KabinKitty

1. I don't think the doctors know as much as they think they do. A few years ago, I lost 72 pounds in six months (and gained all but 3 pounds back but that's a whole 'nother story!). I didn't have hair loss and I didn't suddenly get cold all the time before I had even lost any weight like I do now. This single digit weather is killing me! WHAT DID THE DR'S TELL YOU THAT WAS UNTRUE? I'VE HAD ABOUT 10 SURGERIES AND ONLY HAD HAIR LOSS AFTER THE MOST SERIOUS ONE. THE ANTESTHESIA DID NOT CAUSE ANY HAIR LOSS, EVEN WHEN I HAD GALL BLADDER SUGERY THE OLD FASHIONED WAY, WITH AN 8 INCH INCISION. 2. Cookie cutter dietary recommendations do not work. I can measure my time since surgery in weeks instead of months and have had several stalls and even gained over and over again. I have found that the closer I stay to 1,000 calories, the more and faster I lose. When I try to stick to 600-800, I lose nothing - not weight, not inches. 3. Diabetes doesn't always go away. When I started adding HEALTHY carbs like fruit, dairy and vegetables, my blood sugar went up again. I am back on the oral meds but only one of the insulins once a day. Hopefully this will change when I lose more weight, but I am not holding my breath since my beanpole husband takes a long acting insulin every night and a short acting for every carb he eats (and he eats a LOT of them!). DOESN'T INSULIN USE DEPEND ON WHAT'S CAUSING THE DIABETES AND WHAT YOU EAT? OBVIOUSLY YOUR HUSBAND IS GOING TO NEED TO CONTINUE TO USE ALOT OF INSULIN IF HE CHOOSES TO HEAR ALOT OF CARBS. THE BODY REACTS TO SIMPLE CARBS AS IF YOU WERE EATING PURE SUGAR. 4. You don't necessarily lose weight from the same places each time you lose weight. My boobs and butt are disappearing this time but my gut stubbornly stays the same size! 5. Weighing every day can be a good thing. If I didn't weigh every day, I would never have known what broke my stalls. 6. If you don't want food servers commenting on how much you eat, take small children with you. Nearly everyone at the table shared my potatoes and I shared my granddaughter's fruit yesterday and no one had any idea how much anyone else had eaten. Yesterday was the first time I have been in a restaurant since surgery and I felt completely comfortable and knew exactly what I was eating since I entered it into my phone app. We had Thanksgiving dinner and I was still 200 calories short of my goal at bedtime. So I had a cup of Silk Nog. (mm mm good!) IF AFTER I HAVE SURGERY A SERVER COMMENTS ON MY FOOD CONSUMPTION, I'LL JUST SAY THE FOOD WAS GREAT, I GUESS I SHOULDN'T HAVE EATEN A WHOPPER BEFORE DINNER. LOL And, as I said, your mileage may vary, but this has worked for me. I am not exercising a lot yet until my blood sugar is totally in control but I am doing plenty of housework since I don't have tall enough boots to go tromp outside and play! I THOUGHT EXERCISING HELPED TO LOWER YOUR BLOOD SUGAR.......? I JUST CAN'T WAIT TO HAVE MY SURGERY AND SEE WHAT WORKS FOR ME. I'M SURE EVERYBODY IS DIFFERENT AND LOSES IN DIFFERENT WAYS. GOOD LUCK TO EACH OF YOU!

BC/BS of Ohio just started covering the sleeve as of 11/18/10. My paperwork was recently resubmitted and I'm waiting for my approval. The weight considerations are: 1.BMI of 40 or greater, or BMI of 35 or greater with an obesity-related co-morbid conditions. I hope this helps!

Liza, Are you kidding me? You guys will be second to know, after I tell hubby! I read Anthem's webpage over the weekend and it states that the change was actually in effect since November 18th. It's been a long journey since I first called the surgeon's office in March 2010. Like alot of people on these boards I have only shared my surgery secret with 2 people (who basically know nothing about the sleeve). I have felt very lonely in this situation, but sharing with all of you has helped tremendously. I've gone to alot of the surgeon's support meeting and I'm sick of hearing people discussing "the surgery", which is referring to gastric bypass. I always raise my hand and ask a question about the "cadillac surgery", the sleeve. Sometimes I go to people in the room after the meeting to discuss the sleeve with them. None of them had ever even heard of it. I know that's not true as my surgeon discusses all the surgical options at the seminar. I'm so happy I stuck with my surgery choice and didn't opt out for the band or the bypass. Twice I was asked by my surgeon's office if I would reconsider either of these. I hope this gives someone else the courage to hang in there!!

