Looking to understand DS... (RNY revision questions)

Hi All,

 

Just wanted to stop in and say hi and introduce myself a bit.

 

I had RNY July 2009 in the USA (approved from Canada) at 240lbs, and from the beginning it was a disaster. Turns out I grew a “candy cane limb" and I saw my surgeon 5 times to be told I was crazy, and he prescribed me pills that are meant to help drug addicts with hallucinations.

 

I went through my local Bariatric Centre and forced a second option after a written letter saying I was ‘wasting the health professional’s time".  I was back bordering on 200lbs

 

I was sent to the wonderful Dr. Dennis Hong in Hamilton! He found the limb, and removed it March 2012. I got as low as 140 on my wedding day, and am now back at 160-165.

 

My hunger has never ceased. I can eat more in volume than most, and I have to eat about every 1.5-2 hours, it’s nuckin futz!

I went back to see Dr. Hong to talk to him about my concerns and he said if in 6 months I’m still up, we will discuss the DS.

 

I have been reading about the DS since the very beginning, as I was always curious.

 

I was wondering if you guys could help me understand it a bit more? (I have gone to ds facts) but I don’t see many people here posting about menus.. etc.

 

How many calories can a DS’er have? What about protein? Carbs?

 

Can I still have salads and fruits? I’m worried about the sugars in the fruits being carbs.. how can I tell what’s “bad"?

 

Is it pretty much like an Atkins lifestyle?

 

If you could help me understand a bit more I’d very much appreciate it!!

 

Emily

 

Oh!! 1 more thing… are you able to eat large volumes of food? How can you eat so many fats and not absorb them? (use small words LOL.. medical terms confuse me.. I’m sorry.. like bougie.. etc)

I'm nearly 9 years post-op, and I'm maintaining a loss of 1710+ pounds, eating 2500-3000 calories a day. I eat 120-150 grams of protein every day, and I do eat fruits and veggies. (More veggies than fruits, because fruits do have a lot of sugar.)

We absorb very little fat because roughly 60% of the upper part of our small intestine is bypassed. This is the bilio-pancreatic lumb, and it carries the bile from the pancreas down to the common channel (roughly the last 100-150 cms of the small intestine.). Fat can't be absorbed until it's emulsified by bile, so we can only absorb it in the short common channel. This is why we eat lots of fat but have cholesterol numbers around 100. (*grin*)

Carbs are evil, but we do still eat SOME of them. Complex ones are better, like the ones found in fruits, veggies, and whole grains. Simple ones are absorbed almost completely by everyone, alas.

As for volume---I can eat an 8-ounce ribeye, along with a small salad, a few bites of baked potato, a yeast roll, and a small dessert, accompanies by a glass or two of iced tea.

 There will be several variations of answers, but I'll share you my approach to living with the DS.

My standards:
Protein:  100-120g
Fluids:     64oz minimum, but I usually triple that
Calories:  Never Counted, but a guess would be that I may eat around 3000 calories
Fat: LOTS - we malabsorb about 80%, so fat is a free food
Carbs:  I'm mindful, but I never counted those either.  

The way I eat is that I finish my protein item first, then veggies.  When those are done, I'll spend the last bit of space on whatever I want, be it rice, pasta, or chocolate cake.  My husband says I eat like a bird -- a little at a time, but all the damn time.  I'm a grazer, it works for me to get in all of that protein.

Em R.

What you'll probably get, owing to the pouch you already have contsructed, will not be a true DS, but most likely a distal RNY. 

That means that they give you the bottom configuration of the DS, bypassing more intestine, but leaving your pouch intact.  I don't know of many surgeons who have or can reconstruct your stomach, then make it into a sleeve, which is the top half of the DS. That's an awful lot of surgery!

Make sure you discuss the anatomy of the surgery you're going to get with your surgeon, and find out if he/she can do this.   I recall reading a post about a couple vetted DS surgeons who can...I think they're on the East Coast.  I've seen a post or two in the past about this, but I don't remember who the surgeons were.

Anybody else have a clue as to who I'm talking about?

Why would you assume that she will get a distal RNY? That is a horrible surgery. Many surgeons revise RNY to DS, it is a complicated surgery, but done frequently by many DS surgeons. And a distal RNY DOES NOT have the "bottom configuration of the DS" because the pyloric valve and all of the duodenum are still bypassed! These two things are the hallmarks of the DS! Distal RNY and DS are NOTHING alike. FMR!

Em - Ignore this - it will just confuse you more. You can revise your RNY to a DS. Dr. Hong is a DS specialist, and anything he is unable to revise, he sends to Dr. Gagner in Montreal. I think pursuing a revision to VSG or DS is a great idea in your situation.

Pat,

If you read carefully the last part of my post, I advised Em to discuss the anatomy of the surgery with her doctor, and solicited comments from anyone else who might know of surgeons who did the reconstruct. 

As for the distal RNY, a couple surgeons in my neck of the woods still do them as revisions to original RNY, once it loses its malabsoption.  I have read studies that noted return to normal function is not certain after reconstruction from the pouch, back to a stomach or conversion to a sleeve. As for the "bottom" I should have been clearer in stating I was referring the point where the newly-formed common channel joins the large bowel.

I agree with you that it's horrible, and I wouldn't let any of these purported bariatric "surgeons" in my town near me to do anything.  The larger hospital here has simply jumped on the WLS bandwagon in pursuit of increased revenue.  It is not a COE, which is why those of us who have WLS here traveled to an out of town COE to get it.  We all went to the same hosptial, whch sets up the support groups for its patients statewide, but opens the groups to anyone!  All *three* of us DSers in the group have the same surgeon, who is the only one in the state who performs the DS.

Yeah....Dr. Hong is NOT on the short list of surgeons that are qualified to do a true RNY to DS revision.  You will really need to do your research and make sure that you are with a qualified surgeon.  Doing a DS as a first surgery is VERY DIFFERENT than doing a revision to DS from a RNY.  It is a highly technically challenging procedure and there really are only a few that can truely do it.  Be careful.

Dr. Hong doesn't do the RNY to DS revisions himself, he does a number of revision surgeries and virgin DS's, but he makes the referral for that surgery to Dr. Gagner in Montreal... but Dr. Hong is the gatekeeper of that referral in Ontario which is why she would have to discuss it with him first.

What surgeons are on the short list that are qualified to do a true RNY to DS revision?

Here's a link to a thread about this: http://www.obesityhelp.com/forums/revision/4599894/RNY-to-DS -revision-surgeons/#38139268