Greetings! I had my first meeting with my surgeon this week and he rocked my world a bit. I went in determined for a Lap-Band because it's less invasive and hopefully would have a shorter recovery time, but he recommends either gastric bypass or VSG for the long term outcomes. He said their clinic rarely does the band these days. He authored a study in 2011 that compared long term outcomes of band vs. bypass. So I've been in research mode this week again. I'm leaning toward VSG but am open to bypass, too. I have insurance coverage for bariatric surgery this year but may not have it in 2014 and beyond. My PCP who has treated me for 20 years thinks this is a great option for me after all the failed diets plus I have other surgeries that I need in the future and we both think I would have a better recovery if I weighed a lot (80-100) less. I did one of the surgeries (left ankle) last year and I had complications (pulmonary embolisms) and a slow recovery. I still need to do the right ankle- probably in 2015 if my Achilles doesn't rupture before then. Another complicating factor is a big vacation planned for the Xmas holidays. I don't have a date for my surgery but I'm hoping for August or September. Is it realistic that I would be well enough along my recovery to enjoy Hawaii and eat solid food? We are renting a house, so I plan on making most meals hopefully taking advantage of the fresh fish and fruit that should be available. We can still cancel our plans with little penalty but I am hoping that if I'm able to hike, swim, snorkel it will be a great goal and reward. I realize that everyone heals differently and that surgeons have their own dietary guidelines, but I'm looking for some seasoned VSGers' advice. Cancel Hawaii and do it next year and concentrate on VSG recovery? Or a Hawaii vacation 3-4 months after VSG sounds doable and should be fun? What do you think?

Hawaii anytime would be fun. I'd be back there in a heart beat. I'd also stick with the plan. It would keep you motivated to get your recovery done and over with. You are going to feel like crap for a few weeks, but by the time you take off for Hawaii, you should be in pretty good shape. Stay off the surf boards though.

It's doable! It's doable! For me, I felt fine after the discomfort from my large incision (where the stomach was removed) went away in about a week. Don't get me wrong, the first week just had me moving slower and being aware of my incisions. I think a Hawaii vacation would be great! I'm envious that you get to go to Hawaii

By the way, I chose the sleeve mainly because it does not cause malnutrition like the bypass can.

How wonderful for you to have Hawaii to look forward too! I've never been there.

I'm planning on a Disney (FL) trip in December & hoping to be sleeved in July/Aug & am looking forward to walking the parks with a lot less weight to drag around! We're also renting a condo this time around because I may need a kitchen but all in all, I'm looking forward to bringing my sleeve to Disney World!

Thanks so much for your thoughtful replies! The Hawaii vacation is really special, not a typical vacation for our family. I turn 50 around Xmas. This will be my Hawaii 5-0. :-)

Best of luck to you on whichever procedure you choose. I had the choice of 4 options (band, plication, sleeve and bypass) My insurance would have covered either the band or the bypass, I would have had to pay out of pocket for plication $14000 or sleeve $20000.

I did not choose the band because the success and rate of loss were only a little higher than 1/2 as good as the bypass or sleeve based on a meta analysis I located on PubMed. Also, I wasn't too excited about having a medical device implanted and the risk for slippage, herniation, etc.

I did not choose bypass because of the rerouting of the digestive system and the skipping of a section of the system and the high risk of nutritional deficiencies in the future (and let's not forget everyone's favorite "dumping syndrome"). Then there is the increased rate of complication. (My surgeon validated my concern and said that she felt that because some complications happen so long after the bypass is done, that the patient doesn't go back to the original surgeon so the complication may not get reported as such. It was really just more than I was prepared to allow. Based on the same PubMed abstract, it was only slightly more successful than the sleeve.

I did choose the sleeve because it had a success/loss rate near the bypass, and the complication risk is lower. I'm more comfortable with having a section of my stomach removed than the other options. Also, there is the added benefit of the removal of the portion of the stomach that produces grehlin (hunger hormone, if you haven't gotten that far in your research). My surgeon validated my choice and said that if she had to have it done herself, she would pick the sleeve.

