if one were to – for example – eat a pt. of Hagan Dazs, are they looking at reserving the rest room?
Now, as for RNY, that its unpleasant as well but I admit I am not as well versed on this procedure. My biggest concern was dumping syndrome (from the nausea in particular). Dr. Roslin, who doesn’t even suggest RNY on me over DS, even said that’s not a concern, that most patients don’t even realize when it’s happening and its short. Dr. Pomp said he rarely encounters patients who experience it. So I guess it’s not that much of a concern. Ulcers are worse with RNY right? I have a friend who received ulcers as a result of smoking with RNY. Is the same the case with DS? What about alcohol – is it as bad with DS as it is with RNY in terms of tolerance or getting sick? I was assuming no because of the sugar dumping not being a DS issue. Can carbonation be tolerated, beer for example? With lap-band – nightmare.
GERD. As explained before, this is a problem for me. I had a hitatal hernia before my band, and it was repaired during the band placement. According to a recent endoscopy, it is back and may be contributing to my heartburn. If I choose to only have the lap-band removed and no other bariatric surgery at this time, we can’t really repair the hernia because it can complicate future bariatric surgery, that is the hiatal hernia repair is approached differently with the other procedures. Dr. Roslin said the GERD would be similar. Dr. Pomp said this is completely not true, and that due to the high-pressure system with the sleeve or DS I am looking at it being the same as I experience now, hopefully not worse. (Granted my band is making it worse than usual…) Ironically Dr. Roslin said in his post on here that he would consider pushing RNY over DS if the patient had severe GERD or esophageal cancer. All surgeons feel I would virtually be cured of the heartburn with RNY, so one less things to worry about in life including needs endoscopies to watch for pre-cancer signs. I am likely looking at staying on Nexium or Prilosec with DS and possibly eliminating such with RNY. Having said that, I am not sure if this would truly guide my decision. That is, if DS gave me better long-term results, I would likely rather live on proton pump inhibitors.
Are there any instances where RNY has worse side effects in a specific area than DS? I assume DS has far more side effects and possibly more long-term complications? Why is DS considered so more aggressive or “major” in the other surgeons eyes? Now, Dr. Roslin references on here many anti-DS as simply not knowing better. But one must keep in mind that the surgeons I met with all perform DS, some much longer prior to when Dr. Roslin was doing so. I don’t know where Dr. Bessler or Dr. Pomp stand on the vetted lists, but I specifically took Dr. Inabnet off the list on this forum. Even him, as a PRO-DS, feels it’s too major of a surgery and that I would have a good outcome with RNY (although I am completely against the sleeve he suggests). Why is only 1 surgeon pushing the DS on me? Why are half not even willing to do it on me? How frequently is RNY getting performed on low-BMI patients and is it primary when they have diabetes? Dr. Inabnet said they are just beginning trials now on whether DS cures such, however I believe Europe already takes the position that it goes. Am I making a big mistake? I can’t help but feel “I am asking for trouble” with the DS. One person told me “good you’ll be the best looking in the coffin.” I realize that’s extreme, but what about long-term complications or day to day living with me? In your opinion, is it crazy just to lose 40 pounds?
Now, to get to 170 (25 BMI) I would need to lose 40 pounds. To get to 160, 50 pounds. So one would say my goal is to lose 40 pounds for now. Now statistically if 60% of RNY weight loss is maintained at three years, or if Dr. Roslin’s beliefs of long term weight regain due to hunger is true, it sounds like I can possibly start creeping back up to 190 or more. In this case, it doesn’t seem worth it to get RNY in the first place – as I would be close to my starting weight. So while other surgeons say RNY in my case, I almost feel like if I am not doing this to end this once and for all, it is almost not even worth it. That is, if I am going to do it, do it – an all or none attitude almost. When you hear these stories about a lap-band being placed over a RNY, etc. I don’t want additional surgeries and if I am putting myself through this, shouldn’t be to be as close to thin as possible once and for all? Having said that, when you look at the weight regain a lot of people are starting near 300 pounds. It is of course possible because I do not have much to lose, that I will be near 170 even with RNY and experience less weight regain. Of course, there’s no way to know. I will say, if I end up back to 195 or 200 with RNY when I only started at 212, I will be disappointed. Although as Dr. Bessler put it: “You may not be thin even with DS.” But when I read some of your weights with DS, I am simply amazed. Some of you are THIN! You came from morbid obesity and showed your genes who is boss. Any of you that lost weight with any procedure should of course be very proud. There is also that small fear, if I hit 248 at only 25, may I hit 280 someday? I don’t in my heart really think so, but keep in mind I have been stable in the low 200’s mostly due to a lap-band where I can’t over-indulge without using prescription Ativan or alcohol.
Again, some of these surgeons call performing a DS on me “crazy.” None really the R Y although of course any local hospitals would few even an RNY as highly aggressive on me. I can’t help but think if my goal is 170 or below, the DS is going to give me the best damn chances to comes as close to that as possible? And at what cost versus the RNY? Some say bathroom problems not bad with DS versus RNY, others say night the day without comparison. Granted, we are looking at a 150 common channel. Another thing I need to ask Dr. Roslin about is he wrote on here “for many bands to ds, that do not have esophageal dilation, I see little difference in outcomes.” Well I have extreme esophageal dilation. Does that mean DS is less likely to be good on me? What/where are these NIH/CMS guidelines he says he will not operate out of? Now, one may say I will not get thin because of my Nadir point, but if I have achieved 180s several times taking amphetamines, I am not so concerned with the DS. I wonder, if such a small amount to lose relative to other patients, if the weight loss would be comparable or within 10 pounds. Theres no real studies on low BMI patients, right? Again, very little DSs have been done on someone of my BMI – the lowest Inabnet did was 35 and I recall Dr. Roslin saying 1 patient, if that’s accurate. I’m sure all have done RNY on BMI’s under 35 though. I also read somewhere that with RNY, doing an endoscopy is in a sense “blind” and other things like that are more complex.
