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Helana -> RE: Weight Loss Surgery (4/25/2010 12:11:53 AM)
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Hi candles, since no one responded who actually has had wls I thought I would chime in.
First of all, wls is a huge step, as I am sure you already know and not one to be taken lightly.
Now, there are 4 different types of weight loss surgical procedures they all have pros and cons.
I suggest you look into each of them before deciding which one if any would be right for you.
The first procedure is commonly known as the lap band. This procedure wraps a silicone band around your stomach and you have a port that goes under your skin. The band then gets filled through the port to increase or decrease the amount of restriction you receive.
This procedure allows you to feel full faster and for a longer period of time. Some people do really well with the band and others do terribly. There rarely seem to be people in the middle.
Pros:
Minor surgical procedure can be done with only 1 small incision
Completely reversible if necessary
No gastrointestinal side effects
Cons:
Generally there are complications within 7 years
Slippage
Port moving or turning
You have a piece of medical hardware inside your body
Constant aftercare (getting your band filled and unfilled)
Restriction that isn’t always constant
Foods like ice cream and sugary drinks go right through the band
General surgical risks (blood clots, infection etc.)
The next procedure and the one you have probably heard the most about is called the Roux-en-Y gastric bypass.
In this procedure the stomach has a very small (30 cc) portion stapled off to form a pouch, then the duodenum and pyloric valve are bypassed and your intestines are connected to the new pouch. When you eat the food goes from your pouch right into your small intestine (bypassing the upper portion) thus you are absorbing fewer calories.
Pros:
Faster weight loss because it is restrictive and malabsorptive
It can be done laparoscopically
Many doctors perform this procedure
Cons:
Dumping syndrome - because you have no pyloric valve sugars can enter your intestine more quickly which results in something known as dumping syndrome for about 50% of people who have the gastric bypass. It includes nausea, diarrhea, vomiting, hot flashes and huge amounts of discomfort. (some actually view this as a positive thing since it keeps them from eating sweets)
You will need to take high doses of bariatric vitamins for the rest of your life. - because you do not absorb all the calories from foods you do not absorb all the nutrients either.
You will need to get lab work done every few months initially and then at least once a year to make sure you are not deficient in any vitamins or minerals
Food gets stuck in the pouch
Cannot drink 30 min before or after meals
Leaks in the staple line
Must stick to a high protein, low fat diet
You lose most of the malabsorptive component after a couple of years
Limitations on medications you can take
The next procedure is called a vertical sleeve gastrectomy. This is a restrictive only procedure similar to the lap band except you do not have most of the problems associated with the lap band. Think of your stomach as being shaped like a bean. This procedure removes most of your stomach so that it is now shaped like a banana. This provides restriction but no malabsorption so you have your own fully functioning stomach only smaller.
Pros:
It’s your own stomach
You feel fuller faster
It will never be able to stretch to be as large as your former stomach
constant restriction
doesn’t involve seeing doctors every few months or tons of vitamins
can be done laparoscopically
losing the part of your stomach that produces the hunger hormone ghrelin
Cons:
Still a surgical procedure
chance of leaks etc.
permanently losing part of your stomach
Many insurance policies will not cover the sleeve because they consider it to be *experimental*
The last procedure is known as the duodenal switch. Like the Roux-en-Y it is a restrictive and malabsorptive procedure but unlike the RNY you do not have a pouch but rather a sleeve gastrectomy (see above) for your stomach, although it’s generally slightly larger if you are having a Duodenal Switch procedure than a straight Vertical Sleeve. This means that you can eat small normal sized meals and drink with your meals which is nice during social situations. You also maintain pyloric function so there is no dumping syndrome. With this procedure, 2 cuts are made in the small intestine. The first is made in the duodenum and the second is made at the alimentary limb (lower 8f of the small intestine). You then connect the alimentary limb to the duodenum. The bypassed section is called the biliopancreatic limb, which is where most digestion takes place, is now connected to the end of the small intestine. The last part of the small intestine is called the common channel, which is where your food and enzymes digest. Because you are bypassing so much of the small intestine the amount of calories you actually get from food are greatly reduced. The estimated absorption numbers are 20% fat, 50% protein, 60% complex carbs and 100% simple carbs. This means that if you eat a food that has 100 calories, 8g fat and 7g protein you are actually only absorbing about 28 calories instead of 100.
Pros:
Most people who have this procedure lose 85% of the weight they needed to lose and maintain it 10+ years out. This is the highest sustainability rate of any weight loss surgery.
The fastest weight loss.
Can be done laparoscopically
Ability to eat small normal sized meals
Ability to drink while eating
Maintain pyloric function
No pouches
Cures type 2 diabetes in 99% of cases often before you even leave the hospital
Has the highest cure rate of comorbidities overall
Cons:
Very complicated surgical procedure and many surgeons aren’t skilled enough to perform the procedure
Surgical risks including leaks, infection, blood clots etc.