Here it is Sunday, December the 5th and I still can't believe what's happened in the past week. Chris from Dr. Lalor's office called me on Thursday, December 2nd to let me know that she resubmitted my paperwork to Anthem BC/BS on Wednesday, December 1st. She had gotten an email from Anthem stating that they now cover the sleeve as a "stand alone" surgery! My paperwork was submitted July 29th, and I had gotten a denial letter in September due to the sleeve being considered experimental/investigational. I have been waiting for the surgeon to send an appeal letter for me since that point. I'm just in shock! I called Chris back on Friday the 3rd to ask her when she was scheduling surgeries. She told me that she just started scheduling for February 2011 and that she expects to hear back from Anthem within 2 weeks. That means I should be having my surgery in February if all goes well !!! I expect to have to redo my bloodwork and chest xray, but I hope that's all. What a great Christmas present!!

I just ordered a Jack LaLane Power Juicer. How do Sleevers do with juices made from a mixture of fruits and veggies? Hubby's enzymes are messed up and it caused an episode where he basically passed out at work and ended up riding to the hospital in an ambulance. He spent the night in the hospital and had tons of tests. I've read where if you eat too many cooked vegetables and fruits you won't get enough enzymes. I just want to know if I'll be able to enjoy all the fresh juices too, after I have surgery.

Just contacted by my surgeon's office this week. They told me Anthem of Ohio contacted them to say they are now covering the Sleeve as a "stand alone" surgery. My information has been resubmitted after Anthem had denied me in August due to the Sleeve being considered experimental/investigational. I should know within 2 weeks if I am approved and will have surgery in February!!!!

My surgeon's office called me this week to let me know that they were resubmitting all my information to Anthem. They got an email from Anthem, informing them that they now cover the Sleeve as a stand alone surgery! They usually get word from Anthem within 2 weeks. I asked how far out she was scheduling surgeries and she said she just scheduled the first one for February. It's been a long wait and I had almost given up hope that I would ever get to have surgery. I'M SO HAPPY!!!

I don't mean to throw a wet blanket on your hopes and dreams, but I too have BC/BS. I'm in Ohio and like many other states BC/BS is still considering the Sleeve to be investigational/experimental. I recieved my expected denial letter just under 30 days from when my surgeon's office submitted the paperwork. It was not a surprize at all, just a big disappointment to read it in black and white. My surgeon's insurance gal said she would call when he submitted a letter to appeal the denial. The deadline to submit the appeal letter was yesterday October 9th, and I've not heard anything. If his appeal letter results in another denial, then I'm told my surgeon will request a peer review meeting. This is when a provider meets in person with a doctor who is not involved with BC/BS to plead my case. I am getting more and more depressed everyday. The surgeon's nurse asked me if I would consider RNY and I told her absolutely not. This week the surgeon's ins. gal called to ask, since my plan covers the Lapband, if I would consider that. I again told her "no, there are too many complications with it". She then told me that this could be a long drawn out process, since my plan does not cover the Sleeve. I feel so lied to, as she told me at my initial seminar that she was getting Sleeves approved by BC/BS easily. I had read on this site that it was not happening, that's why I asked her. I feel my surgeon is an excellent doctor, but his office staff gets patients to switch with a covered surgery, instead of fighting for the Sleeve. He does ALOT of RNY's. My husband say's that I never take the easy way out, and he's right!! It's just so depressing to see all these people getting approved and having their surgery, when I've been working since March of 2010 to get through this process! I am head strong and will perservere. Good luck to you, don't give up!

Krys, The thing that gets rid of my Water weight the best is to stop eating anything with gluten in it. No bread, Pasta, cereals etc. You can eat basically any meat, veggie and fruit...just forget the simple carbs. I find when I eat like this I also feel SO much better! I'm not so depressed, I think better and just have an all around better attitude. I hope you do well on your journey!

Michiganmama, There are hundreds of us out here that wish we had your problem! We're fighting our insurance companies to let us have our sleeve, when all they want is to give us the lap band or gastric bypass. If you want a little more convincing that the sleeve is better, go to Obesityhelp.com and start reading under the heading of "Complications or Problems". Then compare the same heading on this website. I have coworkers who had the RNY and believe me some of them are now packin' the pounds back on....and as an added bonus they are going for regular iron infusions! :thumbup1: Seems like a no-brainer to me. Hope you make the best decision for your health!! :001_tongue: Wish I was in your shoes.