RITALIN/ADDERALL/ADD: OK, is there anyone on here who takes either of these stimulant medications who had a DS? The reason I ask is… Ritalin and Adderall especially are strong stimulants, hell Adderall has two forms of amphetamine in it, and both have a laxative like effect on me. Not severe or bathroom problems, just having to go to the bathroom quicker after taking them, kind of like an extreme amount of Coffee. They clear you out in some sense. I am concerned about this being mixed with a procedure such as a DS making you prone to bathroom sensitivity to begin with? I doubt theres any studies on this? Anyone have experience with this???
Other medications: It is my understanding time-release medicines will not be as effective, although one doctor said not all medicines are absorbed in the small intestines and over time XR formulas should be fine. If I need to use immediate release, so be it. But I am worried if my medicines will all work the same. Have any of you needed to have your dosages changed as a result of DS or malabsorption? Im worried if it will make it hard for doctors to prescribe typical strengths of medications, and I take a few.
I have recently read a recent post by a post-DS Dr. Roslin patient who woke up having one of those scare days of “What did I do?” Is the recovery on DS really worse than RNY? In my case, I imagine I will have lost most weight by September from not being back on a normal diet, but should I anticipate being miserable this summer? No alcohol? No solids?
Dr. Roslin says most surgeons are not motivated to learn DS. But how of the others who do, why are they not pushing it more? Dr. Pomp pointed out how only 3-5% of WLS are DS, but if its so effective why would it not gain more popularity? I do not buy that its just not as profitable because RNY is not as profitable as Lap-band when a surgeon could do several of those in a day. (It took Dr. Roslin 18 mins to band my friend).
It seems everyone knows someone who knows someone who ended up in the hospital with RNY. I suppose that would be the same case if DS patients were more known? Is there anyone here 10 years out who has never once been to the hospital?
Finally, Dr. Pomp said nothing will be as restrictive or as unpleasant or as vomiting-prone as the Lap-band I had, so hopefully in terms of eating ability I can only improve. I guess I will replace the lap-band attacks with stomach attacks. ;-)
CASTLE CONNOLLY TOP DOCTORS BOOKS: I know some may not agree with these books, but I am very into them and by them annually and collect them. The NY Metro area is designed to represent the top 10% of doctors in the NY Metro Area. Doctors cannot pay to be included, and is primarily based on peer evaluations by doctors in the same specialty, and then edited by the staff based on malpractice and a host of other factors. What is weird is Dr. Bessler, Dr. Pomp, and Dr. Inabnet are all in it. However, it appears Dr. Roslin is not and may have been cut. I will not read too much into this, perhaps it’s because he is viewed as overly-aggressive with DS among other bariatric leaders so it may be a popularity thing.
IN SUMMARY: Lap-band must come out due to severe complication. Been to 4 DS surgeons. Only 1 suggests DS. 2 willing to do DS. 2 adamantly opposed to and not willing to consider it. 3 willing to do RNY without being totally opposed to it. Concerns of diarrhea, nausea, Ritalin, and which will have best outcome on a patient only starting with a 31 BMI. I am scheduled for DS with Dr. Roslin on June 25th with the lap-band removal. I have the option of downgrading to RNY or just taking out the lap-band. 2 weeks to decide if I am flat-out crazy.
I realize all your time is valuable, and that I let this go on way too long. I am sorry. I just am desperate for opinions and these are the only places I can get real feedback instead of reading published material on how DS is only for the highly severely morbidly obese patients who aren’t even good candidates for RNY, etc.
RNY? DS? SEWING MY MOUTH SHUT?
I should conclude by saying I have two passions in life: blondies and food, and both get me intro trouble!
Your new-found friend,
Paul
OK this post is long-overdue. I have been lurking for a month or so and should not have procrastinated, since as of last week my surgery is now scheduled for two weeks from today – Monday June 25th, 2012. As the subject implies, my BMI is very low for a DS. Weighing in at 212 pounds at 5’9, my BMI is 31.3 – making me what this board calls a “light-weight.” (If only I could be described as such off this forum, ah?) I am 30 years old.
I AM DEPERATE FOR FEEDBACK, AND TIME IS OFF THE ESSENCE. I AM NOT A TYPICAL CASE, EVEN FOR THE MOST AGGRESSIVE OF SURGEONS. All do the DS. My below feedback is NOT to suggest they do NOT like the DS or prefer it to RNY, but rather that most people feel it is aggressive for me. I hate the idea of referencing specific surgeons names. While one is highly active and known on here, the rest I contemplating with mentioning despite most being on vetted lists or mentioned here. But given the seriousness of the surgery, my low BMI, the experience of everyone on here not only with the procedure but the vetted surgeons and two weeks left before d-day, I feel it is best I just honestly disclose my office visits. If I had more time, I would have likely just said the hospitals and implied who each was (anyone knowing I say Lenox Hill will likely assume Roslin, etc.), and then disclosed such in private messages with people. I have seen forum posts of the past get attention, make their way onto search engines, and never fully disappear even when it was attempted. As such, I hope any bariatric surgeons reading this in the future will understand, and not come chasing me with a rubber-hose.
Before starting, please do not be offended, insulted, or feel I am a whiny dramatic pain because of wanting surgery to lose only 50 pounds. I realize this is not typical, and trust me, nothing pisses me off more than hearing some thin person say “I’m so fat, I need to go on a diet” for attention. Everyone is different, and losing the weight is important to me.
