Good for you, Manny!
Maastricht, what exactly is a mini GBP? I’ve never heard of it.
tdn, here’s my thread about the MGB with lots of links.
Short take: the Mini Gastric bypass is an surgery similar to the regular gastric bypass, the " Roux-en-Y" . It is newer and the long term effects are not as well established yet. However, the results are promising, with the same weight loss as the classic Roux-en-Y and slightly less complications. MannyL had sleeve surgery, another alternative for bypass, but less invasive because only the stomach gets to be made smaller, while with both gastric bypasses also a part of the intestines gets rerouted.
OK, we call it a laparoscopic roux-en-Y here. We now do far more of those than we do open rouxs. I think it’s just safer and less invasive. It’s been our most “popular” procedure in the last year. Sleeves and lap bands are about equal. There was only one open roux.
The open roux, based on very little data, remains the most effective. Lap bands are the least effective. Sleeves and lap rouxs are somewhere in the middle.
No, the Roux-en-Y is anatomically different from the Mini gastric Bypass. Both can be done open or laparoscopically.
Here you can see schematics of both surgeries side by side.
Huh. Maybe we just call it something different.
The “mini” looks like a hybrid of a traditional RNY and a vertical sleeve gastrectomy. That site claims the mini is reversible, but I don’t know what would make the RNY irreversible and a mini reversible. Either one cuts down the size of the stomach and re-arranges the small intestine. AFAIK, nothing is actually removed from the body with either procedure.
In the US, the mini is still being considered experimental by most insurance companies. The chicken and egg problem is that if insurance won’t cover it, people can’t afford it. If fewer people have the procedure, less empirical data will be available. With less data, the insurance companies will be slower to consider covering it. As a result, laparoscopic RNY is usually the “gold standard” here.
I asked my husband’s surgeon about the daVinci surgical robot that he uses, and found that he usually does about 15 surgeries per week. Last year, he did three open procedures, which is a vanishingly small percentage out of 750 or so. Apparently, the robot enables him to do more difficult procedures that would normally be done open, and he thinks it’s just about the best thing to happen to surgery since the invention of anaesthesia.
Manny, congrats on the decision, and best of luck!
I had a VSG back in November 2011, my GF had hers in August 2011.
Best thing I’ve ever done, really. As of this past weekend, just about six months from surgery, I’ve lost exactly 100 lbs! (my GF is down 123 lbs-- women lose weight a little slower than men typically). I’ve got about another 20-30 lbs to go until I reach my goal weight.
Things to expect:
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You will not want to go back to work on 23 April. Trust me, you’ll want at least a week to recover-- in fact, I took three weeks off after my surgery. That’s probably overkill, but I had the sick leave, and I used every day of that time off. The first week is about pain and recovery, the second week is about simple weakness-- you simply don’t have the energy on your liquid recovery diet to do much of anything.
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The surgery itself went fine, no complications. I used a LOT of the pain pump meds to get through it, though. This led to the lousy side effect of being constipated for a good 48 hours after surgery. Not a big problem-- it wasn’t like my stomach was full!-- but the hospital was reluctant to check me out until I passed gas. I only did an overnight, felt good enough to go home, but had to weight a few extra hours until nature called ;-).
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If you have anti-clotting medicine (usually self-administered shots), TAKE IT. It’s important. Be aware that any minor incisions you may have may weep because of it-- if there’s too much blood, don’t wait around for it to clot, it won’t, just go on in to an ER and get an extra stitch or three (had to do that with my GF, the incision where she had her drain line removed wouldn’t close up, we were at the ER the night she got home getting it stitched… NOT fun when you’d rather be in bed).
Oh, and keep walking. Get up, get moving, stay mobile-- that’ll help prevent leg clots and any life-threatening complications that can arise.