Hubby called my surgeon's office to cancell my Monday visit with the nutritionist, after she left me a message to say that I am doing good on my own and since my case is in appeal the appt isn't necessary. Hubby also talked with the nurse, who said the surgeon has dictated a letter for the appeal and it's waiting to be typed. He told her that I would like my letter to be a part of the appeal if possible. Then Friday (yesterday) afternoon I got a call from my pcp's office to say that my test for Celiac Sprue was negative. As soon as I had the blood draw I went back to eating gluten free and all my syptoms that were starting to show up again, began disappearing. My rashes are going away, my "gut" feels so much better and the gas and bloating is going away. I'm sure I have some intolerance to gluten, but maybe it's just not at the stage it shows up in a blood test yet...darn! I will NOT settle for the RNY, no way, no how, NEVER! I sure do appreciate all the support of you all. More than you will EVER know!! :thumbup1:

Kelkie, I guess my surgeon is just the opposite in that I don't think he wants my imput. I don't know for sure, cause they are not communicating with me. I called and left a message with the nurse to let her know I had blood drawn for the Celiac test this morning (thanks to my pcp). I told her I'd let her know as soon as I get some results. She has not called me back. I think that office is used to people giving up on being approved for the sleeve and they just get the RNY. I think I'll call them again!!

Thanks to Fitatfifty I may have some more ammo to get my denial overturned. She got approved because of her diagnosis of Celiac Sprue. So, I looked up the symptoms and I have ALOT of them. I'm in the process of getting my pcp to order a blood test. If that's not conclusive the next test is to be scoped and getting a biopsy of my small intestines. Heck they can biopsy anything they want if it gets me approved! I talked to my surgeon's nurse (she's going to talk to him between surgeries today) and to my pcp's nurse (he's out of the office today) and should hear something later today or tomorrow. I told both of them how important this is to get an approval...if I have it. Celiac Sprue is gluten intolerance and if you have it and continue to eat gluten it can permanently damage your small intestines. Good ammunition against an RNY surgery! Oh, my surgeon's nurse asked if I was set on having the sleeve!? I said yes, I will NOT have gastric bypass!!! I think they have alot of people who have requested the sleeve switch to RNY just to get approved. NOT THIS CHICK!

I called the surgeon's office this morning and talked to the ins gal. Of course she is saying that this would be a long process, since BC/BS does not cover the sleeve. Duhhhhh I told her that at the seminar, but she insisted at that time she was getting BC/BS approvals for the sleeve with no problem. I told her I have composed a letter to BC/BS for the appeal. She told me that the surgeon would be handling the appeal, be it a peer review or an appeal. She told me if I sent a letter that it would be considered the appeal. I said that I would hope that the surgeon could use the letter along with what ever he was going to say. She told me that would not be a good idea, that the surgeon would handle it. I asked if I would get a chance to speak to him before the appeal or review...I didn't get the feeling that it would happen. I don't have a good feeling about this now! :w00t:

I have Blue Cross/Blue Shield Blue Access PPO in Ohio. In some states BC/BS is approving the sleeve, but not in Ohio yet. I have had some other health issues that my surgeon believes would help the ins co consider the sleeve as my only option. So, the fight begins!! :001_tongue: Of course there is the appeal, but the peer review is where my surgeon says he goes nose to nose with a doctor who would basically let my surgeon plead my case in person. It's rumored that my surgeon is real good at this. Anyway, I expected the denial, but when you read it in black and white it's so REAL! I've already begun composing a letter to BC/BS. It's basically a letter to introduce myself to them and explain what's gotten me to this point in my life and how I and my surgeon feel the sleeve is the only option for me.

I hope Tiffykins is right in your case. I also have BC/BS, but I'm in Ohio. I just got my denial letter in the mail on Friday. There are a few states where BC/BS is finally approving the sleeve, but most (as in Ohio) still consider it investigational/experimental. I will be appealing their decision. I'm VERY surprized your surgeon's ins. gal didn't understand the language in your policy!! My surgeon required me to be under the supervision of his hospital's nutritionist for 3 months. They don't really expect you to lose weight, but it is encouraged. I still got denied. I'm sure they would have approved an RNY in a heartbeat, as I meet all their requirements. You should be able to go to your BC/BS website and read what is allowed and what is excluded. My surgeon's ins. gal basically lied when she told me at the seminar that she wasn't having any trouble getting approval's for the sleeve through BC/BS. I expected to be denied and figured she was not being honest with me. I'm ready for a fight now!:thumbdown:

