Surgical Consultation Today
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rpyle111
Posts: 1,066 Member
Busy day today! More hurdles cleared!
I met my surgeon today and made it through another couple of steps prior to surgery. I didn’t get my date yet, but everything went well. I believe I get my surgery date when i see the surgeon next on July 18th. I could have gotten the date this Friday, but the appointment didn’t fit my schedule, so I have to wait until the surgeon is back from vacation.
The appointment consisted of getting a quick physical workup from a nurse, weight (-52 lb by their scales), height (down an inch from what I thought I was, I’m shrinking!), BP/pulse, etc.
Then a surgical resident came in and we reviewed my letter of intent (the program requires that you write a letter to the surgeon explaining your motivation, history, understanding of the process and post-surgery life, etc.), my health history, etc. We talked about which surgery I would like (I officially opted for the VSG today). I was a good candidate for either VSG or RnY, and chose based on the reduced changes to the plumbing and simpler VSG surgery. I am counting on my own post-surgery ability to lose the extra weight to make up for the statistical lower amount of weight lost by VSG patients.
Then the surgeon came in and talked with my wife and I. With the pre-surgery success I have had, everything was very positive and they believe I will be an excellent candidate ad will follow the post-surgery life well. I asked about postponing the surgery based on my success, to see if I could hack it on my own. They were open to that (it was completely up to me), but suggested that because of the very low percentages of people who succeed at losing as much as I need to, that having the surgery statistically is much more likely to be successful. They also brought up some hormonal changes that happen in the surgery that help more than is generally known/talked about. In the end, I decided to continue toward the surgery, but I was very happy with the way the conversation went.
After that, the Insurance Specialist came in and verified that my insurance approvals were in order. Following that, the nurse who coordinates the program came in and took me to her office to schedule my next appointments. She was very pleased with my progress (which I attribute in a large part to her; she ran the initial information session where the switch flipped, and I have only been following the plan she lad out for us: 1500 calories, log everything, exercise more, eat lots of protein.) She found an opening today for the medical clearance appointment, so I got that taken care of today as well.
I am now fully cleared for the surgery and will get my date scheduled on July 18th!! Very exciting day. I wanted to go through it in detail to share with those in the early stages of the process as those already post-surgery have been so helpful to me.
Rob
I met my surgeon today and made it through another couple of steps prior to surgery. I didn’t get my date yet, but everything went well. I believe I get my surgery date when i see the surgeon next on July 18th. I could have gotten the date this Friday, but the appointment didn’t fit my schedule, so I have to wait until the surgeon is back from vacation.
The appointment consisted of getting a quick physical workup from a nurse, weight (-52 lb by their scales), height (down an inch from what I thought I was, I’m shrinking!), BP/pulse, etc.
Then a surgical resident came in and we reviewed my letter of intent (the program requires that you write a letter to the surgeon explaining your motivation, history, understanding of the process and post-surgery life, etc.), my health history, etc. We talked about which surgery I would like (I officially opted for the VSG today). I was a good candidate for either VSG or RnY, and chose based on the reduced changes to the plumbing and simpler VSG surgery. I am counting on my own post-surgery ability to lose the extra weight to make up for the statistical lower amount of weight lost by VSG patients.
Then the surgeon came in and talked with my wife and I. With the pre-surgery success I have had, everything was very positive and they believe I will be an excellent candidate ad will follow the post-surgery life well. I asked about postponing the surgery based on my success, to see if I could hack it on my own. They were open to that (it was completely up to me), but suggested that because of the very low percentages of people who succeed at losing as much as I need to, that having the surgery statistically is much more likely to be successful. They also brought up some hormonal changes that happen in the surgery that help more than is generally known/talked about. In the end, I decided to continue toward the surgery, but I was very happy with the way the conversation went.
After that, the Insurance Specialist came in and verified that my insurance approvals were in order. Following that, the nurse who coordinates the program came in and took me to her office to schedule my next appointments. She was very pleased with my progress (which I attribute in a large part to her; she ran the initial information session where the switch flipped, and I have only been following the plan she lad out for us: 1500 calories, log everything, exercise more, eat lots of protein.) She found an opening today for the medical clearance appointment, so I got that taken care of today as well.
I am now fully cleared for the surgery and will get my date scheduled on July 18th!! Very exciting day. I wanted to go through it in detail to share with those in the early stages of the process as those already post-surgery have been so helpful to me.
Rob
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Replies
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Congrats! You are one step closer to your new you. I had my sleeve done 03/25/2014 and am down 72 lbs! Good luck with everything! I hope all goes well. If you need any advice, any encouragement, or any support feel free to add me!0
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Congratulations!!! That is great news!!!! Sounds like you are ready to go! :flowerforyou:0
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Excellent! Congratulations on this big step.0
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Congratulations on moving one step closer to your goal.0
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Awesome Rob!! You have been a great addition to our group and I look forward to seeing your progress(as well as mine!) :bigsmile:0
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Congratulations, Rob!! :happy:0
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That's great Rob! I am so happy for you!0
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Congrats!0
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Great news! Bariatric Surgery changed my life! You will be amazed! Best wishes!0
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That's a big step. Keep us updated.0
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Congrats! I think you are amazing. Way to lose 52 lbs, buddy!! That is the proof that your VSG will work for you
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Fantastic!0
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Yay for You!!
Just wondering...when she was talking about "hormonal changes" did she go into details...like what did she mean?0 -
We were talking about the Rny vs. VSG and I mentioned that with the removal of most of the stomach with VSG, I knew that the production of Ghrelin was significantly reduced. The surgeon said that the Ghrelin change was the one that most people knew about, but that the many more hormonal changes also went on that hadn't made it into common knowledge. He also said that the hormonal changes were a very significant part of the long term success (as grim_traveller has said), rather than the restriction, which is the common thought.
