I started the surgery process a couple months ago, and just had my second nutrition appointment....and now I'm getting very overwhelmed and having second thoughts. I have my psych appointment next week and my endoscopy in two weeks and I'm thinking about cancelling them cause I feel like this is really rushed and that this is such a big decision I should take some time to think it through and everything.

I'm very worried about possible complications and things going wrong. I have had GERD in the past (this was several years ago and I did weigh more then) and have been on pantoprazole for years. I am tapering off, so it might not be an issue, but my doc kinda pushes the sleeve and I'm worried about getting bad heartburn afterwards, even tho he said there's a 50/50 chance. I've read accounts of people getting crazy bad heartburn afterwards, or just being ravenously hungry all the time, which would be absolute torture for me. Also, I'm on depression, anxiety, and ADHD meds and I just learned about possible malabsorption issues, or even the difficulty of taking pills after surgery. I'm worried enough about remembering everything you're supposed to do post-surgery and not getting totally overwhelmed, it will pretty much be impossible if my depression gets worse....

I wish there were less permanent options available, the idea that you can't go back if anything goes wrong is terrifying....I know the chances of something going wrong are low, but I don't want to rush into anything and regret it afterwards.

There’s no rush. Maybe a Sadi might be a better option? Take your time.

I don't know much about that, is it different from the sleeve and the bypass?

Just take some time out. You are right not to procede if you feel rushed or feel your surgeon is not the one for you. You will know when its your time to do this.

If you have had GERD in the past then I think they recommend a Bypass. I ended up with Gerd after surgery. Its not a major issue if I eat early in the evening and avoid very spicy foods.

We all felt anxiety before this surgery because it is a leap into the unknown. The after surgery meds and routines do seem all to much to take in. After surgery it all becomes clear as you progress along the different stages what you need to be doing. It really is not something that you need to worry about.

There are people on this forum with your medications and have managed very well. If they are about they will chip in to reassure you.

What ever you decide this forum will help you any way it can, you will only find kindness here

I totally get it.

This is scary stuff and we humans are wired to not be very good at measuring TRUE risk. In other words, we can completely ignore the risks inherent in obesity since that's the norm for us, all the while overinflating the risks involved in bariatric surgery since that's unknown territory.

It's the same reason some people are deathly afraid of flying, all the while ignoring the fact that they are significantly more likely to die in a car crash.

I think at the end of the day, you have to do you. If you feel rushed, there's nothing wrong with taking longer to work your way through the process. That said, I don't think I'd advise cancelling the psych and endo appointments, since you can do those now and still put off or cancel your surgery. If you cancel those appointments and decide later you do want to go through with the surgery, you may have to restart the process.

In the interim, you might consider discussing these fears with your therapist?

I know you didn't ask, but I think you'll find that the vast majority of us that have that the surgery have no regrets at all. If anything, I personally wish I'd done it when I was much younger instead of wasting so many of my younger years living an unhealthy life.

I wanted to address the GERD fears as well.

Overall, I think the number of people that develop GERD after gastric sleeve is pretty low. That said, I personally am a bit concerned when you say your surgeon "pushes the sleeve". Any doctor that pushes one surgery over another is a bit of a red flag to me? I personally would want them to advise on what they think is best for ME, not what's best for them.

My surgeon felt like I was pretty likely to develop GERD if I did go with sleeve, so they advised against it due to what they saw on the endo. FWIW, I didn't even have a history of GERD. It might have helped that I went into the process with an open mind and not fixated on a specific surgery?

Lots of people are successful with sleeve surgery even if they have a history of GERD, but this was one I wasn't willing to risk personally. Knowing that bypass is often the revision surgery of choice for sleevers that do develop severe GERD, it made sense to me to avoid all that and go straight to bypass.

2 hours ago, learn2cook said:

Maybe a Sadi might be a better option?

Can you explain what you mean? I might be misunderstanding, but SADI has the same risks of GERD as Sleeve so I'm not getting why you'd suggest that? SADI also has greater issues with malabsorption than either sleeve or gastric bypass, so it seems like a poor choice on that front since the OP is also worried about malabsorption.

Keep in mind too that insurance almost never covers SADI.

Regarding malabsorption of gastric bypass, I find that most people contemplating surgery way overestimate the impact of this. In gastric bypass, only a small part of your small intestine is bypassed. Just from a nutrient absorption perspective, the amount of malabsorption is around 5 to 10%. That's really an oversimplification however, because different nutrients are absorbed differently across various parts of the small intestine.

I'm not an expert on depression meds, but if that's your major concern, it's entirely possible your current prescription might work just fine if you did end up having bypass surgery. I don't take any depression meds, but I do take a pretty high number of other medications and have not had to take MORE of any of those meds due to malabsorption. In fact, most of them I've had to reduce or stop entirely because I'm a healthier, smaller person than I was before.

Even if it did become an issue for you, I'm sure your doctors would be able to find the right combo of meds for you.

