Second Meeting with Surgeon Next Tuesday

[MrBeeswax 5]

My purpose of doing this surgery so late in life (I'm 46) is to be healthier. I have multiple co-morbidities including hypertension, left ventricular hypertrophy, sleep apnea, CKD 2, and hyperlipidemia. There is a family history of stroke and cancer, including colon a stomach cancer. I meet with my surgeon for the second time Tuesday. The staff said the surgeon wanted to meet with me because had questions, but that did't make sense because they've responded to my questions. The only new information was from my EGD pathology report. My EGD found asymptomatic HP negative gastritis. The GI Doc didn't know what may cause it but tossed PPIs at me and I will learned Tuesday if I need another EGD or what. If I have contra-indicators for Sleeve Gastrectomy I'm considering backing out of surgery because that means my only option, anywhere would be RYGB. I'm afraid of having a remnant stomach that could continue down the path of inflammation. Apparently I was on the path to stomach ulcers. Maybe I'm being unreasonable, I'm just afraid of my remnant stomach being a time bomb. I'm also concerned about dumping, not being able to take NSAIDs, and perhaps having to change my other medications.

I've committed to having a procedure including buying Vitamins, typing Protein Shakes, losing weight in advance, learning more and more about the procedures, my relationship with food, and continuing to exercise with my personal trainer, and attending support groups. But I have this fear of RYGB and maybe it's silly. I know people, good friends, with RYGB. I get the sense they like the results, but not the down sides. One even told me they are surprised hospitals still perform RYGB because of the issues they had. I don't really know what I'm walking into on Tuesday and I am nervous. I've been taking 80 mg or pantoprazole daily. I learned my insurance company will only pay for 90 pills, so my refill was tricky. I don't know how longer I will have to take it or what that all means, and i don't know what impact all this will have on the surgery (if any). I'm terrified of having come this far, made peace with the decision to have surgery, over come the shame, had to deal with the doubts and fears of other people including my own spouse to find myself with the possibility that it's all a no-go. I won't have surgery until the fall, and normally the second appointment with the surgeon is closer to the the surgery point. Even the program staff weren't sure why it was being scheduled. My RD follow up, last week as also much sooner than it should have been, and after the meeting the RD said it wasn't the actual required follow up. I'm left scratching my head, being coming anxious, and I feel some slight indigestion which is wild since I've been on the PPI since early last month. I doubt my experience is unique so I open to learning from others. I'm currently on Zepbound and losing weight, but it's expensive with insurance and the insurance could decide to not cover even with the insurance and a coupon it's about the amount of a car note every month. So that's not sustainable for the rest of my life. Ia also need to lose more than the 20% max it would get me to. So if surgery is a bust, I I don't know. The gastritis is a contra-indicator for Endoscopic Sleeve Gastroplasty and it's not covered by insurance anyway. Thinking about all of this makes me kinda nauseated.

[SpartanMaker 1,184]

I can totally understand your fears regarding the remnant stomach. They may tell you you're fine and it's okay to proceed with SG. If not and they are recommending RYGB, then I do think you should discuss your concerns and family history of stomach cancer.

Obviously your doctor would be the best source of info, but I did want to mention that the inability to do an endo is probably not as big a concern as you think. There are lots of other ways to monitor for stomach cancer in this instance. It would also be worth discussing with your doctor whether you are at increased or decreased risk of developing stomach cancer currently vs. if you did have RYGB. It's entirely possible based on the endo results that failure to act may also increase your risks, so it would be a good idea to discuss all options.

I do also think it would be unwise to let this particular fear outweigh the real risks of obesity and the other comorbidities you already have. As I'm sure you know, with the issues you currently have your risks of a heart attack are quite high.

Best of luck with whatever you decide.

[MrBeeswax 5]

2 hours ago, SpartanMaker said:

I can totally understand your fears regarding the remnant stomach. They may tell you you're fine and it's okay to proceed with SG. If not and they are recommending RYGB, then I do think you should discuss your concerns and family history of stomach cancer.

Obviously your doctor would be the best source of info, but I did want to mention that the inability to do an endo is probably not as big a concern as you think. There are lots of other ways to monitor for stomach cancer in this instance. It would also be worth discussing with your doctor whether you are at increased or decreased risk of developing stomach cancer currently vs. if you did have RYGB. It's entirely possible based on the endo results that failure to act may also increase your risks, so it would be a good idea to discuss all options.

I do also think it would be unwise to let this particular fear outweigh the real risks of obesity and the other comorbidities you already have. As I'm sure you know, with the issues you currently have your risks of a heart attack are quite high.

Best of luck with whatever you decide.

The doctor responded to my question in writing a few weeks ago that there is no good answer because there is no way to know, but saw the value of having access to my stomach to monitor, i don't think she had a chance then to review the EGD pathology report and now suddenly I have a meeting with her. The program coordinator couldn't explain to me why it was so early. 15 years ago I had a bladder cancer scare, and the urologist reacted the same way after they got a pathology report. In that instance they had access to my bladder and did a scope and did not find anything really abnormal. I know the risk is rare, and I look forward to learning about the alternative ways to monitor. And I hope you're correct.

