The gastric bypass process in Ontario (roux-en-y)

I find your response and that of Lizmari quite amusing. When I refute your points, you then go in a different and irrelevant direction. My responses to your comments dealt with real factual medical issues where I believed the two of you were just wrong. Nothing you have said changes my mind on those issues, nor does it impact on my decision to do the roux-en-y or not - I haven’t pressed the button yet, but I’m leaning towards doing it more now than before, due mainly to talking with other people in the program yesterday. I wish you well in your battle with diabetes and thank you for taking the time to provide your comments.

Hi Grant,
I am like-minded about the gastric bypass procedure and I hope one day it will be embraced as a mainstream treatment and possible cure for t2d. I am recently diagnosed as diabetic and am going to ask my doctor for a referral this week to a surgery centre here in Toronto… previously my weight would have been just below the threshold for eligibility, but now with the diabetes I hope to be considered a good candidate as I am only 26 years old and otherwise in pretty good health, though I have a knee injury which keeps me from most exercise and which has been getting worse with the wear of my weight. I really hope to be able to have this surgery, I see everything that all four of my grand parents went through with their diabetes and what my father has been going through for the past 20 years. I am still very interested to hear more about your experience as you prepare for surgery. It is very frustrating to hear these other non-sense comments from those who are obviously less well informed, I hope they have not deterred you from posting further about your experience. All the best to you.

Please excuse my skepticsm. I have had good friends who have had this surgery and I don’t see it as a “treatment” for diabetes. If you are looking at it for weight control and are ready to undergo the rigorous regime of eating, exercise and possible side effects, more power to you. But please do not say that this is a treatment for diabetes, because it is not.
It very well, can stave off the diabetes that you have already developed, but it is not a cure. Your diabetes might go into remission for a while, but as you progress, so might the diabetes, and you could find yourself giving yourself more than 5 shots a day after a time. This surgery is distinctly for weight loss, not the control of any disease except that one. Please do some more research and soul searching before you under go the procedure…

I wish instead of going to more doctors, and quacks who want to quick fix everything… people would go to forums, and online, to seek the experiences of those who highly regret and are sorry they got this ridiculous procedure, and all the complications they now face… Not to mention the huge number of them who have become alcoholics now, replacing one addiction with another… because the operation only takes care of external things… Not our habits and behavior.

A woman’s experience gone wrong with gastric bypass…
Part 1, http://www.youtube.com/watch?v=xgRtxRvd3pE
Part 2, http://www.youtube.com/watch?v=u06IY3YlZxE&feature=related
Constant seizures, lost her license… http://www.youtube.com/watch?v=rhrax6Ev1cw

Replacing compulsive behaviors with others, after gastric bypass… http://www.intelihealth.com/IH/ihtIH/WSIHW000/333/8014/510565.html

I think weight loss surgery in the beginning “forces” you to adjust how you relate to food, but having had three friends undergo this procedure, and me having Lap band surgery, after a while some habits do come back. Unless one realizes that the surgery is only a tool, and not a cure, then you will be fine. It does not cure anything…you still have to make the commitment to weight loss. Actually, to be perfectly honest, Weight Watchers, or a similar plan, prepares you to actually change you habits. What a great combo…weight loss surgery, and the support of a group like Weight Watchers. I feel whatever someone wants to do to help themselves is great! But the surgery does not “cure” you. It is work, and unless you can follow your plan 100% of the time, exercise, and do everything they tell you, you will take the weight off, but have a higher chance of putting it back on…

