Question:
Would love to hear from successful RNY proximal post-ops who started over 400lbs

I have a surgery date of April 9th, 2003, but the surgeon I have to use only does a lap RNY proximal. I had my heart set on a distal. I would be so very grateful for some encouragement and success stories from proximal post-ops who began their WLS journey at over 400lbs. Good grief, I am ashamed of myself for feeling this way. I am honestly very thankful for this opportunity to regain my health and life, but I am concerned that a proximal won't be good enough to get the weight off and be able to keep it off long term. Now I know I am getting ridiculous because this is the third time I have posted a question to this message board; and I NEVER post to message boards!!! I just wouldn't have the courage to press on if you all weren't here for support! Bless you all!!!    — victoriandove (posted on March 1, 2003)

February 28, 2003
Lisa - I had a proximal RNY done 7/17/2002. My pre-op weight was 427 pounds (BMI 74). As of my last weigh-in on 2/8, I weighed 275 pounds (BMI 47) - a loss of 152 pounds in less than 7 months. Please feel free to peruse my profile and e-mail me through there if you have any other questions...JR
   — John Rushton

February 28, 2003
Lisa, I'm glad John saw this question because he was one I was going to tell you to contact. In my pre-op state I corresponded with John and his success made me feel a lot better about the whole thing. On top of it John has at least a 2 ounce pouch - I forget exactly which size it is. So based on the statistics John should be a total failure - over 400 lbs, proximal and large pouch. Yet he has proved everyone wrong. The main thing though is he works the program to the max. So it really comes down to taking full advantage of this wonderful tool you will be given. <p>I am a recent open RNY but at 150cm but with a 1/2 ounce pouch. I'm confident if I had ended up with 100cm I still would succeed in getting it off and keeping it off. Chris
   — zoedogcbr

March 1, 2003
Lisa, I had proximal RNY on January 10,2002 with a 1oz pouch. As of today I have lost 204lbs (and still losing slowly)with no complications. My starting weight was 441lbs. I know several people that have had proximal with great success. Good Luck to you in your journey! Toni (441/237/1??)
   — toni D.

March 1, 2003
Okay, I KNOW this will sound totally dumb. But what is the difference between proximal and distal. All I know is I had the basic bypass procedure. The pouch was made very small (stomach was reduced by 95-97%) The small bowel was divided about two feet below the stomach and a new opening was made, attaching the small stomach pouch to the small intestine. I have NO idea (but I will on my next visit to my surgeon, you can be sure!) how large the new pouch is or how many cm's were bypassed. I started out (open RNY 10/30/02) at the weight of 405 and I am now at 294 or 5 or 3. ;) I am ashamed to admit I haven't a clue here. And I thought I did my homework.
   — Ginger M.

March 1, 2003
I'm sure there are many success stories from people who started out over 400 pounds and were able to get down to a non-obese weight (and stay there) with the proximal RNY. However, they certainly seem to be the exception rather than the rule. If it were me, I would be doing everything in my power to get a more malabsorptive surgery (either the DS or a truly distal RNY). I ate lunch with a friend last week who is about two years post-op from a proximal RNY. She lost 200 pounds in the first year, but very little since then. She still has 150 pounds to go. Her surgeon tells her it's her fault (he's not a very nice person), that she just isn't working hard enough. He refuses to discuss a revision. Other surgeons she's talked to won't take on her case, either because they don't do revisions or they don't want to step on the toes of her first surgeon. So she is doing her best to lose the rest through diet and exercise, and of course she's finding that to be extremely difficult (as we all know). She's very grateful for the success that she's had, yet it's depressing to her that she's still morbidly obese and likely to stay that way. She wishes that she had done more research before her surgery -- sought out a different doctor and a different procedure. I know this isn't the kind of encouragement you were looking for when you asked your question, and I'm truly sorry. I just feel so terrible for my friend, and I don't want to see anyone else find herself in a similar situation if it can be avoided. I do know of many patients who have gone to Brazil to get the DS as self-pay patients (there's a great doctor and hospital there that's very affordable), even though they could have stayed home and had a proximal RNY paid by insurance. Maybe that could be an option for you?
   — Tally

March 1, 2003
Re: Ginger's question below about what is distal, and what is proximal? From what I've read on here, 150 cm is the cut off point: 150 cm and above=distal, 149 cm and below=proximal. A little hint to remember which is which - I think of the word "distance" in relation to distal (as in far away), and I think of the word "approximate" for proximal (as in making a <b>close</b> estimation). Just my little trick to remember...I couldn't remember which was which in the beginning of my journey. Hugs, Joy
   — [Deactivated Member]

