Sleeve or Bypass? Lots of medical issues against each

[CyclicalLoser 155]

Hello everyone, I am moving along the process of my gastric bypass fairly well, no surgery date yet, but 2 months left of the classes and all I's will be dotted. I'm actually writing this for my wife.

My wife is going along the process with me, but she is about a month behind me. She has many issues, and we're trying to figure out the best surgery for her. In order to keep this post as short as possible, I will briefly summarize here:

• Early forties
• Beginning stages of abnormal menstration (irregular/delayed menses)
• Migraines, sometimes occular. She has tried Topamax, but it caused significant (permanent) Hair loss (Has been off it a year). It helped, but made her nauseous when she took it and became somewhat forgetful. The Triptains sometimes help, but sometimes are worse. The only thing that helps more than half the time is excedrin Migraine, which has an NSAID in it. She had them in 20's onwards, sometimes birth control helped, sometimes not. They seem to have gotten worse after the birth of our child. She no longer takes BC because it is not needed (I got a vasectomy).
• She also has GERD quite bad. Docs put her on protonix, but we are very concerned about the anticholinergic effects of PPIs (Alzheimers and Dementia) and so she grins and bears it using zantac (Still anticholinergic, but a lower amount) and tums. We have yet to try Pepcid AC, which is not anticholinergic.
• She has very bad knee and hip pain, and has restless leg syndrome
• She has a sweet tooth (Pastries being the worst). She is not a diabetic, but her fasting blood levels are over 100, so she is technically prediabetic. Her father has diabetes.
• She is a bit worried that after bypass, she will no longer be able to eat sweet foods at all. While it is certainly not a good idea (After all they got us here), for legitimately rare circumstances (Holidays and birthdays) can sugar-free items be consumed (ice cream/cake/pastries)?
• She has a slow metabolism, but didn't like how ill she felt on synthroid, so she stopped taking it.
• I think she has high testosterone and low estrogen, but I could be wrong, I can't remember the test results.
• She also has motion sickness pretty bad. I don't know if that is connected to the migraines, or if others that had it noticed it went away or got worse after WLS?

According to the surgeon, the bypass is the best cure for GERD in the world, because it is impossible to get it with no stomach acid. But, NSAIDS are a no-no. The Sleeve (I've read) allows for NSAIDS, but sometimes makes GERD even worse. Plue the Sleeve doesn't have a negative reinforcement of high carbs like the bypass does. In the information seminar, they mentioned that WLS sometimes reduces or cures migraines, so maybe that is a moot issue?

Between the two, I think the migraines are the more severe. She gets them several times a month, at least once to twice a week, and they are worse before/during/after menses. She has not tried botox injections (Botulism is not something we want to inject into our bodies), and she has not tried antidepressants or acupuncture. Antidepressants because of the weight gain, and the anticholinergic effects many of them have. (I take Luvox and Lamictal, but they are both very low).

I'm sure that others here have had similar NSAID/GERD & Bypass/Sleeve decisions, and I'm curious which direction you're going (or did go), why, and if you like or regret your decision. Diabetes runs rampant in my family, and because of that, I want the bypass, and I think that is the best way for her as well (Get rid of the GERD and the Pre-Diabetes, and likely lose the most weight helping the sore knees/hips), but I want to cry (And I'm a guy) when I see her constantly suffering with the migraines.

My wife and I thank you very much for any advice you have. God bless you all!

[KimTriesRNY 1,853]

No matter which is chosen, the surgeon is going to recommend a low carb way of eating. When you can only eat a small amount of food, the food you are eating needs to be nutritious. I would not disregard getting a bypass in order to avoid dumping syndrome, I have seen some sleevers on here speak of getting dumping and some ppl that have bypass don’t get dumping.

In my surgeons booklet I had a whole list of meds I was never to take again. NSAIDs were listed so that’s a no go.

Most people that have GERD end up with a bypass it seems or if they develop GERD post sleeve I have seen in here where they had to be revised to bypass afterwards.

True hypothyroidism is so much more than a “slow metabolism” and affects multiple systems of the body if left untreated. If thyroid labs are out of whack and the patient has a history, insurance can even require that the labs be normal prior to surgery. This was true with my insurance.

Good luck to you both with whatever you decide!

[Introversion 1,876]

Only a very small percentage of bypass patients and sleeve patients experience dumping:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4875983/

If your wife opts for a bypass, there's no guarantee that she'll experience adverse reactions to ingested sweets and simple carbs.