------------- BACKGROUND ------------
In August of 2007, I had a lap-band implant with a local hospital here on Long Island, who only does gastric banding. Prior to gaining insurance approval, at my consult in that is, my BMI was 36.6 with a weight of 248. After fasting to prep for surgery, on the date of the operation my weight was 228 with a BMI of 33.7. While 248 was my highest weight and I didn’t come back to it, the lap-band has been a bit of a roller coaster ride. I had many adjustments over the years in an attempt to find my “sweet spot,” which became a non-fixed relative term depending what stress I had going on in my life at any given time. You see, because of the muscles involved near the upper stomach gastric banding, when I was very relaxed it would ease in a sense, and tighten on the opposite. As a result, I rarely could eat during the daytime and yet if it was late at night or I was away on vacation I could tolerate food much better. In the past year or so, I have had to take a benzo (Xanax, Ativan, etc.) in order to relax myself and make it easier to eat when out or enjoying a moderate meal. My band was a 4 CC band, and the amount of saline in it at any given time has ranged from 0 to the mid 3’s or so. While the latter had me at my best success with a weight in the upper 180s, it did not become sustainable to maintain the filling so high due to problems eating – resulting in the band being drained, along with weight gain, and then starting over. The point is my weight has varied from 228 down to 190 or so, up to 202, 204, 208, and three months ago 221. I am currently at 212, which is due mostly to problems eating due to a lap-band complication.
I have been on it all. Xenical/Alli, Phentermine, Meridia, Optifast, Jenny Craig, Weight Watchers, “fat camp” as a kid, etc. All help but temporary. Have been adequate several times in life – at 17 my senior year of high school graduation I went from 230 to 170 for a few months. Three years later I went from 200 or so to 180 when I was placed on Adderall/amphetamines at UNC Chapel Hill and living the dorm life, and that’s about it. Other than that, life has been primarily been spent obese. While I know the flaws in the BMI scaling, to have a normal BMI my max would be 172. This is what I want more than anything – hell 160 would be nice, but it is important to me to weigh in the 170s and something I have wanted for as long as I can remember. I pretty much became fat from 8 years old on and playing the crash diet and fluctuation game my whole life.
History of sleep apnea, and GERD – sometimes severe. While my apnea was in remission when I was last tested at a weight of 190 in June 2009, it is likely it has reappeared since my weight has climbed up a little combined with everyone telling me my snoring is very loud. I have lived on Nexium since 2006, prior to the band placement, having endoscopies before the surgery, a year after the surgery, and two weeks ago. At times it has been as simple as some heartburn, at other times, although rare, it has meant waking up choking as the acid creeps up. For the most part, it is under control when I take proton pump inhibitors. Likely this has been made worse from the lap-band and will be controlled with medication after the band is removed. Light asthma more with the weight gain.
Around February 2012, my band was once again emptied in full due to a lot of vomiting or “lap-band attacks” (pain, etc.) as my fellow banders called it. Knowing I had fluctuated a lot and “never really been happy” with the band, my surgeon agreed to have me see highly experienced surgeons in the city to discuss revisional surgery – which he assumed would, at most, be RNY. He did this for two reasons: 1) On Long Island, he knew most surgeons would not have the flexibility (due to administrative flags) to due this type of surgery on a BMI of less than 35, noting the research hospitals of the city can be more aggressive and 2) Noting “if anyone knew the options out there available to me, it would be [these guys]. He initially gave me two referrals followed by a third one, the last of which was because I had been given highly conflicting recommendations by the first two. I was honestly surprised, since he was conservative about anything besides the band years ago and only performs the band. He was very nice and open minded, though, and said: “It was different years ago, Paul, you had options – now that I feel lap-band and the sleeve are off the table, you only have 1-2 options left if you are concerned about long-term health. Although I want to be sure you are doing it for such and not purely for cosmetic reasons.” He was an AWESOME doctor and often spent an hour with me at each visit, and suggested I see the first 3 highly respects surgeons below. And off we are…
------------- THE DS SURGEONS I MET ------------
MARC BESSLER, NY-Presby/Columbia Univ Med Ctr. February 2012. Dr. Bessler at the time felt a new lap-band would be appropriate, or possibly a sleeve. He felt a DS was crazy on someone of my weight and ruled it out as “out of the question,” and was highly reluctant to even consider RNY. He said, given my BMI, it would only really be justified for him to do RNY if I had diabetes or barrets from my acid reflux disease (which I was negative for). Otherwise he would not be willing to do anything besides a band replacement or possibly a sleeve. While he was aware of the symptoms and the recent emptying of the band, I note he did not order an upper GI and, as such, was NOT aware how serious the dilation was (something I will get to in the next paragraph). Last month he was made aware of such and provided with the upper GI reports and x-rays, and lightly changed his position. He now feels both the sleeve and a lap-band replacement are NOT appropriate procedures and that he would have to “think about” whether or not he would be willing to do a RNY given my BMI of less than 35. He maintains the position of feeling a DS is out of the question for me. While he has a good amount of experience with DS, I did not see his name on the vetted list on these forums and note he generally seems more conservative of the DS surgeons and even made ethical and medical malpractice implications. He would be willing if my BMI was a 35.
