Alright folks, give it to me straight...life after DS

I have worked through just about every surgery in my mind since I started this process back in April. I initially only wanted the band because it seemed less invasive, done as outpatient, and relatively safe. Now that I've had some esophageal issues identified I've rethought the band and have decided with 99.9% certainty that I don't want it. 

I never wanted RNY. Sweets aren't my problem and I don't want to dump. My MIL passed away from complications from RNY and I don't think I could put my husband through that worry. Yes, I know any WLS has risks but I think if it was a different procedure my husband can say to himself that it's not the *same* surgery that killed his mother and it might bring him less anxiety.

I have been leaning toward VSG more and more. I love the idea of not having that little vestigal stomach like RNY. Taking NSAIDs, minimal dumping, no fills -- all of this seems very appealing to me. Except my original surgeon isn't an advocate of the sleeve. 

So now I'm going for a second opinion with Dr Bell in CT. It will be awhile before I get a consultation because I have to get copies of all my preop work (psych clearance, nutritionist eval, endoscopy, PCP, etc) before they'll even look at me. But...I'm going to see this through. I have one chance at WLS and I want to make sure I make the right one.

Now that I'm planning on seeing Dr Bell anyway, I figured I'd ask him about DS. Why not -- I've been a pain in the butt on these boards posting in every surgery subforum asking a million questions. Why not explore DS too?

My questions -- if you don't mind indulging me:

1. The gas. Is it as horrible as I've read about? Is it controllable (ie, will it happen when I'm doing a presentation at work?) 
2. Do you ever have a solid BM again? I've heard that you don't (have also heard this with RNYers too)
3. What is the recovery time like? 
4. Alcohol -- can you have it eventually?
5. Food tolerance -- sushi is my absolute fave followed by pasta and Mexican. Are all these out for good?
6. Post surgery vitamin deficiencies -- how serious are they? Are they easily controlled by supplements?
7. At one point do you not have to worry about leaks? I am particularly concerned about this question as I believe it was a leak that killed my MIL -- she was a week out. Will I ever be able to breathe a sigh of relief that I'm "okay" and life can go on after my surgery?

It seems I've been climbing the ladder of WLS since starting this journey going from a reversible, restrictive only procedure to the grand daddy of restriction and malabsorption with DS.

A little about me in helping you answer my questions (which I truly appreciate any replies): I am 37, would possibly like to have kids in the next 2 years, my main comorbidities are GERD and joint pain. My BMI is around 41-42. I used to love to run but haven't been able to for the last 2 years because I regained the 90 lbs I lost on WW so I don't mind exercising. I feel that I can eat fairly healthfully when I am focused but portions have always been a problem.

Please -- I know you DSers are fanstastic about paying it forward. Any words of advice?

Thanks again for any insights you have.

1. Gas---is pretty much dependant on diet. You'll have to learn what YOUR body can handle. I really don't have any more gas now than I did pre-op, but it does smell different. Rather than being uncontrollable, sometimes I atually have to work at passing it.

2. BMs. Mine started being solid about week four, the same time I started taking iron.

3. Recovery time was about the same as for my hernia repair. In about ten days, I was ready to go shopping. (*grin*)

4. Alcohol---certainly!

5. Food tolerances. There is nothing that I can't tolerate. There is nothing that I cannot eat if I choose.

6. Vitamin deficiencies. I'm 5.5 years post-op, and everything's fine for me. That's the idea behind regular bloodwork---catch a problem while it's small, and easily corrected.

7. Leaks. I'm thinking that every day that passed after surgery, you're less likely to develop a leak. By 2-4 weeks, they should be virtually unheard-of.

