DS Pioneer Gives Up On DS - For Lapband???

How far are you post-op? 4 months What were your approximate pre-op levels for the following cardiac risk factors? My Pre-op Results
-- Triglycerides:  111 -- Total cholesterol: 187 -- HDL: 42
-- LDL: 123
-- Fasting blood sugar: 97
-- C-reactive protein:

What are your most recent levels for these cardiac risk factors? My 3 Month Post-op Results -- Triglycerides:  93
-- Total cholesterol: 162
-- HDL: 35
-- LDL: 113
-- Fasting blood sugar: 95
-- C-reactive protein:  HDL needs work, but maybe after dropping 65+ lbs, I'll be able to get some exercise!

Don't flame out on me. I meant my coronary artery. Geeze.

Maybe YOU should get the DS.....

Then perhaps you'd be so kind as to clarify that in your other post, Dr. Simpson. We DS'ers have a hard enough time with people making snarky remarks about how much fat we eat and misunderstanding our limited absorption thereof, without having a surgeon add fuel to that particular assumption.

I am new to this group. But i felt i wanted to say  a couple of things concerning Dr. Terry Simpson.

First  I want everyone on here to know that Dr.Simpson is a wonderful Dr., His care and concern for his patients goes far above and beyond what alot of other doctors do for their patients after surgery.

It is my understanding,, and feel free to correct me Dr. Simpson if i am wrong, That the reason he stopped doing the DS surgery, is because people come to him begging for help to lose weight. Promising that they will do the nessesary labs and follow ups after this kind of surgery. Then they start feeling great,,, and dont go back for office visits, or labs..... The DS can be a malabsorbtive surgery. If you do not take the proper vitamens etc. You can get very ill. and even die.....It is my understanding that,,,,, Dr. Simpson decided not to do the DS anymore before of the lack of commitment to follow ups from his patients...... He is a kind and wonderful man,  and felt as though he was doing somthing to make them better, then they didnt follow up. and become sick . He didnt want to be a part of someone getting sick after the surgery, and not being able to do anything about it because the patient themselves chose not to do what they were told... It had nothing to do with money.... I am appalled someone would say this about him.

I have found Dr. Simpson and his staff to be very kind, caring and truly concerned about their patients.

Yes he is only doing lap bands now. I still go to the support groups, even though they are geared more towards lap banders.  He is usually present at most of the meetings , as is a member of his staff, and a dietician. They are all wonderful and knowledgable  people.  We are all free to ask questions of any of them,,, it dosent matter if we are lap band or DS patients.  Please dont say things about people that you are not for sure it is the truth.This is the way rumors get started.  And could cause some serious problems for the person you are talking about.  Thank you Dr. Simpson for all of your wonderful care for me......  Priscilla

I think "until the last artery clogs" was meant to be a JOKE--as one would say kick the bucket, buy the farm etc...

keeping in line with the study that Diana posted. 
How far are you post-op?   3 years 3 months
What were your approximate pre-op levels for the following cardiac risk factors?
-- Triglycerides: 320 -- Total cholesterol: 197
-- HDL: 35.6
-- LDL::129
-- Fasting blood sugar:
-- C-reactive protein:

What are your most recent levels for these cardiac risk factors?
-- Triglycerides:  129
-- Total cholesterol: 155
-- HDL: 37
-- LDL: 92
-- Fasting blood sugar:
-- C-reactive protein: Please do not post and run.  This is serious stuff to us, the post op DS patients.  If you have studies proving that the arteries are clogged by the DS, then you need to tell us.   Laurie