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You will have SERIOUS trouble drinking anything for the first few days. Not only is most of your stomach gone, but what’s there is swollen and healing. The single best piece of advice I can give you is to get a hold of some plastic syringes (the hospital should have some, if not just pick some up at a CVS or even a cooking department) and use those to drink. Sounds stupid, but trust me, you won’t be able to even so much as sip out of a cup for 48-72 hours. I just sat there dunking the syringe into my water and taking it down bit by bit. In time, I could move to sipping (it’ll be months before you can even approach normal drinking, and alas, you’ll never get to gulp or chug again).
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Get your protein. It’s important to heal, and important to be healthy. There are tons of varieties out there, you’ll find you hate some, tolerate others. If you find something you love, you’re lucky; me, I always hated the protein shakes, still do, but it’s just something you have to choke down for a while.
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Take your vitamins. For my surgery, I’m on a multi twice a day, calcium twice a day, and B12 3X a week. If you’re on B-12, don’t blow it off-- B-12 is vital to keeping your neurological system healthy, and while rare, a B-12 deficiency will result in lasting nerve damage. Not fun.
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Living with the sleeve… once I graduated to mushies it was wonderful to eat something with flavor (I was on a liquid diet two weeks prior and two weeks post). 6 weeks after that, I went to solids and that was even better. You’ll enjoy the progression back to “normal” eating, be patient, it’ll happen.
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DON’T push the sleeve. Follow your surgeon’s advice. Seriously, I know of two examples of patients who tried to eat something solid during their liquid/mushy phases and ended up back in the hospital, one of them in intensive care for 5 weeks. It’s not worth it, obviously.
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My tastes buds haven’t changed dramatically, but they did change. I’ve lost most of my cravings for sweets, but my craving for salty/savoury is greater than ever. If you’re like me and my GF, you’re liable to enjoy more “complex” flavors now simply because anything less will strike you as bland. That’s the downside: eating is nowhere near as enjoyable as it once was for me. I still have some things that I enjoy, but much of what I once loved doesn’t appeal to me nearly as much as it used to.
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The first 3-4 months after surgery is your golden window. You will lose most of your weight then the fastest. Getting active/exercising as soon as your surgeon clears you to do so will help your recovery and make the most of it. You’ll still lose weight for a long time to come-- up to a year or more post-surgery-- but it’ll start to slow down after that point (“slow” is relative; I’ve still been losing about 10 lbs a month but that’s a far cry from the 20+ I lost in the first month).
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You’ll plateau a couple of times, you’ll step on the scale and you’ll wonder why you aren’t losing weight. Don’t worry about it, it’s temporary, in another week or two you’ll be back to losing.
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Recovery pain is odd. You’ll lose a lot of pain you might have had from being overweight but replace it with new pain in different muscle groups as your frame adjusts to its new “load.” I’ve had uncomfortable pain in my belly as the fat’s disappeared and the skin’s started sagging, and I now have back pain in a weird area. Again, this is normal and will pass (I sure hope!), but exercise helps beat it.
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I never had high blood pressure before the surgery, thank goodness, but after the surgery my BP plummeted (I now average 95/50!). This is good but also bad-- I find that if I sit too long or lay in bed when I get up I grow lightheaded and often have to grab a wall or table. If this happens to you, take your time getting up, it’ll pass, it’s normal for those why trade hypertension for hypotension.
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The surgery wiped out my cholesterol, and has practically eliminated my sleep apnea. Yay! Hope you get great results, too.
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Appetite: aside from food tastes, with the Sleeve your appetite will change. In that aforementioned “golden period” immediately after the surgery, you may be forcing yourself to eat, you just won’t be hungry at all. DO force yourself, you need your nutrition, what’s left of your stomach won’t be large enough to get more than 1,000 calories or so a day anyway (so don’t ever feel bad about eating). In time, your appetite will return, but even now six months later it still isn’t anywhere near what it once was for me.