March 1, 2003
i highly recomend the yahoo group [email protected] it is made up of people who started out at over 400 pounds. heafty weights (bmi's over 50) have much different problems than 'lightweights'(100 pounds over) it is a great list, vey inspiring.
   — janetc00

March 1, 2003
This is addressed to a previous poster - Tally. This is the 2nd Q&A today that I have seen addressed to RNY post-ops that you have butted in on espousing duodenal switch rhetoric. The poster wanted to hear from successful post-op RNY patients over 400 pounds - not DS patients....JR
   — John Rushton

March 1, 2003
in another support group, there was a girl who started out over 500 pounds and is now thirty pounds from goal. she has lost over 300 pounds. i know she works out it as well, exercise and such and has also had plastic surgery b/c of such bad saggy skin. i believe she had her surgery either a year and a half ago or two.
   — Jennifer S.

March 1, 2003
Regarding John's comments: I did actually hesitate to post a response to Lisa's question, because I realize that she was specifically looking for encouragement from RNYers who started out over 400lbs. I decided to go ahead and post anyway at the risk of "butting in", because I do have a personal friendship with someone who started out super-MO, had the proximal RNY, and now regrets that decision. Since Lisa is still pre-op and still wavering in her choice of procedure, I wanted to share my friend's experience and suggest an option that she might not yet be aware of. If I were in Lisa's shoes, I would want as much information as possible from as many people as possible, even if it wasn't always what I wanted to hear. Lisa, if I offended you or distressed you with my post, I sincerely apologize. I wish you only the best.<br><br> John, I realize that we are all very passionate about our surgeries of choice, and I certainly didn't mean to offend you either. However, I disagree with you that my post in the -other- thread was at all inappropriate, since at no point did that person specify that she was interested in hearing particularly from RNY post-ops, and since I had done quite a bit of research about the question she raised (long-term weight maintenance after the proximal RNY). I also noted in her profile that she has been considering having the DS, so I had that in mind when I replied. You know...I'm just sharing my experience and my research here, just as all of us do. It wasn't so long ago that I was a pre-op RNY who was lurking here, hoping to find the answers to many of these same questions. I ended up having a different surgery, and so that's what I tend to post the most about now. I'm sorry if that gets on your nerves, but I hear from many pre-ops who appreciate the information and who very much want to learn about all of their options.
   — Tally

March 1, 2003
Tally, I think your post was tastefully done and not intrusive at all - my opinion. For Lisa though I encourage you to check out how much each surgeon is bypassing. Proximal/Medial/Distal are JUST labels. Someone may have success with a Proximal of right at 150 bypassed, while some end up with a proximal that has 6" bypassed (seriously!!). When I was heavy into researching I spoke with others in my area who had the RNY done. It was amazing to me that NOBODY knew how much their surgeon had bypassed. While some surgeons adjust the amount bypassed to the patient, in my opinion, most don't. Its one size fits all and you have to find the right surgeon WITH the right bypass for you. I was 324 pounds when I was searching. At that point I felt I needed a more distal bypass based on my research. Its unfortunate but when you look at people long term, some have real problems keeping off the weight down the road. Nobody bothers to tell you that your intestine will actually adjust to compensate for the malabsorption issue over time. That something you find out with a lot of research. I don't have an answer for you, just the suggestion that you don't get caught up in labels of the surgery done but to find out how much is bypassed and then make your choices from there. Also you might want to check further into your insurance. Some insurances won't pay for anything more than a "proximal" specifically telling the doctor how much they can bypass at most. I believe it was Tally that spoke to the insurance issue with people self paying to get around their insurances mandates in order to get the surgery they felt they truly wanted or needed. For myself, I seriously looked into going to Mexico for a distal RNY as I was a total self pay. No matter what path you choose I wish you the best.
   — Shelly S.

March 1, 2003
Hi Lisa! I'm 10 months out from a medial RNY--100cm bypassed. I started out at 408 at 5'5". I have lost about 160 lbs to date. The weight loss is very slow right now and I've been on a plateau for about 2 months. I'm very happy with the loss so far, but I need to lose another 80-100lbs in order to have all the saggy, blobby skin removed. I need to have the thighs, rear, hips, abdomen, arms, boobs and the skin between my underarm and waist removed! I am a success according to the standars but I need to get rid of this spare tire! I would be a size 14 if I didn't have my gigantic gut in the way!
   — jenn2002