Doc Simpson ... One more thing ... you wrote this letter and emailed it to me in July of 2003.  What happened to change your postition on the DS??? Laurie To Whom It May Concern: I have been asked to write a letter discussing the Duodenal Switch (DS), and how it relates to weight loss surgery. There have been a number of careful studies which show the efficacy of the duodenal switch as a weight loss surgery, and those, I presume, have been made available to you. The purpose of this letter is to summarize a few of those studies, and to remove some of the myths about this surgery. To de-mystify the DS it is important to break down its components, and look at each of their merits. The first component of the DS is the sleeve gastrectomy. This decreases the size of the stomach dramatically – to 4-8 ounces. It leaves intact the antrum, and removes the major acid producing portion of the stomach. In contrast to the Roux en Y gastric bypass (RNYGB), food cannot passively leave the stomach (or pouch) into the small intestine. This means that patients, once they become full, stay full until the pylorus opens and allows the food to pass. With gastric bypass, the patient merely drinks some liquid to force the food out of the pouch and into the intestine where it begins absorption. One cause for weight re-gain with the gastric bypass is that patients will eat and then drink, or drink high calorie liquids. The second advantage of the DS is that the entire stomach and first portion of the duodenum can be visualized by endoscopy. With gastric bypass the stomach is divided into an upper and lower pouch, and thus the lower pouch cannot be endoscopically visualized. The advantage is that a patient with a DS may take non-steroidal anti-inflammatory medications (aspirin, Motrin, etc.) and should they develop an ulcer, it can be seen and possibly endoscopically treated. Patients with RNYGB are often counseled to not take non-steroidal anti-inflammatory medications because of the systemic effect of NSAID’s on the stomach can cause ulceration in the lower pouch, which cannot be evaluated or treated endoscopically. The DS also has an advantage that intrinsic factor can combine with B12, where often patients with RNYGB have to be on life-long B12 supplementation. Further, much iron is absorbed in the first portion of the duodenum, which is bypassed in the RNY-gastric bypass, but available in the DS patient. The DS patient may also consume fruits and vegetables, regardless of their fiber content. This is because the antrum – or the hopper of the stomach – is intact. Patients with RNY-gastric bypass are asked to not eat fruits which contain pulp, or fibrous vegetables and fruits as they can lead to bezoar production. The DS patient may also take any pill. Patients with RNY-gastric bypass are told that they should not take large pills, as the stoma, or anastomosis between the upper pouch and jejunum is small (17 mm diameter) and the pill might become lodged causing an obstruction. The DS patients do not have “dumping” syndrome. While some bariatric surgeons tout “dumping” as a negative reinforcement for patients who eat high carbohydrate foods, there is no relationship between dumping and weight loss. Further, dumping can be a severe, even life-threatening condition, which can cause patients to be on life-long medicines (Sandostatin) or not allow patients to have any simple carbohydrates in their diet. This can severely limit what foods patients take, and grossly limit lifestyle. There are no inherent advantages of the RNY-gastric bypass regarding the pouch vs. the duodenal switch with the single exception that the RNY provides an immediate benefit for gastro-esophageal reflux. However, that is not an approved indication for the RNY. The second portion of the DS is the “switch.” This is the portion which carries with it the main concern, as some feel it reminds them of the jejunal-ileal bypass (JI). There is no relationship, in any anatomical fashion with the JI. Hess developed this operation from DeMeester’s first switch, and from Scopinaro’s biliopancreatic diversion, but the operation is really not that complex to consider. Anatomically the switch is simply a Roux-en-Y (RNY) to the first portion of the duodenum. Like an RNY, which are used for a variety of surgical interventions (drainage of pancreatic pseudo cysts, reconstruction of bile duct injuries, reconstruction of traumatized duodenums, and in stomach surgery for patients who have antrectomies for ulcer disease) there is nothing magical about the RNY. There is no malabsorption, and while some, including myself, call this a “malabsorptive” procedure, it is not. Xenical, a drug which is approved by the FDA, is malabsorptive, as is cholestyramine. The RNY is not malabsorptive. The segment of the small bowel which is bypassed does not see food, which is true of all RNY procedures no matter what they are done for. There is a CPT coding which arbitrarily divides the RNY into 100 cm and less proximal segments and those which are more, and this coding has little to do with any factual evidence based on studies. Because the DS does a RNY which is greater than 100 cm, one has to wonder how much an effect, and over what period of time, this occurs, and we actually have good historical evidence that after a few years the small bowel accommodates and absorbs fats, fat-soluble vitamins, quite well. The amount of fat which is not absorbed in the typical DS patient is less than the amount of fat which is not absorbed in patients who take the recommended dose of Xenical. This does change over time, as the small bowel mucosa hypertrophies and allows more absorption of fat over time. This accommodation takes place over 18 months. This is one area where the JI bypass has given us credible information. Patients who underwent JI bypass were left with a small bowel 18 inches long from the ligament of Trietz, or one fourth the length in a DS patient. Late weight re-gain was from that small bowel accommodating. Better evidence comes from patients who have had intra-abdominal castrophies, and have had to have much of their small bowel removed. Those patients who have at least 100 cm of small bowel do well and that small bowel does hypertrophy and accommodate. With DS, the common channel is 100 cm in most, and the entire enteric portion of the small bowel (or the side of the RNY which sees food) is well over 200 cm, sometimes up to 300 cm. But, because of the fear of having a procedure which does more harm, let us contrast the DS with JI. The JI had a blind loop of small bowel which allowed bacterial overgrowth and a series of problems, including immune-complex formation with resultant arthritis. The DS has no blind loop. There is no increase in arthritis or immune-complex disease with the DS over the standard seen in the population in general. The JI didn’t have a reduction in the stomach size, so patients were able to eat anything – this resulted in some high carbohydrate diets, which aggravated non-alcoholic steatohepatitis (NASH) and within three years many patients were manifested with cirrhosis. There were a number of fatalities from NASH and cirrhosis which is why the JI bypass is no longer performed – there have been no cases of liver failure from the DS, and the DS has been done as an obesity surgery for fifteen years (All patients from JI bypass manifested liver disease within three years of the JI). JI   bypass patients had a high incidence of kidney stones because of the calcium-oxalate axis, which was severely disturbed. There has been no increase in kidney stone formation reported in DS patients over the standard population. Gallstones are a problem with all patients who undergo weight loss surgery, regardless of the type. In summary, the statistics so far show that DS is a better operation in terms of efficacy for weight loss. It has had no long-term sequella specific to it. The operation allows patients to consume fruits and vegetables, as well as take NSAID’s, which the more standard RNY-GB operation does not allow. It is a more complex operation, and, as with all weight loss surgeries, is an operation which requires long-term follow up. If you have any questions, please feel free to contact me. Email works the best. [email protected] Sincerely, Terry Simpson, M.D., F.A.C.S.

