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Just had The Talk with my doctor..



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I had a doctor's appointment today. I just had my first serious talk with a doctor about considering bariatric surgery. She sent a referral for a specialist so I haven't even had my first intake yet. I will ask her all the questions when I meet her but for now, I can't stop thinking about how big of a life change that would be, and the idea is kind of terrifying at the moment. I'm most interested in the sleeve.

A bit about me, I have PCOS, will likely get a hysterectomy, and am around 400lb. If you have experience with these things and have a sleeve I'd love to hear more.

What made you choose the sleeve? What are your top pros and cons?

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I'm a little different because I had the bypass (8.5 years ago), but I started out at almost 400 lbs, so weight-wise, we were in similar starting positions. The first year seems like a huge life change, but sitting here years out, the only thing that's different is that I average about 1600 calories a day rather than 3000+. When I go out to eat, I eat maybe half the entree and take the rest home in a to-go box (or sometimes I'll get something like an appetizer or Soup rather than an entree if I'm not that hungry). Other than that...??? Oh - I take Vitamins regularly now. But other than that, not that much different. But again, the first year or so - yes. But you'll be doing quite a bit of prep work before that. For example, my insurance required me to do a six-month diet with a registered dietitian, and she kind of eased me into the type of diet I'd be following after surgery. She had me eating 2300 kcal/cay (which now would seem like a ton - like Thanksgiving day - but at the time seemed like a diet - although enough calories to be at least tolerable). She also had me gradually decrease my carb intake and increase my Protein intake. I focused on healthy foods (although I ate a pretty healthy diet even BEFORE surgery, I just ate way too much). She had me start taking a Multivitamin every day and getting some exercise about 3x a week. My surgeon also didn't want us drinking caffeinated beverages for the first six months after surgery (although some surgeons are fine with caffeine), so she also had me gradually decrease my caffeine intake. So basically, I was as prepared as I could be before they rolled me into surgery.

I don't have PCOS and have never had a hysterectomy, so I can't address that, but I know WLS patients who've had both. Hopefully someone will respond to you on that.

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I will be having gastric bypass done at the end of this month, but when I was trying to decide between sleeve or bypass, one of the resources I used was this risk calculator. In addition to risks, it lets you select your own co-morbidities such as sleep apnea, hypertension, or diabetes to see how likely it is that they will resolve based on which procedure you choose, and shows you a BMI predictor chart at the 12-month mark. I found it pretty helpful. Additionally, I found this video super informative:

The factors that I considered most were GERD risk and the desire to control my blood sugar and blood pressure, as well as feeling like I could benefit from the threat of dumping if I ate too much fat or sugar, my weaknesses! It definitely took me several weeks to decide as I weighed it all.

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I have had both sleeve and then a bypass revision. I had to get revised because of GERD due to the sleeve. If you've had any type of gerd in the past, go bypass instead and save yourself years of pain and suffering.

Both are life changing as in you lose weight, and it stops you from binging, but other than that, once you are are completely healed, I don't really see it being any different than living as a thin person. You still have to watch your weight, watch the things that you eat for health purposes. Be aware that one can eat around the sleeve. You can't eat around the bypass though. I think the only thing that is different than life pre-surgeries is that I have to use a daily Multivitamin patch (so I don't have to deal with a lot of pills). I added one chewable adek after I had the bypass.

If I had to do it over again I would skip the sleeve. At the time, I was afraid of the bypass. I got severe gerd from the sleeve but please know that not everybody gets gerd from the sleeve. Now I realize that having a bypass was absolutely nothing for me to be afraid of. It's been a problem/side affect-free experience. It resolved all my problems I had with my sleeve.

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I've had the DS. I'm about a month post op and my highest weight was 320. At your starting weight I'd really consider the DS for its better weight loss and lack of regain, or go bypass if you have a lot of GERD issues. I have some GERD issues but it is controlled by medication pretty well and I needed the DS because I'm diabetic with high blood pressure, high cholesterol, sleep apnea. I had a hysterectomy for cancer.

All in all so far it is worth it! I'm down 30+ lbs from my highest weight, off all diabetes medications, off blood pressure medications, my blood sugar is normal, my BP is normal, and I have more energy! I'm really glad I went with the DS. Its a riskier surgery but only by a bit, and the things you gain from it like disease remission made it very much worth it for me. I'd encourage you to read about ALL the various surgeries and then discuss it with your surgeon. They'll be able to tell you what will be most effective for your individual case based on their experiences. If you can, go to someone who can perform any of the surgeries, only certain surgeons can do the DS or Bypass.