MITCHELL ROSLIN, Lenox Hill. March 2012 to Present. In March 2012, I met with Dr. Roslin for a revisional surgery consult (not knowing I had a complication, but rather just because I was dissatisfied with the weight loss). At the time, Dr. Roslin required I had an immediate upper GI performed before he would discuss any revisional options. After doing so, he told me the lap-band had to come out – that such was not even an elective choice but medical necessity. Despite me being completely emptied a month prior on Long Island due to a lot of vomiting or “lap-band attacks” (pain, etc.) as my fellow banders called it, I had extreme dilation of the esophagus. (Not a slipped band, an enlarged esophagus). Dr. Roslin felt this was leading towards a motility disorder known as pesudoachalasia. Although not all surgeons agreed with this strong wording, there was no dispute the lap-band had to come out. Dr. Roslin stated he would not even be willing to do switch the band given my problems and the likely hood of them repeating. While the sleeve would be better than a band, he feels I would only lose another 20 pounds or so from such and that it would not be worth it. Leaving, you guessed it, RNY and DS – both of which he was willing to do. I know the readers of this forum are well educated and informed, so it will not come as a surprise to you to know he suggests the DS given his strong believe that preserving the pyloric valve is the way of the future. While many of you may feel any highly vetted pro-DS surgeon may agree with this, you may be surprised to know Dr. Roslin is alone on this one, but we will get to that. Dr. Roslin had initially stated the disagree would be comparable or better with the DS. At the time, last March, I wasn’t as educated on DS and simply took notes on all this. I felt saying I would make a decision. Of course, him simply removing the band was another option, but he warned I could “blow up.” Later on, after making my mind up on RNY after meeting the next vetted surgeon, he said to me in his office “You don’t want to preserve the pyloric valve?” I found this funny, as most would just say DS – but he assumed, like all of you, I was the “Harvard” of bariatric patients. What a funny thing to say. Lastly, I should note that at my initial consult it came out he had only done 1 DS surgery on somewhat of my weight, although at a subsequent visit he did not recall saying that and seem surprised.
ALFONS POMP, NY-Presby/Weill Cornell Med Ctr. May 2012. Now, here is someone that was on one of your vetted lists, and also on the Castle Connolly Top Doctors list. The director of bariatric surgery at Columbia, I met with his resident and him. In summary, he was willing to do a sleeve or a RNY. The sleeve, his resident noted, could be more problematic given the area of my band the scar tissue from such, in addition to making my acid reflux worse. RNY, what he wanted to do, he liked best because it would cure my heartburn while still being effective. I was surprised he was even willing to do RNY frankly (because the other previous Columbia surgeon was not). He noted how they lead the studies on doing RNY on low-BMI patients who have diabetes, how it puts them into remission, etc., and that he had a lot of experience doing RNY on people of my weight. I believe he said maybe he did 1 DS on someone of my weight. Now, before continuing, I must note he has significant DS experience, and I know he has been performing the procedure longer than Dr. Roslin. Now, here comes what would later become the scariest part of me considering the DS. “Paul, you’re a young guy, do you want to be going to the bathroom 9 times a day?” He went on to explain that, easily, my bowel movement would triple. He explained I would have “room-clearing” gas, and reference one patient who had been evicted from an apartment because of the landlords dissatisfaction with the foul-smelling odors of their bowel movements coming through the floors. Obviously, I realize this is extreme, and I went on to mention I would want it more conservatively done, and that Dr. Roslin had noted that he would not be as aggressive as more severely overweight patients, and that he could control it a lot in how much be bypasses. Dr. Pomp said back to me that there were no real studies distinguishing long limb versus short limb patients in terms of side effects and success. This had be wondering: The Lenox Hill patient handbook boasting 85% weight loss at 3 years with DS (versus 60% with RNY): was it skewed if history had more severely obese getting the procedure until recently? His resident said they often have patients go on Xenical/Alli to get an idea what it will be like, etc. I have years and years of experience with such, but unlike DS, I can stop taking Xenical on the weekends! In summary, Dr. Pomp was NOT willing to perform the DS on me. He concluded with “Don’t get me wrong Paul, the DS is a great procedure – fun to do and I do it all the time, but it’s NOT for you!” I should note he spent more time with me than any other surgeon.
And, finally…..
WILLIAM INABNET, Mount Sinai Med Ctr. June 2012. He believes very much in the DS and preserving the p-valve, and seems closest to Roslin in terms of aggressively believing in the DS. However, he did NOT suggest such for me. Unlike most former, he actually suggested the sleeve. For one he felt it would provide me with adequate weight loss since with the lap-band I did “well” with only a restrictive procedure. Second, he noted that this would allow me to easily add on the d-switch portion and in a sense help me do the DS switch in stages if I was not happy with the sleeve alone. (Although I disagree feeling the DS would be even less justified 20 pounds lighter, and that, like Dr. Roslin said, I will have moderate weight loss with such). I explained I wish I had been more aggressive five years ago and that I am worried if I only do the sleeve now I will be back in having surgery again. He reminded me I have my whole life ahead of me. In addition, he also prefers to do an RNY over DS on me. He said it is a major major surgery especially for someone of my weight and even noted “And I am a very pro DS surgeon so that can show you how aggressive I think it is for you.” Having said that, unlike everyone but Dr. Roslin, HE IS willing to do it on me. He would prefer it be done in stages as a plan, but is willing to do which ever option I want. I asked him about the diarrhea and nausea concerns of mine. He said it should not a be a problem, noting what he would do doing would be known as a “modified duodenal switch.” I asked if that meant leaving more common channel, and he said “exactly – leaving 150cm.” This is exactly what I was going to ask Dr. Roslin. Although the idea of a conservative DS sounds like a paradox, lol. In any event, I get it and do feel I need not be as aggressive as others – especially given diarrhea is my #1 concern. I explained I can’t be on trial as a future attorney and have to run out of court and he said “you should be fine.” He explained I may have 2-3 bowel movements a day (I do already) or that I may get loose stools, but that full fledge diarrhea would not be the issue I thought it would be. As he rushed out the room, I said “Will I be able to stay on fire island, a beach resort here on the Island, out on the weekend and have tortilla chips and Mexican food, and not be rushing to the bathroom with chronic diarrhea? (I remember an ALLI/XENICAL experience there years ago after such…) He said “You’ll be fine.” He had to run on me to start seeing other patients before I even broke out my very technical questions.
