Attacked for hating diets and MY surgery choice.

Look people, I don't have as much time to post and help others here as I would like anymore, nor am I interested in people's petty little surgery wars whether your posturing be defensive or  to the contrary in nature. But, I'll be damned if I am going to idly sit by and be attacked for imparting information in a polite and a what I believed to be a helpful manner for Pre-ops and those that might be seeking  revisions.

Yeah, I HATE DIETING and don't believe in it.  So shoot me! This doesn’t mean I don't believe we shouldn't have to eat a healthy wide variety of foods when our surgery choice allows for it. But If I can help keep one person, and their have been DOZENS .... spending the rest of their lives in the self-punishment mode of highly restrictive diets and avoid the barbaric risk of dumping, then I have accomplished my wish. Not everyone is nearly as successful with their surgery choice as so many of you have proven to have been, so this isn’t about you. That said, I know how very, very hard many of you have to work at this the longer out you are. Put simply, I DON'T! Doesn't make me better, but I am one HAPPY CAMPER who doesn't have to worry and obsess over everything I put in my mouth.

So string me up for making the surgery choice I did and hating the diet mentality, but I'm not here to debate the issue. I could, but I just don't have time as my work constraints don't now allow for it..

From a post made last week. Your response really had nothing to do with the post! Why is it necessary for you DSers to always start something! Give some facts and move on and let people make up their own minds. You don't have to put us RNYers down all the time. You are NO BETTER than us!!!! BACK OFF!!!!! Preops and newbies, there are a group of DSers that are militant and think "their surgery" is the ONLY surgery, THEY ARE WRONG!!!! There are multiple WLS surgeries and the choice is very personal between you and your doctor. Don't be swayed by the milatant DSers. Make up your own mind!!!!

