Differing medical opinions (sleeve v bypass)

[Sharonimo]

Well I've been sleeved so there's no going back now.

However, my surgeon does not appear to be quite as keen on the sleeve as some other surgeons (including one I am aware of at the Homerton who is now favouring the sleeve for many patients).

When I saw Mr Sufi in January and told him of my decision to change from bypass to sleeve, he gave me the lecture about "you might not lose as much weight as with a bypass" etc etc .... but I went into that meeting with print outs of shed loads of sleeve research papers I had found (or been sent by our resident researcher, Wannabeminime -- LOL!) .... and convinced him that I was making this choice after serious consideration.

Then 2 days ago when I saw him a few hours before my op, he was still saying to me: "you might stretch the sleeve, especially 4 or 5 years down the line there is a tendency to regain the weight".

Then he started talking to me about the post-op diet and the regime I should adhere to.

At that point (slightly peee'd off that he was still trying to put a downer on the sleeve on the actual day of my operation) I piped up that I had bought the book "Successful Weight Loss with the Gastric Sleeve" and read all about the post op diet phases.

MR SUFI: "Who wrote that?"

ME: "Dr Alvarez"

MR SUFI: "Ah yes, the Mexican -- he does give a very rosey picture".

Hmmmmm ..............

I did not enquire further -- assume Mr Sufi was implying that Guillermo Alvarez gives the 'rosey picture' that all his patients lose 90+% excess weight loss, with loads of success stories on his website of 70lbs, 100 lbs, 150 lbs, 200 lbs and 250 lbs losses ..... and perhaps that is not the full picture, or not the picture that Mr Sufi has encountered with long term sleevers.

(But unfortunately people who don't do well with the sleeve -- or any weight loss surgery -- are ususally the ones who don't return for all their 1 year and 2 year post op check up appointments, and who disappear off the forums, not wanting to admit defeat or failure etc, so we hear less about them !!!).

[MORE ON NEXT BOX -- PLEASE HOLD OFF COMMENTS UNTIL I HAVE COMPLETED -- THANKS]

 

[Sharonimo]

I get the impression that Mr Sufi does support the sleeve in 2 cases:

1. For people with a lower starting BMI (40 or less) and less than 100 lbs to lose (like our Ruthie).

2. For people with a BMI over 60 as a "first stage" procedure.

But that for those of us in the middle (the "average" morbidly obese peeps with BMI's 40 - 50 ish and Type 2 diabetes) he favours the bypass as the first port of call.

90% of the patients at the Whittington go for the full bypass ..... and I have met very few sleevers (other than one who was a 1st stage / 2nd stage procedure chap, and one who had been sleeved at the Homerton but turned up at a Whittington support meeting -- who had done well).

So then my mind gets working into paranoid overdrive overtime thinking:

1. If Mr Sufi does not 100% fully support the sleeve and thinks I will fail and be back for a bypass in a year or two has he deliberately given me a large / wide sleeve to start with so that I will fail and he can turn round and say "you see, I told you" and prove that he was right ......???????

I do seem able to consume quite large amounts of liquid -- over 500 mls of water since 8 am (it is now 1 pm), plus 250 mls breakfast shake, and my liquid pain meds as well ....... Hmmmmmmmm

[MORE ON NEXT BOX -- AGAIN PLEASE HOLD OFF COMMENTS YET -- THERE IS A "BUT" COMING!]

 

[Sharonimo]

But is Mr Sufi just giving me the "NHS claptrap corporate official line" about the sleeve?

Is he contractually obliged to tell me "you might not lose as much weight as with a bypass" and "the bypass does offer the best resolution of diabetes" etc because that is what the current NHS / NICE clinical criteria states ...?

Is this all because of the "corporate thinking" of the NHS, whereas in the US and Mexico and Australia many surgeons (who operate independently and privately) are now favouring the sleeve, and a few are actually dropping the bypass as a surgery they no longer offer ....???

[MORE COMING -- SORRY -- THERE IS ONE MORE BIT !!! -- NEXT BOX]

 

[pharmgirldee]

if you set your mind to succeeding, you will succeed. sharonimo YOU will succeed!
dee

 

[Sharonimo]

But ....

When I got down to the operating theatre and had a chat with the anaesthetist, he asked me why I had chosen the sleeve and I gave him my reasons and the anaesthetist said:

"Yes, absolutely. There is lots of new data emerging to suggest that the sleeve should actually be the operation of choice for the majority of patients, not the minority."

The anaesthetist was very "pro" sleeve and seemed to be impressed with my decision and that I had researched it so much before making that choice.

HOW ODD !!

The anaesthetist supports the sleeve more than my own surgeon (!!!).

I guess I just gotta prove Mr Sufi wrong then and that a BMI 51.7 starting weight person *can* achieve significant weight loss with the sleeve !!!