I find the latest comments somewhat amusing, if not distressing for their lack of understanding of Roux-en-Y surgery as it relates to Type 2. The comments remind me of climate change deniers. No one, certainly not me, ever said this surgery is a silver bullet or perfect or without qualifications and limitations. One makes choices in life and balances costs and benefits. For me, and many, many others in the program here in Ontario, it is very successful. Of course there are limitations and requirements for diet, nutrition, exercise, etc to maintain the success. Is anything really good, easy? The program here screens applicants very carefully, and I think this helps to achieve more success. Anything new attracts curiousity, criticism, rejection and attack from vested interests (big pharma and the gigantic diabetes industry) and people who fear change and challenge. The actual factual record speaks for itself and the dire consequences referred to in a couple responses are bs perpetrated by a tiny no. of people that should not have had the surgery in the first place. I’m not an advocate for any surgery, drug, tester or thing, except that people keep in an open mind to solutions and treatments that could be better than the old industry mantra: take drugs, test often. For me, I feel 25 years younger in all respects, have so much energy, enjoy exercise now, sleep better, apnea is gone or greatly reduced, take no insulin, only take metformin for weight loss purposes, cut my lipitor and lipidil in half on Dr.'s instructions, am consistently below 6 after meals and below 7 morning fasting, don’t infect with every cut I get, my legs and toes feel normal again, no more busy leg, numb toes, no hip pain/arthritis, my neck has appeared again, as have my ankles, I eat for flavour, very small amounts, save several hundred a month (easily +$500) on drugs, food and booze, can buy normal clothes now and feel better, hugely better about my appearance, feel more self confident, can’t abide sitting watching TV anymore, need to do things, get up and do something physical, not so moody, depressed or lethargic anymore, can act like a non-diabetic…and so on. I am happy to follow the limitations and restrictions for the immense benefits enjoyed so far, it is a conscious, carefully considered and weighed trade-off. It is one of the best, smartest things I have ever done.

Grant, I am so happy for you! A new lease on life! I can only hope that I too can be approved for surgery and have a similar experience - I see my doctor tomorrow for a referral, wish me luck!

Again, more and more people who don’t know what they are talking about keep sounding off here on what is suppossed to be a thread about your experience. Why do they assume that being overweight is neccessarily due to a disordered relationship with food? I eat much healthier than most people, but a knee injury that keeps me from most exercise and the metabolism of a slug (the result of years of the losing/gaining weight yo-yo and my genetics) have meant that I have gained weight consistently since puberty. These people have obviously done little research in gastric bypass for t2d - repeated studies have found it to be an incredible treatment and even a cure, and not due to the weight loss, but due to the anatomical and chemical changes in the gut. Why would anyone make decisions based on these few anecdotes of people who have died or had severe side-effects? It is completely irrational, the statistics and studies speak for themselves.

Grant, I am glad you made the right decision for you. That is what it is all about. As you have the right to express your opinions, you do not have the right to assume some of us have not investigated this procedure as well. My opinions have never attacked you, or your belief and right to do what you want. Please do not assume my lack of knowledge on the procedure, for I am a surgical tech and have observed first hand the procedure from the “inside” out. My doctor is one of the top obesity surgeons in the US, and trains doctors all over the world. I am happy for you. It is a major decision, and through all your postoperative care, I am sure you will continue to do well. You seem extremely motivated, and that is what counts.
Good job!

Thanks for your comment and all the very best to you. If you go forward because it is right for you, I would be happy to offer any tips about both negatives and positives, and tips - some may not work for you, and some may be useful. One funny one: if I eat too much, the warning I get that the “dumping syndrome” is kicking in is that I have one or two sneezes, like an allergy - weird, eh?

Well, my response was to a few comments, not to just you, so don’t take it personally. Your comment was perhaps the least bothersome to me personally, as I’ve received lots of ones that imply that I don’t know what I’m doing, or that I’m over-compensating for my own insecurities about the op, etc, etc. Your comment was balanced as compared to some, but I don’t have time to respond to every single comment individually. Your knowledge and experience base is likely very strong, though what you don’t have is the personal experience of a successful RNYGB patient who adopts the recommended post-op limitations, restrictions, and behaviours at a reasonable level, and I can say that the op has thus far achieve 100% of the predicted results - not just weight loss. My other health issues were far more important than appearance, frankly - my bp went from 140-120/90-85 ish on avapro to 110/60 on 1/2 the avapro! I have three groups monitoring/advising me: the hospital bariatric program, my MD, and my endo, and all are very pleased, but not surprised by my results to date. Again, I suspect that the Ontario program ensure success by very careful screening as compared to private US hospitals that are profit-motivated, though my care if not gold-plated by any means.