--------- My apologies, Becky, I simply haven’t had the time to reply to your specious, malicious ad hominem attack. Perhaps you have a reading comprehension problem or were just having a bad day. (Hungry, or craving the wrong food choices, perhaps?) Who knows what your issues might might have been on this particular day, but that said, I have seen similar maligning postings from you in the past. As a fairly recent post op, relegated to a lifetime of highly restrictive dieting, I CLEARLY prefaced my remarks as NOT INTENDED for you, or, those similarly positioned as post-ops unless they might be entertaining a revision from a failed procedure or outcome. In reviewing my remarks I cannot find where I put down any procedure or group. PERIOD! An argument can clearly be made for putting down the concept of "needless dieting," not to be confused with those necessary dietary requirements that are needed for each procedure. I personally find it HEARTBREAKING that some people risk their very lives for having procedures only to have to suffer with such heavily restrictive diets post-op, not to mention DUMPING for some which is nothing short of medieval in this writer's opinion. And I constantly get thanks from Pre- and even Post-Ops for imparting the information. One only needs to take a look at this thread a s example. http://www.obesityhelp.com/forums/ds/a,messageboard/action,replies/board_id,5357/cat_id,4957/topic_id,3484967/ Some of us are of the opinion that having spent a lifetime of failed dieting is PUNISHMENT ENOUGH. My reasoning for posting this is just what I thought I made clear. Diets don't work for more than 95 % of us and for those wanting a procedure offering the least restrictive diet, in addition, to the best short and long term weight loss and long term weight loss retention, there is another option. Becky, you made your choice and seem relatively happy with it. I couldn't be more pleased for you and anyone else who is happy with theirs. Especially, for all those long term successes that really have to work their tool after the honeymoon period. As to your point about our thinking our procedure is better. Well, I think it rather special not to have to diet and being able to eat normally. That's all I ever wanted... Well, that and not having to fear anything more than some VERY MINIMAL WEIGHT REGAIN out long-term. At nearly five years out, I haven't even had that other than some minor fluctuations either side of goal. Lost 3 lbs. today and this after a less than frequent  dining experience at KFC last night. (maybe 2 or three times a month) Hardly my usual, but it was GOOD.... 4 large pieces of fried chicken ..(two breast, two thighs,) mash potatoes and gravy, cole slaw and a healthy slice of their chocolate chip cake. But, hey, this is just me talking and therfore strictly anecdotal. Becky, perhaps you RESENT  what the long standing peer reviewed data is showing and likewise the actions of the physicians at CA Department Managed Health Care when they consistently tout the advantages of the DS over the RNY and other WLS procedures. I'm sorry, Becky as I just can't help you with that, but for the benefit of those who are interested and might derive some benefit, the following cases speak for themselves. -------------- Rehttp://tinyurl.com/5xo4tq Reference ID #      Type MN05-4402     Medical Necessity Patient Age     Patient Gender 54     Female Diagnosis Category     Diagnosis Subcategory Morbid Obesity     Hypertension Treatment Category     Treatment Subcategory General Surgery     Biliopancreatic Diversion IMRO Determination      Overturned Decision of Health Plan      Reviewer's Findings The patient is a 54-year-old female who is 5’3” weighing 226 pounds with a body mass index (BMI) of 41. She has comorbid conditions of hypertension, gastroesophageal reflux disease, and degenerative joint disease. She has undergone a psychological evaluation and is considered an appropriate candidate for weight loss surgery. She is requesting authorization for a duodenal switch procedure. The Health Plan has denied this request and in the alternative authorized Roux-en-Y gastric bypass. Peer-reviewed literature demonstrates duodenal switch has superior long-term outcomes and quality of life compared to Roux-en-Y gastric bypass. In addition, the incidence of weight regain is much higher for patients who undergo Roux-en-Y gastric bypass than those who undergo duodenal switch. Furthermore, there is less likelihood of complications with duodenal switch than with Roux-en-Y gastric bypass. Therefore, I have determined the requested procedure is medically necessary for treatment of the patient’s medical condition. The Health Plan’s denial should be overturned. MN04-3589      Medical Necessity Patient Age     Patient Gender 30     Female Diagnosis Category     Diagnosis Subcategory Morbid Obesity     Other Treatment Category     Treatment Subcategory General Surgery     Duodenstomy IMRO Determination      Overturned Decision of Health Plan      Reviewer's Findings The patient is a 30-year-old female who is seeking reimbursement for duodenal switch surgery. The patient’s body mass index (BMI) prior to surgery was 56.2. In addition, the patient has a number of comorbid conditions including hypertension and gastroesophageal reflux disease (GERD). The Health Plan has denied reimbursement for the duodenal switch procedure. The duodenal switch procedure has a track record greater than 15 years. The anticipated complication associated with other malabsorptive procedures (i.e., distal gastric bypass, jejunoileal bypass) has not been encountered with the duodenal switch. At the 2003 American Society of Bariatric Surgeons meeting held in Boston, Massachusetts, scientific papers were presented, which indicated there is growing evidence that protein malnutrition is a much larger problem post gastric bypass than was initially suspected. This is due to patients’ inability to consume “normal” meals after the gastric bypass procedure. Furthermore, there is sufficient data to show that duodenal switch has a far more superior long-term outcome when compared to gastric bypass. Therefore, the duodenal switch procedure was medically indicated for treatment of this patient’s super morbid obesity. Based upon the information set forth above, I have determined that the procedure at issue was medically necessary for treatment of the patient’s medical condition. Therefore, the Health Plan’s denial should be overturned. Reference ID #      Type MN08-7635     Medical Necessity Patient Age     Patient Gender 48     Female Diagnosis Category     Diagnosis Subcategory Morbid Obesity     Hypertension Treatment Category     Treatment Subcategory General Surgery     null IMRO Determination      Overturned Decision of Health Plan      Reviewer's Findings A 48-year-old female enrollee has requested a duodenal switch procedure for the treatment of her obesity. Findings: The physician reviewer found that there is no question that BPD-DS is appropriate, and even more so than other popular obesity procedures, such as banding and Roux-en-Y gastric bypass, in treating this enrollee’s obesity. There are many reasons cited in the literature that may have convinced the enrollee to be so committed to undergoing BPD-DS. These include data from Hess et al that show the best long-term results for weight loss while ameliorating the highest percent of co-morbidities. Anthone also agrees with the above and states that patients ingest about 2/3 of their pre-op dietary intake without any specific food intolerance. Ninety-eight percent maintained normal albumin levels three years post-op. Vitamin B-12 deficiencies are less likely to occur and, if they do, they are much easier to treat. Patients do not show any clinical evidence of hypocalcemia or bone loss. Furthermore, Baltasar et al, along with the other authors, agree that where the pylorus is preserved dumping is almost non-existent; biliopancreatic reflux is prevented, which would improve the patient’s GERD; and vomiting is very rare. For the reasons stated above, I have determined that the requested procedure is medically necessary for treatment of the patient’s medical condition. The Health Plan’s denial should be overturned. N06-5854      Medical Necessity Patient Age     Patient Gender 50     Female Diagnosis Category     Diagnosis Subcategory Morbid Obesity     Musculoskeletal/ Ortho Problem Treatment Category     Treatment Subcategory General Surgery     null IMRO Determination      Overturned Decision of Health Plan      Reviewer's Findings The patient is a 50-year-old female who has a history of morbid obesity with a body mass index (BMI) of 48.5. She has several comorbid conditions including gastroesophageal reflux disease, low back pain, and shortness of breath. Although the patient reports she has undergone a psychological evaluation and is an appropriate candidate for weight loss surgery, the findings from the evaluation have not been provided. The Health Plan has authorized Roux-en-Y gastric bypass for the patient. However, she believes gastric bypass with duodenal switch is more appropriate in her case. A review of the published data shows that the duodenal switch procedure is superior to other surgical procedures, not only in terms of percentage of excess body weight loss (EBWL), but also from a quality of life perspective. Roux-en-Y gastric bypass is associated with a failure rate of more than 30% in three to five years, with a reported maximum EBWL of 60% to 70%. The duodenal switch procedure has a higher success rate and its efficacy is well established. As such, the requested procedure should be authorized. Prior to surgery it should be confirmed that the patient has obtained psychological clearance for weight loss surgery. For the reasons stated above, I have determined that the requested procedure is medically necessary for treatment of the patient’s medical condition. The Health Plan’s denial should be overturned. MN06-5657      Medical Necessity Patient Age     Patient Gender 25     Female Diagnosis Category     Diagnosis Subcategory Morbid Obesity     Other Treatment Category     Treatment Subcategory General Surgery     null IMRO Determination      Overturned Decision of Health Plan      Reviewer's Findings The patient is a 25-year-old female with a body mass index (BMI) of 37.3 and significant comorbid conditions. She indicates that she has researched all the surgical procedures and has selected the duodenal switch operation for treatment of her obesity. The patient has completed a psychological evaluation and was deemed an appropriate candidate for weight loss surgery. The Health Plan has denied coverage for the duodenal switch surgery asserting that this surgical procedure is not medically necessary for treatment of the patient’s condition. This patient clearly meets the criteria set forth by the National Institutes of Health for surgical treatment of obesity with a BMI of 37.3 and co-morbid conditions. The duodenal switch operation has been shown to be effective for patients with a BMI of less than 50. Additionally, there is no data indicating that nutritional deraignment after the duodenal switch operation is any more prevalent or more serious than what is encountered with the gastric bypass operation. In fact, the lifestyle of patients after duodenal switch is generally free of the ill effects of the gastric bypass, such as the dumping syndrome and intolerance of solid foods. As cited above, there is a large body of scientific evidence available that shows the duodenal switch operation is more durable with a better long-term success rate when compared to the gastric bypass or the Lap Band operation. Based upon the information set forth above, I have determined the requested duodenal switch bariatric surgical procedure is medically necessary for treatment of the patient’s medical condition. The Health Plan’s denial should be overturned. Re --------------- Wishing you continued success, Becky, in your choice and dieting plans both now and in the future. Rock http://www.obesityhelp.com/forums/CA/a,messageboard/action,replies/board_id,4806/cat_id,4406/topic_id,3610322/