Perhaps if I do that (and lots of other new sleevers continue to do that) ...... Mr Sufi (and other surgeons) might eventually come round to supporting the sleeve more ????

[ok end of posts now! Ta !]

 

[Wonderlust]

I am three week post-op and I've been able to drink over a litre in the timescale you use as an example.

Every one is different, and I lost just under 17lbs in the first two weeks.

From the limited research I've done it seems that the Sleeve is easier for both the surgeon (quicker to perform)and the patient (Easier recovery).

It also, and I may be wrong on this, has the benefit of leaving the "valves" intact so it makes for less food issues.

Also I had no choice, I was told I was having a sleeve....

 

[Nuxley]

Hi Sharon

I have been reading your posts with great interest as I too have had a battle to convince my surgeon that a sleeve is the best option for me. I flatly refused the bypass that was offered to me (all too easily) at my first appointment and I think this has annoyed my surgeon because he is still trying to persuade me to have a bypass now, and my surgery is less than two weeks away!

Like you I have done my research and am of the opinion that, whilst I may not lose 90% of my excess weight with the sleeve, I will lose a significant amout and have a healthier life because of it. Malabsorbtion and dumping are not for me nomatter what anyone says. I just want a smaller stomach so that I eat less and don't feel hungry all the time.

I hope that your dire hospital experience does not upset you for too much longer as now is the time for you to be focussing on YOU and taking time to heal. I am inspired by the masses of support available on here and will continue to follow your journey (which I'm sure will be remarkable!) for as long as you share it with us.

Wishing you a very happy and healthy road ahead. x

 

[wannabeminime]

I have a real life friend who went from 440lb to 172lb with a sleeve. With the right diet advice and support, it can be done! Stop worrying hun, you know you made the right decision for you Xx

 

[stuckinafatsuit]

You can stretch both a bypassed pouch and a sleeved pouch if your not careful. Sharon do you remember reading my post on "new data on weight gain" and you said it was the final nail in the coffin to help you decide on a sleeve. This is one mans opinion, my surgeon was the complete opposite and he was very supportive and said it would be successful as long as i followed the rules. Bypassers have to follow the rules as well or it wont work for them. You have nothing to worry about, wait until your on solid foods the amout you can eat is very small and your appetite is hugely reduced. Im a pound off 5 stone in 18 weeks, and this is going to work because im bloody well determined that it will!!
Drink as much as you can, b4 you know it you will be on solid food and then you will really feel the sleeve working

Kim

 

[pharmgirldee]

i have found, if i am busy and do not eat during the day like i should (i am 8 months out from op) i have trouble getting food in the next few days. almost like my stomach shrinks and i am starting all over again... just make sure you follow the rules and you will do great!
dee

 

[Fuffs]

Sharon, I think you are over thinking it all.

I don't think the surgeon would waste yours or his time by sabotaging your sleeve. He is a respectable surgeon. As 90% of his patients have the bypass that would be his preference. But I don't think he would make your pouch big to prove a point.

The anaethetist could only give his opinion, as it's not his area of expertise.

You have had your sleeve AND it will work well for you. Just be pleased you can drink a lot. You will stay nicely hydrated.

Now it's time to relax, heal and look forward to this journey

 

[yviec1972]

I have read a lot and hope to get a sleeve but am worried if the surgeon is dead against it. I hope it will be ok as many of the other people from bradford have told me that the sleeve and bypass are preferred and its the band they don't like doing. I just hope they take my wishes into account xx

 

[angeeb]

I wouldn't worry in the least how much fluid you can get in....(or puree's for that matter) wait till you try some solid food....meat or fish, you'll be shocked!

 

[Sharonimo]

Malabsorbtion and dumping are not for me nomatter what anyone says. I just want a smaller stomach so that I eat less and don't feel hungry all the time.

Me too.

So far it seems I do not dump on sugar which is pleasing me -- not because I was ever a sweets / cakes / chocs addict (my downfall was always savoury carbs -- bread, crisps, chips, mashed potato, etc) but because:

** I can take all my sugary pain meds with no probs (Calpol Ibuprofen and Calpol Paracetemol etc)

** I will never have to worry about whether lemsip or any other cough / cold medicine might be problematic and cause me to dump


Yes, I do realise I am probably over thinking this (Fuffs!) but it it is just slightly disconcerting that my own surgeon does not seem to support the sleeve as much as some other surgeons.

 

[Fuffs]

Me too.

So far it seems I do not dump on sugar which is pleasing me -- not because I was ever a sweets / cakes / chocs addict (my downfall was always savoury carbs -- bread, crisps, chips, mashed potato, etc) but because:

** I can take all my sugary pain meds with no probs (Calpol Ibuprofen and Calpol Paracetemol etc)

** I will never have to worry about whether lemsip or any other cough / cold medicine might be problematic and cause me to dump

Yes, I do realise I am probably over thinking this (Fuffs!) but it it is just slightly disconcerting that my own surgeon does not seem to support the sleeve as much as some other surgeons.