Well I have been considering this. I have a good friend who had the roux-en-y, not for diabetes but for other conditions, and it has been several years and she is healthy and has not gained back anything significant.

The way I look at it is as a balance of risks. Sure the surgery has risks. But so does my current effort to combat the horrors in store for me if I fail to control by BGs.

For my BMI the risks seem to balance, i.e. its about the same either way.

I never would have thought of it before, but my friend, and others who have had the surgery and gone on to healthy lives, give me something to think about. I hear it can be done laproscopically now too, so the surgery is less traumatic. I do know someone, however, who had the bypass surgery, and in two years has gained back over half the weight.

The big thing is, on the one side, can I continue to control my blood sugars. I have been diangonesed type 2 since June 1 and have done well so far, and not coincedently, lost a pound a week since then. But realistically, can I keep this level of attention to details? I did not get a sudden incease in discipline. I am helped by the drugs, and I am scared out of my mind. And what if the drugs begin to be less effective? Especially the Victoza, which really takes away my apitite? If I can’t seem to do it on my own, doesn’t the bypass make some sense?

On the other side. What are the statistics 3 and 5 year post surgery. Do most people gain the weight (and the diabetes) back? If it is just as hard to stay healthy after the surgery, then what have I gained?

I am very interested in this as an option. I will be seeing an endo next week, and I have called a surgeon about the rouxe-en-y and will see him as soon as I can.

I am still very scared of all the complications of diabetes, very very scared, and I do not trust myself (yet?) to be able to avoid them. If surgery will help, (perhaps a big if), I would be foolish not to at least look into it.

Jeff: Your analysis is sound. I would add:

  1. the drugs typically work for about 10 years, then you’re into insulin
  2. insuling is expensive and sometimes, needles do hurt, are inconvenient, make travel awkward; oh yeah, you gain weight and feel hungry all the time, and you can cheat by shooting more insulin, a dangerous spiral effect
  3. experts have continually lowered the level that is “safe” for BGs: used to be below 9, then 8, then 7, now 6 or below. That’s very hard to maintain day in day out.
  4. if you’re above 6, you’re suffering permanent damage to your body; most t2ds have good and bad months, up and down, with moods and events, with weight gain throughout unless you’re keen on ever-increasing exercise regimes
  5. beside BGs, you will have a host of other t2d things going on: bp, weight, bad legs, feet, sleep apnea, even if you control BG, as I did too
  6. I wouldn’t consider anything but laparscopic type of roux en y
  7. post op, still must be disciplined of course, but is easier, more effective
  8. I feel 25 yrs younger in all ways, and I do mean ALL ways.
    Don’t be lulled into complacency by all the bs from the industry: take your meds, eat salads, test often and exercise will make everything OK. You won’t, it won’t, they won’t. It isn’t reality except for a small minority of people. Most will deteriorate gradually, symptoms/side effects will worsen, and die young of heart or kidney problems. That is reality for the vast majority of t2ds. Beware particularly of the t1ds who argue it is just a matter of lifestyle, so you are shamed to shut up and follow conventional wisdom.

That is the kind of thing I am worried about, what happens if and when the drugs don’t seem to help. I have been able to keep my levels below 150 for the past week or so, with diet and exercise, but also with 2000 mg of metformin and 1.2 mg of Victoza injection daily.

I am able to do this because I am running scared. Not the best of motivations long term, I know. Diabetes has taken over my life, with the stress and worry and bad dreams, I am not confident that this is a sustainable life style, however effective it might be.

I get most of the lifestyle comments, not from type 1s, those I know have been very sympathetic, but from less informed friends and family, and especially some of my nutritional suppliments alternative health western civilization is killing us friends.

The one message that I have taken to heart is that there is nobody else but me responsible for my health. Nobody. Apologies, as if I would get them, from doctors, insurance providers, specialists, dieticians, friends, nutritionists, will not do much for my bleeding eyes and numb feet. No “oops we were wrong” will be of any comfort when I am in the hospital with ketoacidosis.