1. The gas. Is it as horrible as I've read about? Is it controllable (ie, will it happen when I'm doing a presentation at work?) Completely controlled by what I eat...havent had any embarassing moments and believe me I would be told if I had (I am a day care provider :0))
2. Do you ever have a solid BM again? I've heard that you don't (have also heard this with RNYers too) I dont have diahrrea...softer bms yes
3. What is the recovery time like?Recovery depends on how we do as individuals...we are all different with different needs...my recovery was 6 weeks after open DS. 
4. Alcohol -- can you have it eventually?Yep
5. Food tolerance -- sushi is my absolute fave followed by pasta and Mexican. Are all these out for good?  At nearly 8 years post op I can and do enjoy Mexican foods often...pastas I do have some tummy problems with (gas and a little tummy ache) so I limit it to when I am going to be home and not have to go anywhere else...
6. Post surgery vitamin deficiencies -- how serious are they? Are they easily controlled by supplements?  At nearly 8 years post op my labs have been fine...I take all of the needed supplements and tweak as my labs need
7. At one point do you not have to worry about leaks? I am particularly concerned about this question as I believe it was a leak that killed my MIL -- she was a week out. Will I ever be able to breathe a sigh of relief that I'm "okay" and life can go on after my surgery?
I believe with all WLS there is the risk of a leak following surgery however we are tested for leaks prior to leaving the hospital.

I am so proud of who I have become now that I have no question this has been the best thing I have ever gifted myself as well as my children!  I now have 2 wonderful little grandbabies that I am able to do all of the things that I never could have done with my own children.  Just being here to enjoy them has made all of this more than a dream come true!

Good for you doing your research!

Really, the band has the roughly the same mortality rates as the RnY and the DS. Comparing apples to apples (people of similar BMI's and prior health problems) ALL WLS have the same percentage of mortalities.

Now, on to your questions:

1. The gas. Is it as horrible as I've read about? Is it controllable (ie, will it happen when I'm doing a presentation at work?) 

My gas is entirely controllable by restricting or timing when I have white carbs. Cut the carbs, cut the gas. If you crave them, hold out until eveing & THEN enjoy them.

Other causes, such as lactose intolerance are also controllable by retricting what you eat.


2. Do you ever have a solid BM again? I've heard that you don't (have also heard this with RNYers too)

Unfortunately, I do have solid bm's. I MISS my nice, cleansing DS pudding poos. The iron I take makes them too solid for my taste.

3. What is the recovery time like? 

Hell. It sucks. No two ways about it. Giving your long-healing innards time to recover as well as adjusting to your new anatomy, takes time and patience. But, the end result is MORE than worth the early days' struggle.

4. Alcohol -- can you have it eventually?

Yeppers. And I am living proof. ;-)

5. Food tolerance -- sushi is my absolute fave followed by pasta and Mexican. Are all these out for good?

Sushi is great, probably from tight out of the gate. Pasta is something I can still only tolerate in very small portions. Mexican is fine as long as I stay away from flour tortillas.

6. Post surgery vitamin deficiencies -- how serious are they? Are they easily controlled by supplements?

No more so than the RnY or any surgery if you don't supplement. In your average, compliant DSer, they are easily managed by regular labs and supplementation. I am actually in better health now than pre-op because I never paid attention to my deficiencies pre-op. My nails are stronger, my hair is stronger, my skin is more clear, my immune is system is stronger.

7. At one point do you not have to worry about leaks? I am particularly concerned about this question as I believe it was a leak that killed my MIL -- she was a week out. Will I ever be able to breathe a sigh of relief that I'm "okay" and life can go on after my surgery?

The risk of leaks declines dramatically as the days pass from your surgery. I am so sorry about your MIL. But, that was a rare occurence. Leaks are generally caught early and fixed while still in the hospital. If not, stay tuned here and we will tell you when to haul your butt to an emergency room. Too many times, it is the time that lapses before treatment that puts life at risk. You'll be on your toes.

I'm slightly out of the loop lately, but does Dr. Bell even do the DS? Check out www.dsfacts.com for a vetted list of surgeons. A surgeon who doesn't perform the DS isn't going to promote it as an option for you.

They all answered about the same as I would have...except:

My body doesnt respond well to Chinese Food (might be the msg) nor does it like Chicken Strips or Popcorn Shrimp (may be the breading - although mozzarella sticks go down like a dream!).  I can also eat Pasta without any issues.  Your body will tell you what it likes and dislikes and your taste might change pre-op and post op - but all I can say is the trade-offs are worth it 100%!!

