Little Green

My surgeon told me that less than 25% of people with RNY get dumping syndrome. I think this is another case where people with the worst symptoms or bad experiences pipe up far more than those who have good experiences. It's also frequently cited as a reason some people chose to get VSG instead of RNY so just based on sheer volume of seeing "RNY=dumping," it can seem like it's inevitable. But according to my surgeon, it's not. Different foods can cause dumping, apparently. For some it's all sweets, for some it's sugary beverages in particular, for some it's fatty meats, for some it's fried food. I'm not sure if the "dose" (so to speak) affects it, like if you have a bite or two of cake vs. a whole piece. I did read that over the course of a few years, the intestines adapt and the incidence of dumping is vastly reduced. (I'll try to find the source and come back!) So even if you do get it, it doesn't mean it's forever. Sorry I'm not more helpful, I'm still preop myself so I just have to go based on what I've read and heard from my bariatric team. Hopefully others who are postop will be by soon to share their experiences.

In my experience, no, they will not accept it. Generally it has to be done "in house" with the surgeon's bariatric program. I hope they do, though! That would be fabulous. And good on you for taking initiative to establish healthy habits! The lower your weight at surgery, the safer and more effective it will be, so even if you have to do another 3 months you've still done yourself a great favor.

This was a post about switching surgeons at the last minute. They had gone through everything and were waiting on insurance approval, but they found another hospital a few hours away with more surgeries per year and fewer complications and wanted advice on if they should switch and how to do it. Not sure why that merited a delete! *shrug*

Yes. Honestly I don't really like TOPS itself at all anymore (regardless of surgery) but I still go because some of the members have become friends and I feel like I need to keep the pseudoscience in check. We do a "program" each week but anyone can bring in any content. The # of random Dr. Oz and Women's World crappy fad diet articles that people bring in drives me nuts. I was the leader of our group for awhile and tried to influence the program types but then my husband's accident happen and I had to step down so nothing ever really stuck. So now I just try to pipe up a lot and offer sound nutrition advice prefaced with, "My registered dietitian told me blah blah... HINT HINT" LOL.

I don't think anyone needs to get defensive over their decision. I just think there are pros to RNY that I rarely see discussed on this site because a vast majority are sleeve patients who were fearful of the RNY or felt it was too extreme or invasive. If they felt that way, it's fine, but the truth is it's a very safe surgery that's performed without complications every single day and it's a great option for a lot of bariatric patients. Not trying to flame any drama, but someone posted a thread the other day saying their doctor recommended WLS and they had no idea where to start, so they wanted information. Within just a few posts that person was saying that it sounded like "the sleeve is the better option" and she was going to go with that one. I don't mind if she gets VSG - heck, like I said, if I woke up with a VSG instead of RNY I'd be pleased as punch. But I would hate for someone to make a decision about surgery without evaluating all of the evidence simply because of fear.

Even though I am choosing RNY, the bolded is exactly what my surgeon and RD have said. In my consult I expressed concerns about ever being able to get to BMI 25 and said I'd settle for BMI 29. My surgeon dismissed that completely and said with my age and health there is no reason I can't get to BMI 25 if I want to. The numbers are just that, numbers. Statistics, averages, etc. They are of course very useful for educational purposes and I'm definitely an evidence-driven person, but body chemistry, hormones, environment, stress, etc. all play a role in our results and the stats don't factor that in. And... never forget that statistics proves the average human has one t*sticle! (Ok, I stole that from a Facebook post I saw!) Nowadays the recommendations are usually based on which surgery matches the health profile of the patient better; if none of these specific "go left" or "go right" conditions is present, it's for the patient to decide which surgery they feel most comfortable with - based on any of the factors we're discussing in this thread. Which, incidentally, is the info OP asked for! So how are we doing, OP?! Clear as mud, eh?

I learned to paint my nails really well and do nail art. I'm still pre-op but I wanted something that wasn't "go shopping" or "go get a pedicure" because my life is too stressful to be able to afford that stuff all the time LOL. So painting nails is something cheap... and you can't eat during obviously, and you also can't eat after because either your nails are still wet or they reek of nail polish/acetone. Very effective lol. I am a "peeler" so I now do my nails 2-3x a week to prevent myself from peeling them.