The letter came on Friday, Sept. 17th. It stated I had 10 days from the "date of the letter" to ask for a peer review. The letter was dated Sept. 9th. Today is the 10th day and it's a Sunday....SCREWED on that option. I will contact the surgeon's office tomorrow about filing an appeal. Then (if I'm reading the letter correctly) when the appeal is denied, we can ask for a peer review. Their reason for the denial (of course) was the ole experimental/investigational excuse. My hospital was the first in the USA to perform the Biliopancreatic Diversion with Duodenal Switch. It is a malabsorbtive procedure in which a portion of the stomach actually is removed. In addition to the stomach becoming much smaller, much more of the small intestine is bypassed than with the RNY. In 1978 Dr. Hess perfected and began performing this surgery. So, 32 years ago he began removing a large portion of his patient's stomach (a sleeve gastrectomy) and then doing the duodenal switch at that time or at a later date. So, with a 32 year track record of success with the sleeve part of that surgery how can any ins. company call it investigational/experimental! BEATS ME!

Like another poster, I work with alot of nosey women who gossip and love to put people down. I'm pre-op and don't want to lie. I've told two good friends who know I'm counting on them to keep quiet. All I have to give my boss is a note from the surgeon for time off work. If anyone asks me, I will tell them I did not have gastric bypass, if they press it to find out what I did, I will tell them that I only share the details with someone who is considering wls for themselves. I just remember when on obesityhelp.com I learned about this surgery I thought that removing most of my stomach would be the stupidest thing ever! Actually, I felt sick even thinking about it. I thought HOW DRASTIC! Actually it is, but gastric bypass is even more drastic and people don't bat an eye when they learn that someone has had that done.

You need to check with your provider or the surgeon's ins. person on this. I believe you have to have a medically supervised weight loss, but I'm no expert. BC/BS is a stickler for following their policies exactly. I hope all goes well for you. My surgeon has a dietition that works directly out of his office. I am billed through the hospital and it's always $20, just like a co-pay. My surgeon has a very smooth running operation and I'm hoping for an approval sooner than later. I've jumped through all the hoops as far as he knows. Now I just wait and see if I get approved. His ins. gal is not hopeful that I'll get approved the first time.

I got a call from Chris (ins. gal) from Dr. Lalor's office on Friday. She told me that my paperwork was submitted to BC/BS that day. She told me that because my ins. still consideres the sleeve "investigational" that I may be in for a long wait. I told her that I was already expecting that. She told me that when she received any word from BC/BS that she would let me know. Nothing to do but wait, wait, wait......

Two days ago I had my 3rd visit with the dietition and my only visit with Dr. Dawley (internal medicine doctor). The dietition said she was very pleased with my progress. I lost 3 3/4 lbs in the last month, despite alot of heel pain, which limits my walking. She told me to continue to practice chewing my food very well, small bites and eating protein first. My surgeon, Dr. Lalor, requires all of his patients to be cleared for surgery by Dr. Dawley before submitting the paperwork to the insurance company, and he is VERY thorough with his exam. He reviews all the tests results, does a medical history and an exam. He told me at the end of my visit that he will recommend to Dr. Lalor that I would be a candidate for surgery. He did say that he will be requesting the results of my echo cardiogram test. I told him that my pcp said it did not show any problems with my heart. When I told Dr. Dawley about the pain I have in my hips he said it is most likely due to osteoarthritis. If he puts that in his report, I'm hoping it will help me get approved for the vertical sleeve surgery. I understand that if you have arthritis that gastric bypass is not the best choice, due to malabsorbing the needed medications. With all my previous abdominal surgeries, adhesions and diverticulities Dr. Lalor is really against gastric bypass for me. BC/BS of Ohio is currently still considering the sleeve investigational, but I'm hopeful they will make an exception in my case. More and more states are approving the sleeve (ie Illinois), as they see it is effective and there seems to be fewer complications after.I will wait two weeks and then call Dr. Lalor's office, if I don't hear anything, to see where things stand. I will update this post at that time or before if I get news. It's my goal to try and lose 10 lbs before surgery.

Nana, I'm so sorry that you're feeling down. It sounds like your new job isn't really a good fit for you. If you have the option, you might go out and do some job searching. Even looking can lift your spirits, and who knows you might just find a much better more fulfilling job! You deserve it!!! Isn't it great to have a forum like this, where there are people who care and do the happy dance right along with you? Chin up gal! I'm just starting my journey and have NO ONE to talk to but my hubby. He knows practically nothing about the feelings I'm having and his poor ears are tired of me trying to educate him. Congratulations on your weight loss and your NEW LIFE!