------------- WHY, PAUL, WHY? ------------
Well I mentioned the co-morbidities before, but let’s be honest – they are not really on my mind right now and in remission. Will my weight come on if I remove the band? Likely. Will the co-morbidities then follow? Likely. Having said, I do believe I am capable of not getting heavier than I am now with decent dedication to not going over-board with my eating. I have been used to this from the lap-band. When my friends eat at the restaurants and all, I am usually wrapping my dinner – sometimes taking 3 more sittings to finish it. Eating is definitely hard work and a chore sometimes. Although the sudden removal of such – it would take a lot of discipline to not become a kid in a candy store. (Buffet celebration!!!) J/K. Anyway, as for losing more weight, I think with moderate eating I can probably keep myself below 200. I think with a significant dedication and commitment (dieting, working out, etc.) I can even get myself down to 190. Every pounds beneath that would take extreme dedication, and unless I was working as a personal trainer in a gym for a living, I just don’t know if it’s realistic, especially when I begin law school or a tough career. I do NOT believe I will ever truly be at a normal weight or thin without something as aggressive as RNY or DS. I am confident I will come damn close or hit goal with the DS. (As I write this, damn do I want a cigarette as a break between sections – but I had to quit today to be ready for surgery in 14 days).
I don’t have to tell you being thin has been a life-long dream. You all know what it’s like. I have a friend 300 pounds who eats like I do. Some of us just get a rotten card in terms of genes. I know a lot of you have it far worse than me so please don’t take my writing as me being a wining bitch. I come from a family history of obesity – not morbidly but still. I hate ignorant people with their naive statements: “Just join a gym, go on a diet.” (I want to say “Really? You mean that helps with weight loss? No shit? Who knew?) I see friends eat three times what I do and weigh less. If I meet someone who has lost all the weight and kept it off long-term, I will listen. Otherwise shut up. ? Naturally the people that weigh 210, 220, 240 and say to me “I lost a ton of weight and was thin when I just…” Keyword WAS. Anyone can lose weight, keeping it off is the hard part and how many really do? I mean, if someone is saying “was” or “was thin when I,” it translates to me as they inevitably gained all of it back, thus I care less for their opinion on how to crash diet it off. My uncle has said “well when I did it,” and my mom “well when I got down to a size four.” While I love them, neither maintained it. I have yo-yoed as much as the next person, but I don’t want to do this the rest of my life. Being prone to obesity since child hood, I just don’t feel it’s realistic to maintain a normal BMI without something as drastic as surgery.
Being the Pisces water lover I am, I used to frequent the beach – till I was 10-11 or so. Then, I could no longer take my shirt off comfortably as the weight got worse and worse. Many said “so take your shirt off, look at others” -- but I do not see a lot of youth take their shirt off like that. Certainly my teenage days and 20s I was not comfortable to do so. While I may care less in the future, it is something I just can’t bring myself to do at a crowded beach or environment. If you go to LI’s top “Jones Beach,” it is just packed and packed with people, the majority of which I would say don’t look bad – especially in the young adults.
I spent high school being tortured and made fun of, particularly in the locker room with “Paul has breasts.” I realize this is the nature of high school. Ironically, half of these people I now see on facebook have gained weight, some are flat-out fat, including a kid that made fun of me going to fat camp. My high school nemesis, a girl, would tell me that there’s no way I could be related to my brother, who was thin and even resorted to weight gain shakes when he was in high school and college. Don’t get me wrong, I am not doing this surgery for psychological scars. It just goes to the long history of wanting it so bad. My senior year, I had extreme motivation with a “deal” with a teacher to give me a credit needed for graduation if I reached below 180. I hit 170 over many months, but had extreme motivation of that plus not wanting to graduate 230. I was eating veggie burgers and protein every day, and worked out at 5am before school and often after school. Some say “well see you did it,” but I was also 17. I have never again come as close, although was able to maintain 190s my first two years of college, while on and off of Meridia, which I had also used my senior year of high school. I was a clean-cut kid: No smoking, no drinking, no drugs. Food was my drug back then. (After lap-band I started smoking, one addiction for another!)
