DS Surgery

A negative of DS? Well let's see...the biggest one that sticks out in my mind is the malabsorption issues. You will almost always have to deal with severe diarrhea (Of course this depends on your water intake as well as your food choices). You will also be required to take additional vitamins / supplements since you absorb even less than RNY. Also, there is a higher risk of going under weight.

But yeah, the biggest down side is the constant diarrhea (stats at my surgeons office show 94% of patients with DS deal with this), which is something to really think about. With RNY, I only get mild diarrhea and thats if I eat something a little sugary.

~Heather

the biggest one that sticks out in my mind is the malabsorption issues - Same happens to RNY patients.

You will almost always have to deal with severe diarrhea - Not true

You will also be required to take additional vitamins / supplements - RNYers also take additional vitamins.

 Also, there is a higher risk of going under weight. - Again, not true.

But yeah, the biggest down side is the constant diarrhea (stats at my surgeons office show 94% of patients with DS deal with this - Stats from a RNY office?

I only get mild diarrhea and thats if I eat something a little sugary. - Easy to eliminate. Stop the sugar...you're dumping.

Haha, your post made me laugh. I believe my post said "almost always" as well and my surgeons office posts stats from clinical studies and 94% of DSers exp diarrhea MUCH more than a RNY patient.

Where did I say RNY does not need supplements? DSers require even MORE than RNY. Why? Because even less nutrients are absorbed than RNY.

Risk of going underweight is very true, learn to ask for stats from your surgeon.

I'm dumping? Really? No cold sweat, no dizziness. Come on now, I'm dumping from eatting a banana. Get real. Fruits have natural sugars than can cause MILD diarrhea.

I did EXTENSIVE reseach on DS due to its higher rate of resolving diabetes. I know the Pros AND Cons. EVERY surgery has Cons, whether you want to see it or not.

Oh, and lets not forget that DS is a much more complex surgery that can have more complications than an RNY and only a handful of surgeons in Illinois are even trained on how to perform it as well as only a handful of hospitals that are trained to handle this procedure.

~Heather

Glad to have made you laugh

I'm happy to see that you've done your research. I'm not going to cyber argue with you.....that's for another board. I answered the post to clear up any flawed information that you gave the OP.

Well seeming how you didn't read my post clearly, acting as if I was saying RNY doesnt need supplements when my post said they needed even more than RNY, etc shows me that not only are you correcting a post that you didn't read but you are not even a DS Patient so how could you possibly know that they do not have diarrhea issues. If you noticed I also said it depends on your water intake / food consumption.

So I guess all the DS patients & doctors I've talked to in the last 5 years of research have lied to me. Shame on me.

Heather, you are freshly out of surgery that you are currently regretting, so I am going to be gentle with you: you are full of ****

Yes, SHAME ON YOU for believing lies (and spreading them) from your surgeon who has NEVER done a DS, according to his office staff. In fact, NONE of his colleagues in the Lake County Surgeons office have done the DS, so I am not sure WHY you would think they would tell you the truth about it. It would be like counting on a Buick dealer to tell you the truth about a Rolls Royce.

Surely to God your exhaustive research for five years brought you to actual medical consults with a few surgeons who actually do a variety of surgeries, including the DS??? Even though I was pretty certain I wanted the DS, I met with docs who truly did the lap band, RNY and the DS. They reviewed my case and made their recommendations. THAT was a useful exercise.

I'm guessing the RNY is simply what your insurance (Kidcare) would pay for. I am sorry for that. Money matters, for sure. BUT I would have paid out-of-pocket for my DS. In fact, I was about to get a part-time job at Starbucks, since their insurance covers the DS. That's rrght. I was going to pay a babysitter $15/hour to get an $8/hour job just so I could get the DS. It's that important to me to get the surgery that gave me the best chance of long-term success.

To give your learned doctor the benefit of the doubt, he may be confusing today's DS with the BPD-DS of old, which was really more of a RNY with more malabsorption. Many doctors who churn out RNYs and Lapbands all make this same mistake, hoping that what they are saying is true about today's DS. The DS is more complicated sugery and not just any bozo can do it. You doc should get current on what's available out there.

