Hi! It was recommended to me to come to this board after my first post on the other board. I was more or less introducing myself with one question: why RNY vs DS? Now I'm completely confused. I was comfortable with my decision for the RNY but now I wonder.

First of all, these are my issues:

1. I'm at this point of time 332 lbs. My initial consultation is Jan. 8 with Dr. Graber (originally it was Fritzer but I can't figure out how to change it! lol) and I had hoped to get the surgery done in March sometime. The main delay is work. I'm in marketing and with xmas and the olympics my job needs me.

2. I have type II diabetes controled with drugs.

3. I have severe osteoarthritis and take a regular anti inflammatory. Although I know weight loss won't cure it, it will help but I'm sure I'll need to take something still.

4. I'm a terrible eater. I can stick to most diets - for a bit, then fall off the wagon fast. I love sugar and sweets but am sure I can eventually get it out of my system. I emotionally eat, mostly at night and sometimes binge eat but not severely any more.

5. I'm Canadian so OHIP must cover my surgery or it's not possible.

6. I"m not rich but would be willing to go stateside to get it done if I didn't have to go too far. Utica was a great location.

7. I'd love to find some canadians who had this done and who can give me some advice!!

Go check out dsfacts.com.  The creator of that site is canadian. She's out here under the name "Bev"

- DS has, by far, the best cure-rate for type II diabetes! 
- Many people have fought for, and won, insurance coverage on the DS... 
- Can't take NSAIDS with RNY. Arthritis runs in my family and I feel reassured that my DS will allow me to take anti-inflammatories if I even need them!
-If you think that "dumping" will 'train' you not to eat sweets, that's usually not the case (see the study that EathyMami posted on your mainboard thread)... And not ALL RNYers dump. 
If you are a volume eater, the extra malabsorbtion of the DS might be the extra measure that you need to prevent postoperative re-gain.

Everything you wrote screams DS!  Your obstacle is going to be OHIP.  Save your pennies, if nothing else, and wait for the DS - from what you've written, you're NOT going to be happy (and probably not successful long term) with the RnY.  If you can't stick to a diet, you're going to struggle with the RnY 'eating plan'  Check out Jillybean's profile for the diabetes studies (I'm sure she'll post the same thing soon!).  NSAIDS are a no-no with the RnY, but not the DS.  A DSer CAN have sugar, if they have had their required protein (I eat it plenty, now that I'm at goal).  There's no guarantee you'll dump with the RnY, if you're hoping to use that as a deterrent to sweets.

Hi, Arttina,

Welcome to the DS forum.

I agree with what the others have posted and add that you and I are the same wt.
People with higher BMI's do very well with the DS because we have a longer window
to lose the weight and malabsorbtition to aide in keeping it off.  Those were the magic words for me; to keep it off.  

Good luck in your research.

 There are lots of Canadians here.  

Take your time and do your research.  The most sensible attitude to take is to think twice and cut once.  Learn about every option.

If you want to lose the weight and get rid of the diabetes, the DS is statistically your best option.

My ears were ringing...

So...

Check out my profile for articles and studies on the DS effect on type 2 diabetes!

Hayley_Hayley: RNY compared to the DS

 

RNY – expected weight loss

*50-65% expected excess weight loss (percentage varies in opinion – this is the most commonly seen estimate)

 

Regain

*Possible regain: more prevalent after 5 years

*50-100% regain of weight has been recorded

*Results may vary

*Must follow “pouch rules" in an attempt to not regain

 

DS – expected weight loss

*85% expected excess weight loss

*Results may vary

 

Regain

*Studies show little to no regain (no one recorded as to gaining all of weight back like with the RNY)

*Results may vary

*Highest success rate over 10 year study (78% avg. Excess Weight Loss – EWL)

 

RNY – have a stoma (stomach made into a pouch – size of an egg)

*Size: 2 oz

*Stretch to average size of 6 oz in 2 years  (possible to stretch up to 9-10 oz)

*You can eat more as time goes by

*Average after 1 year is 1-1.5 cups of food

 

No Endoscopes on blind stomach/remnant stomach that is bypassed

*Doctor evaluation: cannot use an endoscope (to find ulcers and tumors)

 

*RYGBP construction makes the large bypassed distal stomach inaccessible to standard non-invasive diagnostic modalities. Neither x-ray contrast studies nor endoscopy can assess this potentially important but hidden area.

 

Stomach: pouch

*Should not take Nonsteroidal Anti-Inflammatory drugs (NSAID).