Gas! - this is probably the biggest downfall with this procedure. For many people, simple carbs, at least during the first year after surgery cause offensive gas. It will take some time to figure out what you can or cannot eat when you are going to be going out to eat or will be around people. In general, after you have a duodenal switch you go on a high protein, high fat diet and keep the carbs pretty low. It will take a while until you will be able to eat carbs and because you don't absorb 50% of protein you must make sure to get at least 90g of protein in a day. You always eat your protein first and if you still have any room in your stomach you can eat some carbs.
Vitamins! - for the rest of your life you will not be absorbing a large percentage of what you eat you will need to supplement with a lot of vitamins, sometimes taking 20 or more pills a day and it generally will cost about $100/month. You must be able to afford this and commit to it for the rest of your life.
If you want to find out more about the duodenal switch check out www.dsfacts.com and http://www.obesityhelp.com/forums/DS/a,messageboard/board_id,5357/
As for my story, the duodenal switch saved my life. I yo yo dieted for years and probably lost over 1000 pounds if you count how many times I lost weight only to gain it back. It wasn’t a matter of putting down the fork and moving a bit more. In order for me to maintain a weight of 160 pounds, which isn’t even thin, I would have to eat about 800 calories a day and spend 2 hours at the gym 5 days a week. It was miserable for me and almost impossible for me to maintain. As soon as I would slip up even a little the weight would just come on so quickly. I could gain 5 pounds in a week just slipping up a little and it would take me over a month to lose it again. I ate less than all my friends, I obsessed over food counting calories and carbs. I didn’t know a thing about weight loss surgery; I used to swear by eating less and moving more. I blamed my problems on a sluggish thyroid, years of yo yo dieting, slow metabolism etc. I started gaining weight at 17 and there were points in my life where I was at a normal bmi, most of the time it was overweight and then obese. Even being obese I was living a very active life and making healthy food choices. If you asked anyone at the time they would insist that I was the healthiest eater they knew. I tried low fat, low carb, vegetarian, vegan, crash diets, weight watchers, medifast, pills, personal trainers, nutritionists, hypnosis, liquid diets, fasting, and just about anything that you can think of. Most of them worked to some degree, they were just unsustainable for the long term. The best results I had were low carbing where I kept a weight of 160 pounds for 2 years but again, that was at eating 800 calories a day to get that low and 2 hours at the gym. DS saved my life. I had the procedure done 5 years ago, I lost 175 pounds in a year and a half and I have been at 130 pounds since. I eat more now than I have ever eaten on any diet before, I no longer feel like I am starving all the time. I don't have cravings like I used to. I am off my blood pressure meds, I am ovulating on my own, my hormones balanced themselves out. I have never been healthier in my life. I am active but I no longer have to live at the gym. I don't even really think about my food any more, the best thing about DS for me is that food is no longer an obsession in my life. I eat when I am hungry, I make sure to get my protein and vitamins in and other than that I eat whatever I want. I had some gas issues for the first year but its mostly white flour in large quantities that makes me gassy. When eaten with protein and fat (like fried chicken) I don't have any problems.
WLS is a huge step and it isn’t for everyone. It’s a very serious commitment and there are very serious risks involved including malnutrition. From my perspective there were also serious risks involved in being the size that I was. I didn’t have a life, I was tired all the time, I hid indoors because of the way I was treated by people. The risk, to me, was worth it. I only wish I did it sooner. I lost my 20s due to my constant struggle with food but my 30s have been the best years of my life. As far as excess skin is concerned, everyone is different. I have some excess skin but it isn’t too terrible. Nothing that spanx can't cure. My arms are the worst and I would like to get those taken care of but right now my husband and I are considering having a baby so I am going to wait until I am done having children before I think about a tummy tuck. If it wasn’t for my DS I would still be infertile.
As for playing and things like that, it depends on a lot of things including the procedure you have. The lap band is an outpatient procedure and you can be back to work by the end of the week. The DS takes a while to heal. You are on liquids for the first 2 weeks and then soft foods for the next 2 weeks while your stomach heals. I would say that 6 months out the play can be pretty normal... while very rare I believe that a leak can happen even up to 3 years post op so you should be a little careful. Also, as you get thinner you will discover things like your bones and they hurt when you bump into things, especially when you are used to being cushioned. Let your body be your guide.
Anyway, I wish you the best of luck with whatever you decide to do.
Edited to add: Check out a WLS support group if there is one in your area, meet people who have had the procedure done and share a meal with them. Look at their scars, loose skin, how much weight theyve lost, any regain, see what they eat and how much. Ask yourself honestly if you can make that commitment. It took me a lot of soul searching before I knew that I could do it. Talk to surgeons that perform all 4 procedures (many do not perform the DS) and ask them which patients are the happiest and most successful. Look at the statistics for dieting vs. wls and who keeps what percentage of weight off longest. Ask yourself what are your reasons for doing this. Can you remember to take vitamins 4+ times a day or would you do better with something that was purely restrictive?
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