carolinafirefly

I'm new here and haven't even introduced myself yet, so forgive me for skipping that part and jumping straight in with a question, but my surgery is scheduled for exactly 1 week from today and I'm feeling the need to get a decision made quickly. I've been in preparations for bariatric surgery for a year now. The plan was always for sleeve. The intestinal rerouting thing just scares the bejeezus out of me, but it's really the rates of longterm complications that scare me the most about RNY, especially the "lightning strike" complications like internal hernia that can pop up unexpectedly years down the road, probably when you're hiking and about 100 miles from any decent hospital if you have my luck. I was much more comfortable with the idea of VSG. However... I have a long history of GERD. It's milder when I lose weight but still there, and I had to switch from ranitidine to a daily PPI (omeprazole 20 mg) several months ago because the ranitidine just wasn't doing it for me anymore. Even with the PPI, I've sometimes had breakthrough heartburn and admit I've taken a second omeprazole later in the day every now and then for it. I figured I'd just have to stay on a PPI after surgery and convinced myself that would be a better option than taking on the added risks of RNY, but my pre-op EGD this morning showed LA grade A esophagitis (i.e. mild esophagitis) and a small hiatal hernia. Those were just the initial impressions and the final report and biopsy results aren't in yet, but the surgeon showed me about how big the hernia is and I'd guess it's 2-3 cm. He says no problem, it can be fixed during surgery and we can treat GERD with medications or, eventually, even LINX if needed, but I'm concerned for a few reasons. It seems ominous to me that I have even mild esophagitis after several months adherence to a PPI regimen that's supposed to heal acid damage. I'm thinking that means I'd have to be bumped up to a higher/more frequent PPI dose after surgery just to keep things stable if I'm lucky. I'm a research person, so I've reviewed most of the recent research regarding GERD and the sleeve, and it looks like there is a large chance of the esophagitis worsening in grade after VSG. It also looks like there's a huge chance of recurrent hernia despite repair and as much as a 1 in 8 chance (according to one small study) of needing revision to RNY later. With that factored in, my chances of needing additional surgery after a sleeve actually appear to be the same or higher than my chances of needing additional surgery after RNY. I also wouldn't look forward to having to pay for EGDs every year to reassure myself that my esophagitis hasn't turned into Barrett's. The general consensus of everything I've read leans toward RNY over sleeve for preexisting GERD, but this doesn't match my surgeon's encouragement to go with sleeve. Then again, he might have that can-do attitude because he knows how much I originally wanted the sleeve? I don't know. Anyway, needless to say, I'm having major second thoughts about the sleeve, but I have so little time left to decide and I'm worried about making the wrong decision. I was hoping my EGD results would give more clarity, but they just seem to have made the waters even murkier. If you made it through that longgg post, I guess my question for you guys is: Am I being overdramatic about a little heartburn? Did any of you have esophagitis on your pre-op EGD? Which surgery did you choose and how did it work out? All opinions and anecdotes welcome and thank you in advance!

You shouldn't be embarrassed. I really think shame is a big part of why I am here at this point in my life and why my relationship with food is so sucky. Coincidentally, I was just reading a section entitled "Pushing for Perfection" in the bariatric manual from my surgeon's office. It starts out, "The desire to be the 'perfect patient' is going to leave you disappointed. If your personality is one who strives to be perfect at everything, be mindful of this trap. You are not going to be perfect. You are still encouraged to try your best..." So saying no more is a very good thing, but let go of shame. It usually serves its purpose in the first few minutes of feeling it, so it does no good to hang onto it.

😂 Licking a Dorito I've heard there's always that one port incision that's worse than the others. I think it was the one you're talking about (left flank/side?)

Me, too. I think I love my doctor now.

I called the office back today to ask some questions about the Barrett's like whether it was short or long segment and if there was any dysplasia. I got a call back from the nurse a little later with, "It's short segment, no dysplasia, and <long pause> the doctor says to stay off the internet." So busted 🤣

I feel the same way, CaribeRidge. I'm terrified, to be totally honest. Not the most positive thing to say, but the truth, nevertheless. Logically, it's a good gamble for me, the surgery, but I've never been much of a gambler. Even in Vegas, I stick to penny and nickel slots because risking a lot makes me feel sick. (Do they even still have penny slots?) I'm also a nurse, so I think about and see complications more than I do success. Right now, I'm trying to remember the reasons logical me decided this was a good idea. With the Barrett's I was just diagnosed with, it's an even better idea, but still... *eyes the high roller table nervously*

I did food funerals, too. Know how I said I started the pre-op diet a week early? Welllll, technically, it's true, but I started it on a Sunday and then on the next Sunday, my son, his gf, and I went to Chili's. There were ribs. And cake. But um, I didn't have any 🤥 Okay, I did have some, but I justified it by saying I'd started the pre-op diet a week early of my own, free will, and it wasn't really supposed to start 'til the next day in the first place. It made me retain water for a couple of days. I haven't cheated in the "official" 2 weeks before surgery, but it was a close thing one night. I made my son keep his donut sticks in his room, but they were right there on his tall dresser, which is visible through the crack he leaves in the door at night. So, it was 2 am, he was fast asleep, and my arm, of its own accord, started to stretchhh through the opening to ever so quietly purloin the box. I mean, nothing really counts at 2 am, right, and I'd forgotten to have a food funeral for Little miss Debbie! Don't worry, I put it back 😔

I still have caffeinated coffee occasionally. We're allowed to have it up until surgery, but it was recommended to stop so you'd go through any withdrawals out of the hospital. I don't have withdrawals at all, so I really think I'm fine to just keep drinking it. Should probably save these decaf k-cups for post-surgery.