He rattled off a few, but we didn't talk about any in particular.
Rob
Here's an article that I fond that goes into detail (with lots of medical jargon that it will take me a while to try to understand):
http://www.laparoscopic.md/sleeve/hormones
And here's one (actually just an abstract) comparing hormonal changes between RnY and VSG:
http://www.ncbi.nlm.nih.gov/pubmed/219966000 -
Great studies, thanks.0
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Fantastic Rob! This is such an exciting time for you, and I'm so glad you're sharing it with us. I had my VSG 5/5/14 and I'm down 47 lbs. You're already doing great so keep up the good work. You're on your next step in your journey. I'm so glad you have the support of your wife. That's so important.0
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Fantastic Rob! This is such an exciting time for you, and I'm so glad you're sharing it with us. I had my VSG 5/5/14 and I'm down 47 lbs. You're already doing great so keep up the good work. You're on your next step in your journey. I'm so glad you have the support of your wife. That's so important.
You folks who gave give before us have been so helpful and inspirational, I am trying to pay it forward to those behind me in the process by detailing my process. Finding this group has been so helpful!
Yes my wife is an Angel! She has joined me on MFP and is down about 20ish herself. I am the luckiest man in the world to have her!
Rob0 -
Here's an article that I fond that goes into detail (with lots of medical jargon that it will take me a while to try to understand):
http://www.laparoscopic.md/sleeve/hormones
And here's one (actually just an abstract) comparing hormonal changes between RnY and VSG:
http://www.ncbi.nlm.nih.gov/pubmed/21996600
Changes in postprandial gut hormones after metabolic surgery: a comparison of gastric bypass and sleeve gastrectomy.
Lee WJ1, Chen CY, Chong K, Lee YC, Chen SC, Lee SD.
Author information
Abstract
BACKGROUND:
Laparoscopic gastric bypass (GB) is reportedly more effective than laparoscopic sleeve gastrectomy (SG) in the treatment of patients with a low body mass index and type 2 diabetes mellitus. However, the mechanism remains speculative. We compared the postprandial gut hormone patterns between patients undergoing laparoscopic GB and laparoscopic SG at 2 years after surgery in a hospital-based, prospective study.
METHODS:
A total of 16 laparoscopic GB and 16 laparoscopic SG patients were followed up and appraised for glucose homeostasis. Two years after surgery, the mixed meal test and gut hormones were evaluated in 13 laparoscopic GB and 13 laparoscopic SG patients who had been included in the previous randomized trial.
RESULTS:
The preoperative characteristics, such as body mass index, body weight, waist circumference, and duration of T2DM were comparable between the 2 groups. T2DM remission was achieved in 13 (81%) laparoscopic GB and 3 (19%) laparoscopic SG patients (P < .05) 2 years after surgery. The laparoscopic GB patients had lost more weight and had a smaller waist circumference and lower levels of glucose and hemoglobin A1c, and lower insulin resistance than the SG patients. Significant differences were found in acyl ghrelin, des-acyl ghrelin, cholecystokinin, and resistin between the 2 groups, but none in obestatin, gastric inhibitory peptide, glucagon-like peptide-1, and leptin.
CONCLUSIONS:
Both laparoscopic GB and laparoscopic SG have strong hindgut effects after surgery,but GB has a significant duodenal exclusion effect on cholecystokinin. The laparoscopic SG group had lower acyl ghrelin and des-acyl ghrelin levels but greater concentrations of resistin than the laparoscopic GB group.
Copyright © 2011 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved
LOTS of technical terms here....
I think I understand it for the most part but in regards to the conclussion in particulat this part "but GB has a significant uodenal exclusion effect on cholecystokinin. Could someone (grim_travelle maybe?) elaborate on this a little further??0 -
RESULTS:
The preoperative characteristics, such as body mass index, body weight, waist circumference, and duration of T2DM were comparable between the 2 groups. T2DM remission was achieved in 13 (81%) laparoscopic GB and 3 (19%) laparoscopic SG patients (P < .05) 2 years after surgery. The laparoscopic GB patients had lost more weight and had a smaller waist circumference and lower levels of glucose and hemoglobin A1c, and lower insulin resistance than the SG patients. Significant differences were found in acyl ghrelin, des-acyl ghrelin, cholecystokinin, and resistin between the 2 groups, but none in obestatin, gastric inhibitory peptide, glucagon-like peptide-1, and leptin.
CONCLUSIONS:
Both laparoscopic GB and laparoscopic SG have strong hindgut effects after surgery,but GB has a significant duodenal exclusion effect on cholecystokinin. The laparoscopic SG group had lower acyl ghrelin and des-acyl ghrelin levels but greater concentrations of resistin than the laparoscopic GB group.
Copyright © 2011 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved
LOTS of technical terms here....
I think I understand it for the most part but in regards to the conclussion in particulat this part "but GB has a significant uodenal exclusion effect on cholecystokinin. Could someone (grim_travelle maybe?) elaborate on this a little further??
As I understand it, they looked at the hormone differences between RnY and VSG patients. They looked at 8 hormones, found no difference in 4 of them (obestatin, gastric inhibitory peptide, glucagon-like peptide-1, and leptin). RnY patients had lower levels of resistin and cholecystokinin, while VSG patients had lower levels of acyl ghrelin and des-acyl ghrelin.
Note that this does not compare the hormone levels between surgery patients and non-surgical people, just between the two types of surgeries.
The sentence you asked about explains the lower levels of cholecystokinin are due to the bypassing of the duodenum in the bypass surgery.
I think the other article goes into more detail about what each of those hormones does.
Hope that this helps and that I understood it correctly.
Rob0