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Sugar: this is the weird thing. Part of the reason why I chose to have the Sleeve over the Bypass was there is no “dumping” associated with the VSG, i.e. I wasn’t supposed to lose my tolerance for sugar. Unfortunately, that’s not the case for either me OR my girlfriend. It’s obviously not a terrible thing-- shouldn’t be eating the stuff anyway, that’s how I got fat!-- but even so, it limits the flexibility of what you eat. I find anything more sugary than fruit will lead to something that sure comes close to approximating dumping: say, a small piece of birthday cake with frosting will in 15 minutes turn into a very uncomfortable tension in my back, sweating, cramping, and all around discomfort. It quickly passes, but it can be SERIOUSLY unpleasant, and it’s been enough to keep me away from all but the smallest amounts of sugar. I’ll still eat sweets on special occasions, but in very small amounts, just to get the taste, and I’ll choose less-sweet options (aka I’ll eat the cake and not the frosting, no candy, etc.).
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Alcohol: You won’t be able to tolerate alchohol in great amounts after the sleeve. People hear you have lost 90% of your stomach, they think you’re a cheap date, but what they don’t understand is that you’re now the worst of all worlds: your stomach is what initially processes booze, so without enough surface area to process it, you skip the “buzz” and go straight to the hangover as the undiluted alcohol heads straight for your liver. Result: one drink equals 3-5 drinks hitting your liver, skipping the fun buzz part but still making you legally intoxicated.
That said, I’ve had some alcohol since the surgery. I liked wine beforehand, red was my favorite, but I don’t tolerate reds very well anymore (too acidic for my pouch). I’m not a big fan of white wine, but I can drink a glass of it to be social without ill effect. One thing to note is that alcohol = sugar as far as dumping is concerned, so you’ll get the same cramping effects if you drink too much or too fast (above and beyond the splitting hangover you’re liable to enjoy-- same day hangover, too, you don’t have to wait until morning like now!).
- Carbonation: You’re not supposed to have it. Everyone does :-). You won’t tolerate it for a few months, it’ll just be too turbulent on your pouch. Eventually, you’ll be able to have a little bit, but it’ll either need to be lightly carbonated or nearly flat. In my experimentation, anything out of a 20-oz plastic bottle has too many bubbles, cans a little less, and fountain drinks the least. Also, I drink Diet Red Bull for my caffeine fix, I find that I tolerate that fine enough if I sip it.
Alas, beer is next to impossible. I can nurse a Guinness over a long time, but I’ve never had more than half a pint. A lager is out of the question for me, one sip and it hurts. 
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When it hurts. I’ve luckily avoided any pain, but the GF hasn’t been so lucky. Eat SLOWLY. Chew your food-- then chew it again. Take your time. If you get something stuck, DON’T panic-- just stand up, let gravity do its job. Don’t be afraid to burp-- you will burp, a lot more than you ever did before the surgery. If it’s particularly tough, chew some Papaya Extract, the enzymes will help break it up. I’m sure that 99.9% of the stuff that gets “stuck” goes down in time (~5 minutes). The .1% of the time that it doesn’t leads to an ER visit. You don’t want to be that .1%.
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When it comes up. Some people carry around little baggies in case they eat too much and it comes up. I’ve luckily never had anything come up (again, eat slow and chew well), but the GF has had a few incidents-- anything overly dry or dense may do this (her nemesis was a really dense protein bar, not a good idea anytime soon).
… and last, but certainly NOT least: if your surgeon’s anything like mine, the single most important piece of advice they’ll give you is the ONE RULE you must ALWAYS follow: do not eat and drink at the same time. Stop drinking 30 minutes before you eat, take 30 minutes to eat, then don’t resume drinking for 30 minutes until after you’re done eating. This way you’re not lubricating your pouch for the food to slide right through, and you’re not flushing out what you just ate. You want to feel full, you WILL feel full, but you need to respect the new you.
According to my surgeon (at a national bariatric center of excellence, i.e. they know what they’re talking about), the single biggest cause of failure over time to the Sleeve and Bypass is failing to separate drinking and eating, or likewise drinking your food (i.e. easily-liquefied food, milkshakes, etc.). The drinking will enable you to eat more than you should, and over time the combination will put pressure on expanding your pouch. The Sleeve will never get bigger than about 20% of what your old stomach was size-wise, but even that amount is enough to get us in trouble.