*NSAIDs are: Advil, Alka Seltzer, Aleve, Anacin, Ascription, Aspirin, Bufferin, Coricidin, Cortisone, Dolobid, Empirin, Excedrin, Feldene, Fiorinol, Ibuprofen, Meclomen, Motrin, Nalfon, Naprosyn, Norgesic, Tolectin, Vanquish

 

NSAIDs are used for arthritis, bursitis, tendonitis, back pain, headaches, and general aches and pains.

*Taking NSAIDs could develop into a bleeding ulcer and interfere with kidney function.

 

Possible Problems

*Ulcers (Some doctors recommend taking prilosec for 6 months to 1/2 years in an attempt to prevent the ulcers)

*Possibility of a staple line failure

*Noncompliance: simply do not lose enough (even with following the rules)

*Vitamin Deficiencies

*Narrowing/blockage of the stoma

*Vomiting if food is not properly chewed or if food is eaten to quickly

 

*Dumping syndrome, NIPHS, Hypoglycemia

No Valve (pyloric valve that opens and closes to let food enter intestines is bypassed) which means food empties directly into the small intestines and causes dumping and/or can cause NIPHS or Hypoglycemia

 

Dumping: food (most commonly sugar but not necessarily “just" sugar) enters/dumps directly into small intestines and causes physical pain (some people believe this pain enforces good eating habits)

*Dumping varies in degree of occurrence and discomfort

*Dumping symptoms:

Nausea

Vomiting

Bloated stomach

Diarrhea

Excessive sweating

Increased bowel sounds

Dizziness

“Emotional" reactions

 

NIPHS (insulin over production): “the body overproduces insulin in response to food entering the intestines at a point where food would normally be more digested already - this part of the intestine is not used to coping with metabolizing glucose in the condition it arrives after RNY, and it is suspected that the intestine signals the pancreas for more insulin to aid digestion, causing a MASSIVE overproduction.  The change occurs on a cellular level, hard to diagnose.  Treatment: Removal of half the pancreas."

 

*RNY stoma that is created allows food to go straight through the stomach into the small intestine unrestricted so it does not control the flow.  Because of that the body reads that it needs more insulin because the food is moving through so quickly and it thinks there's going to be a lot more food.  With the DS, the normal peristalsis works because the pyloric valve is in place and can control the movement of food into the small intestines.  

 

*NIPHS, Hypoglycemia is deadly if not corrected

 

DS – whole stomach (size of banana)

“Whole working stomach" - meaning the stomach’s outer curvature is removed as opposed to making a pouch/stoma.

 

*Part of the stomach removed is where most of the hormone called Grehlin is produced.

Grehlin gives the sensation of hunger so by removing most of that section of the stomach a DSer is not as hungry as before.

*Whole working stomach: no blind stomach.  Endoscope can be used.

*Can take NSAIDs

*Do not need to take Prilosec to prevent ulcers.

*Valves are in tack: no Dumping Syndrome or NIPHS

 

RNY – Eating

*Eat protein first

60g of protein a day

*Recommended to chew food to liquid consistency (pureed, soft, thoroughly chewed)

This is more important for people early out (new pouch stomach will stretch out with time).

Food is thoroughly chewed to prevent blockage (the hole/path leaving the stomach and into the intestine is roughly the size of a dime).

To get food unstuck, patients drink meat tenderizer mixed with water.

*Low carbohydrates

Carbohydrates can slow weight loss and lead to possible regain

Avoid sugars in particular (to prevent dumping syndrome)

*Low fat

Foods high in fat may cause Dumping Syndrome

Fatty foods can lead to slow weight loss or possible regain

*64 oz of water

Stop drinking within 15-30 minutes of a meal

Do not begin drinking after a meal for 1-1.5 hours

Some doctors do not encourage the use of a straw (pushes food too quickly through the stomach and can cause gas/discomfort)

*Water Loading

15 minutes before the next meal, drink as much as possible as fast as possible. 

Water loading will not work if you haven’t been drinking over the last few hours.

You can water load at any time 2-3 hours before your next meal if you get hungry, which will cause a strong feeling of fullness.

Disclaimer: this is a practice some people use to feel “full" and lose weight. Not a requirement.

DS – Eating

*Eat protein first

80-100g of protein

DS patients can on average eat more food than any other type of weight loss surgery.

