Decisions, Decisions... RNY or DS?

[patrice1 81]

Hi Friends. I am new to the site, and have been approved by Kaiser for weight loss surgery. I have a meeting this week to decide which path I want to pursue. I live in the Denver area, and the only options shown are Lapband or RNY. Of those two, of course I will choose RNY. However, I have researched DS (Duodenal Switch) and I see the benefits of it and now am not sure which way to go. The only problem is, Kaiser does not offer DS here in Colorado. I have heard if you pressure them you have a chance to get that approved under certain circumstances. I have 120 pounds to lose (I am 5'7" tall and 280 pounds). Currently, Kaiser approves DS only if you are above 50 BMI. (I have a BMI of 42-44). But I have heard of exceptions to that, if someone is willing to pay to fly to another Kaiser region to have an in-network surgeon perform DS.

In short, DS seems like a better long-term solution, but I know it is more extreme than the RNY. RNY is great, but requires a person to use the tool well, and change one's lifestyle drastically to ensure its success. I get that and am motivated to do that. I just get scared when I hear of people who went through the RNY only to get back right where they started after the first year. I have a sluggish metabolism and a tendency to regain after diet success anyway, so this is of concern. I want to take responsibility for my life and choices, of course. But if I am going under the knife, I want the best solution available, and I have heard that DS offers a better long-term success percentage (not sure if this is true for everyone, but just saying what I have read).

So here's my question - any thoughts out there as to why you chose one or the other? I am truly not sure which path to go. Any advice or simply sharing your experience with me would be so helpful! Thank you

Edited December 9, 2013 by patrice1

[KristinaRnY 455]

I also have kaiser here in Oregon and am getting the RNY, my bmi is over 50 and they still wouldn't give me anymore options. Originally I wanted to go with the sleeve. I have 6 family members, 5 with rny and 1 with DS, I'm happy with getting the RNY for several reasons but looking at all of them and they are 4-16years post op, everyone with RNY is maintaining there weight much better, over the long run.

[patrice1 81]

Hi, kpat. Thank you so much for your reply. That really, really helps. It seems like RNY definitely can do the trick, and it's nice to have "real life" results like that. All the best to you and your family.

[KristinaRnY 455]

Also my cousin who had the DS also has a friend who 2 years ago I believe had a lap band revision to DS and she's not successful at all in the process, either way if you want it to work and are determined it will work, for me in all my failed attempts in weight loss it wasn't the getting there that's hard for me it's the maintaining, for years I could get to my goal but then would gain back plus. From what I've seen and from what I've read I believe RNY is the best option for me. Goodluck on your journey, ultimately it's your decision so do your research, find testimonies of people who have had both and take some time to carefully consider which is right for you.

[patrice1 81]

Hi kpat! Thank you -- what you said is so true: "if you want it to work and are determined it will work" that's key. I agree with you, getting there is not hard for me, but maintaining. In fact, I can say that "the regain PLUS the extra" (the extra being the operative word here) is what ballooned my weight to where it is today. Regains always come with extra poundage from where I began previously. Weight loss surgery to me is a "tool" not a "cure." The only reason I need surgery now is that my feet swell and bruise if I walk too much. My metabolism has slowed to a crawl. I did a physician-assisted fast last spring, and didn't cheat once. 800 calories a day, and I walked 8-10,000 steps a day, in spite of the pain. The results? 5 pounds in one month. Weight loss surgery will reset my body but will require maintenance and dedication.

Anyway, I SO appreciate the support! It makes a lot of difference.

[DLCoggin 1,788]

I don't know much about DS but in the absence of a doctor's specific recommendation that you have DS for specific reasons, you may want to consider the advantages of RnY. RnY has a history spanning more than 30 years. It is the most researched bariatric surgery option there is - by a very wide margin. It is the single most effective treatment known to medical science for obesity, type 2 diabetes and more than 30 comorbidities associated with obesity. Minor complication rate (usually defined as not requiring hospitalization) is about 15%. Major complication rate is less than 5% and continues to decline as the result of advancements in laparoscopic surgery techniques. And the mortality rate is at an all time low of less than one tenth of one percent. RnY has been and continues to be the "gold standard" of bariatric surgery and for very good reasons.

You will find many RnY success stories right here on this forum and it's safe to say that the vast majority of us had a history of yo-yo dieting and failure to maintain weight loss. But as you noted, any bariatric surgery can be defeated. It is a tool and there are no guarantees. No absolutes. No surgery changes the need for the all important Prime Directive - lifestyle changes. But you sound to me like a person ready, willing and able to make those changes. If that is true, you're gonna love the new you!!

Edited December 10, 2013 by DLCoggin

[Taterweight 12]

I was in a similar situation to you, trying to decide which surgery was for me. I am choosing the DS. (Hoping for an early February 2014 surgery date) There is a wealth of information at the newly updated dsfacts.com website. I also watched hundreds of YouTube.com videos just doing a search for "duodenal switch" so I understood what a post-op life would be like.

I would not try to sway you one way or the other, but what made me choose the DS over others: 98% total remission/cure rate of diabetes, intact "sleeved" stomach with pyloric valve (so no dumping as with the the rny), better long term maintenance (rny has a fairly high rate of weight gainers after 5 yrs), and DS percentage of excess weight loss is higher than the gastric sleeve. My BMI is over 50, so I needed something that would get me down closer to a normal BMI range.

On the downside, like with the rny, you have to commit to supplements. Both of these procedures have malabsorption from intestinal re-routing. I've never been much of a pill taker, but to be able have a life -- be around for my child and husband, I'm willing and able to take whatever I need to at this point!

