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Help! Possibly doing DS rather than Sleeve



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via my plastics FB group I have met alot of DS'ers. There are benefits to it, but also bigger risks. When I did plastics consults years ago I had two different surgeons tell me that the only patients they had that they really worried about were DS patients because unless you are quite diligent about nutrition and supplements you can be thin but not necessarily healthy.

My suggestion is to check out obesity help where they have a larger group of DS patients. I would be sure that your surgeon has a great track record with this more complex/higher risk surgery.

I have also heard about a newer procedure that is more of a "mini" DS that you might want to look into (cannot recall what it is called!)

I considered DS as my backup plan, but since I have been maintaining well as a sleever I haven't looked into it any further.

Good luck whatever you decide!

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via my plastics FB group I have met alot of DS'ers. There are benefits to it, but also bigger risks. When I did plastics consults years ago I had two different surgeons tell me that the only patients they had that they really worried about were DS patients because unless you are quite diligent about nutrition and supplements you can be thin but not necessarily healthy.

My suggestion is to check out obesity help where they have a larger group of DS patients. I would be sure that your surgeon has a great track record with this more complex/higher risk surgery.

I have also heard about a newer procedure that is more of a "mini" DS that you might want to look into (cannot recall what it is called!)

I considered DS as my backup plan, but since I have been maintaining well as a sleever I haven't looked into it any further.

Good luck whatever you decide!

It's exactly these increased risks that is making me scared about doing DS rather than the sleeve. I'm just turning 40 in January which is when my surgery would likely be, and I'm currently 'healthy'. I keep thinking why put myself through the increased risk of DS when so many people are successful with the sleeve. And honestly, if I can self-sabotage my sleeve i'm sure I can also sabotage my DS right??

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Please keep a close eye on your bloods. You're very new to the DS and as the years go by the supplements generally increase.

I had a sleeve done in August and take a chewable Multivitamin and a chewable calcium citrate every day.

Yep, same for me. I take two chewables Multivitamins a day, though, and the Calcium. I had a DS. I'm always a bit confused when I read about the tons of Vitamins people are taking - I really don't take tons of Vitamins at all.

I was originally going to have the sleeve as well. I opted for the DS in the last month of my 6 month supervised diet, because I was concerned about keeping weight off. I had surgery on October first, and I honestly feel great. Good luck to you, no matter what you choose to do, and congratulations on your decision to take charge of your health.

Edited by Postop

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Thanks Postop, that's good to know. I wasn't ever told they would increase.

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Yes, it's why we have bloods done so often. Some do it yearly, some every 6 mos. That way you can catch issues and tweak your vitamins/minerals, Iron, etc.

Thanks Postop, that's good to know. I wasn't ever told they would increase.

Edited by Postop

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A few random thoughts on the DS vs. VSG, but first my relevant background - my wife and I have been in this game for about twelve years now, from when we first went to one of the support group/seminars and started the common insurance mandated six month diet/exercise roadblock to approval deal. It took us close to two years to get her on the table after the serial insurance denials (DS was still "investigational/experimental" then) and getting our ducks in a row to self pay the job. Her history since has been boringly normal, losing 200+ (350 into the 140s) and regaining about 20 from her (too) low - not uncommon to overshoot the mark some with any of these procedures.

In the meantime, I lost about 50 over that first 6-8 months or so from basic diet clean-up (wanted it to be sustainable, no fad diets, just what I could change a do for the long term - cut out/down the junk food, more fruits/veg started tracking and monitoring calories/nutrition, etc.); kept tweaking and trying different things and lost a bit more here and there, but overall simply maintained that original 50lb loss and fundamentally worked into a WLS maintenance life along with my wife (but without the WLS on my side.) Maintained that state for 5-6 years, not comfortable with the DS if I could maintain what I had lost, so was in a holding pattern until finding that the VSG was then being covered by insurance, so went ahead with it. Four and a half years out on it and so far, so good.