My BM's are 99% solid as I do take 2 - 18mg irons a day as my doctor instructs all menstruating women to do.

Gas - I think you'll be fine and all can be controlled with diet. 

Recovery- I was a lightweight also - fairly athletic with no comorbids and had my DS done laprascopically.  Besides being worn out...I was functioning decently within 1 week and ready to drive by end of week two.  I would take your time recovering though,,,take the time for yourself.

Leaks - I am sorry about your MIL.  I am sure they happen with any type of surgery.  All I can say is that my doc doesn't even do a drain after surgery - so I am fairly confident that they know if there will be any leaks prior to you leaving the operating table...

IMHO.

Dana

Folks have given you great responses but I am concerned that you're going to talk to a surgeon that probably is going to try to talk you into the RNY rather than supporting the DS even if that's what you want. So, please look at the surgeon listed on www.DSFacts.com or www.duodenalswitch.com. You might have to travel to see one of them but you sill get an unbiased opinion from a surgeon that does all WLSs. Good luck!
Gina

I agree with Gina, the surgeon you're going to see in CT is not a DS surgeon I really doubt you will get an unbiased opinion from a surgeon that doesn't do the DS. Here's a link to a list of DS surgeons:

http://www.dsfacts.com/North-American-Duodenal-Switch-Surgeons.html

You're on the right track in looking into all your options, but I caution you; do not take a surgeons word for what's best for you or what you should do. Do your own due diligence, read the published papers on the subject, study the stats, look at the facts, listen to what people who have had the experience. I would also recommend you read the Revision board and the Regrets board; it's full of RNY and Lap Banders *****gret getting RNY and Lap Band, but I've yet to read of a DSer looking for a revision to either RNY or Lap Band.

And you can add me to the chorus of people who did not do well with RNY. While it did help me lose the weight originally, it was useless in helping me keep it off and in fact hindered my ability to do so. I had RNY for 28 years, I managed to keep the weight off for 15 of the 28, but it was a struggle. You can read all the details on my profile if you want to; it's pretty much all there. 

The long and short of it is that IMO, RNY sucks compared to the DS. The DS has given me a quality of life I never dreamed possible for me and even though I had complications and a very difficult recovery, the results are well worth it.

I was at a family lake trip at Lake Powell last summer and the only picture of me from that trip is one of me sleeping on the couch; it was pretty sad. Here's one of the pictures of me on this years trip to Powell:

http://www.obesityhelp.com/myoh/photos/507856/Fish-Me/Lake-Powell-July-2009/
 

Kerry

1. The gas. Is it as horrible as I've read about? Is it controllable (ie, will it happen when I'm doing a presentation at work?) 

the only thing that gives me gas is sugar alcohols in full sugar candy, like gummy life savers and twizzlers so I don't eat them right now because I'm still losing.  If you do get gas while doing a presentation at work it's because of something you ate.  If you know  you will be presenting, don't eat any new foods beforehand.  Only eat things you know settle well with you.