I know of two really well respected doctors in California that you can do with Kaiser. There's also a good surgeon in Salt Lake, not sure if Kaiser is there. I'm having to self-pay thanks to no bariatrics in my insurance. I'm also opting to go out of state to have a highly experienced surgeon.

Hopefully that helps and gives you another perspective to consider. Best of luck!

[patrice1 81]

Hi Dave. Thank you for your reply. You are right - RNY has been the standard for a long time. I see benefits with it and with the DS. It really helps to consider all of these things. I will bring it up at my surgeon appointment and discuss. The two main surgeons here for Kaiser do not list DS as their recommended choice. Therefore, I want to be armed with all the information I can in case I decide to fight for DS. Ultimately, I know it is between my surgeon and I, but again - find everyone's information and experiences shared as valuable in the process. It truly helps! To be honest,

[patrice1 81]

Hi Tater! Thanks for the info on Kaiser surgeons. If I go toward the DS route, it is good to know they are out there. I know that there are Kaiser patients that have achieved approval (and subsequent success) for DS. So much to think about. Good luck on your surgery! I would love to stay in touch. I am excited for you. Every single person here, I feel like I have found my "tribe" I have to get very, very honest with myself about how I think I will fare post-surgery. While I am motivated, it is hard to not fear the lack of long-term success I have had in the past with how I will do in the future. I will know a lot more after speaking with my surgeon and getting more information on how Kaiser feels about all the choices available. It is not just the physical, it is getting my head wrapped around the entire thing. This process truly helps with both.

All the best to you - it's exciting, isn't it?

[DLCoggin 1,788]

You're certainly welcome Patrice! Prompted by your question I did a little more research on DS (without the BPD). Here are a couple of articles that you might find interesting. Note that one is from 2011 and the second one from 2012 so they're not quite "current". The first one is especially informative and summarized by the author's statement "This is the most aggressive procedure with the highest risk, but it comes with the best potential for reward." The second link is from 2011 and has some good information but the study cited has a much smaller cohort (60 patients vs. 1,156 in the first one). In this study the author concludes "...the added weight loss compared with gastric bypass is offset by complications that far outweigh any potential benefits."

I'm planning on doing more research as time allows. Hopefully there are more current studies (things change fast in the bariatric surgery world) with even larger cohorts. I'll let you know if I find anything more current. The weight loss numbers and long term weight maintenance for DS certainly appear to be very favorable. The challenge is to weigh those benefits against the increased risk of complications. Have a great day!!

http://heartland.time.com/2012/09/18/researchers-take-a-closer-look-at-weight-loss-surgeries/

http://medscape.com/viewarticle/749385

[patrice1 81]

Hi Dave-

Thank you - these articles are very helpful. It is a "pro-and-con" analysis for sure! I appreciate your taking the time to research this and pass info along. Your personal stats on your surgery are undeniably successful. If you were able to do that on RNY that says a lot for this surgery!

Patrice

[iamsoworthit 430]

I asked abour DS when I was converted from my band to rny. I did not have a high enough bmi and my doctor did not think it was the right choice for me. I was worried I wouldn't lose because my metabolism is so bad. I am definitely a slow loser but am losing. In june when I was converted I was 220 and am now 169. I would recommend doing all of your research and trust your medical team. You are partnering with them so it has to be your decision too. Good luck!!

[7 Bites_Jen 479]

One thing I want to point out is that it's possible to regain on ANY WLS - RnY, DS, Lap Band, Sleeve ... It's possible to "eat around" any and all of these if one REALLY wants to. So don't let your fear of that be a deterrent.

Like others have said: RnY is a tried-and-true surgery. Many MANY people have done amazingly well on it. A good friend of mine from high school had it done and she's done wonderfully. If you follow your guidelines and do what you're supposed to do, chances are good that you'll do great!

Good luck!

[patrice1 81]

Iamsoworthit and 7BitesJen: Thank you both - that really helps. I had my first meeting this morning and I am soooo excited. They have a much more expedited program now with Kaiser, and so I could have surgery in as little as two months from now. I have to re-learn how to trust myself, regardless of what I do, I have to put myself in the driver's seat again, instead of feeling so defeated. As you said, Jen - any WLS can be defeated if a person elects to do so. I won't let my fear of my past influence my decision, thanks for that. I'll let you know! Onward and upward! (Or downward, actually, as in weight!) LOL

[mistysj 1,939]

The sleeve is the first "half" of the DS. Would you consider the sleeve, with future revision to DS if necessary? There are heaps of Sleevers who have lost more than you need to lose. Anecdotally I am a sleever who left the hospital with a sleeve and without diabetes. I have also lost over 70 pounds in just under 7 months so far. I got the sleeve with the plan that if I needed a revision because I couldn't get to a healthy weight, I'd go with DS.

Another thing to consider is your pattern of eating. If your weakness is fatty foods, the DS is known to be more "ok" with that, because it inhibits absorption of fats. But if your weakness is sweets, you are much more likely to have dumping with DS than even RNY. And we are talking uncontrollable diarrhea and nausea if you eat a lot of sugar or carbs in a sitting. Some people would consider dumping a good thing because it can keep you on the straight and narrow, but others would consider it a quality of life issue they are not willing to risk. True dumping is very rare with the sleeve or band because the pyloric valve is left intact and the intestines are not shortened by rerouting.

Evaluate your food demons, your goals, and what potential side effects you feel able to handle, research, and talk frankly with your surgeon or even several surgeons. That's my best advice.