I am no expert here, but I did have an experience with sleeping pills. After I got my Bi-Pap machine the doc prescribed Ambien to help me relax and get used to the machine. He did not say how long to stay on them. I pretty much took them for a month. I slowly noticed how I was beginning to have thoughts of paranoia. I would imagine that someone was lurking outside, and that at night he would break in. My husband was working nights. One night I started crying as he was getting ready to leave. I explained to him my crazy fears, he offered to stay home, but I told him to go and I'd deal with it. I got on the internet and learned how addictive sleeping pills can become and that people have done some crazy things while on Ambien. I quit that night. It took about 3 nights to be able to get any real sleep. When I told the doc later he said I should have gotten off of them gradually. Hope this helps you or someone else!

This is an article from the Amerian Society of Metabolic and Bariatric Surgery: http://www.asmbs.org/Newsite07/resources/Updated_Position_Statement_on_Sleeve_Gastrectomy.pdf This is an article I found on another site: The VSG is the Vertical Sleeve Gastrectomy or Gastric Sleeve, a newer type of WLS in which most (approximately 85%, depending on the surgeon and patient) of the stomach is permanently removed, leaving a slender "sleeve" of stomach about the size of a Sharpie marker, with normal connections between esophagus and stomach and stomach and small intestine. At one time, it was performed most commonly as the easier, less-invasive first stage of a two-stage procedure (the second stage being a Duodenal Switch, for example) on super-super obese people (BMI above 60) who were not physically in good enough shape for a RNY. After losing the first 100 or more pounds post-VSG, the patients were then fit enough to go through the second surgery to lose the rest of their excess weight. Presently, it's also done as a stand-alone WLS procedure on people who have less weight to lose, and the surgeons are finding that many people with high BMIs like mine lose all the weight they need even without a second surgery. The sleeve, like a RNY pouch, cuts gherelin production (which suppresses physical sensations of hunger), but unlike the RNY pouch, it still produces stomach acids so that meds (including anti-inflammatories) can still be taken normally once the sleeve has healed post-op. The VSG procedure is strictly restrictive, like the LapBand, rather than restrictive and malabsorbtive, like RNY, so calories and nutrients are better absorbed during digestion. Nutritional supplements are still necessary, however - I have to take the same Multivitamins, Calcium, Iron, B12, etc. as RNY patients, although I could get my calcium as carbonate rather than citrate (I don't - I use the same calcium citrate products as everyone else here on TT). The surgery is irreversible, unlike the LapBand, but has a better weight loss rate than LapBand - more like RNY. Most insurance companies don't cover VSG yet because they still consider it "investigational", but it tends to have a lower complication rate because it's a simpler procedure and many WLS surgeons believe it will eventually be widely performed. Through my own research, I have found some information which would be helpful to those considering WLS. This is neither authored by nor endorsed by the owners of this forum but is simply the gathering in one place some useful information I personally have come across. Let's look at an overview of the major WLS options out there: http://www.thinnertimes.com/weight-l...omparison.html http://www.lapsf.com/weight-loss-surgeries.html Restrictive versus Malabsorptive Surgery There are a number of weight loss surgery procedures available to treat obesity. Bariatric surgery has two primary approaches to achieve weight loss, and treatment typically emphasizes either the restrictive or malabsorptive approach or a combination of the two. Restrictive Weight Loss Surgery This type of bariatric surgery involves closing off parts of the stomach to make it smaller, thus decreasing the amount of food that can be eaten. The LAP-BAND?, Vertical Sleeve gastrectomy and Vertical Banded Gastroplasty procedures are restrictive types of bariatric surgery. LAP-BAND? Surgery The Laparoscopic Adjustable Gastric Band procedure, more commonly known as LAP-BAND? surgery, is growing in popularity. This restrictive procedure involves using a Silastic? band to create a smaller stomach pouch, causing patients to become full after eating a minimal amount of food. Vertical Banded Gastroplasty (VBG) The Vertical Banded Gastroplasty weight loss surgery procedure creates a smaller stomach pouch by stapling off a section of the stomach, then using a band to restrict the passage of food out of the pouch. After stomach stapling, the patient is unable to consume large amounts of food in one sitting. Once the food leaves the pouch, it goes through the normal digestive tract. Malabsorptive Weight Loss Surgery This weight loss surgery approach entails altering the digestive