March 1, 2003
I personally also have a problem with the DS people constantly saying they will lose more weight, because when checking profiles of of RNY's and DS's, who are at one year, typically the RNY's are much further ahead in weight loss. Yes I know DS's lose slower. Yet when I look at 2 years out I don't see the DS's down a whole lot more and at goal. I realize everyone is different and this generalization does not apply to everyone, but the fact is that in general RNY's do as good or better than DS's in losing. Whether you get to goal and maintain, no matter which surgery, is dependent on the person and their committment to this new life. <p>For me it was important to change my eating habits. From everything I have read, at about 1 year I will be eating around 1200 calories and that is plenty of food and not necessarily void of carbs and sweets. I have lost 200 lbs before on 1200 calories and let me tell you I was way more than satisfied and if I wanted something sweet I had it. So I know that what I am able to eat will be fine. Yes I will not be living on bread and pasta anymore but for me that is a change I needed to make due to my obsession with it. I have now been almost totally devoid of carbs for 2 months now and doing fine. The only carbs I get is a little bit in some of the proteins I eat and I have had 1/2 slice of toast 3 times, but because it was a higer protein bread. I thought I would be having a whole lot more problems with it, but again this is what was needed to get my body moving in the right direction. <p>A lot of DS's fail to mention the very real possibility of significant bowel problems and BM's that could kill you with the smell. I did not make this up, I read post from DS people that talked about carrying bathroom spray with them because they were embarrased by the smell when using public bathrooms. When someone is checking out all surgeries I will tell them what I had and how I am doing but I also direct them dualswitch.com as I know that is the best place for them to get info on that surgery. Presenting facts and experiences to people is what is needed, not pressure to get them to come over to either side. People who are making this choice are intelligent and want to do well by themselves and get a healthier life, so they will likely check all procedures out and chose which one is best for them. So let's answer the questions and leave opinions out unless an opinion is speciaically asked for. In this case, experiences with proximal RNY's is what was asked for. I posted previously even though I am a distal but I directed the person to someone I knew could help .
   — zoedogcbr

March 1, 2003
I had proximal lap RNY last August - this week will be my 7 month anniversary and I'm down 143 pounds. There's a "2" in front of my wieght now!!!!! I was a 6X and today bought a 2X (my top is shrinking faster than my bottom!). These last 2 months have been really hard, but MAYBE things are picking up again. My profile is updated and thorough - feel free to check it out or email me anytime!
   — jen41766

March 1, 2003
Hi Chris (and congrats!),<br>You're absolutely right that there is a *lot* of individual variation when it comes to the success of these surgeries. Just because the published research shows greater average sustained weight loss with the DS than with the proximal RNY doesn't mean that it will be true for all patients. I think we DSers just tend to be pretty excited about our procedure, as well as feel that it's the field's "best kept secret," so I apologize if we sometimes get annoying with our enthusiasm! In the end, I do think it's important to emphasize that ALL of the modern weight loss surgeries are remarkably effective, and there's no one procedure that is right for everybody. For patients with several hundred pounds to lose, a very distal RNY (e.g., 100cm common channel, 150cm Roux limb, 300+ cm bypassed) can often be an even better choice than the DS, because you have the advantage of maximum restriction *and* maximum malabsorption. There are more side effects too (higher incidence than DS for nutrient deficiencies, same risk as DS for "bathroom" side effects, plus the typical "pouch" side effects of the prox. RNY), but for "super-super MO" patients, the results are often more than worth it. BTW, not all distal procedure patients do have problems with bathroom side effects. I'm 8 months out, and I average one BM each day, and it's not particularly smelly (might be because I'm a vegetarian... it seems that meat is often the culprit behind very "fragrant" BMs). I haven't had any diarrhea, and only mild/occasional episodes of gas (again, mostly non-smelly). All in all, very manageable, and only a little different from my pre-op days. Of course, every person is different, and like you, I have read quite a few posts from DSers and distal RNYers who say the smell of their BMs can "peel the paint off the walls"! Still, most of them consider it to be a small price to pay, and their intestinal tracts do seem to adjust and calm down (for the most part) after the first six months or so.<br><br>P.S. Shelly, thanks for your supportive words!
   — Tally

March 5, 2003
I started out at 444# I'm also 6'1" and at 5 1/2 months I've dropped over 100# and 62+ inches!!! I'm a proximal rny'r and feel FANTASTIC!!!! Another lady that went to my surgeon is Kathy Allen from Kansas her beginning weight was 524# and she's lost 279# in a little over a year!!! just AMAZING!!! I really think your attitude has sooo much to do with your success not just your procedure. BIG HUGS!!!
   — Deanna_K

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