To the random thoughts:

supplements, Vitamins, etc. - you should be taking some with any procedure, or even no WLS at all given the state of our food chain, so at least a Multivitamin and probably more as we age. Calcium is likely with the sleeve just from our overall lower intake of food - I take one dose a day to keep my total intake including food in the 1500-2000 range, so that is no great inconvenience (I take it with my normal evening pills.) The DS will typically require more due to the malabsorption: Iron will probably need to be supplemented with the DS and the other "typical" DS supplement is an ADEKs tablet (for the fat soluble Vitamins A,E,D &K in a "dry" or Water soluble form as the normal fat soluble forms are not well absorbed due to the fat malabsorption of the DS) or some subset of that group depending upon your labs.

Supplementation with the DS is moderately more complex (or PITA) than with the sleeve, but periodic (annual typically) lab testing is critical as things can skew out control much more easily if not watched.

Most of the DSers that I know are healthier than the general population, in good part because they become amateur nutritionists and are much more aware of their body's needs than average people (and often better than their family doctors - some keep spreadsheets of their lab results to watch trends more closely than their PCP.)

One of the common problems with the sleeve is the prospect of reflux or GERD - it's a function of a small stomach with potential acid production that is not proportionately reduced along with the stomach size coupled with the pyloric valve closing things off at the bottom. PPI medications like Prilosec or Nexium usually keep things in check, but are not desirable long term as they can impair absorption of minerals like Calcium and Iron (so there is potential malabsorption there without the intestinal work.) The DS is less prone to this problem as they typically use a larger sleeve with the DS (though some surgeons these days like to use smaller, VSG sized sleeves with their DS's). This is a point to ponder when considering the "VSG and revise to the DS if I need to" approach. This is a subject to discuss with your surgeon.

When we were first getting into the DS world 10-12 years ago, our doc's figures for needed revisions was around 5%, roughly split between adjustments needed for inadequate weight loss and those needed for excessive weight loss that couldn't be resolved with diet and enzyme supplements; since then, the DS world has gotten much better a tailoring the DS for individual needs rather than the one-size-fits-all that it used to be, so the uncontrolled losers are much less common now.

I understand your surgeon's concerns about metabolic issues stemming from your previous loss/regain history - yoyo dieting can really screw up our metabolism (though if it was only one cycle as you indicate, it may not be as big a deal as those who have been serial yoyo dieters.) Have you, or are you now, tracking your intake with My Fitness Pal or some similar app or program? Tracking, beyond being a good tool for controlling our weight and understanding our dietary needs, is one of the best means of getting a handle on your metabolic rate (given that the calculators are useless, most particularly for us fatties/former fatties, and even the active VOx tests are suspect for us.) If you have decent idea of where your metabolism is, that is a good guide toward deciding on a procedure. For instance, if you are keeping yourself under 2000 calories (as a guy) and still gaining, then a DS is a good bet as it will allow your long term diet to be more "normal" and easier to maintain. With a sleeve, you would likely be maintaining in the 1200 or so calorie range which is hard for most guys to stick with long term. OTH, if you are stable in the mid to upper 2000's, then a sleeve can be a good fit. Before surgery, I was maintaining my weight in the 26-2800 calorie range, and now do so in the 2000-2200 range (it just takes less energy to move <200lb around than it does 300+.)

The prospect of doing a DS as a back-up if the VSG is a tricky one. Beyond what I mentioned above about the prospect of using a larger sleeve with a "virgin" DS, there are some other considerations or risks that I discussed with the doc. It is generally considered that a virgin DS works better than a 2 step or revision DS. Like your doc, his experience has been that the second stage should come fairly soon after the first, but certainly before any significant regain occurs - it works much better to allow the "switch" part do mostly the maintenance job rather than depending upon it to get significant weight off. So, if one is starting to lose control and regain, when does one pull the trigger - 10lb up? 20? 30?... Adding to the conundrum is that insurance typically doesn't cover the revision unless one has regained back up to the normal 35-40 BMI level, which reduces the effectiveness of the revision. In my case, with the weight stability that I had been experiencing, I thought it was worth the risk. YMMV

I'm sure there are more points I can think of, but this is enough bytes for now (and it's time to get the steaks on the fire,) but good luck with the decision and hopefully I have not obfuscated things too much.

