I am excited and curious — tomorrow is my first consult with Dr. Doe*.
I didn’t know really, who to pick from the group. There are three doctors in the Bariatric Center of Excellence I will be working with. Dr. Smith is the big shot, who has the most surgeries under his belt and a great reputation. Dr. Doolittle is who did the seminar I attended in August 2011. He has a reputation of meticulous and a good surgeon, but I didn’t click with him at all.
Dr. Doe is the one with the least experience, but still lots of surgeries under his belt. So why, you ask, did I pick him out of the three? Well, in talking with the nurse/patient advocate, she said I could switch at any time with no worries, happens all the time. Based on what I’ve heard about Dr. Smith, he is likely to be a great personality fit for me, but he is so backloggeddue to his popularity that I could be waiting an exceedingly long time to get in with him. Dr. Doolittle, I have a feeling I would continue to not appreciate his fairly paternalistic approach to medicine, given my background and education, it will rub me the wrong way. So, I’m going to start with Dr. Doe, he still has a lot of surgeries under his belt, he’s practicing in a COE, so there are standards he has to meet, etc, and I think he may be slightly more compatible in terms of attitude. If he isn’t a match, I’ll flip over to one of the other two, but I’ll already have the initial consult under my belt so hopefully it won’t be too much of a hassle.
I’ve spent the weeks since the seminar thinking a lot about weight loss surgery, and trying to learn as much as I can. Using my obsessive nature to my benefit, I’ve been able to consume an ungodly amount of information about the procedures, what to expect and how to succeed in a few weeks. (The one benefit of a mildly obsessive/compulsive personality…LOL)
Which procedure am I leaning toward? For years when thinking about this, I always thought Lap-Band would be the way to go, but looking at the actual stats of the procedure, I’m not so sure about that now. In Lap band, as I think most people know, they stick a ring around the top part of your stomach, creating a little tiny restricted stomach that you feel fuller faster with because they fill up the ring to manage the restriction of the stomach. Its a restrictive procedure that is reversible, and requires regular checks and fills to be sure the band is restricted the appropriate level. It is the cheapest procedure and certainly the one that gets the most press.
The statistics regarding averages for Excess Weight Loss (EWL) with Lap-band are not nearly as good as the other procedures. A lot of variation in what is reported and by whom, but all agree it has a lower and slower weight loss rate, averaging generally somewhere between 30-50% excess weight lost, and that the variations in individual experience are wide, so the ranges go pretty solidly from 20% to 80%. So if you have 100 lbs to lose, the chances that you could be a person who only loses 20-30 lbs from the procedure are fairly decent, and that seems like a big surgery to have for potentially crappy results. I was also surprised by the foods that were on the ‘never’ list, even after surgery recovery, for lap-band, such as breads, pastas, rice, popcorn, pizza, etc. I know my diet is going to change, and that if i go RnY, I will have dumping to content with on high sugar/high fat foods, and if I go lapband, I’ll have significant restrictions because of fears of blockage. So I know I’ll have something crappy to accept long term either way. With lap band, since they aren’t rearranging intestines, food absorption is normal, and you don’t end up with things like dumping syndrome or worries about leaks.
Gastric sleeve is quite interesting. They have not been doing it as long, but it has been having really promising results, similar in excess weight loss to gastric bypass. In this procedure they take off most of your stomach, leaving you a smaller stomach about the size of a banana. Its still a restrictive procedure, as they don’t rearrange your guts, so there is no adjustment to absorption. They are seeing really good results with it, but they don’t have a long track record with it to know if the results will hold as well long term. It appeals to me because it doesn’t mess with absorption, so seems more forgiving, but still has the benefits of reduced grehlin production, because so much of the stomach is removed. Of course, that is a key fact, because they actually REMOVE the stomach, it is not a reversible procedure. So once it is done, it is done. I have a friend in an online mom’s group that had this procedure done recently, and I am hoping to talk to her soon about her satisfaction with the procedure. I have heard that not all insurance plans cover it, however, so not sure if its even an option for me. If it IS covered for me, I think its a contender, depending on what I hear from the doctor tomorrow.
Ultimately, barring confirmation that my insurance will cover sleeve, it seems I’m leaning towards gastric bypass (RNY). In this procedure they make a new tiny stomach at the top of your stomach called a pouch, and staple off the rest and the old stomach just kinda hangs out. Then they reroute your intestines to bypass part of them so that you can absorb less from your foods. Its the procedure that has the longest track record and stats. And unlike lap band which seems to have a decent average of EWL, I guess, the average amount of EWL is higher with gastric bypass typically 50-75% EWL, and the results plot more like a bellcurve than a scatter chart, which most people seeming to see about 60% EWL. So that means if a person has 100 lbs to lose, you are quite likely to lose 60 lbs and so so many people do much better if they follow the guidelines for eating. Dumping syndrome really scares me, but it might be just the tool I need to break my addiction to high sugar and high fat foods.
My favorite resources so far are:
Weight Loss Surgery for Dummies book
* I will not be referring to my doctors by their real names in order to be able to talk freely.