In the beginning, I was sure I wanted the DS, but the more I learn the more confused to the point that I change my mind every few hours. The only procedure I’ve ruled out completely is LapBand. The others... the trade-offs are really glaring.
Here’s my situation: my insurance excludes all WLS (heck, any treatment for obesity whatsoever), and any complications arising from it. My mother has generously offered to pay for my bariatric surgery, but I am otherwise on a pretty tight budget always and doubt that will ever substantially change. So, here are my major constraints:
1) Whatever surgery is the only one I will ever get — there will be no revisions if I fail to lose enough weight on it
2) Any complications that arise, even something like a bowel obstruction years later, is totally on me
3) I don’t have a ton of money to spend out-of-pocket every month/year for uncovered lab work or vitamins
So far i’ve only had the seminar, first surgeon consult is on October 12. The nutritionist who led the seminar had indicated when I asked if labwork would be covered that there was a possibility they could cover it if coded properly because of my comorbidities (diabetes, hypertension, chronic kidney disease). But, there’s a possibility not. I also asked about how much vitamins run per month for DS, and she said around $25 (which would be doable) but I have since seen numbers around here MUCH higher than that which I could not manage.
So, I think, maybe VSG — less chance of major late whammy complications, lower amount of vitamins/labwork needed, etc. But the one long-term study I see (ten years) has average weight maintained on that just under 50%.
So, I think, cut the difference and go with GB — sure, bowel obstructions and so forth are still a risk, but less risk of malnutrition and slightly less intense vitamin schedule, but you still get a decent average maintained long-term, but not as good as DS, and heck, you still have a lot of risk
So, then I’m back at DS, thinking probabilities of late catastrophe still relatively low, and maybe labs will be covered, and maybe nutritionist was right and vitamins won’t be exorbitant. But maybe not. And then there’s the smell-factor...
...
So, I’m just hoping maybe you guys can give me some clarity and perspective on how realistic all these fears are, or am I just reading the internet too much and freaking myself out?

How severe is your diabetes, and do you have a history of GERD?

I really think you should put DS out of your mind. The DS requires huge amounts of protein and vitamins that could potentially cause problems with your compromised kidneys. The idea is you won't absorb all of it, but the management would be a nightmare.

At your weight, even maintaining 50% excess weight loss will get you into a much healthier range.

If you have a history of GERD, go with bypass.

If you don't, then if your diabetes is mild (controlled on 1 oral med), or very severe (you've had it a long time or need lots of insulin).. go with the sleeve.

If your diabetes is moderate, go with bypass.

My diabetes is mild and controlled with 500mg metformin bid. Likewise, kidney disease is mild (stage II) — creatinine levels had been higher early on, but last five years or so they’ve been hovering just above normal (1.1-1.2). I do have a hiatal hernia, but until this month had only gotten any noticeable reflux/heartburn after major overeating, so had only been treating it with occasional Tums. But, lately I’ve had a couple of heartburn episodes per week for no obvious cause, so have started taking omeprazole. My hope has been that whatever surgery I get, the surgeon can repair the hernia while he’s in there and that will likely either fix or at least improve the reflux, but if not there’s always omeprazole.

So, I guess that narrows it down to sleeve v bypass. Thanks!

If you have heartburn, I would rule out sleeve. It will most likely get worse and you'll need a revision to bypass, I wouldn't risk it.

Good luck with your decision.

My vitamins cost me about $60 a month. I had GB and I take Bariatric quality vitamins because I have read and been told that store brand vitamins are not absorbed well by GB patients. I use Nutrametrix/Isotonix powered multi-vitamins/calcium that I mix with water and drink in the morning and evening (additional calcium). I also take additional Iron via pill and also a B12 sublingual every other day. Your vitamin bill should be offset by your lowered grocery bill as you will be eating 1/3rd - 1/2 of what you ate previously.

This is a conversation you should be having with your surgeon. Go over the pros & cons for each given your medial situation and ask his/ her advice.
Regarding vitamins, you can spends as much as you want, and get the same results. I had RNY and take the exact same over the counter vitamins I did before surgery, only I take them twice a day. If you want to go fancy and buy custom blended liquids or patches or designer vitamins you can do that too, but your lab results won't be any better. ?