So I look at all of that as love and caring and professional and personal concern for me, couched in unfortunate language.

Nobody wants to see me undergo surgery. But I would be delinquent in my responsibility to my self if I let them decide how I get healthy.

Yikes!

Lizmari I would be foolish to ignore or discount your point of view as well. I have found you to be a voice of reason in a very cluttered landscape.

If being healthy after surgery takes as much attention to detail and discipline as it does now, have I really gotten further ahead?

I am very scared of the surgery. Is my motivation that it might be a magic bullet? AND, I am very scared of the diabetes. What makes me think I can do that, if I don’t think I can do this?

I mostly just want it to all go away, to wake up and have breakfast at IHOP.

Reading your comments is like a deja vu for me, as it is so close to how I felt and acted in 98 when I was first diagnosed. In deference to the conventional industry wisdom, it is true that each person will have their own solutions to this diabetes thing - if they work at it and keep an open mind. I am firmly of the mind that the so-called “lifestyle” solutions require Herculean strength, willpower and perseverence, beyond that exercised frankly by either type 1’s or non-diabetics. A bit of exercise just won’t do the trick; going off the wagon will not be tolerated by your body, and besides, as people on this site frequently fail to mention, t2ds often have other baggage as a side effect or medically linked to t2d, such as depression. T2ds are vulnerable people, I know I was and am still. Listen, I was strong etc. for 10 yrs., but it gets tougher, not easier as you get older and heavier - that is reality.

Yeah, beware of the natural cure nuts, they just want to sell untested stuff for outrageous prices based on unfounded claims and possible detrimental side effects. They combine their natural message with attacks on the industry of drugs and testing - so do I, but I also have said that drugs and testing did a great job for about 10 years.

I know a t2d who is in a serious deterioration mode, resentful of having to restrict her diet, stuck in a business that involves sitting at a desk for too long every day, and she’s now too old for RNYGB to be done here - over 60. If I could have done this in say 2003, I would have had that much more healthy time, but at 56, it was now or never. I had to persevere with the local bureaucracy in Ontario for almost two years to get on the right list and be moved along, my application/referral was lost in space a couple times, and I deteriorated in the meantime.

You are so right that only you are responsible for your health! Support is the best thing to expect, but it is all you, and you can’t rely on others - family, work, doctors, etc. to always make it easy for you.

BTW, if RNYGB isn’t right for you, then get your doc to get you on some OptiFast stuff for 2 meals a day and lose some serious weight that way. If you can lose and keep off 50 lbs, then everything else starts to work for you - but I don’t think the average t2d can get and KEEP OFF 50 lbs with exercise and eating salad. It just won’t happen for many reasons. If I hadn’t gone the RNYGB route, I would have used OptiFast for two meals a day - late afternoon and supper, or mid-evening snack/small meal.

Everyone will discourage you from even considering RNYGB so early in your t2d state, but remember, there is a long lead time to commencement of the process to the op, including convincing your GP to refer you! My GP was not enthused at all, but he is convinced now. Best, gbt

Listen… while that guy has to liquify everything he eats, so he doesn’t throw it up… and thinks people on diets eat only lettuce, every day… I’ll be having burgers, three meat pizza, hamburger helper, peanut butter cups, nuts and almonds, pepperoni, eggs, and bacon… And my A1C is 5.5%, and I’ve already lost 75 LBS. lol I’ve lost more weight than most of the people who get this crazy surgery, in less time! lol It is NOT the hardest thing in the world. The hardest thing in the world is liquifying all your food so you don’t throw it up, having seizures, and hypoglycemia in public places, and all the time, and not being able to drive any more! lol The hardest thing is not limiting yourself to just a handful of nuts… It’s NOT being able to have any at all cus your stupid surgery will make you puke, or seriously get you injured from ingesting a handful of peanuts! lol While people can make their own choices, my beef is not with that… It’s with telling everyone that this is the sensible choice they should make, and that a lifestyle change doesn’t work.

My GP suggested it. I have to lose 100 lbs, at a pound a week, in two years. So far, eight weeks, eight pounds. (Good start.)