2. Do you ever have a solid BM again? I've heard that you don't (have also heard this with RNYers too)

I wish I could have one of those great emptying everyone here talks about.  Sadly, I don't.  I take two colace every night so I can keep myself going and I am not the only DSer out here who deals with things on this end of the spectrum.  Yes Virginia BM's can be solid after DS. 
3. What is the recovery time like? 
sitting in the recliner looking for something to watch, sipping liquid, trying proteins a bite at a time, walking around the house or outside depending on how scary I looked for the first week, then better and better until about week 3 I was relatively normal, then by week 6 energy was back and feeling really good.
4. Alcohol -- can you have it eventually?
supposed to stay away from it during the first year to give your liver a break - I did that and can have a drink if I want one now, but find that I am something of a lightweight, maybe it's cause I lost weight and didn't drink for a year?
5. Food tolerance -- sushi is my absolute fave followed by pasta and Mexican. Are all these out for good?
we eat pasta around here weekly, I use dreamfields and my family can't tell the difference.  It settles fine on my stomach and gives me no gas, I even use it in mac n cheese.  Actually I can use regular pasta but feel the dreamfields is better for them anyway so I use it.  Downside to pasta - it takes up too much room to eat alot of it so I don't.  I eat mostly the sauce with meat in it and a few noodles when making a pasta dish.
Sushi absolutely - again go light on the rice or leave it out, I love sushi for the sauces mostly anyway
Mexican - here again, I can do it but I don't have the space to stuff that whole burrito shell so I usually slice mine open down the middle and eat the stuffings usually with a bite or two of the tortilla if I need it, usually I don't.  It doesn't cause me gas or other issues, I just don't have the space.
6. Post surgery vitamin deficiencies -- how serious are they? Are they easily controlled by supplements?
all of my deficiencies were preop - since I learned about them they have resolved as of my 6 month labs = still waiting on my 1 year labs but expect they have gotten better as well, keeping fingers crossed.
7. At one point do you not have to worry about leaks? I am particularly concerned about this question as I believe it was a leak that killed my MIL -- she was a week out. Will I ever be able to breathe a sigh of relief that I'm "okay" and life can go on after my surgery?
I have not worried about leaks since I woke up from surgery.  I know they have happened to many people on the boards and it is scary.  I wish I could address this but it might be better answered in a post of it's own.  Just to get the attention of anyone who might have had a leak.

I am only going to respond to 2 of your questions.  I have a leak, my surgery was April 30th, I am still on tube feeding and still have a drain.  I was vigilant abou****ching my fever and signs and symptoms, therefore caught my leak.  My life now is different, I cannot eat anything but I know there is a light at the end of the tunnel. 

Pregnancy:  You can not get pregnant for at least 18 months post surgery which would put you at 39 before you could consider pregnancy.  Then it will be harder to get pregnant with more risks associated. 

Just some things to think about.

So it sounds like you're down to deciding between the DS and the VSG. IMO, those are the two BEST options currently available! And both will allow you to take NSAIDs (which you wouldn't be able to take regularly with the RNY) for your joint pain.

It also sounds like you've been fed some extreme exaggerations regarding post-DS life. I honestly think I know of more posst-op DSers who battle constipation than those who battle constant liquid BMs. I take 2 stool softeners and magnesium oxide daily to combat rock-hard stools (I have read of this issue on the VSG board as well, so it's not a problem specific only to DSers).

I haven't taken anything for gas since I left the hospital after my surgery. At one point, I was adding fiber to my drinks and foods to see if that would help soften my BMs, and THAT caused me some gurgly gas, but as soon as I stopped adding extra fiber, the gas stopped as well.

Now, I will say I am a bit different in that I was eating lower in carbs for about a year before my DS due to my type 2 diabetes anyway, so I won't say I eat things like pasta, potato chips, or bread much now, but that's because of my diabetes and hasn't changed since pre-op.

As others have mentioned, I would definitely see if you could get a consult (even if only by phone) with a real DS surgeon. There are currently NO known DS surgeons in all of New England. The closest are in NY followed by NJ and Scranton, PA.

In all honesty (I know this might not be popular here, but here goes anyway!), a VSG may very well be enough for you with yor low BMI and no serious comorbidities (the GERD could go either way - a sleeved stomach, as with the VSG and DS, could make it better or worse). The biggest risk, IMO, with the stand-alone VSG is that there are no solid long-term statistics right now about how well the weight STAYS off. The most recent 5-year stats for the VSG were NOT very positive, but since they make the sleeve smaller now than they did back then, they are hoping future results will be better. The DS has upwards of a proven 80% EWL maintenance at 5+ years. So, that's something you have to talk over with yourself.

For me, I knew the stand-alone VSG wouldn't be enough. I wanted the 98.9% type 2 diabetes cure rate that only the DS can boast. I, too, plan on starting a family in about 2 years-ish, and I sure didn't want to be battling diabetes and pregnancy together!