*Low carbohydrates

Carbohydrates can slow the weight loss and lead to possible regain

No dumping syndrome from eating sugar (or fat)

*Eat high in fat

DS only absorb 20% of fat (do not need to eat low fat)

 

If a taco has 20g of fat, a DSer only absorbs 4g while a person without surgery or RNY absorbs ALL 20g. (this is just an example, measuring absorption is not an exact science)

 

*When experiencing a “stall" (slowed weight loss/plateau) a DS patient commonly increases fat consumption to resolve

 

*64 oz of water

Can drink with meals

Can use a straw

 

RNY – Possible Issues

*Vitamin deficiencies: Must follow a vitamin regime for the rest of your life

Common vitamin deficiencies found in vitamins B12, iron, and zinc

Calcium must be supplemented for the rest of your life

*Bathroom issues

Gas

Constipation

Dumping in the form of loose stools

*Reversible procedure (Reversals of any surgery is very complicated)

Revision often performed instead of reversal

Revising to a different type of surgery is possible.

 

 

DS – Possible Issues

*Vitamin deficiencies: Must follow a vitamin regime for the rest of your life

Common vitamin deficiencies found in vitamins A, D, and iron

“Water soluble"/ “water miscible" / “dry" vitamins absorb best (in other words get vitamins that are not fat/oil based)

Calcium must be supplemented for the rest of your life

*Bathroom issues

Gas

Loose stool (Most common in the first few weeks of surgery. Generally food related)

*Reversible procedure

The intestinal bypass is reversible for those having absorption complications revision: lengthening common channel (to stop losing weight and/or to absorb vitamins)

Stomach is obviously not reversible (part of stomach was removed)

 

RNY - Diabetes

*85% cure rate

*RNY can put diabetes in remission.

Diabetes may come back in two or three years--even if the
patient maintains most of their weight loss.

Even a small amount of weight gain, long-term, can cause a diabetes
relapse.

 

DS – Diabetes

98 % cure rate for type II diabetes.

 

 

DS – Myth or Fact

 

DSers will have a heart attack from all the fatty food they eat = Myth / Not True

-Cholesterol levels lower after having the DS. 

-80% of the fatty food is not absorbed – the fatty food is healthier to eat as a DSer than a person without surgery.

      **The fat therefore does NOT enter the bloodstream**

 

If a taco has 20g of fat, a DSer only absorbs 4g while a person without surgery or a person with the RNY will absorb ALL 20g.  Good meal for the DSer. (this is just an example, measuring absorption is not an exact science)

 

The DS is only recommended for the super morbid obese (BMI over 60) = Myth / Not True

-To be eligble for ANY type of weight loss surgery, a person has to be 100 lbs. over weight or have a body mass index (BMI) of 40 or more.

-BMI’s under 40 have also been approved (usually require a comorbidy/health problem - an example is sleep apnea).

 

The DS is “experimental and investigational" = Myth / Not True

-Medicare approves the DS

-Many insurance companies are starting to cover the DS.

-DS has been performed since the 1970s

 

DSer will have a problem when they become old = Not True

-We wont need to eat as much when we are older b/c our bodies will adapt

-The little hair-like villa located in the intestines grows longer to adjust to the new digestive system (grows longer to increase absorbtion).

 

DSer’s gas stink = true

-The gas does smell. (This is true for the DS and RNY)

      *Most people see no difference in gas smell but more in the way their poop smells.

-There are products called air fresheners that a person can use.

-Controllable by diet (stay away from trigger foods)

-May take Flagyl or fish zole

 

DSers may need to wear a diaper = Myth / Not True

-That is silly

 

Skin color turns yellow or pallor = Myth / Not True

-Patients who follow their regular vitamin regime (keep up with blood work) do not turn pallor

-If someone looks pallor, they could have a vitamin deficiency.  This applies to any type of weight loss surgery. For both RNY and the DS.

-Vitamins and blood work must be monitored for life. For both RNY and the DS.

 

Dsers don’t need to exercise = Myth / Not true

-DSer’s are aware of the benefits of exercise (body and soul).

-Exercise helps in losing weight and maintaining goal weight 

 

 

*Some practices may not be used by all patients. Some recommendations will differ depending on a person’s surgeon.  Possible issues are just that, “possible," and may or may not occur.

 

Not every surgery will be right for everyone. Not every surgery will be covered by insurance. Good luck to everyone and thank you for reading my comparison chart. Hayley F.

Wow, thanks for the comparason. I'm slowly making my way thru the dsfacts site. So much to read. SOunds like I have a whole lot of obstacles though at this point with my trying to get OHIP to cover it. I'm in the process of getting approval for the RNY at this point but I am going to have to learn how to \switch somehow. I've got soooo many questions! Going to keep reading first though.