I understand that and wasn't having a go. But what I was saying is I am sure despite his misgivings he has given you an A class sleeve and all will be fantastic

 

[Jamast]

The reality is that all GP's, hospital consultants; surgeons etc, (no matter what country they are based in) have particular 'preferences' - generally underpinned (or perhaps that should say 'guided') by whomever funds their research, training, fields of practice and so on. Dr. Sufi and Dr Alvarez will both have beliefs based on whatever area is of most interest to them - for which they receive most backing.
At the end of the day, your choices are what matter. If after seriously considering and researching all your options, which I have no doubt that you did, that felt that the sleeve was for you - then you did the right thing in insisting on the sleeve.

There is no reason why you should not succeed. I know many people who have had WLS. Two have had the sleeve; one is losing the weight that she wants to - the other has gained almost all he lost, but his eating habits are now back to what they were before his op - I actually saw him eat two of take-away meals and then he said he was still hungry.
You can and will do this Sharonimo - just remember we're watching you lol x

 

[Fuffs]

The reality is that all GP's, hospital consultants; surgeons etc, (no matter what country they are based in) have particular 'preferences' - generally underpinned (or perhaps that should say 'guided') by whomever funds their research, training, fields of practice and so on. Dr. Sufi and Dr Alvarez will both have beliefs based on whatever area is of most interest to them - for which they receive most backing.
At the end of the day, your choices are what matter. If after seriously considering and researching all your options, which I have no doubt that you did, that felt that the sleeve was for you - then you did the right thing in insisting on the sleeve.

There is no reason why you should not succeed. I know many people who have had WLS. Two have had the sleeve; one is losing the weight that she wants to - the other has gained almost all he lost, but his eating habits are now back to what they were before his op - I actually saw him eat two of take-away meals and then he said he was still hungry.
You can and will do this Sharonimo - just remember we're watching you lol x

Good post Jamast

 

[Ruthiep]

I didn't get the impression at all that Mr. Sufi was against the sleeve, Sharon. And I certainly don't think he would deliberately do a "bad job" (large sleeve) just so you fail. As Fuffs said, he's a competent surgeon, and his reputation is on the line.

You're right that he doesn't do as many sleeves as he does bands AND bypasses, but that's because his patients have their own preferences, and the sleeve, being the newest type of surgery, isn't as generally known as the others.

He definitely has a bee in his bonnet about the sleeve stretching; he has put the fear of God into me about it too. He did say the following at our last support group on April 11th..

His own data is that 40% of sleevers will regain some of the weight lost, and 25% will gain back a significant amount. Both he and Kirsten, his nurse, agreed that the sleeve will never stretch back to its original size, and as he put it "that data means that 60% and 75% of patients won't regain anything." He also added that a lot of the regaining patients were those that drank a lot of beer, which is both empty calories in large quantities, AND fizzy. As I don't drink, I have hopes I'll be OK.

I am very pleased with my weight loss. I am not yet 5 months post op and I am within 11lbs of my (revised) goal of 10st. If I go lower than 10st I will regard it as "wiggle room" to allow me the odd pound or two up and down the scales.

When he was talking about the percentage of excess body weight loss each procedure resulted in, he did quote the bypass as a higher percentage than the sleeve, but not by so much that it would make me choose it, with all its attendant issues of dumping and malabsorption.

I feel sure that bypass patients can also regain.

Please be confident in your choice and work with it. Every procedure requires your own input too; although my sleeve makes it so much easier not to overeat; if I grazed on high calorie food all day, I could overeat, as could any WLS patient. It's still up to us.

 

[Sharonimo]

He definitely has a bee in his bonnet about the sleeve stretching; he has put the fear of God into me about it too. He did say the following at our last support group on April 11th..

and as he put it "that data means that 60% and 75% of patients won't regain anything."

He also added that a lot of the regaining patients were those that drank a lot of beer, which is both empty calories in large quantities, AND fizzy. As I don't drink, I have hopes I'll be OK.

Thanks so much, Ruthie.

Yes he definitely does bang on and on about the sleeve stretching -- possibly to knock it into our heads to stick to the rules (!!!).

I have never drunk beer, or hardly any alcohol (about once a year at a wedding or big family do) so that will not be difficult to avoid.

Just gotta make sure that we are in the 60% to 75% of patients who don't regain anything then -- I want to be in that group !!!

 

[Mazza]

Please be confident in your choice and work with it. Every procedure requires your own input too; although my sleeve makes it so much easier not to overeat; if I grazed on high calorie food all day, I could overeat, as could any WLS patient. It's still up to us.

Very well put Ruthiep!

Sharon could you be feeling a bit of 'buyers remorse'?

After going through the trauma of surgery your mind can go into overdrive - I suffered from major post op blues!

I'm sure you will be in 'that' group