system to decrease the body's ability to absorb calories. The Biliopancreatic Diversion and Extended (Distal) Roux-en-Y Gastric Bypass procedures are malabsorptive types of bariatric surgery. Biliopancreatic Diversion (BPD) Biliopancreatic Diversion involves first creating a reduced stomach pouch and then diverting the digestive juices in the small intestine. The first part of the small intestine, where most of the calories are normally absorbed, is bypassed. That section, which contains the bile and pancreatic juices, is reattached to the small intestine much further down. There is a variation of this procedure called Biliopancreatic Diversion with "Duodenal Switch." This operation utilizes a larger stomach "sleeve" and leaves the beginning of the duodenum attached, but is otherwise very similar to standard BPD. Extended (Distal) Roux-en-Y Gastric Bypass (RYGBP-E) This weight loss surgery procedure is a variation of the Roux-en-Y Gastric Bypass operation. It differs in that a somewhat larger stomach pouch is created, but a significantly longer section of the small intestine is bypassed. There is less emphasis on restricting food intake quantity and more on inhibiting the body's ability to absorb calories. The Combined Approach - Restrictive and Malabsorptive Surgery The Roux-en-Y gastric bypass procedure is a combination operation in which stomach restriction and a partial bypass of the small intestine work in tandem as one of the most effective treatments for severe obesity. Roux-en-Y Gastric Bypass The most commonly performed weight loss surgery in the United States is Roux-en-Y Gastric Bypass. This operation involves severely restricting the size of the stomach and altering the small intestine so that caloric absorption is inhibited. Open versus Laparoscopic Surgery There are also varying techniques that can be used during bariatric surgery procedures. The two techniques are laparoscopic and open bariatric surgery. Open Bariatric Surgery While laparoscopic bariatric surgery can be performed through several small incisions in the stomach area, open bariatric surgery requires one larger incision that begins directly below the patient's breastbone and ends just above the navel. While both the open and laparoscopic procedures produce similar long term results, open bariatric surgery is associated with a longer recovery period. Laparoscopic Bariatric Surgery As opposed to "open" bariatric surgery, laparoscopic bariatric surgery involves making several small incisions and performing the operation by video camera. A laparoscope, the device used to capture the video, is inserted through an abdominal incision. This provides the bariatric surgeon a magnified view inside the abdomen, allowing the operation to be performed using special surgical instruments and a television monitor. The long-term results for laparoscopic bariatric surgery and gastric bypass surgery should be similar to those for open procedures. The advantages of the laparoscopic approach include less post-operative pain, a shorter recovery period, and less extensive scarring. The Vertical Sleeve Gastrectomy procedure (also called Sleeve Gastrectomy, Vertical Gastrectomy, Greater Curvature Gastrectomy, Parietal Gastrectomy, Gastric Reduction, Logitudinal Gastrectomy and even Vertical Gastroplasty) is performed by more and more surgeons worldwide. The earliest forms of this procedure were conceived of by Dr. Jamieson in Australia (Long Vertical Gastroplasty, Obesity Surgery 1993)- and by Dr. Johnston in England in 1996 (Magenstrasse and Mill operation- Obesity Surgery 2003). Dr Gagner in New York, refined the operation to include gastrectomy(removal of stomach) and offered it to high risk patients in 2001. Several surgeons worldwide have adopted the procedure and have offered it to low BMI and low risk patients as an alternative to laparoscopic banding of the stomach. It generates weight loss by restricting the amount of food (and therefore calories) that can be eaten by removing 85% or more of the stomach without bypassing the intestines or causing any gastrointestinal malabsorption. It is a purely restrictive operation. It is currently indicated as an alternative to the Lap-Band? procedure for low weight individuals and as a safe option for higher weight individuals. Anatomy This procedure generates weight loss solely through gastric restriction (reduced stomach volume). The stomach is restricted by stapling and dividing it vertically and removing more than 85% of it. This part of the procedure is not reversible. The stomach that remains is shaped like a very slim banana and measures from 1-5 ounces (30-150cc), depending on the surgeon performing the procedure. The nerves to the stomach and the outlet valve (pylorus) remain intact with the idea of preserving the functions of the stomach while drastically reducing the volume. By comparison, in a Roux-en-Y gastric bypass, the stomach is divided, not removed, and the pylorus is excluded. The Roux-en-Y gastric bypass stomach can be reconnected (reversed) if necessary. Note that there is no