Regarding remembering to take vitamins, it's really not a big deal. Like anything, you get used to it over time and there are ways to remind you if you need those reminders.

there really isn't malabsorption at all with sleeve. There is with bypass - that's why we take more vitamins than sleevers. But the vitamin thing is really second nature after a while - you just go on autopilot.

major complications with either surgery are pretty rare. With sleeve, the most common one is GERD, but not everyone gets it, and for most who do get it, it can be controlled medically (e.g. pantaprazole, which you said you're already taking). Some people with severe GERD do revise to bypass, but it's not a huge percentage that have it that badly. But yes - it IS a potential issue. The most common issue with bypass (besides dumping, which about 30% of us deal with (I never have), but that can be controlled by not eating a bunch of sugar or fat at one sitting, which we shouldn't be doing anyway). The second most common is a stricture, but those are an easy fix. They just do an endoscopy and stretch it out. I had one. Happens to about 5% of us, according to the PA in my surgeon's office (if they're going to happen, it'll be within the first three months after surgery - it's very rare for them to occur after that).

if you need more time to think about this, though, then take it. It's a big decision. But as SpartanMaker said, you almost never hear anyone say they regretted it. The only regret most people have is that they didn't do it sooner. I had it at age 55. I wish now that I'd done it at least a decade earlier.

P.S. I had GERD prior to surgery, so I went with bypass. I know the chance of having it get worse (for those who already have GERD) with sleeve is only 30%, but I didn't want to risk it. Besides, sleeve was still pretty new when I had my surgery, and I was a little afraid of it turning into "lapband 2" - but it's been around long enough at this point that I wouldn't have had that particular worry. It works well and it's safe. But I still would have chosen bypass for myself because I was afraid I'd be one of those whose GERD would get worse.

Edited May 24, 20251 yr by catwoman7

I chose to go with the bypass due to the risk of GERD that I just hate. I have had no issues and I'm only 2 weeks out, never had any pain and just a bit tired following surgery but able to walk with no problems from the beginning of my new life. I must agree, I wish I did it long ago and not wait until now to have done it. I was on the verge of cancelling, but post op I have no hunger and the pounds are leaving quickly. I'm the lightest I have been in years and years and already feel better and I'm off all my diabetes medications. If you need extra support in your journey, I would recommending looking up some YouTube videos by BariNation, they have experts and experienced people with bariatiric patients and the mental part of decision making, it might be helpful. Wishing you well.

TBH, I'm in a similar boat, I meet with the surgeon next week for my second meeting with them. We'll discuss surgery types. In my hometown all the hospitals only do two (SG and RYGB). So I don't really have a choice unless I got to hospitals out of state, and I'm concerned about getting medical care if I have complications and have to drive a 45 to an hour plus to get to the hospital, also the state south of me won't do telelhealth across the boarder, but they also don't have many in-person appointments because normal practice is telehealth. One hospital that does SG, RYGB, SADI-S, and BPD/DS basically said I was out of luck. My situation is a bit different because I am concerned about stomach cancer because it runs in my family. The idea of a remnant stomach freaks me out, at the same time my EGD found H. Pylori negative gastritis (antral and oxyntic mucosa with mild chronic inflammation). To be frank I didn't know how that impacted anything, and all the GI doc did was put me on a high does of a PPI. I don't have GERD, like most people I have heart burn from time to time and Pepcid complete works and i'm done. Surgery is hella scary, but these surgeries are amazingly safer than a lot of surgeries. I am more scared of the recovery and any complications, than dying from the surgery. At the same time, although I've fished my program's requirements save for the final exam I and waiting until this fall to have a procedure. If Tuesday I learn they was to do the RYGB I may very well back away and continue Zepbound. Not being able to scope my stomach is a fear of mine because the GI had no idea what as causing the gastritis and his report suggested that I was on my way to ulcers. So Joy. The human body is complicated. Take your time, it's your time, your life, your body. If you feel rushed tell them so, and if you're scared tell them so. It's okay to be scared, it's okay to be that annoying patient (I know I'm that patient) that asks questions and needs to feel settled. It's also okay to change your mind, and change you mind again. It's a big freaking deal. And living with obesity is also a big freaking deal. Only you can make the decision that's best for you right now. You'll be fabulous if you have the surgery, and you'll be fabulous if you defer.

If you want to talk about it, join www.Barination.mn.co it is only $40/month and there are nutritionists, movement specialists, Licensed social workers, counselors and there is a lot of community and support groups that can help you through this difficult time. Something to think about anyway. I now pay less in food, so I put it towards my membership and knowing that Obesity thrives in Isolation, I joined the group and has been great. Just another way to obtain information, knowledge and deal with your fears. They do not make decisions for you, but asks great questions. Try it for one month, see how you like it. Just another option for discussions.

Definitely don't proceed if you're having doubts. My surgeon advised against the sleeve because of my pre-existing GERD, and I got the Omega Loop/Mini bypass instead. While my GERD thankfully didn't get worse, it still happens every so often so I'm still on Pantoprazole daily (which also stops stomach ulcers which I'm prone to).

For what it's worth, I also have ADHD and take an antidepressant for chronic vestibular migraines. I make sure I take them after food and ease off water for a bit so they don't go down too fast, and don't really have any issues. I can't take any slow-release meds though, so Vyvanse and extended release Ritalin are out. I take Ritalin 10, which works fine.

The most important ingredients needed are:

1. The right surgeon
2. The right facility
3. Your mindset and long term commitment

The first two you'll take care of nailing down well prior.

Until that third aspect is a lock...then waiting and further consideration is wise.