I had the VSG in 2014 and lost 110lbs. Unfortunately a mix of sleeve failure (after an egd my gastroenterologist said if he hadn't known I had the surgery he never would have guessed, my stomach was normal sized) and emotional eating cause me to gain back about half.

My surgeon offered a revision with option to do resleeve, RNY, or DS. I don't wanna do an RNY because I need frequent EGD'S. I've always wanted the DS so that seems most logical.

Vitamins and bowel movements don't worry me. What worries me is the amount of protein malabsorption. Has anyone had issues with this?

I already have a protein losing enteropathy so this is a concern.

On one hand adding the DS could exacerbate the issue since it's not certain where the protein loss is located .

On the other hand, it could help. My last biopsy showed the small intestine villi were enlarged. Which could be (and most likely is) the reason for the protein loss. If the diseased part is bypassed with the DS then it could potentially give me a better shot at protein absorption.

Now people say eat 80-100g of protein a day and no worries. Has this amount ever given u an issue?

Thanks in advance!!

The average person requires 50-60g of protein daily.

The average DSer malabsorbs 50% of the protein they consume, which is why we strive for 100-120g daily.

But does that work? Never seen low protein/albumin on blood tests?

Yes, it works. If you've never seen low protein on your blood tests, then how do you know you're malabsorbing protein right now? Given your health condition, your results may vary, so you'll want to watch your labs.

Oh I've had low protein/albumin on my labs since I started getting tests done (probably teens). Docs ignored it till I started swelling. Long story short, it was discovered I had an immune deficiency with a separate protein losing enteropathy.

Sorry your having this problem. I was trying to get a handle on why this would change with a DS revision and I'm still not sure. I read what you wrote other places about the enzymes being introduced further up and I hope that's right. Just a couple of questions coming from a place of limited knowledge.

From what I saw on Wikipedia the protein losing enteropathy is usually a complication of another underlying condition although but maybe they can't find an underlying cause in your case. Is that right?

I think the enlarged villi are probably a result of them working harder to absorb protein. (enlarged not swollen). I've heard some comments that the villi can become enlarged over time as they try to absorb more protein. The example that was used was exercising a single muscle more than the others will cause a larger muscle over time just like the villi can get bigger over time. Did the Doc who did the biopsy say that was probably the cause of the absorption problem?

I hate when Docs have to hunt for an answer so I hope they have this figured out for you.

Pete

First of all, i appologize dor the length of this response...

I wish I had a better answer to give you for what the gastroenterologist says about it, but unfortunately he didn't seem to care. My medical is extremely complicated. Because of that doctors get overwhelmed.

I have CVID (common variable Immune deficiency) which despite infusions my levels remain very low. This is because of the protein losing enteropathy.

I have a high chance of stomach cancer because of the CVID. That is the reason I was scoped in the first place. He found abnormal apearing villi and took biopsies. His exact wording was "I had never seen that before, I thought it was cancer". Pathology showed it was "edematous" but not cancer. I specifically asked him if that was the cause of my protein losing enteropathy. He said "most likely". He wasn't going to look in to it though because as he said "there's nothing that can be done about it". His recommendation was that I continue doing my CVID infusions.

I did ALOT of research ( I'm big into medical and my research is actually what figured out my cvid) and between my tests and symptoms I came across PIL (Primary intestinal lymphangiectasia). I asked my PCP about it and she agreed it was most likely. However the ball was dropped and definitive diagnosis was never pursued.

I talked with my surgeon today and we made the decision to do the DS. There is a very good chance it can cure things. I'm hoping so cause I can sure use a break. In the past 5 years I've been diagnosed with cvid, protein losing enteropathy, (probable PIL) and POTS (positional orthostatic tachycardia syndrome). All of it exacerbated by obesity. The DS could literally save my life.

Sorry if all that was confusing!

No apologies necessary, I've been on my own set of Doc merry go rounds trying to figure out problems now and again although none as serious as yours.

I do try and follow up on anything I see about malabsorption that isn't familiar. I've had no problems in that area over the last 4 years but I was pretty panicked, for no good reason, about the whole subject right after my ds and just find myself keeping up with as much as I can.

Thanks for the explanation. More than enough for me.

Good luck on the surgery I hope it starts you back on the road to better health.

Pete

Thank u! I hope so as well.

I have a psychiatrist who put the doc merry go round into perfect perspective. She said "it's called "practicing" medicine for a reason.

It's nice to know u panicked about malabsorption but havnt had issues. It's always nice to be safe then sorry. Have you found out any tips/tricks or good things to know?

My surgeon assured me that if need be it would be a simple surgery for him to revise the DS so that put me at ease alot.