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I had the sleeve and the revision to bypass. I had to have the revision due to so many complications that came about because of the sleeve. I started off at 421 pounds, and I am also having a hysterectomy (mine is March 6th). And I have PCOS. If it were me, I would choose a bypass over the sleeve. My one real regret is that I didn't just do the bypass to begin with. Recovery was way better and easier, so much less pain, all around better experience.

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I had PCOS for decades which involved several surgeries; I eventually had a hysterectomy. I chose the sleeve and due to the amount of adhesions I have from previous abdominal surgeries the bypass is not feasible.

That being said, I would probably have chosen the sleeve over the bypass anyway.

Edited by CelticSoul
misspelling

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Birth control pills and eventually menopause took care of the PCOS for me. I went into Vitamin and weightlifting mode in my 30’s to also manage symptoms and preserve child bearing abilities, and that was somewhat successful for me (I did have one child, yeah!) Others definitely have more serious issues and other solutions so there is only encouragement for you to live your best life.

I was very undecided about sleeve or bypass but further testing in me confirmed severe GERD. Bypass was the only solution my insurance would cover. In a perfect world I would have chosen DS or mini bypass as a more reliable alternative for more permanent weight loss. I still keep an eye on how my clothes feel, and how my skin looks. I do not lift weights with the vigilance I used to, just a couple days a week to beat age related decomp. I still track Vitamins because it’s easy to forget Iron or the B’s, or Proteins, then my hair falls out (not again!). I think of the changes and tracking I would have to do as a full blown diabetic verses now, and I chose the surgery and health every day. I am so grateful for bypass every, single, day! 2+ years now

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I just made an account to answer this. I am two and a half weeks post op from gastric sleeve. I too have PCOS. I am 37 years old and my highest weight was 330. At surgery and after the pre-op diet I was down to 305. I'm currently 289 today. My comorbidities were hypertension, high cholesterol, newly onset GERD, and insulin resistance. (never made it into the diabetic range).

I watched a ton of videos on youtube after I decided to have surgery. I watched the testimony of patients ranging from a few weeks out to twenty years. I also listened to bariatric surgeons discuss the process, pitfalls, and successes.

My PCP had been talking to me about this surgery for three years and at first I declined because of all the people I knew of that experienced full weight regain. I only decided to have the surgery when I had determined that not being able to eat as much and what I want all the time was a small price to pay for my health and quality of life.

Some things to consider between sleeve and bypass. Myth: Bypass patients are much more successful at keeping weight off. The sleeve is a newer surgery and was discovered as the first part of the duodenal switch. The 5 and 10 year outcomes for weight loss and regain tend to be around the same with the bypass slightly better.

The sleeve is less punishing and is easier to 'stretch' out with poor eating habits but it can be done with the bypass as well. Overall, a change in relationship with food is a higher predictor of sustained weight loss than either surgery. The Switch is the surgery with the most rapid weight loss and sustained loss without regain but it is a heavily malabsorption procedure, carries the most risk of post operative complications, including dehydration and Vitamin deficiency and requires a very strict regiment to sustain a healthy lifestyle. It can also result in some interesting bowel changes. Too rapid weightloss can also result in gallstones. Quite a few bariatric patients have had gallbladder removal after surgery. It should be noted that actual operative complications are low for all surgeries but not zero.

Another controversial topic of sleeve vs gastric bypass is that the bypass is better for GERD. There are contradicting experiences for both surgeries. One thing is for sure you can certainly still have GERD with the bypass, although it seems revision from sleeve to bypass has worked to cure GERD for a lot of people. My GERD was very mild before surgery and so far I have not experienced any after. I am on a daily dosage of omerprazole but that's nothing new to what I was taking before. My triggers for GERD were fried foods and canned tomatoes. I know to stay away from that now.

Keep in mind that the bypass is reversible in most cases while the sleeve is not. Also, the sleeve can be converted into a bypass or switch if complications arise or you fail to lose or sustain a meaningful amount of weight. There are very few options for bypass and switch if regain occurs outside of dietary changes, exercise and will power.

Bypass patients can no longer consume NSAIDS, steriods, and possibly other medications after surgery for life.