Plication is still in the study stage ad my clinic. I'm just not comfortable with that...

I felt strongly enough about choosing the sleeve over the other two common options that I was willing to pay $20k over having my insurance pay 100% of the cost of either band or bypass (I have double coverage...).

As far as your timeline goes, do you know what your insurance is going to require you to do to qualify? Both companies I have required a 6 month medically supervised diet. In their terms, that didn't mean Weight Watchers, or multiple appointments to discuss weight management with my primary, or anything that made any modicum of sense. They wanted me to go to a doctor/nutritionist/whatever of their choosing for 6 months starting at the time the request was submitted (no credit for "time served"!). That played into my decision to pay out of pocket as well. I've made my decision, I'm not willing to fiddle-fart around for another 6 months to make my insurance company happy. Sorry, digressed a bit there... Anyway, if you have to do a 3, 6, or 12 month additional diet, Hawaii may be tough. Although, dieting in HI is pretty dang easy. There are grilled fish choices literally everywhere and it's super easy to be active.

From what I've read so far, you probably won't be cleared for activity much more strenuous than walking for about 2 months, and it might take 6 weeks (I think that's what I read???) for your largest incision to fully heal.

Hope this helps.

(Full disclosure: I'm pre sleeve, but my research is pretty fresh in my mind...)

Best of luck to you on your surgery and your new life!!!

dd

Our insurance is Premera BCBS. They require 6 mos supervised program. I'm on month 5 seeing a nutritionist. At my last appointment, she said it was time to start working with the bariatric clinic. I also saw my PCP last month to discuss next steps and by the end of that appointment, I was scheduled for the initial surgeon appointment, the psych tests (done last Tuesday) and the psychologist appointment (tomorrow) and bariatric nutritionist this Thurs. I also have an endoscopy scheduled for July 3rd. I'm not sure yet when the paperwork will be sent to Premera or how long before I'm approved.

I am definitely in the "action phase", as determined by my PCP and NUT. I've been measuring foods and tracking everything that I eat and drink for 5 months so far. It's pretty easy to do with the app MyFitnessPal. This week, I've started not drinking with my meals to get accustomed to that. I've tried to be more mindful when I eat so I recognize satiation. The piece that is hardest for me is adding exercise. The wonky ankles and time pressures are my biggest barriers right now. When my younger autistic son (I have 2) is finished with this school year next week, I should have more time because I won't have to be the homework warden until September again.

I'm strongly leaning towards the sleeve for all the reasons mentioned. I'm most afraid of dumping syndrome and getting all the nutrients ill need if I go bypass. The whole rerouting doesn't seem appealing either.

Sounds like you are prepared and well on your way! You might give your billing specialist a ring and see what he/she thinks will be likely as far as approval and how long that might take to give you a better idea of when you might have a chance to get scheduled. Also, someone at the office should be able to tell you approximately (assuming no complications) how long it usually takes to be cleared for full activity. Once you start putting those pieces of the puzzle together, you should be able to make a well-educated decision on whether you should keep your vacation scheduled. I imagine unless your insurance takes forever, you'll be a-ok.

Best of luck!

dd

Great suggestions, DD! Luckily, I still have some time before I need to make a final decision, but the sooner, the better for piece of mind. I might pop into the billing office after my psych appointment tomorrow.

I had a talk with the bariatric psychologist today. The appointment went well. I asked about timing. He thinks that Hawaii for Xmas might be too soon after getting back to a full diet. Oddly, I'm not too disappointed. We'll just plan it for 2014. Perhaps I'll learn to scuba or surf since, hopefully, I'll be 15 or 16 months out from surgery. So, it will be Hawaii 5-0 plus 1.

I'm really glad you feel settled about it. Sometimes (and by sometimes, I mean almost all the time...) we try to push ourselves a little harder than we probably should and we would be able to enjoy things more if we just took some extra time with them.

When you do get to your trip, I hope that it is great!

dd