A simple pubmed search would have turned up lots of scientific FACT about the DS. A visit to www.dsfacts.com would have given you some helpful info. You may want to share these research sources with your surgeon, especially this peer-reviewed medical journal article on bowel habits after the RNY and the DS:

Bowel Habits after Gastric Bypass Versus the Duodenal Switch Operation.
Wasserberg et al. Aug 2008
http://www.ncbi.nlm.nih.gov/pubmed/18752029

BACKGROUND: One of the perceived disadvantages of the biliopancreatic diversion with duodenal switch operation is diarrhea. The aim of this study was to compare the bowel habits of patients after duodenal switch operation or Roux-en-Y gastric bypass.
METHODS: A prospective comparative case series design was used. Forty-six patients who underwent duodenal switch (n = 28) or gastric bypass (n = 18) were asked to complete a daily diary for 14 days after losing least 50% of their excess body weight. Data were collected on number of bowel episodes, incontinence, urgency, stool consistency, and awakening from sleep to defecate. Background variables were recorded from the medical files.
RESULTS: The duodenal switch group was heavier (body mass index 53.5 vs 47.0 kg/m(2), p = 0.03) and older (47.5 vs 41.0 years, p = NS) than the gastric bypass group. Median time to 50% excess body weight loss was 22 months in the duodenal switch group compared to 10.0 months in the gastric bypass group (p = 0.001). Patients after duodenal switch surgery reported a median of 23.5 bowel episodes over the 14-day study period compared to 16.5 in the gastric bypass group (p = NS). There was no between-group differences in any of the other bowel parameters studied.

CONCLUSIONS: Although duodenal switch is associated with more bowel episodes than gastric bypass, the difference is not statistically significant. Bowel habits are similar in patients who achieve 50% estimated body weight loss with duodenal switch surgery or gastric bypass.

Here are some more FACTS from peer-reviewed medical jourrnals:

Baltasar et al., "Gastric emptying in patients with morbid obesity treated with a duodenal switch", May 1997. [36]

81.3% of Duodenal Switch patients experience normal gastric emptying.

 

Gary Anthone, MD, "The duodenal switch operation for morbid obesity", Aug 2005. [9]

The average number of bowel movements per day for 43 pre-op patients was 1.9, 421 patients six months post-op was 2.7, 316 patients twelve months post-op was 2.6 and 113 patients > thirty six months post-op was 2.8.

  If you had truly done ANY in-depth research, instead of just believing what you heard from people who don't actually do the DS, you'd know that the DS has the BEST success rate of any of today's weight loss surgeries, including the LapBand and RNY.

On average, DS patients lose the most weight and more keep it off 7-10 years out, which is what we all should shoot for, right?  See page 10 of this guideline document of the American Society for Metabolic and Bariatric Surgery. It lays out the stats nicely.

http://www.aace.com/pub/pdf/guidelines/Bariatric.pdf

The DS has a excess weight loss rate, 7-10 years post-op, of 60-80% and the RNY has a 25-68% rate. That means if you only had 100 pounds to lose, the DS would keep 60-80 pounds of that off and the RNY would keep 25-68 pounds of that off, on average. I like the odds of the DS!!

PLUS, it has the most success rate of resolving patient comorbidities such as diabetes. AND, once you get your daily protein in, you can eat a wide variety of foods without fear of dumping, sliming, foamies, etc. which can happen with the other weight loss surgeries. I eat steak, cake, potatoes, cheese--you name it, and still lose weight!

And BTW, I am a DS patient (18 months out and I have lost over 200 pounds) and I have NEVER had diarhhea. I attend a monthly support group of about 20-30 different people in person and NONE of us have had diarrhea beyond the first month or so after surgey, when our plumbing is new (like almost any other WLS). I am a regular on the DS board which has hundreds of us who do NOT have diarhhea. We do not fart all day long either.

If anything, many of us swing toward constipation. We must eat a decent amount of fat to "keep things moving."

Today, I ate:

6 pieces of bacon
2 pieces of colby jack cheese
2 frozen waffles
1 glass of milk

a protein shake (a dessert-type of milkshake from my healthclub)

A McDonald's Deluxe Angus burger
small fries
large Diet Coke

For dinner, I'll probably have some spaghetti with sausage and garlic bread. And then wa**** down with some ice cream.

NO diarrhea. NONE. Just yummy, weight-loss inducing goodness. Actually, I am maintaining now, not trying to lose weight anymore. This has been the easiest thing I ever did.

