"Excuse me?"
What's in a name?

Why the sleeve?


The Vertical "sleeve" Gastrectomy is a relatively new procedure for weight loss and I was very cautious about getting any kind of surgery at all. So how did I end up with a procedure that most insurance companies still consider "experimental?"


Like most people, when I first looked into WLS, all I knew about was the lapband and RnY. And, like most people, I had this idea that lapband was "safe" and RnY was "dangerous". I also like the idea that the lapband was reversible. I figured that if I turned into one of those people who WLS didn't agree with, I could just take it out.

Of course, I know now that I was hopelessly naive and also fairly ignorant as to what options were out there and what the pros and cons are of the different surgery types. And, yet, after learning a lot more about it, my initial analysis of bypass held.

Sure, it was a lot less dangerous than the media would lead you to believe, but my biggest fear of having surgery was that I'd end up less healthy than I was when I started. (I didn't know Melting Mama back then, but basically I was afraid that something like what happened to her would happen to me.)

Also, I really, really, really didn't want to dump. I'm not a person who responds well to negative reinforcement and I like to have a fair amount of control over my choices. Dumping sounded like it would be my worst nightmare.

I also found out about the blind stomach of bypass, how you can't take NSAIDs, and how, over time, you come to absorb your calories again, but not certain nutrients.

As an engineer, I just felt like this was a surgery with a poor system design and it just didn't appeal to me on some basic level.

In the meantime, I learned about the sleeve and the duodenal switch. The DS was another malabsorption surgery, only with even more malabsorption than the bypass, so that was out. The sleeve involved a permanent change to my stomach and I was still in my "what if something horrible happens and I need it reversed?" mode of thinking. So I rejected that too.

I was still on the bandwagon, it seemed.

But the more I learned about the band, the more disenchanted I became with my choice.

The first nail in the band's coffin happened right off the bat when I discovered that slippage rates were around 3-4%. Any complication with over a 1% chance of happening really wasn't acceptable to me. But I consoled myself with the idea that most slippage is supposedly due to "patient non-compliance" and moved on.

But over time I saw more and more people who did fine with the band at first but then one day they'd wake up choking on their own acid or their band slipped even though they followed all the rules.

The other thing that scared me was the people who never got to their sweet spot. They were essentially white knuckle dieting -- the very thing I was getting WLS to stop having to do. I knew I could diet without surgery, but I also knew I couldn't keep it off if I was hungry all the time.

Then, I found out that I'd been misinformed and all the policies at my company had weight loss surgery exclusions. So, if I wanted WLS, I was going to have to pay for it. If I was going to have to pay for it, I wanted a surgery that I was sure would work. I was no longer sure that was the band.

Finally, a series of studies came out showing a very high long-term complication rate for the band. One study showed that up to 40% of band patients had to have a second surgery! Now, I found that number suspiciously high and it included people who had their port flips fixed -- technically surgery, but a simple office procedure. But, even if the real number was half of that, that's a freakingly high number of people who end up losing their bands eventually.

That, combined with getting used to the idea that I was going to have surgery to solve my problems and I had to think of it as permanent, is what got me to look at the sleeve again. This time, the permanent removal of my stomach didn't freak me out as badly. Plus, I had learned about ghrelin and knew that was what was causing my ravenous appetite.

Finding out that the sleeve would remove the part of my stomach that made ghrelin was the big "aha" moment for me. If I didn't have ghrelin, I could be successful. My stomach was "broken" (it was too big and made too much ghrelin) and the sleeve would "fix" it.

So I was sold. The sleeve made sense to me, from an engineering point of view, in a way that bypass and band did not. It just felt right. Plus, if it turned out I was wrong about needing malabsorption, I could always get switched later. I like the idea of having a Plan B in my back pocket even if I was pretty sure I wouldn't need it.

Given the way that the sleeve works, I didn't mind that it's a relatively new surgery with few long-term results. Partial gastrectomies have been around for decades -- I even have a relative with one -- and the sleeve has been done as part of the DS. Plus, I knew it would work for me because it directly addressed my problem -- too much ghrelin.

I had come to see that ALL the surgeries work for someone and none of the surgeries work for everyone, so the most important thing is to pick the one that's has the best chance of working for you.

For me, that seemed to be the sleeve.

So, it's been almost a year.... am I happy with my choice? You bet.

As I suspected, I lost my weight just fine. As I also suspected, I'm having a bit of trouble not dropping too low. I have to watch my calories very carefully so that my body fat doesn't drop too low. I suspect that will be less of a problem over time, but I'm very glad that, right now, I haven't got malabsorption to deal with while trying to get in all my calories.

What I didn't suspect is how much I'd be tempted to cheat and work around my surgery. I tend to be a rule follower and I never thought I'd deliberately try to drink with meals or eat every hour in order to get more in. But sometimes I do. I find then that the restriction of the sleeve is very helpful to limit the damage and not being able to wash food out of my pouch as easily as you can with a band or bypass has also been a big help.

The biggest problem I've had with my sleeve is that sometimes I still eat too much or too fast. It doesn't take much more than one extra bite to get that tight feeling in my chest. I really hate that feeling and try to avoid it at all costs. But sometimes I just eat mindlessly or miss my "full" signal (it's still pretty subtle) and sometimes I'm eating with the unaltered and peer-pressure gets to me and I just eat too much. When that happens -- ugh.

The other thing that has surprised me is that I absolutely do feel hunger and have pretty much from the beginning. Sometimes it's really "hunger" -- that is something else masquerading as hunger -- but a lot of times I feel regular, normal hunger. In this, I think I'm unusual for people with the sleeve.

What I don't feel is that raging hunger where I want to hunt something down and kill it and where my brain is telling me that if I don't eat something RIGHT NOW, I will DIE even though I just ate something an hour ago. That's the ghrelin hunger and that is still pretty much gone.

But regular hunger, like normal people feel? Yeah, I get that.

It's taken me a while, but I think I like it. I've always wanted to be normal since I was old enough to realize that my family was not. So I feel like I've been given a gift -- the gift of normalcy. I feel this way even when I eat my very small portions. They feel normal to me. (Probably because they satisfy me.)

It's just so different from what I'm used to -- my body's been lying to me since I was 10, trying to get me heavier and heavier -- and now it seems like it tells me the truth. 

Now, I still don't trust it 100%. I keep looking for the catch. But, so far, there hasn't been one.

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