Rock I know you personally and I say...say it like it is..and I am happy for you that you do not have to make choices like us RNY people. Honestly I think I would have gone DS if it had been available to me at the time. I am okay with watching what I eat.....and I think people should be okay with your choices too. I do not know you to be a mallicious person....I only know you to be a kind supportive person. However people do not like having their numbers pulled like you can do so well. Thank you for being who you are...and helping me too when I have been in need and being a kind ear! Don' stop being who you are!

Ah, Jeanine, the feelings are mutual... Always good to see and hear from you! Rock

Rockne I have to agree with Janine. I have been flamed and attacked many times in the past 7 plus years here....it  doesn't get any easier..... We all have choices....your choice was DS, others choose banding, some rny....I can tell you that if DS had been offered to me at the time i would have seriously looked into it....but it wasn't and I knew nothing about it..... Keep up the good work, we all need the info on DS, RBY, banding and all other types of surgey.....want me to get you one of my flame retardant suits....????

Oye....I sure do hope that this doesn't bring on the drama~although, I feel it may.

That is a bummer.  Everyone has to be educated in whatever procedure they are looking into.  PERIOD.   Let's just stick with the support.  Although we don't see you much Rockne, you give support (especially to me when my darn computer was upside down! lol) and that is one of the things this site is for.   People, do your research and find out what will work best for you.

