Friday, March 8, 2013

My Band-to-Sleeve Experience

A lot of people (especially those considering first-time bariatric surgery or revision surgery) have asked me about my band-to-sleeve revision, and how my sleeve compares to my band. Below is a summary of my experience so far. I'll warn you in advance that I'm not happy with my sleeve. I do know several sleevesters (band-to-sleeve patients) who love their sleeve, but I have a strong suspicion that they feel that way because their experience with the band was unhappy, not because the sleeve is intrinsically better than the band. When they had their band removed and revised to the sleeve, the euphoria they felt was a bit like the relief you feel when you stop banging your head against a wall.

I was banded in September 2007. I lost 100% of my excess weight (90 lbs) in one year. I had a minor band slip (cured with a complete unfill and 6-week rest period) and a port flip (fixed with outpatient surgery) and loved my band. When it was properly adjusted, it drastically reduced both my physical hunger and my appetite (desire) for food. Food just did not taste as wonderful to me as it had in the bad old days. I also experienced the early and prolonged satiety that is the band's #1 claim to fame.

Unfortunately, I lost my band in April 2012 because of damage from 20+ years of silent reflux, which my band may have been aggravating. My surgeon and gastro doc agreed that my band had to come out, so I opted to revise to the sleeve in the same procedure. That didn't happen because my surgeon couldn't pass the bougie (the sleeve "calibration" tool) through my esophagus because of an undiagnosed stricture, so I was bandless until my 2nd attempt on August 16, 2012. I had the stricture dilated during an EGD in May 2012.

I had thought that the sleeve would be a good 2nd choice for me because I wasn't crazy about the malabsorption aspect of RNY or DS, because one of the best features of the sleeve is that the reduced stomach size drastically reduces production of the hunger hormone, ghrelin, and because the idea of a surgery that wouldn't require fills to achieve optimal restriction was appealing.

Unfortunately, it didn't work out that way for me. I am now ferociously hungry on an hourly basis no matter what, how much, or when I eat. I have to eat 8-10 times a day in order to keep my blood sugar steady. I've had to start taking metformin for my type 2 diabetes after easily managing it with diet and exercise for 7 years. I've discovered that sleeve patients can dump just like gastric bypass patients. The official term for dumping is rapid gastric emptying. My surgeon says that my sleeve is too small to hold food long enough for the stomach to start digesting it, so it passes rapidly into my intestines, causing my blood sugar to spike and then dive. It gives me miserable symptoms of nausea, dizziness, drenching sweats, and fatigue. That happens not just when I eat something with sugar in it but also when I eat so-called healthy foods (protein bars, milk, cottage cheese, yogurt, protein shakes, many fruits). And it happens when I eat too fast or too much.

At 6-1/2 mos post-op, I'm still trying to learn my satiety signals. They are not as clear as the stop eating signals I got with my band. All I've identified so far is that when I start feeling slightly nauseated, I've probably eaten one bite too many. Other sleevesters have told me that with their sleeve, they never have a stuck episode or a PB (productive burp or regurgitation). With my sleeve, 2 times I've felt like I was ready to PB, but I didn't. My strategies for dealing with all this are to serve myself half of my planned portion of food, eat that, and if I still feel physically hungry, I eat the rest. When I was banded, I used a salad plate (8") instead of a dinner plate (10"). Now I use a small bread plate (6").

I've become anemic and have to take an iron supplement twice a day in order to give me enough energy to function. Turns out that micronutrient malabsorption isn't unique to RNY & DS patients (anemia and other conditions related to micronutrient malabsorption have been documented by scientific studies; to read an abstract of one study, click here.

Also, a few months after my sleeve surgery I developed a gastric bleed. When doing an EGD to locate the source of the bleed, my gastro doc discovered a gastric polyp (probably the cause of the bleeding) and duodenitis (inflammation of the duodenum), neither of which were present when I had an EGD 3 months before my sleeve surgery. He theorizes that those were caused by surgical trauma.

I'm not able to be objective about my sleeve at this point, and it's probably too early for me to decide it was a mistake. But even if I decide it was a mistake, I'm never going to get that missing chunk of stomach back. It's gone forever. I do know that I absolutely refuse to go back to the land of obesity, and I'm grateful that my sleeve has helped me avoid that. I've lost the 30 lbs I had regained after losing my sleeve (plus another 7 lbs), and that is wonderful thing.

One difference between my band surgery and my sleeve surgery is that my sleeve surgery was much harder to recover from. It wasn't more painful, per se. My port site was very sore because my surgeon used the incision she had made to remove my port in order to remove the big chunk of stomach she had cut off, but my port site was the most uncomfortable incision from my original band surgery, so that was no surprise. My surgeon says that any revision surgery is difficult because she's not operating on a "virgin" belly. I thought that the slow recovery was due to my age (59) because an older friend (age 61) who revised to the sleeve at the same time also found it difficult, but I met a younger woman (mid 30's) in my surgeon's waiting room whose sleeve was her 1st (and we hope last) WLS was also finding it difficult. I think the length and ease of recovery is also related to the patient's age, pain tolerance, general health, and amount of time spent under general anesthesia. My surgeon keeps band patients overnight in the hospital for one night, and sleeve and RNY patients for 2 or more nights. I hate being in the hospital but I was a mess even after 2 nights there. After my band surgery, I felt fine after one night in the hospital and was bored and restless and ready to go back to work (I worked at home then) within 3-4 days. After my sleeve surgery, just lifting a glass of water to my lips was a struggle. I felt like I'd been run over by a truck, and I needed the whole 3 weeks my surgeon insisted on off work, and even then I was dragging.

The other thing I want to say is that while my food capacity now is small (depending on the consistency of the food), my desire for and enjoyment of food is like it was before my band surgery. I feel like I get way, way too much pleasure out of eating. I believe that food tastes good for a reason (to keep us eating enough to survive and perpetuate the species), but that extreme enjoyment is a very mixed blessing. I constantly have to fight with myself to not take another bite so as to prolong the pleasure of eating. With my (adjusted) band, I did have some intrusive food thoughts, but nothing like it was in the bad old days. Now I think about food far too often than is good for my weight management.

I wish I had a happier story to report. I've been told that I'm not trying hard enough to like my sleeve because I loved my band. That may be true, but I sincerely wanted the sleeve and sincerely wanted it to work. I thought I knew what I was getting myself into. Ask me again in a year or so, and I may be waving the sleeve banner. And as the advertising hacks would say, "Your mileage may vary."


jennxaz said...

loved this post..thanks!

Lindyleta said...

WoW, Jean....thank you for posting. I was thinking that my band wasn't working. But it is my brain that isn't working. I eat way too much and make bad choices. Chocolate is my favorite over indulgence. I am so sorry you are having such a hard time with that sleeve. My heart goes out to you and all of us hungry people that have worked so hard to be thin. I've just gained 30 and am back on my path again. I am fighting the food Munch Monster every night. Maybe I should become a monk and meditate at night and fight it in my subconscious where it lives. The struggle continues. Thank you for all of your posts and your book which I keep by my bedside when I need an extra boost of awareness. Linda