My surgeon uses a different pre-op diet: 2 shakes/day, unlimited veggies, 3 oz. of meat/day, and very limited other things, so it's low carb by nature and totals less than 1000 calories/day most days. I started it a week early and have dropped 15 lbs so far and hope to drop a little more this week. For my 2 protein shakes, I'm usually having Amazon Elements Grass-Fed 100% Whey Protein Isolate (vanilla) mixed with 2 tbsp PB2 and 1 tbsp cocoa and 8 ounces of almond milk (yum) for one shake and a "latte" made of chocolate equate premier protein knockoff mixed with 12 oz. of decaf coffee for the other. I don't like most pre-made shakes, but I don't mind it in coffee for now. I'm pleasantly surprised by how much I enjoy the Amazon brand protein powder, though, and I hope my tastes don't change much in that regard after surgery. I only bought it 'cause it was on sale and the ingredients look very similar to an expensive brand called Jay Robb that I've read a lot about. I'm getting about 20 grams of natural fiber/day and STILL need a fiber supplement. I'm not taking it, but I need it. Must be all the protein.

So, I guess you are my people. I'm having bypass on the 21st after spending the last year thinking I'd get VSG. Ah, curveballs. The last-minute change has made me a little unsettled, and I'm having so many second thoughts despite knowing that I really do need this surgery for multiple reasons now. I saw a few of you scheduled for 1/21, too, but I don't know if any of you are getting RNY that day. Doesn't matter, you're all my surgery twins anyway.

Really? What's so awful about being bombarded with radiation on a dusty, barren rock 55 million miles away from everything and everyone you've ever loved? It'd be an awfully big adventure and totally worth the risk <--- *says while being scared of a little surgery*

I had no clue about the villi growing back, GreenTealael. Informative AND you made me laugh, which I needed. Thanks 😊 And how did you know I applied for that Mars One thing? I didn't get picked though *sigh*

Well, I spent most of the day still trying to make a decision, and then the phone rang. As soon as I heard my surgeon's voice, I knew what he was gonna say because surgeons don't just call you themselves for no good reason. The biopsy of the "LA Grade A esophagitis" showed Barrett's. Decision made. But man, am I scared about surgery on Monday. The weirdest fear running through my mind tonight: What if the zombie apocalypse happens and I survive the zombies just to run out of vitamins and die a slow death from malnutrition? My son's been playing The Last of Us lately, so that might have something to do with it, but it's true that I'm nervous about being so reliant on vitamins. My family, who didn't support me that much in my decision to get WLS in the first place, is even more worried now, especially my mother. I get it. I'd be anxious if it were my son getting the surgery. I'd be like, "What? I made you with a perfectly good intestine, and now you wanna go cutting it up?" No, not really, but I'd think it. Speaking of my son, he's pretty anxious about the whole thing, and I hate worrying him. Another stressor is the fact that GreenTealael was right! They have to resubmit to my insurance company! The surgeon mentioned this, and we're both just hoping it gets approved in time for my surgery date to stay the same. The sleeve was approved in only 1 business day, so hopefully it won't take longer than that. On top of all of that, I'm now scared about the Barrett's. I didn't even find out from the doctor if I have any dysplasia with it before hanging up. He just said we'd do another EGD in a couple of years. I'd imagine we'd be doing more than that, maybe, if there were already dysplasia, but I really don't know. I'll have to call and ask tomorrow. Right now, I'm scouring bariatricpal forums for stories from others who had Barrett's and had a really good outcome from gastric bypass. If any of you have a story like that or know of any, please share!

Thanks, y'all. I feel a little calmer about it tonight. I read the prior auth I got from my insurance company, and it just says "surgery for morbid obesity" is approved, so I think it may (hopefully) be good for either/or. Still weighing the options, and all your comments have really helped with that.

lol Sorry for causing confusion, elcee. For some reason, that's just how I think of the later complications. With sleeve, complications other than GERD tend to happen peripoperatively and not years later, but certain risks with RNY are ongoing and there are small chances of complications even many years later (e.g. ulcers, internal hernias, bowel obstruction). Even if the risks were equal, this sorta freaks me out a bit since I hope to travel places that might not have the best medical care in the future. I liked the idea of there being a point in time a couple of months after surgery when I could relax a bit and think, "Well, if something bad was gonna happen, it probably would have happened already" if that makes sense.

Very good point. I signed a consent for both surgeries when I was there for my last pre-op visit, and it only took 1 day for my insurance approval to come through, so hopefully it wouldn't be held up. You never know with insurance companies, though.