intestinal bypass with this procedure, only stomach reduction. The lack of an intestinal bypass avoids potentially costly, long term complications such as marginal ulcers, Vitamin deficiencies and intestinal obstructions. Comparison to prior Gastroplasties (stomach stapling of the 70-80s) The Vertical Gastrectomy is a significant improvement over prior gastroplasty procedures for a number of reasons: 1) Rather than creating a pouch with silastic rings or polypropylene mesh, the VG actually resects or removes the majority of the stomach. The portion of the stomach which is removed is responsible for secreting Ghrelin, which is a hormone that is responsible for appetite and hunger. By removing this portion of the stomach rather than leaving it in-place, the level of Ghrelin is reduced to near zero, actually causing loss of or a reduction in appetite (Obesity Surgery, 15, 1024-1029, 2005). Currently, it is not known if Ghrelin levels increase again after one to two years. Patients do report that some hunger and cravings do slowly return. An excellent study by Dr. Himpens in Belgium(Obesity Surgery 2006) demonstrated that the cravings in a VSG patient 3 years after surgery are much less than in LapBand patients and this probably accounts for the superior weight loss. 2) The removed section of the stomach is actually the portion that ?stretches? the most. The long vertical tube shaped stomach that remains is the portion least likely to expand over time and it creates significant resistance to volumes of food. Remember, resistance is greatest the smaller the diameter and the longer the channel. Not only is appetite reduced, but very small amounts of food generate early and lasting satiety(fullness). 3) Finally, by not having silastic rings or mesh wrapped around the stomach, the problems which are associated with these items are eliminated (infection, obstruction, erosion, and the need for synthetic materials). An additional discussion based on choice of procedures is below. Alternative to a Roux-en-Y Gastric Bypass The Vertical Gastrectomy is a reasonable alternative to a Roux en Y Gastric Bypass for a number of reasons Because there is no intestinal bypass, the risk of malabsorptive complications such as vitamin deficiency and Protein deficiency is minimal. There is no risk of marginal ulcer which occurs in over 2% of Roux en Y Gastric Bypass patients. The pylorus is preserved so dumping syndrome does not occur or is minimal. There is no intestinal obstruction since there is no intestinal bypass. It is relatively easy to modify to an alternative procedure should weight loss be inadequate or weight regain occur. The limited two year and 6 year weight loss data available to date is superior to current Banding and comparable to Gastric Bypass weight loss data(see Lee, Jossart, Cirangle Surgical Endoscopy 2007). First stage of a Duodenal Switch In 2001, Dr. Gagner performed the VSG laparoscopically in a group of very high BMI patients to try to reduce the overall risk of weight loss surgery. This was considered the ?first stage? of the Duodenal Switch procedure. Once a patient?s BMI goes above 60kg/m2, it is increasingly difficult to safely perform a Roux-en-Y gastric bypass or a Duodenal Switch using the laparoscopic approach. Morbidly obese patients who undergo the laparoscopic approach do better overall in their recovery, while minimizing pain and wound complications, when compared to patients who undergo large, open incisions for surgery (Annals of Surgery, 234 (3): pp 279-291, 2001). In addition, the Roux-en-Y gastric bypass tends to yield inadequate weight loss for patients with a BMI greater than 55kg/m2 (Annals of Surgery, 231(4): pp 524-528. The Duodenal Switch is very effective for high BMI patients but unfortunately it can also be quite risky and may be safer if done open in these patients. The solution was to ?stage? the procedure for the high BMI patients. The VSG is a reasonable solution to this problem. It can usually be done laparoscopically even in patients weighing over 500 pounds. The stomach restriction that occurs allows these patients to lose more than 100 pounds. This dramatic weight loss allows significant improvement in health and resolution of associated medical problems such as diabetes and sleep apnea, and therefore effectively ?downstages? a patient to a lower risk group. Once the patients BMI is lower (35-40) they can return to the operating room for the ?second stage? of the procedure, which can either be the Duodenal Switch, Roux?en-Y gastric bypass or even a Lap-Band?. Current, but limited, data for this ?two stage? approach indicate adequate weight loss and fewer complications. Vertical Gastrectomy as an only stage procedure for Low BMI patients(alternative to Lap-Band?and Gastric Bypass) The Vertical Gastrectomy has proven to be quite safe and quite effective for individuals with a BMI in lower ranges. The following points are based on review of existing reports: Dr. Johnston in England, 10% of his patients did fail to achieve a BMI below 35 at 5 years and these tended to be the