I'm a current member of TOPS. I would caution bariatric patients about it... not that you can't, or even shouldn't, join, but just be cautious about it. Based on my 4 years of experience with TOPS they have an extremely negative view of bariatric surgery with members considering it "cheating" and looking down on it. You are not eligible for any royalty awards which is a clear indicator they do not consider WLS-assisted weight loss as an achievement to be celebrated equally. All members who get bariatric surgery are placed into one single division no matter their starting weight. So you could have a 220-lb woman in the same division as a 500-lb man - there is no way that lower weight people could have a fair shot at winning their division, as they go by pounds lost, not percent! However, even if you don't care about the awards at all, you also cannot be Best Loser in your weekly group. So, no matter how well you do, you will not be recognized in the TOPS traditions. Also, imagine sitting at a table with your former self (or 5-6 of your former selves, or 20-25, or however big your group is) and how frustrated and hopeless you felt back then because you kept losing and regaining the same 20 lbs. Do you think anyone is going to listen to what you have to say, about nutrition, or willpower, or suggestions for managing cravings, etc.? No. As soon as you pipe up, their ears will close because in their mind, you cheated by getting surgery. I really don't think that is a positive or helpful environment for a bariatric patient to be in and that's why I'm not staying. Dang, this is by far the most negative post I have ever written on this site! LOL! I'm so sorry! I guess I needed to rant because I'm feeling frustrated that I "have" to leave my group. I just know once I told them about surgery that all of the "support" I get from the group would go away. Every time WLS comes up the conversation is so negative and smug. Even though there are people in my group who joined in the 90's and are 50 or 100 lbs heavier than they were when they joined, so you'd think they'd be open-minded since their way clearly doesn't work. I don't know. Maybe it's just my group and another TOPS group would be great. But I'm not so sure and I don't want to risk the negativity.

Thanks for clarifying @OutsideMatchInside. I appreciate that. I personally have not heard or read of any incidents of intestinal failure due to RNY, but I am sure there are complications of all stripes out there. Thanks for bringing that one to light for this conversation!

OP said he absolutely loves to cook & based on his subsequent comments it seems like he's already pretty good at it. I do agree (in general, not directed at OP) that finding new, interesting ways to cook healthy foods instead of the traditional "grilled chicken with steamed broccoli" is a good way to learn to enjoy healthy food. Definitely something that's VERY high on my priority list.

Disclaimer: I would never question anybody having whichever surgery they prefer! I'm so glad you had VSG & you are one of my favorite members to follow due to your success. Can you elaborate on your comment about intestines? It's my understanding they do not remove or otherwise alter your intestines, beyond connecting them in a different manner to the new pouch. I do completely understand that VSG leaves the intestines totally intact and that was your concern, but I'm confused as to how someone would be "living without intestines" due to RNY.

You're so welcome. Yeah, it would make your life super easy if your surgeon says, "Oh I think [X] would be best for you." Mine left it up to me and I'm like... uhhh..... LOL! Good luck!

I'm about 85% sure I'm going with RNY. My main reasons are 1. that my BMI is over 50, and while many surgeons still do VSG for patients like me (and my surgeon was willing to do it), my current understanding is that in terms of the literature RNY is preferred for us super-obese folks; and 2. due to my life circumstances I need to lose weight very quickly - RNY has a significant edge over VSG in terms of % weight lost at the 1-year mark. VSG mostly catches up by 2 years, though, so many, many people are also very successful even though it might be a bit slower. Some lesser reasons, in no particular order... there is way more data on RNY particularly about complications and long-term success, just a result of it being around longer. With VSG you have about 1/3 risk of developing acid reflux or GERD. Also, you generally lose about 15-20 pounds less on average with VSG. (I want to emphasize it's an average. I believe the numbers I saw at 2 years were RNY 70-77% excess weight loss and VSG 68-70%. So even using averages, 70% is in range for both surgeries.) I have seen many posts of people getting revisions from VSG to RNY and as anesthesia is one of my greatest fears I have no interest in going under the knife again. A majority of people on this forum are sleeve patients so there is a lot of good info out there, and IMO it's a fabulous surgery. If I woke up after surgery and my surgeon said she had to do VSG instead of RNY for x or y reason I would not be unhappy at all. But there are definite pros to RNY as well, which I've noticed are sometimes not discussed. So there ya go

I don't think you got an answer to this. I found my therapist by searching for one that specializes in eating disorders. Although you may not (probably don't) have an actual diagnosable eating disorder, those types of therapists generally have a good understanding of what goes on in our minds when we're struggling with our eating habits so they can really help. They probably have helped many bariatric patients! You can call your insurance company and they can actually look up in-network therapists with this specialty for you. I'm pre-op so with my therapist I'm working on things like mindful eating, emotions about eating, strategies for learning to adapt to nutritious foods instead of "tasty" (what I think of as tasty right now, anyway) processed foods, etc. I'm trying to do this before surgery so I'm prepared, but even after surgery you should get a lot of benefit from it! I've watched a lot of Dr. Weiner's videos, particularly the ones about weight regain after surgery (my second biggest fear - the first being not waking up from the surgery!), and they have convinced me that I need to totally change my diet instead of relying on the restriction for portion control to induce weight loss, because the appetite eventually comes back for 100% of patients. Even so, I personally still think that I'll occasionally eat things like Wendy's chili or a salad from a fast food place. Are leafy greens with red cabbage, tomato, and carrot magically not "whole" foods just because they're from Chick-Fil-A?

