Doc said no to DS (sort of)... Help me argue?

First, please forgive any errors as I am on my phone.

I am in Sweden, approved for RNY (on a waiting list) would prefer the DS for obvious reasons. I wrote to him giving my concerns and asked about the process to change the surgery type. (Keep in mind I am dealing with government coverage, but the DO the DS at my hospital.). I mentioned RH and dumping and wanting my pyloric valve intact and the NSAID concern. This was his response:

Hej Amber!

It is a very good question that you address in your mail. It is true that the weight loss is more substantial with a duodenal switch and the switch is also more efficient in treating diabetes as compared to a bypass. Hover, there are more complications, most importantly due to malabsorption. Consequently, the duodenal switch has become more and more of a rarity. Recently, there was a study performed by some surgeon colleagues of mine. They compared the bypass and the switch in a super obese (BMI>50) population. The study is a pilot, so number of participants is relatively small. They report:

" ...that LDS ( = switch) resulted in greater weight loss than LRYGB in super-obese patients. However, the LDS patients in our series had more frequent gastrointestinal side effects, required greater doses of calcium and vitamin supplementation, and required more postoperative monitoring. Patient satisfaction was high in both groups."

See pubmed : http://www.ncbi.nlm.nih.gov/pubmed/20655023

So, in light of our experiences, this study and others, we recommend today the gastric bypass and not the duodenal switch.

I hope this mail shed some light!

Trevlig vår och lycka till!

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English is his second language. See, he made a recommendation, not an insistance. My wife seems to think i can just respond and say that i want the DS, period. So, I started typing up a response, but wanted to come here first and get opinions. He's a great doctor and there is an approval board that it has to go through. I don't want to be insulting or imply I am smarter than him, but on this particular subject, I feel like I am more informed. I want to get all my ducks in a row, so to speak.

So, what would you absolutely not leave out of your response to this doctor?

Thanks so much!!!
-amber

I think I'd just respond that in light of my own research and knowledge of myself and what I can live with, I want the DS TYVM. Is he a gatekeeper for your choice of procedure?

That's my thinking as well. A gatekeeper is a good way of describing him. He does the initial consult, takes the labs and discusses the procedures. He then takes your information and presents it before the board of surgeons and notifies you of the outcome. Because his office accidentally sent me a denial letter instead of an approval, he called me and gave me his cell phone number and email address. I don't know if he's normally in contact with all the patients like this. He's been great. I just don't know exactly how it works here. My wife (a nurse and native Swede) says the choice is ultimately mine, so I am hoping I can just tell him it's what I want and go with it.

If you want to tip the scale in your direction a bit, maybe you could wow him with your understanding of DS nutritional needs and your plans for how to supplement and watch your stuff?

Well, I basically did just that. I listed the supplements I would be expecting to take and the labs I would need to watch. I once again voiced my concerns including the diabetes on both sides of the family, aspirin regimens that my grandparents are both on and my PCOS issues. I was firm in my decision and stood my ground. Boo-yah! :D

Would you list here the supplements you wrote to him that you would be expecting to take?

I said I would probably need:

including, but not limited to: iron, calcium, zinc, copper, magnesium citrate, vitamins A, B complex, B-12, D3, E, K and a multi with folic acid daily.

Does he even perform the DS? Advocate for yourself and tell him that you fully understand the risks and higher malabsorption. Send him studies that show the high percentage of regain of weight in RNY. If he won't listen to you then you need to find a docto who will.

HE doesn't, but he isn't my surgeon anyway. It doesn't work the same as it does in the US. You don't choose your surgeon. There is one doctor that is the initial contact within the program. He meets and looks over your labs and talks to you about the procedures. Then he presents your case to the board and they say yes or no. Then you are assigned a surgeon based on the procedure you are having done and where you are. There is a surgeon within the program at this hospital who does the DS, possibly more, but I have one name as someone who is good.

What are the names of the DS surgeons?