Should EVERYONE have the DS?

I had a long conversation with someone who's a lot further out than I am with DS, and in her job, she encounters many DS patients.  We talked philosophy of WLS. I LOVE my DS. I argued that everyone should be able to get it with a BMI that qualifies for WLS, except for people who were so intellectually impaired they would be unable to understand the magnitude of what they were doing to their bodies. She disagreed and made me think. She said that there are other groups of people who should not have the DS, even though they need WLS.  this was her list. People who cannot afford the $1000 or so they might have to spend on supplements/year. (She recalled someone taking some of the supplements and not the others because of cost.) People who cannot afford to eat high quality protein every day. (She recalled one person who could barely afford to put a box of macaroni and cheese on the table for her kids, let along tuna or chicken) People who are rebellious and think they are special and can get away without following the nutrition rules. People with erratic health insurance histories who may come in and out of having insurance, just when they needed a long, long list of blood tests. I defined the intelligence barrier lower than she did. She felt people had to be in the upper levels of intelligence to do this. She felt a compulsive personality was a desirable trait for this surgery. People who are more easygoing don't do as well as those who set up their pills in careful order and plan ahead to keep a supply. Would you add to this list? Do you disagree with her?

No,everyone should not have the DS. She makes very valid points that I agree with. I do think that some of those issues would be of concern to other WLS also.

I agree with every point except that those should be the limitations on EVERY WLS.  There are no easy WLS....ok maybe the VSG is the easiest of all the surgeries.....but even in that....new research is showing that there may be a possible connection between ghrelin and the bodies ability to build bone...so they amy not be out of the suppliment "ho****er" so to speak.  EVERY WLS has challenges...every WLS has additonal expenses (RNYers take suppliments like us..and Banders need to pay for fills and unfills).   Every surgery has some aspect of tracking labs, measuring food etc.   Is the DS a bit more complicated....perhaps....but not so much that a person with an average level of intelligence wouldn't be able to figure it out.   On every other point though I agree...and I'd add one more...I don't think anyone under 20 should be allowed to have the DS, and I think those that have it under 25 should be heavily screened to make sure that their lives are stable enough to handle the post op care. Scott

I agree that the limitations are true of every WLS, but the more malabsorptive the surgery (DS and distal RNY), the more risks there are of playing fast and loose with the rules. I didn't think anyone did DS on someone under 21. I agree about age 25 at a minimum.  As for an average level of intelligence, I am not sure how that is defined and how you test for it in advance of surgery. But  we're talking about a potentially fatal disease, morbid obesity. Would you deny diabetics treatment because you don't think they'll follow through on the treatment?   I don't know the answers here. Apparently neither does anyone else.

I'm not sure how you would measure intelligence.....who should decide is another very difficult question....better for someone with a degree in medical ethics oto decide then me.  Giving someone a surgery that causes malabsorbtion knowing that they won't follow up or take their suppliments is like giving a 5 year old a loaded gun.  ON the other hand, these are not 5 year olds they are adults and should be allowed to do what they want with their bodies.... I think the solution would be a BETTER psych exam that actually does something besides annoy preops...lol.    I mean really, how many of us went to a psych exam only to find they basically rubber stamped our surgery.....I mean as long as you don't think that  getting WLS will make you Supreme overlord of the earth....you are gonna get approved.   So a partial solution would be an actual psych exam that would actually evaluate your ability to follow up with after care and such.  This would of course be only a partial solution, and I'm sure it's riddled with unforseen issues. Is there an easy answer?  NO...but as time passes we are getting closer and closer to a day when obesity may be cured with a pill and the DS will be a passe treatment.   Who knows by the time this is all hashed out, maybe no one will need the DS. Scott

Gad, I can't seem to get away from this thread.  Age is very provocative. I think it is SO relative to the individual, as it is with plastic surgery.   I would weep to think that a 400# 21 y/o would have to wait another 4 years for relief.  Age is just a very arbitrary factor.  There are very mature 15 y/o's, and very immature 30 y/o's.   I know the Rabkins operate(d) on adolescents.  As a deveil's advocate here I have to ask: if, as parents, we're already responsible for our children's diets, what difference does is it make if we're monitoring supplements and nutrition requirements for a post-op?  I just can't ignore the suffering of very high MOs, and SMO teens; a a self esteem, and peer acceptance, suffering that is SO debilitating.  I have a RnY friend who needs a revision due to repeated stomal ulcer bleeds.  She has concluded after a lot of research, and watching my life style, that the DS is for her.  She has a daughter who is approaching SMO status.  Daughter will be 18 in July.  For 3 years, daughter has wanted the DS.  Mom is pro, divorced dad has head buried in sand about any WLS.  Friend found very interesting study that asserts the lap-band is VERY effective with adolescents as they are still "trainable" in diet life style.   It's clear to me that I suffer from a DS superiority complex and need to constantly temper my "enthusiasm".   Because the above-mentioned dad could probably be persuaded to go with the band, and because daughter would at least get some relief, I'd like to see her have it, especially as it seems to be a more simple revision--not entirely positive about that though.  However, this is a very, very mature 17 y/o--great grades, hard worker, realistic plan for work and college, independent thinker, AND VERY bright. (Hmm there's that intelligence factor again).  So, in the end, I just have to think that the DS should be available to her at 18.     Just want to add that I think this is a terrific thread that you've started. 

I agree that a 21 year old who is 400 lbs and is mature should be given the opporunity to have the DS,  but again who is to draw that line?  As for the 18 year old?  I still disagree, I think that even at 18 a person is still developing..if not physically ...at least emotionally.  Yes there may be some very mature 18 year olds, but maturity isn't the only issue, life stability is VERY imortant with the DS.  A person has to be able to have medical care for the rest of their life with the DS, it isn't optional.  Going through the "lean" college and post college years with the DS would be extremely difficults...from both my own college epxerience and the experience of those around me.  Perhaps a VSG with the option to revise in a few years to the full DS would be more appropriate?   I don't know...thank God I'm not the one that has to make these decisions. Scott

i dont know where she shops but i did not spend anywhere near 1000 on vitamins. I dont think i even spent 300.   But i guess i could see where this might be an issue...so ill be neutral on this point. someone who cant eat protein....hmm...isnt tuna like 50 cents?? And thighs are like 2-4 dollars for the family pack.  Hamburger is 1.80 at walmart.  Catfish is cheap, etc.  Nah im not buying this one. I think a person can find a way.  I AGREE that people who do not take their vitamins and do not see the importance in taking their vitamins should NOT have ANY WLS. 

I LOVE THIGHS!  hehehe! 

Yup, I agree, the DS can be done on a budget.  I'm on a budget so I can eat out several times a week!  hehe!    I buy the marked-down meat at WalMart, tuna, eggs, cheese.  I buy the Equate/WalMart brands of vitamins that are appropriate.  I take Dry A&D from Vitalady which is cheaper than the ADEKs.

BUT, someone that can't be bothered with doing the supplement and labs dance, should NOT have a DS.  Someone that can't commit to eating mostly protein, should NOT have a DS.

  I dunno. In my college days, I was eating cheerios for dinner.