Milk seems like a good option for a liquid diet - calcium and protein, plus some natural lactose sugar for energy. I never thought about that before. Now that I do think about it, though, I think I saw a sample meal plan for WLS once that included an 8 oz glass of milk as a "snack."

Great idea about putting the puree in yogurt! Yum

I keep thinking the same thing but I will probably be too curious. Gah!

Besides @Diva Taunia and Minnie Me In TN, does anyone here have a YouTube channel or know of some RNY peeps who have one? I love watching all WLS-related videos but would love more pre- and post-op content for the RNY specifically. I'm thinking of doing some videos of my own, my husband is wanting to start a YT channel for himself so it could be a fun project we work on together! And I feel like a lot of people getting RNY feel alone due to the popularity of VSG. So I'm just wondering who else is out there on YouTube!

Pre-op so I can't give too much advice, but I do know the frappucinos would definitely not be considered carbonated, any more than a regular smoothie you make at home. They just use a blender at Starbucks to make those.

My surgeon told me 1/3 of VSG patients will develop issues with acid reflux after surgery. Whether that is full-on GERD, I don't know (although I doubt it). So, you have a 2/3 chance of not having any issues at all. I agree with @OutsideMatchInside, the people who are going to be searching on the internet for help are the ones who have complications. Sort of like vomiting or dumping after RNY - it seems like everyone has that issue but the stats my surgeon gave me disprove that. Many meds have side effects... Tylenol and liver, Advil and heart, etc. But truthfully, being obese is going to reduce your life expectancy far more than taking a PPI long-term. (And that's assuming that stat is true, which sounds a little sensational to me.) So, choose the surgery that you think will be successful, and the one you can live with forever!

I'm glad you said that! The voicemail my coordinator left me said "all insurance plans across the board" -- maybe he just meant the ones they are in-network for, not sure. Definitely good advice about following the individual policy to the letter!

Oh no! I hope you are feeling better soon. Did you have any signs or symptoms of dehydration, or was it just your doctor telling you that alerted you to it?

Nice job! I'm having a breakthrough with the diet, too. I think focusing on protein instead of worrying about calories has really made the difference (and the calories always end up lower anyway!). Eating out is our huge struggle as well. My solution lately is when I do eat out I prioritize finding a meal item with a good balance of protein to fat. So, like, not a double cheeseburger because although it has a lot of protein it has way more fat. But a grilled chicken sandwich with cheese and honey mustard at Wendy's is 40 grams of protein and very tasty! Then I get chili instead of fries. Total calories 540, 49 protein, 12 fat. I don't feel like it's depriving or "dieting" but the macros are great. Also at McDonald's since they have breakfast all day I get the egg mcmuffin with apple slices and go-gurt. Keep up the great work! How much longer do you have of the supervised diet?

Sorry, didn't mean to direct my comment at you! I was referring to those who insist keto is the best way to eat (not just for them personally but in general). You just literally can't eat fruit or beans on keto, you don't have enough carbs in the day. So those become "bad" foods on that diet. I personally think that's crazy! But I do know keto works for many people, so to each his own I guess! I'm going to do exactly what my surgeon tells me for at least a year. After that if I want to experiment with different ratios of carbs or fat, I'll do it. But I figure I've been knowledgeable and well-versed in nutrition for years and I'm still extremely obese, so I'm gonna go with what the person who's rearranging my organs wants me to do, LOL!

LOL at vodka brain! No worries, I think I wasn't clear. I had done 2 out of my 6 visits but I missed the third in May, and then ended up missing the fourth one in June. (I wish I had known that missing the May one was a dealbreaker and I wouldn't have stressed so much over missing the June one too!) So now, what would have been my 3rd diet visit (or 5th if I hadn't missed) on July 13 will now be my first. I thought about that too, about someone letting me know. I guess I can see it both ways - it's on me to show up every month and really it's a sign that you're dedicated and ready for surgery. But, things do happen like in my case so it would have been nice to know. I'm not really upset but I can imagine had my situation with the timing been different, I would have been - so I wanted to warn others. I hope most people are like you and their surgeons emphasize this!