Ohhhh, I've been wanting to talk to you for a long time, Dr. Simpson. I have a comment about this:
>>One of the casualties of modern healthcare is that malpractice insurers forbid us from seeing those patients -- we can continue to see the patients who we have seen and established, but cannot take new out-of-country patients.<< This is sooooo not true!  My husband is an MD and I have talked to his insurance company, I have talked to a few medical malpractice insurance companies and they tell me about the same as Bart Bandy, Sr. VP of Inamed.  It's all about money. You are losing patients to Mexico and other places that are a lot cheaper and far more reasonable.  THAT is what keeps you from seeing patients banded outside the US.  It has absolutely nothing in the world to do with medical malpractice. The medical malpractice insurance co's disagree with your claims, the AZ board of medicine disagrees with your claims, the only one that does is Inamed.  They claim this same happy horse crap as you.  But there is more to that story that Inamed does not tell.  They charge Mexican surgeons $2K for the band and US surgeons are paying around $3500 for the same band.  But it evens out in the end in advertising that Inamed supplements. Inamed is paid more for the band when folks are banded in the US. I don't blame any doctor for not wanting to fill the patients of others.  Office time is expensive, fills are not profitable.  I don't blame any doctor for not filling patients they did not band regardless of country.  But, to continue spreading this stuff around about medical malpractice is a complete load of crap and I'm going to challenge you on it each and every single time I see you post this nonsense. At least be honest with people, they can go to Mexico for half the price that you charge, get a full inpatient stay for 48 hours (vs. you shoving them out the door as soon as they wake up), and receive better care than you are able to provide.  You are losing surgery business. I was going to go to you but you had an employee by the name of Joyce at the time.  I believe that was her name.  She about made my skin crawl and I couldn't fathom the thought of follow up care and dealing with her anymore so I went with option #2, Dr. Aceves in Mexico. Now I'm more glad than ever that Joyce behaved as she did.  It meant I went to the very best doctor for banding. Cheers.

Glad you received your surgery. Joyce is no longer with us. You will clearly believe what you want . My malpractice carrier is specific about out-of-country patients -- .  There are malpractice carriers that do not have that provision -- and that is fine, there are about 10 carriers in Arizona, and I don't pretend to know them all or their policies -- just mine. It isn't the 48 hour inpatient stay that is important in band care-- it is learning how to use the band after surgery.   The vast majority of my patients want to go home the day of surgery, and there are some I require to spend the night and they are disappointed.  But, the important part of the band is learning how to use it after it is placed -- not how long you stay in a hospital after. That is the after care that is important to patients -- and that has been reflected in multiple articles.  Glad you think your surgeon is the best -- but there is more to banding than putting a band on someone.