If your wife cannot control her sweet tooth, she might need to abstain from simple sugars regardless of the bariatric procedure she chooses to undergo,

[PrayingForWeightLoss 337]

Her taste might change too. After going through the preop sleeve and post op diets, I tried to eat something sweet 2 months post op and I couldn't get past the taste. It was overwhelmingly sweet and had to spit it out. I no longer enjoy sweets. That could happen to her. However, if that doesn't happen, she might need to work on the cravings and appreciate the benefits of the surgery with regards to her overall wellbeing. Most of us here have had to let go of our past comfort foods. It is not easy but doable. Good luck on your surgeries.

[Creekimp13 5,838]

No NSAIDS after sleeve, either. Certainly not as often as your wife takes them. (I've heard once in a long while you can safely take a dose or two if you take an antacid before...but NSAIDS are not a maintenance med after sleeve...please talk to a surgeon about this specifically)

Both procedures will likely resolve pre-diabetes.

While you don't typically get true dumping syndrome with sleeve......If I eat too much refined sugar after sleeve, I get a little nauseated. One or two bites of a dessert and I'm ok, but if I eat a whole cookie, I feel gross and need to sit and drink some Water for 20 minutes. This is all pretty individual. Anything sweetened with Splenda doesn't cause me any issues.

Best wishes, and good luck.

Edited January 20, 2018 by Creekimp13

[CyclicalLoser 155]

Thank you all for your replies. We both know our addictions or overeating of poor carb-laden foods is what got us here. My mother told me she thought there was no NSAIDS witht he sleeve either, but she wasn't sure because she hasn't been able to take them for a long time because she has kidney disease.

The comment about everybody being different is also what our surgeon told us. He said some people can't eat red meat ever again, while other's it's something else, yet other people tolerate everything fine.

Our biggest concern was which procedure is best as far as (my incorrect thought) that NSAIDS were okay with the sleeve (For her Migraines) vs. solving the GERD with the bypass. I don't know why I didn't think about this, but I have a lap band right now, and I know I'm not allowed to have NSAIDS either.

Thank you all again, I really appreciate it!

[RickM 1,747]

This is a tough decision and one that needs a lot of back and forth with the docs - medical care is often a game of compromises and trade offs. WLS is not an ideal thing, either, but it beats the alternative of a remaining life of obesity and its complications. You certainly seem to recognize the conflicts involved and sometimes we end up having to choose the "least worst" case.

On dumping, I've see numbers of somewhere around 30% of RNY patients dump, and there are indications that the figure probably improves some over time after surgery. Our luck would usually be that if you want dumping as an aversion therapy, you won't dump! Dumping can hit VSG patients or even non-WLS people, but it is much more rare. Since dumping if basically from the rapid introduction of the sugars (and some fats) into the intestines without things being slowed down by the stomach and pyloric valve, non-RNY people can get it if they introduce simple sugars, particularly liquids, that don't trigger the pyloric valve to close. Early on, if I ate a small piece of chocolate on an empty stomach, I would get a quick "I shouldn't have done that..." feeling, that would pass just as quickly. Call it "dumping lite". With a normal sized stomach, things would be slowed down a bit more than with the small sleeved stomach.

A bit of history on the NSAID thing. The bypass has a weakness at the anastomosis between the stomach pouch and the intestines. Unlike the duodenum (the part of the small intestines immediately below the stomach, which gets bypassed along with most of the stomach in the RNY,) the part of the small intestine where the new pouch joins it is not resistant to stomach acid, so that joint is very sensitive and prone to ulcers, so you treat it very gently and stay away from any meds that induce stomach irritation, such as NSAIDs. When the Duodenal Switch came along, one of its big selling points was that it could tolerate NSAIDs better than the RNY. As the DS is based upon the sleeve, the VSG carries this same basic advantage.

In parallel, over the past 25 years or so, as NSAIDs came off of prescription and into wider use on the OTC market, some problems have been noted within the general population, regarding stomach upset and liver issues with consistent long term use, so most docs have become more cautious in their use overall. In the bariatric world, which has been dominated by the RNY for much of the past 40 years, NSAID aversion has become pretty standard for bariatrics, despite there being some differences in sensitivity between the different procedures. The DS has been performed by a small minority of surgeons (who also originated the VSG as a stand alone procedure) and the VSG is fairly new on the scene for most surgeons, so the NSAID aversion has remained prominent in the business overall. As more surgeons get more comfortable with the VSG, more are recognizing the differences and are more accepting of at least limited NSAID use where appropriate with their VSG patients.