You’ll lose most of your weight over the next few years, you’ll keep it off for a long time to come, but unless you adapt to the pouch and change your old eating habits you won’t be as successful as you can be. It trully is a lifestyle change-- you can’t go back to the old ways of eating, snacking, etc. It’s hard psychologically, but physically it isn’t-- the Sleeve is your friend, it’ll be the best tool you have for keeping you right.
Oops, I see you also asked about how to deal with friends.
Me, I told everyone in my close circle I was having the surgery, and thankfully no one was judgmental. I work in a small office, they all also knew as well, ditto being supportive.
Beyond that, I haven’t told a wide swath of people, but if people ask, I do tell them-- it’s kind of hard to explain losing a hundred pounds in six months otherwise! I tell them the truth: I’ve been fat since I was a toddler, I’ve lost weight before only to gain more back, I’ve tried medically-supervised diets and the most hardcore personal trainers you’ve ever seen and nothing made a dent. I have a family history of heart disease and diabetes, both of which claimed my parents, and after a serious heart scare back in February of last year (which thankfully turned out to be just that, a scare) I finally settled on having the surgery, which I had thought about for more than five years, i.e. this wasn’t some spur-of-the-moment decision.
There will always be some people out there who will say that weight-loss surgery is the easy way out. For some people, I’m sure that’s true; I’d like to meet those lucky people. For me, my GF, and everyone else I know who’s had it, it’s among the most difficult things they’ve ever had to do, and it changes everything.
Again, it changes EVERYTHING.
For 37 years I was a fat guy-- not just how I looked, but how I thought. Now, practically overnight, I’m not. Poof, just like that. Now, I admit I’ve had better success than most, but still, the weight came off, but I’m still the same person inside, warts and all. I was thankfully never an emotional eater-- I liked the taste of food, and more food tasted better, that’s all it ever was for me-- so I’ve been lucky that way. Others with a more emotional relationship with food will have a harder road to follow after the surgery.
In both instances, a support network is essential. My GF and I have each other, we also have other friends who have had the surgery, and having that kind of buddy system where we both know exactly what the other’s going through, share the same fears, the same goals, etc. makes all the difference in the world.
I do miss eating. Like REALLY eating. Before the surgery you’d be hard pressed to find a man more capable of tearing up an all-you-can-eat buffet than yours truly. It was part of my identity-- the hard-eating, hard-drinking frat guy who can down the ol’ 96-ouncer and polish it off with as many steins he can fill and still save room for dessert. That can’t be me anymore, but in a way it still is, and I’ll always have to deal with that.
The Sleeve is irreversible, it’s the anatomic equivalent of Cortez burning his boats-- unlike a lap band, once you’ve done it, there’s no going back. That didn’t scare me all that much before the surgery, but it definitely sinks in afterwards. I didn’t experience quite as much buyer’s remorse as others have in the immediate days after my operation, but in the weeks and months that followed, it definitely hit me: there are now things that I can’t eat, things that I really REALLY once enjoyed.
Bottles of wine with friends, buckets of beer on the beach, foot-longs and big pretzels at ball games, family-style pasta dinners, ribs on the grill, 5-course tasting meals at fine restaurants. Bread, sweet wonderful lovable bread. Unlike so many fat people, I didn’t eat to make myself happy, but eating did make me happy. I miss that, every day, and I suspect that I always will.
In return, however, I have my health. It’s not about losing weight-- that’s a side benefit, it’s inevitable. All the nice new clothes are welcome, but you’ll throw away/donate thousands of dollars worth of old clothes in the meantime, so it’s a wash.
Nope, it’s about living a long and healthy life and dying of something ELSE for once.
Well I was on the low-fat liquid diet before the surgery. Today is the start of my 3rd week with the sleeve. I’ve noticed that while i used to be able to drink bottled water now I can’t stand the taste and I have to add something to it. I know I’m already going to miss Sushi because I know the fish will be good for me I think the rice will be a problem for a while.