Switch and Bypass patients are more likely to experience dumping syndrome but Sleeve patients can also suffer from it.

Constipation, diarrhea, and blockages and strictures can occur with all surgeries. Very minimal risk for long term serious complications.

I have read quite a few posts that spoke about pain after surgery with the sleeve. Speaking for myself the only pain I experienced was gas after surgery from the surgeon introducing it into my abdomen during the procedure. I was given liquid pain meds but never took any, and no otc pains meds either. I felt discomfort from the surgery port sites for maybe a week. After that I was good.

My surgery team has stayed on top of any side effects that could occur after surgery and I was very lucky. They gave me medicine for nausea before surgery, put an anti-nausea patch behind my ear also before surgery and discharged me with anti-nausea dissolveable meds. I took the meds for about a week though I never experience sickness and still luckily have not. I was a Water drinker before surgery and can still easily drink water without any pain or nausea. Cold or hot temps don't seem to upset my stomach though some have reported either can cause pain. I am on the puree stage and things are going well.

Really, experiences vary. I'd choose a doctor carefully and if possible speak to prior patients to get their experience pre and post op. I was lucky my Aunt had the procedure done the year before and could report on her experience. We chose the same surgeon. He had a 98% success rate.

So after this long-winded wall of text I choose a sleeve because:

I wanted a slower and steady weight loss.

I did not want to re-route my insides. Had a co-worker suffer a bad bowel blockage with a bypass and had to have part of his intestine cut out.

I did not want restrictions on not being able to take certain pain or treatment options should they become necessary in the future.

I did not feel I have a dependent relationship with food. I ate too much of it. And sometimes the wrong things because they were easy and accessible. But I also enjoyed a lot of healthy foods. My kryptonite has always been lack of exercise and even skipping meals so that I overate when I did eat. I'm from the finish your plate generation, but I did not and do not rely on food for comfort, bordem or pleasure. Therefore, I felt and still feel that the more punishing procedures were not right for me.

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Just wanted to follow up on a few things from the post above:


1. DS patients do not typically experience dumping syndrome. We maintain our pylorus valve during the sleeve part of the surgery, so we dump at the same rate as the non-surgical population.

2. Bypass patients have about a 30% chance of dumping, lower if they avoid the food behaviors that trigger it. For all but a few it is a manageable phenomenon.

3. Diabetes goes into remission MUCH more frequently with Bypass and DS patients because of the alterations to the small intestines. As do most other co-morbidities.

4. I don't personally view my DS surgery as "punishing". My body has done nothing wrong. I feel no need to punish it. I personally don't have emotional eating issues but I don't judge those that do, nor do I think it is a reason to punish the body... Having my small intestines rerouted was not a punishment. It was a BLESSING! My fasting blood sugars normalized within 24 hours of surgery. So did my high blood pressure. I'm not on medication for either one. I'm currently 7 weeks post op. I consider remission of those two conditions to be a modern medical miracle... I didn't choose the DS to be harsh to my body. I picked it because it had the best chance of restoring my health and keeping the weight off long term. My surgeon put it best "You have a metabolic disorder. You need a metabolically potent surgery. The DS is the most potent one available..."

My bowels habits have changed, but nothing unmanageable. I have to watch my carbs, that's no different than before surgery. I no longer have to count calories because I malabsorb a portion of them. I'm at risk of Vitamin deficiencies if I don't take my Vitamins, that to me is no different than risking a blood sugar or blood pressure emergency from not regularly taking my meds pre-surgery. Nothing about this process is free. There are always trade offs. Any GI issues that occur with the DS can also happen with Bypass, including vitamin and Protein deficiencies. But protein and vitamin deficiencies are also possible with sleeve patients. They may happen at different rates, but they are unusual across the board. As are serious complications. Gallbladder failure can happen with ANY surgery. It is caused by the rapid weight loss and low fat diet many adhere to post surgery. It is not unique to the DS or Bypass.

I don't think DS and Bypass patients are choosing to punish themselves because they pick these surgeries. They pick these surgeries because of their own individual medical challenges and what they need out of their surgery. Most of us are working to heal various dysfunctional relationships with our bodies, or with food, or both. None of us are exempt from that. These surgeries are ALL support tools, not a punishment for past misdeeds.