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Ask your doctor about the SIPS version of the DS. It's a modified DS: less risky, easier for the surgeon to perform with less malnutrition.

http://www.medpagetoday.com/Endocrinology/Obesity/48868

http://www.bariatricpal.com/topic/338199-sips-stomach-intestinal-pylorus-sparing/

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A few random thoughts on the DS vs. VSG, but first my relevant background - my wife and I have been in this game for about twelve years now, from when we first went to one of the support group/seminars and started the common insurance mandated six month diet/exercise roadblock to approval deal. It took us close to two years to get her on the table after the serial insurance denials (DS was still "investigational/experimental" then) and getting our ducks in a row to self pay the job. Her history since has been boringly normal, losing 200+ (350 into the 140s) and regaining about 20 from her (too) low - not uncommon to overshoot the mark some with any of these procedures.

In the meantime, I lost about 50 over that first 6-8 months or so from basic diet clean-up (wanted it to be sustainable, no fad diets, just what I could change a do for the long term - cut out/down the junk food, more fruits/veg started tracking and monitoring calories/nutrition, etc.); kept tweaking and trying different things and lost a bit more here and there, but overall simply maintained that original 50lb loss and fundamentally worked into a WLS maintenance life along with my wife (but without the WLS on my side.) Maintained that state for 5-6 years, not comfortable with the DS if I could maintain what I had lost, so was in a holding pattern until finding that the VSG was then being covered by insurance, so went ahead with it. Four and a half years out on it and so far, so good.

To the random thoughts:

supplements, Vitamins, etc. - you should be taking some with any procedure, or even no WLS at all given the state of our food chain, so at least a multivitamin and probably more as we age. Calcium is likely with the sleeve just from our overall lower intake of food - I take one dose a day to keep my total intake including food in the 1500-2000 range, so that is no great inconvenience (I take it with my normal evening pills.) The DS will typically require more due to the malabsorption: Iron will probably need to be supplemented with the DS and the other "typical" DS supplement is an ADEKs tablet (for the fat soluble Vitamins A,E,D &K in a "dry" or Water soluble form as the normal fat soluble forms are not well absorbed due to the fat malabsorption of the DS) or some subset of that group depending upon your labs.

Supplementation with the DS is moderately more complex (or PITA) than with the sleeve, but periodic (annual typically) lab testing is critical as things can skew out control much more easily if not watched.

Most of the DSers that I know are healthier than the general population, in good part because they become amateur nutritionists and are much more aware of their body's needs than average people (and often better than their family doctors - some keep spreadsheets of their lab results to watch trends more closely than their PCP.)

One of the common problems with the sleeve is the prospect of reflux or GERD - it's a function of a small stomach with potential acid production that is not proportionately reduced along with the stomach size coupled with the pyloric valve closing things off at the bottom. PPI medications like Prilosec or Nexium usually keep things in check, but are not desirable long term as they can impair absorption of minerals like calcium and Iron (so there is potential malabsorption there without the intestinal work.) The DS is less prone to this problem as they typically use a larger sleeve with the DS (though some surgeons these days like to use smaller, VSG sized sleeves with their DS's). This is a point to ponder when considering the "VSG and revise to the DS if I need to" approach. This is a subject to discuss with your surgeon.

When we were first getting into the DS world 10-12 years ago, our doc's figures for needed revisions was around 5%, roughly split between adjustments needed for inadequate weight loss and those needed for excessive weight loss that couldn't be resolved with diet and enzyme supplements; since then, the DS world has gotten much better a tailoring the DS for individual needs rather than the one-size-fits-all that it used to be, so the uncontrolled losers are much less common now.