I’ve read now the FDA said the life of a Lap-Band is 10 years and it needs to be removed after that. I avoided the band because of stories I heard of it eroding into the stomach
Right today I started purees and egg with mayo and relish never tasted so good. I had 1.7 oz and was satisfied. Getting enough liquid and protein has been a problem with me so as I get more 'normal" food the water in it will help.
I do stick with the no drinking 30 min after eating rule and I have no desire for soda.
I used to drink 40 oz a day of diet soda. I am burping and hiccuping more. it seems to happen when I drink water. I’m trying to sip out of a glass but that’s hard. Sompe people can sip with a straw but I don’t want to push that.
As far as pain I didn’t have any once I left the hospital. Today I had severe paid but that’s because of my own stupidity. I was thirsty and gulped some water. I will NEVER do that again. Pain was sudden and hurt badly. After some burps it went away.
Today was the first day I haven’t lost anything but I’m not concerned because it’s the "standard’ three week plateau.
When I was given the Ok to leave the hospital I threw up a little. It was just water because I drank too much. The nurse saw me “cough up” the water into a pan and didn’t want to let me leave! My surgeon had to come back that night talk to me and then re-ok the discharge. It made me angry because I knew what caused it and it wasn’t a medical problem.
I was never much of a drinker so the alcohol restrictions are not a big deal.
I told my office about it some a few months before the surgery some the week before and the rest I told my last day of work. I’m sure as I lose weight my sleep apnea will get better and hopefully go away. I know this makes no sense but I think my lactose intolerance has been “cured” yesterday I was out and needed some nutrition. The only thing I could find was tomato soup with a cream base. I bought it and I had no problems.
Tonight I dine on Cream of Broccoli Soup with Cheddar and canned chicken breast (pureed of course)
Okay, how stupid am I-- I read your post and thought your surgery was coming up on April 19th… d’oh!!
Oh well, sounds like you’re doing great, and the advise is here for any future potential patients to enjoy/discard as they see fit.
RE: water, I was never a big water drinker before the surgery (addicted to regular soda, hence my need for surgery!), but after the surgery I discovered the same problem: plain old water just tastes funny to me now, it’s VERY hard to drink it. I’ve heard from other sleeve patients that this isn’t unheard of, sometimes it goes away over time, others it sticks around. As a result, I tend to get my hydration from flavored water (Crystal Light), Diet Snapple ice teas, low-cal Gatorade, etc. I’ve also discovered those Tropicana 50 drinks-- half the calories of regular OJ/lemonade/etc. I drink those only in moderation since they still have calories, but it satisfies the caloric fix when I get it.
RE: sushi, I was a huge sushi fan before, so it’s hard not eating it now, rice really does a number on the pouch (rice and bread are about equally bad, although I can do some pasta in moderation-- usually can enjoy a few pieces out of a Lean Cuisine/Healthy Choice dinner after I eat all the protein in it). That said, nothing wrong with sashimi.
During the mushies, I lived on refried beans, canned tuna, cream soups (the Bariatric Pantry protein ones ain’t bad), cheese, and eggs. After a few weeks I was dying for a salad, anything with a crunch and texture to it. It’s hard, but again, it ends.
Six months out, chicken is the easiest protein for me, followed by fish (tuna, tilapia, etc.; salmon’s a bit harder). Pork and shrimp/scallops/lobster are a little harder to eat, but if a good cut prepared well I enjoy it. Beef, alas, is a real chore; it doesn’t go down well, it doesn’t digest well, and frankly doesn’t taste as good as it did before. I’ve had cravings for cheeseburgers and steak here and there but every time I’ve tried them I’ve discovered that they just aren’t worth the trouble.
RE: alcohol, then you’re in good shape. I had some hot sake last night for the first time since the surgery and it went down reallllly well, so I may have just discovered my go-to beverage when I need to be social.