RYGB in general would be something I'll have to warm up to because of the increased complications associated with it. The great news is there is a lot of data on it, and surgeons are very familiar. Sinceit's not novel, and if I move I will surely find a doctor familiar with it vs SADI-S or even BPD/DS. For example in my area very few surgeons do either of those two. My insurance doesn't cover SADI-S or OAGB. My preferred surgery is SG. If I'm not a good candidate for it, then I'm glad I'm waiting because I need to do some deep thinking. Dumping sounds terrible. Arthritis runs in my family, and at time even at my age my knuckles and joint hurt. Nevertheless the nephrologist advises against NSAID but they are not off limits with RYGB they would be mostly off limits. I'm not SG or bust really, but I just had a relative share they have precancerous cells in their stomach. That two of my father's siblings with either stomach cancer or precancerous cells. It is a little too close to home. I may be, however, more at risk of dying by slipping in the bath tub, or driving on the highway than getting stomach cancer in my remnant stomach. So I have to be realistic. If I do nothing and get kicked off of Zepbound my weight will return, and my heart will enlarge, and I could die of heart failure or a stroke (in the last 5 years 3 close family members had strokes, and my grandfather die of a stroke years ago). Those are conditions I have now. The enlarging heart may not get worse, but it likely will. My cardiologist is why I aggressively started losing weight to lose 40 lbs since my bariatric first appointment weight-in in February. I've now been taken off one of my four hypertension meds, but I'm still on three. My other concern about RYGB is how will it impact my ability to take sustained released meds. all this I'll talk to my surgeon about in my meeting Tuesday. I've been considering bariatric surgery since 2018, and i put it off. 2022 after a few health scares and being diagnosed with mild but concerning LVH I started seeing a dietician and working out. Later I battled shame to start Wegovy in 2023 and worked with an obesity specialist's practice. In 2005 due to insurance I switched to Zepbound. After my cardiology follow up in January I went for my first bariatric consult. I briefly considered ESG, but after researching decided against it and insurance doesn't cover it. I witched Weightloss clinics and aggressively started tracking and living in a calorie deficit. I'm under no illusions about being able to keep this weight off w/o surgery long term. I don't know if the co pays next year will be even higher already $500 $360 with a coupon, or if my financial situation will change. ifI do nothing, the I'm not sure if I'll make it to my mid sixties if I go back to 315-320. So I have to do something, the question is what.

[WendyJane 34]

Your worry is going to give you a stroke or higher blood pressure if you are not careful. I'm concerned about that so here are my thoughts.

At 61, I finally had the RNY. Initially I wanted the GSleeve, but was educated by my surgeon about RNY and that made the most sense, it is well researched, it is done laparoscopicly and if you need the other part of the stomach removed, you can ask your surgeon to do that. The Y portion of the RNY might need to be attached somewhere else. I'm not sure. I had no pain and have been able to tolerate all of my walking and light housework during my 2 weeks off work. I tolerated the Clear Liquids and the full liquids well and now I am on solid foods and doing well. With RNY you tend to lose more, but it is dependent on you and what you eat. With RNY, I was taken off more than half of the medications I was on, and taking none of my diabetes meds and insulin. Having a fear of the GERD with GSleeve, I also opted for RNY. Because you are already on pantoprazole and still have issues, I would suggest the RNY because there is a higher risk for those who already have indigestion issues or suffer from too much stomach acids. RNY you can't have NSAIDS, but with my arthritis, I am allowed to take it only as needed, and I take a capsule of Celeobrex, and it works fine for my painful arthritis. Just talk to your surgeon about that.

Being down 40 pounds already with the glp1 medication is good, and it will reduce fat on your liver as a side effect. I too have renal problems, stage 3, but was encouraged by my kidney doctor to have the RNY, and yes, the kidney doc also doesn't want me on NSAIDS, but allows me to do so. I need to get down in weight so I can have a hip replacement. Then, I might not need NSIADs any more.

I hope I have been able to give you some information and encouragement to re-look at the different surgeries. RNY is just one step further than the sleeve, and with the history of your family, I'm sure the surgeon will be able to compromise and do a revision to the typical RNY as needed. Having stomach cancer history in your family would be one reason to just take the stomach out that is cut off, like in the sleeve and attach the Y end of RNY elsewhere. A modification should be easy to contemplate and do.

Just another thought, your surgeon may want to meet with you because the ulcer in your stomach is evident on the series of pictures taken, and wants to move quickly to get that part of the stomach taken out? It is possible? Already having an ulcer starting may also be the reason they postpone the surgery and put you on healing meds, and get you to "calm down" because worry makes ulcers worse too.

There are all kinds of reasons and things to factor in, but I would say you definitely need to find out what the surgeon wants to talk about, and go in with some knowledge. I suggest you take a look at some of the YouTube videos by BariNation. You may find out that they help you. I wish you the best, keep us posted after you talk to your surgeon.