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On 12/22/2023 at 12:12 AM, ChunkCat said:

Just wanted to follow up on a few things from the post above:


1. DS patients do not typically experience dumping syndrome. We maintain our pylorus valve during the sleeve part of the surgery, so we dump at the same rate as the non-surgical population.

2. Bypass patients have about a 30% chance of dumping, lower if they avoid the food behaviors that trigger it. For all but a few it is a manageable phenomenon.

3. Diabetes goes into remission MUCH more frequently with Bypass and DS patients because of the alterations to the small intestines. As do most other co-morbidities.

4. I don't personally view my DS surgery as "punishing". My body has done nothing wrong. I feel no need to punish it. I personally don't have emotional eating issues but I don't judge those that do, nor do I think it is a reason to punish the body... Having my small intestines rerouted was not a punishment. It was a BLESSING! My fasting blood sugars normalized within 24 hours of surgery. So did my high blood pressure. I'm not on medication for either one. I'm currently 7 weeks post op. I consider remission of those two conditions to be a modern medical miracle... I didn't choose the DS to be harsh to my body. I picked it because it had the best chance of restoring my health and keeping the weight off long term. My surgeon put it best "You have a metabolic disorder. You need a metabolically potent surgery. The DS is the most potent one available..."

My bowels habits have changed, but nothing unmanageable. I have to watch my carbs, that's no different than before surgery. I no longer have to count calories because I malabsorb a portion of them. I'm at risk of Vitamin deficiencies if I don't take my Vitamins, that to me is no different than risking a blood sugar or blood pressure emergency from not regularly taking my meds pre-surgery. Nothing about this process is free. There are always trade offs. Any GI issues that occur with the DS can also happen with Bypass, including Vitamin and Protein deficiencies. But Protein and vitamin deficiencies are also possible with sleeve patients. They may happen at different rates, but they are unusual across the board. As are serious complications. Gallbladder failure can happen with ANY surgery. It is caused by the rapid weight loss and low fat diet many adhere to post surgery. It is not unique to the DS or Bypass.

I don't think DS and Bypass patients are choosing to punish themselves because they pick these surgeries. They pick these surgeries because of their own individual medical challenges and what they need out of their surgery. Most of us are working to heal various dysfunctional relationships with our bodies, or with food, or both. None of us are exempt from that. These surgeries are ALL support tools, not a punishment for past misdeeds.

There is a lot of conflicting information out there so I'm not going to argue. Even different surgeons say different things. I will say that all bariatric surgeries altogether have a high chance of reversing diabetes. I have not heard of anyone that still has type two diabetes after the sleeve unless they regained their weight.

Maybe the 'punishing' term rang bad to you, but what I meant was consequences for carb dumping and overeating are usually more severe for DS and Bypass patients. So maybe punishing was not the correct term. I'm sorry you saw it as being negative for those with bypass/switch but that was not my intention. But I do view throwing up, foaming at the mouth, dumping, and general malaise as punishing. No one enters into these surgeries to feel that way but keeping bad habits does result in this outcome and I wouldn't call it a reward. It is a definitely and incentive for many not to eat badly.

I have even read on here and seen in other places where people felt they need something really restrictive to keep their diet in check. It happens with sleeves (not the foaming bit) too but you can usually get away with more. This is why the success rate with sleeve patients are slightly less.

Also you don't have to defend your choice in surgery to me or explain it. I am not saying any surgery is better or worse than the other. All surgery comes with risks and downsides. The original poster asked for the NEGATIVES and the positives for the different surgeries and I just told her what my surgeon, research, patients of all three surgeries have said, and some other bariatric surgeons I follow.

Also I never said sleeve patients couldn't suffer from vitamin deficiencies. I said it is more common (easier) with switch and bypass, which it is. Sleeve is not a malabsorption surgery. Vitamin deficiency also occurs in non-bariatric patients. A lot of people are suffering from Vitamin D deficiency right now who have never had surgery. I can point you to a bariatric surgeon who doesn't even believe that sleeve patients need as high as potency and 'bariatric vitamins' like bypass and switch patients but they set the standard and the industry is going with it.

Also, weightloss is more rapid for switch and bypass generally which is why gallbladder problems is more common but as always it doesn't HAVE to occur. Which I never indicated this was a one shoe fits all for anybody. It's a risk.

At the end of the day everyone must make their own decision on what is right for them. Be it sleeve, switch, or bypass. I commend anyone taking charge of their life and going through this difficult process to come out the other side happier and healthier.

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