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I have diabetes (with multiple medications, including a lot of insulin), GERD, high blood pressure, high cholesterol, etc. I had the sleeve a month ago. I'm on half the insulin I was pre-op and have stopped one of the meds completely--blood glucose numbers are great. I controlled GERD pre-op by a medication and now I take a different med for it.

I buy regular vitamins, as I did pre-surgically. I haven't had post-op blood work so I don't know for sure that everything is being absorbed appropriately, but I'm definitely with you--I don't have extra money and I doubt I'm going to suddenly become financially secure or well-off in the future.

I'm hoping that I do better than the 50 percent of excess weight lost, but even at that I'd lose more than a hundred pounds. That's got to help my health issues!

I agree that you should discuss this with your surgeon. He or she may direct you one way or another with reasons that make sense. Whichever surgery you choose, you will almost certainly be better off after it than you are now. It's not easy, but I don't regret doing this for a minute.

Good luck!

Thanks so much for all the input. I do know I need to discuss this with the surgeon, but the two-month lead-time between making the appointment and it actually happening is more than enough for me to drive somewhat-anxious/obsessive self a bit nuts with all the info and possibilities.

I am glad to hear that the vitamins aren't necessarily as onerous as some people are spending. I was okay with the idea of daily vitamins until I saw the Vitalady site and related threads on this board and was like, "Whoa!" But if it's just a matter of one of the bariatric multivitamins plus a few odds and ends I can get at Walmart as needed, that's fine. I'm already chronically low on D3 and supplementing for that, so I imagine I'll have to up things even more on that end, but that's certainly do-able (especially if the bariatric formulations are better absorbed, and higher doses than my 1000mg bid schedule now).

I disagree with the others concerning the Vitamins. The Nutritionist associated with my Bariatric Surgical practice does not recommend taking over the counter vitamins. For normal people, only 50% of the stated values on the bottles are absorbed, meaning that 25% is absorbed for WLS patients. You would have to take 4x the amount stated on the bottle to get the listed values. Many don't have the levels of each vitamin we need so you have to take even more. Vitamin deficiency takes years to show up in blood work. Many patients suffer the consequences ten years down the road, not in one year. By the time a lab test shows deficiency, the health related effects of not getting enough are severe.

I'd rather head off any potential issues by taking vitamins formulated for bariatric patients and not those for the general public. Just my opinion.

I do see that, and the price you listed sounds reasonable. It’s the $125 a month I see bandied about that’s just... I just can’t do it.

I will follow my nutritionist’s advice. She seems to think the cost won’t be so bad. We’ll see.

I think you should devote time to researching both the sleeve and bypass.. but in your shoes I'd be leaning towards the sleeve plus hiatal hernia repair.

Either procedure can have complications early, but after the first couple months the sleeve's complication rates go down below those of the bypass. And, without the malabsorption component, the vitamins might be cheaper.

Obviously your doc may have a different take on things, so it's good to get comfortable with both ideas.

I also think that our health is more important than to even take a small chance that over the counter vitamins are enough!! My Surgeon said absolutely do not take them. Like was said above in order to have the bad stuff happen it takes years for it to show up. Now I went t my new BARIATRIC DR. and she said FLINTSTONES w/Iron is ok to just take 2 a day. I don't use them I don't want to take any chance of hurting myself in the long run. You can buy CELEBRATE BARIATRIC capsules online for $15.00. As for the Calcium, I do but the EQUATE brand, The others I take are the store brands. Please don't scrimp on your vitamins!!! It is a small price to pay for being healthy!!! Good Luck BTW if you drink pop cutting it out will help with buying your health. You will be eating way less and more than likely more beans etc. There some more cuts. I just don't want you to think it isn't important because it is the UPMOST important.

Oh yeah, I know it’s important. I had asked the nutritionist if the vitamins were available locally and she said no, special bariatric ones I’d have to order, so I have no doubt that will be the recommendation and I will go by what she says. But her estimated monthly price is just SO far off from Vitalady’s regimen it does really make me wonder what’s up.