Rock, Even though I love Becky, I did call her out on that post ... I appreciate the passion you have for your cause. Yes, I have seen the drama regarding surgery types here. But in the end, usually cooler heads prevail and life in the "support group" business goes on. And that includes support and information by you. Thank you for all the good information you have posted in the past, please continue to do so.. and Vicki is right.. Pre-ops.. do your homework...! xoxo

Thank you, Rita. I caught your kindness back then. And thanks to all the rest of those of you who took the time to participate.
Rock

Just curious about the diet and I know you are the medical expert, but if you can still eat what you want, do the co-morbids such as diabetes, cholesterol, etc, etc, go away?  It seems to me that unless you reel in the not good for you foods, you may be thinner, but could possibly still be very very unhealthy.  People who don't have weight problems can be super unhealthy because of the diet they choose.  Also, can you put to rest the "stinky (as in peel the paint off the walls)" bathroom issues that DSers have (or I have been told they have), especially when they eat things that have high fat or sugar content.  When I did my research, and having worked with someone who had the DS (and her potty habits smelled so bad that we dedicated one single bathroom to her that no one else went into, EVER! LOL), that issue alone was enough for me to do the RNY.  I do not regret my decision one bit, but everyone has to decide for themselves based on their lifestyle and research. Thanks!! Jillie

Hi, Jill, How good to see and hear from you and what great questions! But please.... No one should hold me out as any kind of medical expert. Just ain’t so. I just pretend to play one on TV **Smirk** Your reasoning that we might possibility still be unhealthy and thin eating so called bad foods would seem completely logical based on people’s normal anatomy.  And we can be unhealthy if we don’t supplement, get enough protein in and keep abreast of our labs. But remember, we DS’rs don’t absorb 80% of the fats we ingest. That 80% passes right through the GI tract without ever getting into blood stream. And it’s crucial we all get some degree of fats in our system. Fat is part of every cell membrane in the body.  It helps transport nutrients and metabolites across cell membranes. Your body uses fat to make a variety of other building blocks needed for everything from hormones to immune function. And, yes, to a degree, the right fats  keep our arteries healthy but also for prostaglandular activity. Prostaglandins are a family of hormones that help control things like fertility, inflammation, immunity and communication between cells. But its more than that, a DS’rs whole metabolic profile dramatically changes, often with in hours postoperatively and while there are lots of complex theories floating around, and it’s still being investigated and not well understood. To a lesser degree, with your surgery, your metabolic profile changes, too, but it appears not to be nearly as profound and broad in scope or permanent.  For example, with an RNY, many, many insulin dependant folks having Type 2 adult onset diabetes can go off their meds once in remission. Many forever stay that way as long as their weight stays in check. But, should they regain back a large percentage of their lost weight “this” and other comorbes will often return. We Ds’rs don’t go into remission for this. All but about 2 or 3 % of actually get permanently cured... often within hours as post-ops. And it’s why the intestinal part of duodenal switch has been done for years as a cure for patients presenting with Type 2 adult onset diabetes in Europe for the NON-OBESE. Part of the metabolic change has to with the hunger producing hormone ghrelin. Your blind or remnant stomach still produces this. Lots of RNY surgeons will tell you that’s not so, and they’re right in the short-term with RNYs, but for the most part it’s temporary as so many of you know who struggle with being hungry or lacking in satiety at what you might consider inappropriate times. With our sleeve gastrectomy and the resection of the gastric fundus most of the greater curvature of the stomach area producing ghrelin levels is removed and satiety is easily reached. It's one of the reasons it’s very rare to hear a DS’r complaining of ever being hungry unless it’s time to eat. Malodorous gas can be problem for any malabsorption surgery. Ds’rs seem to be labeled with this more so than others but it’s mostly exaggerated over other surgery types. This isn’t to say your friend didn’t have a REAL Problem here. I believe you, but it’s generally quite easily ameliorated with a little help. Such things a minor adjustment in diet, repopulating her bowel with normal flora via Probiotics, or in some cases a short course of antibiotics will often do the trick. I’d be happy to try help with  some suggestions for her and/or find her a referral in her area if you would like. As for living on junk food, I certainly don’t  do so as is the case with most of us. We all know normal thin people who seem to eat whatever they want and may not do any more than exercise moderately. And yes they eat junk food as well, but they don’t live on it exclusively. I certainly have my fair share, but I love the healthy foods equally well. Post-Op, I’d get pretty bored stuck with either if that’s all I could eat. In short, I eat pretty much what I want, when I want without worry other than making sure I get my protein and supplements in. For me, that’s the magic. As Counselor Cox likes to say... Life like this “doesn’t suck! Sorry, no time to edit so I hope this makes some sense for you. Thanks for asking and let me know if I can be of any help to your friend. Rockne

Rockne, I think its great that you and Diana Cox both share information on the Cali board. I think pre ops need to totally do their research and look into every option available to them.  I agree with Janine and Darlene, had I known about the DS...I would have looked into it and may have had that done instead. While I have had much success with RNY, and do not regret my decision, I still would have liked to have known about all the options...so newbies...do your research!!!!!!!!!! My husband is researching WLS and is leaning towards the DS. Our insurance does not cover it, but our thought is to go with the best one for him regardless of cost...thats relative. Keep on bringing the info...it will be of good use to alot of people.