Let’s see, any other advice…
– I don’t know what proteins they’ve got you on, but like I said before, tastes vary. I ended up hating about 95% of the potential protein shakes they’ve got out there. The only ones I still drink are Premiere Protein (the Costco brand-- the chocolate only, the others are blech) and the occasional Pure Protein can one can get most anywhere (not a huge fan, too dense, but it works in a pinch). During the mushies I did use a lot of the Unjury powder, particularly the chicken soup flavored one-- I found adding it to some chicken broth (or if you can find it, Pho broth) wasn’t bad, but again, in time I found I couldn’t use it any longer.
You’ll find that’s true of a lot of the things you eat during your recovery phase-- since the diet is so limited, you’ll be in a bit of a rut, and by the time you’re out of the mushies you’ll likely NEVER want to eat the stuff again (even now if I even think about strawberry-flavored drinks & shakes I get a little ill).
Other good things, most of which you can find at Bariatric Pantry:
– The hot chocolates are pretty decent, and satisfy a chocolate craving. Also, be aware the in moderation Cool Whip or Whip Cream has virtually no calories but really improves the flavor, so if you think you can do it, go for it.
– The BBQ protein potato chips aren’t bad once you’re off the mushies. Again, not that anyone should snack, but it’s got the same protein/nutritional value of a protein bar, calories are calories, so they work in a pinch.
– The protein pancakes aren’t bad, either, although I recommend buying a “silver dollar” pan. Some sugar-free or Agave syrup and you’re good to go.
– The puddings are also good, the chocolate, vanilla and cheesecake ones are good (stay away from the strawberry… shudder).
Anyway… again, congrats, and best of luck!
Oh, one other thing:
That was the same reason I chose the sleeve, at least part of it. I didn’t want to bother with fills or worry about slippage, let alone a surgery to replace the band down the road (the newer ones are supposed to be “lifetime” bands, but who knows?). What’s more, the lap band only works on hunger when eating, i.e. you get full just as fast as with the sleeve, but once you’re no longer full, there’s nothing stopping you from getting hungry again. The sleeve nukes your hunger hormones and permanently reduces your appetite, that appealed to me.
In comparison to the gastric bypass, the sleeve has no moving parts, i.e. once the pouch is healed, that’s it, nothing will change. The bypass still has that new “sphincter” built to your small intestine, and my GF (a nurse at the hospital where we had our surgery) has several years of stories of bypass patients coming in years later to have their “blown out” sphincters repaired to address their failed bypasses. Plus, that dumping thing again was something I wanted to avoid (although as I mentioned, I sure as heck have something that closely approximates it, but it’s tolerable).
Anyway… I think it’s a great surgery, and it’s destined to only get more popular over time. The only downside compared to the band is a big one-- once you do it, you never get to go back-- so I’m certain that’s scary to a lot of people. But the way I looked at it, I’m not GOING back: I lived nearly 40 years one way, this is now my new life to live 40, 50 or even 60 years the OTHER way.
I wanted to give an update now that it’s a little more than a month post-op
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I know I am not drinking enough fluid. My urine has been much darker than normal for me but for the past two days it’s getting more “normal” because I feel able to drink more
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I’m adding more foods to my diet. I tried some ground turkey in a frying pan to brown it a few weeks ago and it was good. I then tried 3/4 a meatball at a restaurant and I puked. Tried a turkey meatball I made at home and I puked. This was two weeks ago. Now I’m eating cheese sticks (string cheese) and hard boiled eggs during the day (about 3/4 an egg)
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I want to add more “real food” but I am constantly worried now about puking
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The small Fruit & Yogurt Parfaits from McDonald’s are great I just trash the granola and I can eat the entire thing ( I have a concern that it’s a slider for me)
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The feeling of never feeling hungry is odd but I’m getting used to it
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I’m using the premier protein drinks (chocolate) from Costco they seem to be the only ones I like.
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There is no # 7
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I need to walk and exercise more.