LGBT: If you are highly conservative or offended by alternate lifestyles, please skip this paragraph –Y seriously. Now, if you are not familiar or have friends in such a scene, you may not know how tough looks are in such – especially in youth. Unfortunately, a lot of the stereo types become such for a reason. Too much of an emphasis is placed, initially at least, on sex and looks. I never had the chance to tell people “Hey I went to NYU, have a degree in finance, I have XYZ going for me” because most of the time I wouldn’t be given the time of day to get that far. Everyone wears tight clothing, and I would say the pressure of being thin is far worse than in the “straight” scene. Abercrombie, Hollister, Armani Exchange, etc. – dreams to me. I used to have a joke with my uncle that if I walked into an Abercrombie & Fitch, they would think “you must be here for the cologne,” as it was no secret there was not an item in the store I could buy or fit into. The stereotype of them dressing well and all need not apply to me. I’m sure everyone here can understand the difficult in shopping for clothes as an overweight individual. It has gotten better since lap-band, but by no means do I have any business wearing tight-fitting clothes or anything like that to blend-in at clubs, bars, fire island, etc. Now, the truth is that scene tends to gradually die out from 30 on. That is, it is less important now and will become more and more so over the years. The truth is if I could go back ten years to 20, there would be nothing to think about – I would have done this surgery in a heartbeat, hell even at 25 when I had the lap-band. Now, as I inevitably will settle down, it will matter less. However, I am afraid if I get less severe of a surgery (sleeve, etc.), I will be looking back at 35 or 40 saying I wish I had done it when I was 30. People my age are slowly looking to settle, and I feel I will be years behind because I have not “sowed my wild oats.” This does not mean I am looking to go out and live it up but, rather, I would enjoy a summer or two of wearing tight clothes and being free and confident. On the other side of relationships, I cannot tell you how many times I have been turned down by people more on “my level” in terms of ambition and all, hell even others at the other end. I have had moments in life that will stay with me forever. Imagine talking to someone online and then when meeting them having an emergency call to work before they even got out of their car, or speeding off while you go into a convenience store, or them “not looking for a relationship” and being exclusive with someone two weeks later. Now imagine each happening several times. I am not naive, I realize rejection is part of life and it happens to all. I just feel in the lifestyle, the requirements per say are most stringent. You might as well be in L.A. in the entertainment industry. When I went to school down in North Carolina at UNC Chapel Hill for a year, I did not have one single lead for a relationship. Then, when I transferred and finishing undergrad at NYU over three semesters – also not one relationship or any real luck of any sort. Hell, one or two people befriended me for the purpose of trying to meet my roommate, a 10 in terms of intellect combined with looks. Now, you must understand this is one of the most “open-minded” LGBT-friendly campuses in the country. Located in the village, it does not get more accepting than that. Despite such, nothing. At the time I was 235 pounds or so – even on Adderall (amphetamine) for ADD which in the past (at UNC) accelerated weight loss. Now as for the LGBT, I realize I will not get those years back. But this just makes me more prone to being interested in weight loss – age is already starting to work against me for younger people, and the weight just exponentially makes it worse. Having said that, I know these shallow people should not matter and will seriously become less important as I die more and more out of the scene. (If I am out now once a week that is rare, compared with three times a week eleven years ago). I know this surgery has to be done for me, not them, and I feel like if anything goes wrong during the surgery or I die, I will have let that world gotten the best of me. One last note, with more graphic implications (skip rest if offended). Without spelling it out for you, I lack lots of specific sexual experience. There is stuff I have never done, mostly because I am OCD, find it weird and gross at times, and am not comfortable with my body to even take my shirt off. Having said that, there is a certain inevitable type of activity that I can’t help wonder might be of high concern with the DS. I can’t imagine the embarrassment or increased potential for something to go terribly wrong in that specific manner. (I do not mean something extremely gross or graphic, rather the normal way one who is.. would… ca pisch?) I hope this last part doesn’t stop people from giving me good feedback or replies.
------- RISK VERSUS REWARD & CONCERNS -----
The reality is neither RNY nor DS are truly really medically justified in my case. I do NOT have diabetes or other things to even make me one of the new RNY populations. Hell, if I drop another 2 points on the BMI, I won’t even qualify for obesity medication. It is no secret 35 is the minimum for co-morbidities, and I am a 31. (I am not even referring to insurance coverage because somehow I have been approved given I met the criteria at the time of my lap-band and have a major complication from such). The point is, most doctors would not be willing to touch me for this reason. For the aggressive few, they would be more comfortable with RNY than DS, which is probably even less justified. The reality is Dr. Roslin seems to be the only one who, based on his recent presentation and Q&A on here, feels that if someone is a candidate for RNY weight wise they are also a DS candidate. Typically other surgeons, even vetted pro-DS ones, seem to feel it is a highly aggressive surgery for someone of my weight.
The posts about hospitals not being familiar with DS are scary in the event of an emergency. I imagine nowadays most are familiar with RNY, but to try and explain DS at a crucial time… I recall in 2008 having a major lap-band attack where I needed to have it loosened (saline removed) to let stuck food pass through as my vomiting would not stop. At the E.R., granted a bad hospital, they did not know what to do and wanted to give me something to induce vomiting, something that could make the lap-band slip. I had to explain to them to take a syringe needle where my port was and pull saline out. They had to page my surgeon and be walked through it. I can only imagine with DS… I might as well bring a DS for dummies book to all hospital emergencies.
I am not going to lie, the small chance of mortality scares me. According to national statistics, the risk of death is 2/200 with RNY and DS, and 1/100 (doubled) with revisional surgery. All but Dr. Roslin felt this was significant, not from a death perspective but a complication one, as they have to cut through a lot of scar tissues. Although Dr. Pomp stated it is more like 1/500 for their hospital, and Dr. Inabnet felt the revisional surgery mortality rates have come way down. Dr. Bessler felt the chances of post-op complications in the first 30 days were very increased, and did not justify the surgery with my BMI. He did feel the complications risks could be the same with RNY on me, though. The blood clot thing from the longer DS is a little scary, although Dr. Roslin says “don’t worry we will load you full of blood thinners and have a guy like you walking around the same day.”
Now, as you know most posted mortality rates reflect only 30 days post-op, so now let’s talk about beyond 30 days… Long term the biggest risk, according to Dr. Inabnet, is that of malabsorption. While the vitamin requirements are also there with RNY, I imagine far worse with duodenal switch. Reading the posts on here, it seems inevitable that at one point or another the blood work will not be great. I am told long term if this becomes serious they can reverse the small intestinal bypass portion of the surgery, although even more dangerous than the original procedure. Although this seems to be a main concern for the surgeons, the things I am worried about lay more with the non-serious day-to-day living aspects of either procedure.