heavier individuals. The same ones we would expect to go through a second stage as noted above. The lower BMI patients had good weight loss (Obesity Surgery 2003). In San Francisco, Dr Lee, Jossart and Cirangle initiated this procedure for high risk and high BMI patients in 2002. The results have been very impressive. In more than 700 patients, there were no deaths, no conversions to open and a leak rate of less than 1%. The two year weight loss results are similar to the Roux en Y Gastric Bypass and the Duodenal Switch (81-86% Excess Weight Loss). Results comparing the first 216 patients are published in Surgical Endoscopy.. Earlier results were also presented at the American College of Surgeons National Meeting at a Plenary Session in October 2004 and can be found here: www.facs.org/education/gs2004/gs33lee.pdf. Dr Himpens and colleagues in Brussels have published 3 year results comparing 40 Lap-Band? patients to 40 Laparoscopic VSG patients. The VSG patients had a superior excess weight loss of 57% compared to 41% for the Lap-Band? group (Obesity Surgery, 16, 1450-1456, 2006). Low BMI individuals who should consider this procedure include: Those who are concerned about the potential long term side effects of an intestinal bypass such as intestinal obstruction, ulcers, anemia, osteoporosis, protein deficiency and vitamin deficiency. Those who are considering a Lap-Band? but are concerned about a foreign body or worried about frequent adjustments or finding a band adjustment physician. Those who have other medical problems that prevent them from having weight loss surgery such as anemia, Crohn?s disease, extensive prior surgery, severe asthma requiring frequent steroid use, and other complex medical conditions. People who need to take anti-inflammatory medications may also want to consider the Vertical Gastrectomy. Unlike the gastric bypass where these medications are associated with a very high incidence of ulcer, the VSG does not seem to have the same issues. Also, Lap-Band ? patients are at higher risks for complications from NSAID use. All surgical weight loss procedures have certain risks, complications and benefits. The ultimate result from weight loss surgery is dependent on the patients risk, how much education they receive from their surgeon, commitment to diet, establishing an exercise routine and the surgeons experience. Advantages and Disadvantages of Vertical Sleeve Gastrectomy Vertical Sleeve Gastrectomy Advantages Reduces stomach capacity but tends to allow the stomach to function normally so most food items can be consumed, albeit in small amounts. Eliminates the portion of the stomach that produces the hormones that stimulates hunger (Ghrelin). Dumping syndrome is avoided or minimized because the pylorus is preserved. Minimizes the chance of an ulcer occurring. By avoiding the intestinal bypass, almost eliminates the chance of intestinal obstruction (blockage), marginal ulcers, anemia, osteoporosis, protein deficiency and vitamin deficiency. Very effective as a first stage procedure for high BMI patients (BMI > 55 kg/m2). Limited results appear promising as a single stage procedure for low BMI patients (BMI 30-50 kg/m2). Appealing option for people who are concerned about the complications of intestinal bypass procedures or who have existing anemia, Crohn?s disease and numerous other conditions that make them too high risk for intestinal bypass procedures. Appealing option for people who are concerned about the foreign body aspect of Banding procedures. Can be done laparoscopically in patients weighing over 500 pounds, thereby providing all the advantages of minimally invasive surgery: fewer wound and lung problems, less pain, and faster recovery. Vertical Sleeve Gastrectomy Disadvantages Potential for inadequate weight loss or weight regain. While this is true for all procedures, it is theoretically more possible with procedures that do not have an intestinal bypass. Higher BMI patients will most likely need to have a second stage procedure later to help lose the rest of the weight. Remember, two stages may ultimately be safer and more effective than one operation for high BMI patients. This is an active point of discussion for bariatric surgeons. Soft calories such as ice cream, milk shakes, etc can be absorbed and may slow weight loss. This procedure does involve stomach stapling and therefore leaks and other complications related to stapling may occur. Because the stomach is removed, it is not reversible. It can be converted to almost any other weight loss procedure. Considered investigational by some surgeons and insurance companies. Much of the above information was garnered from information from Laparoscopic Associates of San Francisco. The following links provide additional important information you may want to consider in your research: http://www.hopkinsbayview.org/bariat...ion_sleeve.pdf http://www.iabsobesitysurgery.com/Me...eDietGuide.pdf http://www.cornellweightlosssurgery....astrectomy.pdf Happy Re-Birthday to Me - One Year Out, 244 Pounds Down Post-Op! Aviator's Log Book