I understand your surgeon's concerns about metabolic issues stemming from your previous loss/regain history - yoyo dieting can really screw up our metabolism (though if it was only one cycle as you indicate, it may not be as big a deal as those who have been serial yoyo dieters.) Have you, or are you now, tracking your intake with My Fitness Pal or some similar app or program? Tracking, beyond being a good tool for controlling our weight and understanding our dietary needs, is one of the best means of getting a handle on your metabolic rate (given that the calculators are useless, most particularly for us fatties/former fatties, and even the active VOx tests are suspect for us.) If you have decent idea of where your metabolism is, that is a good guide toward deciding on a procedure. For instance, if you are keeping yourself under 2000 calories (as a guy) and still gaining, then a DS is a good bet as it will allow your long term diet to be more "normal" and easier to maintain. With a sleeve, you would likely be maintaining in the 1200 or so calorie range which is hard for most guys to stick with long term. OTH, if you are stable in the mid to upper 2000's, then a sleeve can be a good fit. Before surgery, I was maintaining my weight in the 26-2800 calorie range, and now do so in the 2000-2200 range (it just takes less energy to move <200lb around than it does 300+.)

The prospect of doing a DS as a back-up if the VSG is a tricky one. Beyond what I mentioned above about the prospect of using a larger sleeve with a "virgin" DS, there are some other considerations or risks that I discussed with the doc. It is generally considered that a virgin DS works better than a 2 step or revision DS. Like your doc, his experience has been that the second stage should come fairly soon after the first, but certainly before any significant regain occurs - it works much better to allow the "switch" part do mostly the maintenance job rather than depending upon it to get significant weight off. So, if one is starting to lose control and regain, when does one pull the trigger - 10lb up? 20? 30?... Adding to the conundrum is that insurance typically doesn't cover the revision unless one has regained back up to the normal 35-40 BMI level, which reduces the effectiveness of the revision. In my case, with the weight stability that I had been experiencing, I thought it was worth the risk. YMMV

I'm sure there are more points I can think of, but this is enough bytes for now (and it's time to get the steaks on the fire,) but good luck with the decision and hopefully I have not obfuscated things too much.

What an AWESOME post by @@rickm . So, so thoughtful and full of good info for those choosing between VSG and DS surgeries.

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Thank you so much everyone for your opinions and advice! I decided on the sleeve and just scheduled my surgery date for March 1!

I think ultimately I chose to go with the less invasive surgery with lower long-term risks. While I was drawn to the DS due to bigger weight loss with better chance of long term success, I feel like with hard work and dedication I can be very successful with the sleeve as well.

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Can I ask why you did not consider the gastric bypass? Not sure how much you have to lose but you ultimately will have better success with the GB.

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Can I ask why you did not consider the gastric bypass? Not sure how much you have to lose but you ultimately will have better success with the GB.

Yeah ... no.

There's absolutely no research to base that categorical statement on.

None.

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Can I ask why you did not consider the gastric bypass? Not sure how much you have to lose but you ultimately will have better success with the GB.

Yeah ... no.

There's absolutely no research to base that categorical statement on.

None.

Yeah! I personally have had the sleeve and the gastric bypass so I speak from experience! I find that I have very different restriction and feelings towards food. Personally as I said with the sleeve it has less restriction from fats and sugars, this is well known as the GB does. With the sleeve I also could eat more food much sooner than I can now(I had a 36F)Personally I find this to be more effective to keeping weight off.

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Thx

I am having a revision done and looks like DS may be best option.

Right now I am just starting the process, so will look to the Dr. for best options.

I had Vertical banding 20 yrs. ago and went from 410 to 170 but started bouncing back within a couple years after that.

Since then, I have I bounced between 200 and 300 several times, never being able to keep it off without severe diet and exercise that I could not maintain.

Edited by RJC5197

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