With the DS, I am VERY concerned about diarrhea. I have read some of your stories and even if rare, not exactly a good for a social life. I may be able to manage if it’s highly rare, but if we are talking on a weekly basis I am troubled. One female posted saying it’s only bad when she over-eats fat on the weekends. Saturday night is when I would be going out to dinner! Am I to assume any time I eat a normal meal at a Chinese buffet, even if rare, troubled times will follow? Ironically, the weekend when out having fun is the most inconvenient time to have bathroom problems, since I will be out socializing. Traditionally I haven’t minded Alli/Xenical at home, but it’s a bitch to deal with sometimes on the weekends. The few horror stories make me say at the time “why am I doing this to myself?” Am I going to be having a monthly nightmare (or more) where I say “What the hell did I do to myself?” I read one persons post about Starbucks – imagine if that were a date? A friend or partner would understand, but imagine someone you barely know. As explained in detail above, I have received conflicting information here. Dr. Roslin compared DS to RNY in this regard. Dr. Pomp flat-out disagreed. Reading published material I do not see how Lenox Hill can even compare the two. Dr. Inabnet is the only one who made me feel a little better saying I will be fine. He also said I could take Imodium and other things when I need to. On his Q&A on here, Dr. Roslin references non-informed doctors speaking of the diarrhea horror stories – but those are extreme examples. What about the day to day living? Am I looking at this being weekly? Is this ever uncontrollable? Does gas turn into an emergency incontrollable bowel movement? On that note, I imagine I would be carrying around Febreeze anytime I use a public rest-room? And the gas is as bad as everyone says? I may be able to live with the latter two, but diarrhea is – completely a major concern for me. A surgeon called this very rare in RNY patients.
Second to that, my other big concern is nausea. Dr. Inanbent said this can occur in about 5-7% of DS patients. I can tolerate pain or a lot of things in my life – but nausea makes me a baby. I cannot work or do anything easily with nausea. I have been prone to it these past few years with the lap-band, especially when I could not eat during the day, and it is not pleasant. I will often take Nauzene chewable tablets that have a mixture of stuff. Again, is this better with RYX? With DS, if one were to – for example – eat a pt. of Hagan Dazs, are they looking at reserving the rest room?
Now, as for RNY, that its unpleasant as well but I admit I am not as well versed on this procedure. My biggest concern was dumping syndrome (from the nausea in particular). Dr. Roslin, who doesn’t even suggest RNY on me over DS, even said that’s not a concern, that most patients don’t even realize when it’s happening and its short. Dr. Pomp said he rarely encounters patients who experience it. So I guess it’s not that much of a concern. Ulcers are worse with RNY right? I have a friend who received ulcers as a result of smoking with RNY. Is the same the case with DS? What about alcohol – is it as bad with DS as it is with RNY in terms of tolerance or getting sick? I was assuming no because of the sugar dumping not being a DS issue. Can carbonation be tolerated, beer for example? With lap-band – nightmare.
GERD. As explained before, this is a problem for me. I had a hitatal hernia before my band, and it was repaired during the band placement. According to a recent endoscopy, it is back and may be contributing to my heartburn. If I choose to only have the lap-band removed and no other bariatric surgery at this time, we can’t really repair the hernia because it can complicate future bariatric surgery, that is the hiatal hernia repair is approached differently with the other procedures. Dr. Roslin said the GERD would be similar. Dr. Pomp said this is completely not true, and that due to the high-pressure system with the sleeve or DS I am looking at it being the same as I experience now, hopefully not worse. (Granted my band is making it worse than usual…) Ironically Dr. Roslin said in his post on here that he would consider pushing RNY over DS if the patient had severe GERD or esophageal cancer. All surgeons feel I would virtually be cured of the heartburn with RNY, so one less things to worry about in life including needs endoscopies to watch for pre-cancer signs. I am likely looking at staying on Nexium or Prilosec with DS and possibly eliminating such with RNY. Having said that, I am not sure if this would truly guide my decision. That is, if DS gave me better long-term results, I would likely rather live on proton pump inhibitors.
Are there any instances where RNY has worse side effects in a specific area than DS? I assume DS has far more side effects and possibly more long-term complications? Why is DS considered so more aggressive or “major” in the other surgeons eyes? Now, Dr. Roslin references on here many anti-DS as simply not knowing better. But one must keep in mind that the surgeons I met with all perform DS, some much longer prior to when Dr. Roslin was doing so. I don’t know where Dr. Bessler or Dr. Pomp stand on the vetted lists, but I specifically took Dr. Inabnet off the list on this forum. Even him, as a PRO-DS, feels it’s too major of a surgery and that I would have a good outcome with RNY (although I am completely against the sleeve he suggests). Why is only 1 surgeon pushing the DS on me? Why are half not even willing to do it on me? How frequently is RNY getting performed on low-BMI patients and is it primary when they have diabetes? Dr. Inabnet said they are just beginning trials now on whether DS cures such, however I believe Europe already takes the position that it goes. Am I making a big mistake? I can’t help but feel “I am asking for trouble” with the DS. One person told me “good you’ll be the best looking in the coffin.” I realize that’s extreme, but what about long-term complications or day to day living with me? In your opinion, is it crazy just to lose 40 pounds?
Now, to get to 170 (25 BMI) I would need to lose 40 pounds. To get to 160, 50 pounds. So one would say my goal is to lose 40 pounds for now. Now statistically if 60% of RNY weight loss is maintained at three years, or if Dr. Roslin’s beliefs of long term weight regain due to hunger is true, it sounds like I can possibly start creeping back up to 190 or more. In this case, it doesn’t seem worth it to get RNY in the first place – as I would be close to my starting weight. So while other surgeons say RNY in my case, I almost feel like if I am not doing this to end this once and for all, it is almost not even worth it. That is, if I am going to do it, do it – an all or none attitude almost. When you hear these stories about a lap-band being placed over a RNY, etc. I don’t want additional surgeries and if I am putting myself through this, shouldn’t be to be as close to thin as possible once and for all? Having said that, when you look at the weight regain a lot of people are starting near 300 pounds. It is of course possible because I do not have much to lose, that I will be near 170 even with RNY and experience less weight regain. Of course, there’s no way to know. I will say, if I end up back to 195 or 200 with RNY when I only started at 212, I will be disappointed. Although as Dr. Bessler put it: “You may not be thin even with DS.” But when I read some of your weights with DS, I am simply amazed. Some of you are THIN! You came from morbid obesity and showed your genes who is boss. Any of you that lost weight with any procedure should of course be very proud. There is also that small fear, if I hit 248 at only 25, may I hit 280 someday? I don’t in my heart really think so, but keep in mind I have been stable in the low 200’s mostly due to a lap-band where I can’t over-indulge without using prescription Ativan or alcohol.
