Should EVERYONE have the DS?

OK. Now I see it's back.  Don't know what happened.  I'm getting hypersensitive to all of this mod stuff.

Personally, I think a lot of those reasons are also good reasons not to get ANY weight loss surgery.  I cringe at some of the implications that the ability to take supplements and eat high quality protein are DS-specific needs because the RNY has been shown to become quite dangerous for people who fail to keep up on supplements, protein and doctor visits. I think there are too many RNYers who are lulled into a false sense of safety when it comes to some of those things because they believe that since they don't have the DS, it's not as big of a worry. While the type of supplementation differs between surgeries, the importance of taking them is equal. I would also worry that people with erratic health insurance histories would probably not do well with the RNY or the Lap-band either. Both require regular follow-up visits, especially in the case of the Lap-band with a need to regularly adjust the fills. The price for regular fills can certainly add up--especially if you have to travel to get them. People who are rebellious or who don't think they need to follow the nutritional rules are also poor candidates for the RNY and Lap-band (perhaps even more so, because the chances of them losing their weight and maintaining it is almost null). Specifically, the RNY and Lap-band have many more rules about what things should be eaten. RNYers have to become very good label-readers. Somebody with the RNY who can only afford macaroni and cheese would be in trouble as well. RNYers need to be able to afford meat and veggies, high protein foods, and low-sugar or sugar-free items as well as low-fat options--which can often be more expensive. I guess what I disagree with is that the list above doesn't equally apply to the RNY and Lap-band. When I look down that list, I don't see anything that would make another surgery a good option. So yes, I think there are some people who should not get the DS. But I would say that most of those people should also not get the other surgeries either. I may get some flaming for saying this, but I honestly believe that most people who get the RNY should be getting the DS. It's not that I blame them, the DS isn't as common (yet) and unfortunately many people don't know about it ,or those who believe that they do know about it actually have a lot of misinformation about it. And there are still some insurance companies who are dragging their feet when it comes to covering the DS. That's what I think is a shame.  I guess what I'm saying is that, while it may not be for everyone, it probably is best for most wls candidates. I think the DS truly should be much more common than it is.

Well said, Dreamy!

Interesting point. She works for a WLS surgeon. I'll have to ask her about this important point. What do you do with someone who wants WLS, but shouldn't have it? The starting point for the conversation was my question, 'why aren't they doing the ds for most people?

"What do you do with someone who wants WLS, but shouldn't have it?" That's really a good question, and I don't know if there is a good answer for it. My heart breaks for people who obviously REALLY need surgery--but who are financially unstable or mentally challenged in some way because they would definitely struggle with some of the requirements for a healthy outcome for the RNY or DS or Lap-band. For someone who is morbidly obese and dying of obesity--but who is also house-bound, jobless, financially struggling, and generally irresponsible when it comes to taking care of their health (buying supplements, etc); I almost feel like their wls should come with a mandatory social worker to help them get their life in order, ensure that they are eating properly, buying their supplements and organizing them, etc. But of course, that's not likely to ever be a reality.

Although already answered, I'll reply to the "why" question with the simple fact that there just aren't that many WL surgeons trained to do the DS, and in that cohort, even fewer who do it lap. As this thread has moved along, I've begun to wonder if your friend's surgeon employer also does the DS? And if so, how many?  I know many DS surgeons do all of the WLS procedures, and who can dispassionately discuss them all, AND who will support their patient's decision; but not too many primary RnY surgeons will give the DS a fair shake.  Hmm. Also, what's your friend's position that has given her the perspective you quoted?  Lots of "nutritionists", don't "get" the DS.  Even RNs can be unfamiliar with it. (I sat through a small group DS seminar with a RnYed RN who couldn't stop referring to our "pouches" in terms of a diet style needed to maintain WL.)  Not that I'm saying she's one of these, I just think her list is a bit wobbly here and there in ways that have already been discussed.  The inverse of "you don't need to be a cow to know what milk is", is "just because you're a cow, doesn't mean you know what milk is". I'm not compulsive, but I do frequently wash my hands because I have children who are exposed to a lot of virus and bacteria at their schools.   I do set up all of my meds, and supplements in a 28 day box, but that's because I'm lazy and don't want to deal with it every day.  I do the same with meds for my children for the same reason. When there are more surgeons doing the DS, and insurers step into the 21st century,  I wonder if we'll have so many hot discussions about DS vs RnY.   One sure thing that I might add to any list about one WLS vs another is the fact that unless one has abundant patience, and a fierce willingness to fight for justice, then the DS is probably not for him/her. Many people wander through the garden of misinformation which surrounds the DS rather than stopping for a minute at the library to look up roses and how they flourish when wisely tended.  I think many RnYers also walk in a similar garden thinking that their flowers don''t need as much attention, while their daffodils do need equally tender attention, just different.   Edited to ask, did I miss the fact that your friend is a DSer?  And to add just for the sake of clarity, at this point, I don't think the DS is a one-size-fits-all WLS, but that--and this is "belief" based--it certainly could serve a vastly larger population than it currently does. 

She made me think in ways that I hadn't.  We've had the same discussion  about why not more DSs before, and the discussion of not having enough surgeons to meet the need has come up.  I think as I have become more passionate, she's had some experiences dealing with people a few years out that haven't gone as expected and was feeling more cautious on the day we met.   And, yes, the practice is a busy one that does both DS and RNY (few lapbands). She 'gets' DS better than anyone I've ever met. I only see my progress (and the 'virtual' progress of the people here, as they report it). She has a broader landscape and more in-depth experience over time. You can be an advocate and a realist at the same time. When passion meets reality it makes for an interesting conversation. The one we're having here is evidence of that.

I like that, ". . . an advocate and a realist at the same time." Interesting thread you started.

 Agreed. There are many people who have the RNY who have NO BUSINESS doing it because they will never be able to conquer their food issues such as grazing or junk food. While I don't think that one should gorge post-op, I think that many people who fail their RNYs would probably have success with the DS--at least when it comes to food. I have to eat protein daily and I have to take supplements daily. That's no different than a DSer. I have to be able to think about the implications my surgery may have on other aspects of my health--medicine absorption, for example.  Honestly, I think waaaay too many stupid people are approved for WLS. This is not a fix that will do the 'work' for you longterm and far too many people think that it will. I don't take my supplements--I may kill myself. For that reason alone, I think there should be a longer waiting period and that folks should be required to take their vitamins and submit bloodwork to prove that they will be able to follow up with the regimen.

Maybe not stupid, but just uneducated. Maybe the insurance companies should be required to provide 20 hours of education with a "WLS educator".