From our online population, you will see people who have been instructed to avoid NSAIDs at all costs for all procedures with others who have been given fairly liberal instructions on their use (our doc is fine with them as soon as narcotic pain relievers are no longer appropriate, but that comes from a primarily DS practice that is experienced with them.) Many docs will be accepting of them after some months of healing, and often advise using a PPI along with them. Best answer - talk it over with your surgeon as he is running your show for you.

[naturallyzee 292]

Only a very small percentage of bypass patients and sleeve patients experience dumping:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4875983/
If your wife opts for a bypass, there's no guarantee that she'll experience adverse reactions to ingested sweets and simple carbs.
If your wife cannot control her sweet tooth, she might need to abstain from simple sugars regardless of the bariatric procedure she chooses to undergo,

I am one of those that do not dump. I have tried sweets one or twice. I no longer have the desire for sweets.


HW 330
SW 292
CW 185
GW below 200

[CyclicalLoser 155]

Thank you RickM. That makes sense on a number of levels. If the most vulnerable procedure cannot tolerate NSAIDS, it is easier to tell all patients to avoid them, and I think most would agree that not taking them (As painful as it may be) is the healthiest option.

I have spinal stenosis (L4-S1) and two bulges. Ironically, I got them when I weighed about 170 pounds after a very OCD-like dieting "binge". When it flares up, I can't walk - it's that bad. So the tylenol bottle and I are unfortunately good friends. I've found help with TENS devices, antidepressants, bio-freeze, and ironically sleeping less than 8 hours, but even so, sometimes I grab the Tylenol because nothing else is helping. I don't like the idea of narcodic pain relievers (Some of which contain tylenol anyway) which is why I try to grin and bear it.

My wife is already compiling her list for the surgeon. I think in the mean time, we may look into the acupuncture to see if it helps. If it does, then it makes the decision easier. Thankfully, I am in CA, where I believe acupuncture is fairly prevalent.

Thank you as well for the anatomical/vulnerability information. A while back I discovered the DS because I was wondering if there was a way to kind-of combine the two in order to keep the pyloric valve. Our surgeon doesn't do it, but from what I've read, it is reserved for higher BMI's than my 43.

[naturallyzee 292]

I suffered from basically all of the symptoms your wife has. Probably a few more. I had gastric bypass March 8, 2017. My tastes be have completely changed. I no longer have the desire for sweets, breads, or many other carbs. My husband also had a vasectomy. I'm 42 but I still take birth control pills because of the benefits. I was on 2 shots and 4 pills na day for diabetes. I no longer take them. I tried protonix and other meds for gerd. I ended up taking 40 mg of Omeprazole. As of a few months ago I no longer need them. I tried Treximet and Imitrex for Migraines. I still have them occasionally but not nearly as bad. I take Excedrin Migraine to help with that. This surgery has basically changed my life. My symptoms are about 95% improved. Even the knee pain is significantly better. I still have a little pain but nothing like it was. I know it's arthritis that stemmed from years of weighing 300 pounds. After years of hurting literally all over I feel gastric bypass has given me my life back. I'm able to do things I haven't done since I was a teenager. I can walk for miles and not skip a beat. I forgot this part. My a1c went from 10+ sometimes to 4.8 at my last visit.

HW 330
SW 292
CW 185
GW below 200

[angyplus5 470]

Being able to take NSAIDS is why I'm having the DS. I have Rheumatoid arthritis and I have to be able to take anti inflammatory drugs. Maybe this is an option?

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[CyclicalLoser 155]

Our surgeon doesn't perform the DS, but maybe I will have my wife talk to him about it nonetheless. I am so sorry to hear about your RA, my grandmother-in-law has it, and I know first hand how much it affects her quality of life. For a while, she found relief with remicade, if that helps at all. It is extremely expensive and I think is delivered with an IV.

Hopefully, the weight loss might help relieve the stress on some of the joints. I've also been reading up on C-Reactive Protein (Mine is quite high) and it's effects (Inflammation). I remember reading elsewhere that white adipose tissue markedly increases inflammation, so hopefully that will help as well. I have Eczema which is also an inflammation/immune system issue, and I am really hoping the weight loss will reduce or eliminate it.