Again, some of these surgeons call performing a DS on me “crazy.” None really the R Y although of course any local hospitals would few even an RNY as highly aggressive on me. I can’t help but think if my goal is 170 or below, the DS is going to give me the best damn chances to comes as close to that as possible? And at what cost versus the RNY? Some say bathroom problems not bad with DS versus RNY, others say night the day without comparison. Granted, we are looking at a 150 common channel. Another thing I need to ask Dr. Roslin about is he wrote on here “for many bands to ds, that do not have esophageal dilation, I see little difference in outcomes.” Well I have extreme esophageal dilation. Does that mean DS is less likely to be good on me? What/where are these NIH/CMS guidelines he says he will not operate out of? Now, one may say I will not get thin because of my Nadir point, but if I have achieved 180s several times taking amphetamines, I am not so concerned with the DS. I wonder, if such a small amount to lose relative to other patients, if the weight loss would be comparable or within 10 pounds. Theres no real studies on low BMI patients, right? Again, very little DSs have been done on someone of my BMI – the lowest Inabnet did was 35 and I recall Dr. Roslin saying 1 patient, if that’s accurate. I’m sure all have done RNY on BMI’s under 35 though. I also read somewhere that with RNY, doing an endoscopy is in a sense “blind” and other things like that are more complex.
RITALIN/ADDERALL/ADD: OK, is there anyone on here who takes either of these stimulant medications who had a DS? The reason I ask is… Ritalin and Adderall especially are strong stimulants, hell Adderall has two forms of amphetamine in it, and both have a laxative like effect on me. Not severe or bathroom problems, just having to go to the bathroom quicker after taking them, kind of like an extreme amount of Coffee. They clear you out in some sense. I am concerned about this being mixed with a procedure such as a DS making you prone to bathroom sensitivity to begin with? I doubt theres any studies on this? Anyone have experience with this???
Other medications: It is my understanding time-release medicines will not be as effective, although one doctor said not all medicines are absorbed in the small intestines and over time XR formulas should be fine. If I need to use immediate release, so be it. But I am worried if my medicines will all work the same. Have any of you needed to have your dosages changed as a result of DS or malabsorption? Im worried if it will make it hard for doctors to prescribe typical strengths of medications, and I take a few.
I have recently read a recent post by a post-DS Dr. Roslin patient who woke up having one of those scare days of “What did I do?” Is the recovery on DS really worse than RNY? In my case, I imagine I will have lost most weight by September from not being back on a normal diet, but should I anticipate being miserable this summer? No alcohol? No solids?
Dr. Roslin says most surgeons are not motivated to learn DS. But how of the others who do, why are they not pushing it more? Dr. Pomp pointed out how only 3-5% of WLS are DS, but if its so effective why would it not gain more popularity? I do not buy that its just not as profitable because RNY is not as profitable as Lap-band when a surgeon could do several of those in a day. (It took Dr. Roslin 18 mins to band my friend).
It seems everyone knows someone who knows someone who ended up in the hospital with RNY. I suppose that would be the same case if DS patients were more known? Is there anyone here 10 years out who has never once been to the hospital?
Finally, Dr. Pomp said nothing will be as restrictive or as unpleasant or as vomiting-prone as the Lap-band I had, so hopefully in terms of eating ability I can only improve. I guess I will replace the lap-band attacks with stomach attacks. ;-)
CASTLE CONNOLLY TOP DOCTORS BOOKS: I know some may not agree with these books, but I am very into them and by them annually and collect them. The NY Metro area is designed to represent the top 10% of doctors in the NY Metro Area. Doctors cannot pay to be included, and is primarily based on peer evaluations by doctors in the same specialty, and then edited by the staff based on malpractice and a host of other factors. What is weird is Dr. Bessler, Dr. Pomp, and Dr. Inabnet are all in it. However, it appears Dr. Roslin is not and may have been cut. I will not read too much into this, perhaps it’s because he is viewed as overly-aggressive with DS among other bariatric leaders so it may be a popularity thing.
IN SUMMARY: Lap-band must come out due to severe complication. Been to 4 DS surgeons. Only 1 suggests DS. 2 willing to do DS. 2 adamantly opposed to and not willing to consider it. 3 willing to do RNY without being totally opposed to it. Concerns of diarrhea, nausea, Ritalin, and which will have best outcome on a patient only starting with a 31 BMI. I am scheduled for DS with Dr. Roslin on June 25th with the lap-band removal. I have the option of downgrading to RNY or just taking out the lap-band. 2 weeks to decide if I am flat-out crazy.
I realize all your time is valuable, and that I let this go on way too long. I am sorry. I just am desperate for opinions and these are the only places I can get real feedback instead of reading published material on how DS is only for the highly severely morbidly obese patients who aren’t even good candidates for RNY, etc.
RNY? DS? SEWING MY MOUTH SHUT?
I should conclude by saying I have two passions in life: blondies and food, and both get me intro trouble!
Your new-found friend,
Paul
Not to gross you out, but thinking of every possible scenario as a future thin single gay male, etc.