I am so sorry your reseach was not comprehensive enough for you to find out FACTS about the DS before you went under the knife. And I am sorry if your insurance would not cover the DS. But please do not spread lies from your sources to newbies here, Heather.

Nicolle




 

Nicole, you are one, count it ONE out of how many people that have gotten the DS. You honestly think I'm dumb enough to talk to a surgeon that is not even trained to do DS? You are a fool. I went to a seminar at UIC and spoke to the surgeons there, the ones that ACTUALLY DO the surgery. I have also spoken to countless people at the seminar and at my local support group. People that have ACTUALLY done the DS.

As for regretting the RNY, I'm not regretting having done the RNY, I'm wishing I would have done the DS because my BLOODSUGARS are still high even without food. I feel like I went through a surgery to mainly get my sugars under control and here I am eatting next to NOTHING and I have to be on a med. I can only imagine what is going to happen now that I will be eatting more.

So, with that being said, just because YOU do not experience diarrhea etc does not mean others will NOT.

Matter of fact, I believe I still have this long drawn-out email where you sent me a PM and insisted I should get the DS because of my diabetes (when I hadn't even asked anyone to contact me - your email was just as pushy and insulting as your post just now). When I asked you about the diarrhea etc you said yes it can happen, it varies from person to person. Maybe I should hunt through my emails and post that.
 
This still does not change the fact that MOST surgeons can't do the DS and MOST hospitals are not trained for the surgery and after-care. As well as MOST insurances wont even cover it.

Oh, and lets not forget the fact that from all the surgeons I've talked to no one would even TOUCH me because my BMI was only 35 and there is a concern of losing too much weight when you have a minimal BMI. So nice of you to suggest I only did the RNY because thats what my insurance would pay for. Um, news flash, I had BCBS at the time I sought out the DS and they DO cover it! It was the fact that no surgeon would perform it on me because I was only 35 BMI!

Funny, I don't see many DSers on these forums....I wonder why...

On August 4, 2009 at 5:06 PM Pacific Time, Heather S. wrote: Nicole, you are one, count it ONE out of how many people that have gotten the DS. You honestly think I'm dumb enough to talk to a surgeon that is not even trained to do DS? You are a fool. I went to a seminar at UIC and spoke to the surgeons there, the ones that ACTUALLY DO the surgery. I have also spoken to countless people at the seminar and at my local support group. People that have ACTUALLY done the DS.

As for regretting the RNY, I'm not regretting having done the RNY, I'm wishing I would have done the DS because my BLOODSUGARS are still high even without food. I feel like I went through a surgery to mainly get my sugars under control and here I am eatting next to NOTHING and I have to be on a med. I can only imagine what is going to happen now that I will be eatting more.

So, with that being said, just because YOU do not experience diarrhea etc does not mean others will NOT.

Matter of fact, I believe I still have this long drawn-out email where you sent me a PM and insisted I should get the DS because of my diabetes (when I hadn't even asked anyone to contact me - your email was just as pushy and insulting as your post just now). When I asked you about the diarrhea etc you said yes it can happen, it varies from person to person. Maybe I should hunt through my emails and post that.
 
This still does not change the fact that MOST surgeons can't do the DS and MOST hospitals are not trained for the surgery and after-care. As well as MOST insurances wont even cover it.

Oh, and lets not forget the fact that from all the surgeons I've talked to no one would even TOUCH me because my BMI was only 35 and there is a concern of losing too much weight when you have a minimal BMI. So nice of you to suggest I only did the RNY because thats what my insurance would pay for. Um, news flash, I had BCBS at the time I sought out the DS and they DO cover it! It was the fact that no surgeon would perform it on me because I was only 35 BMI!

Funny, I don't see many DSers on these forums....I wonder why...

Nope, it looks like YOU are the fool, Heather. You bring up of lots of issues, most of which do NOT highlight your intelligence and bring into question your maturity.

1) First, it looks like you did NOT talk to a surgeon who is trained to do the DS, after all. UIC does NOT do the DS. Since none of THOSE docs and none of your surgeon's group actually do the DS, I find it very hard to believe that you have "countless" DS patients in your support group meetings. Did they wander in from the street?

2) As to WHY are there no people on the Illinois board who have the DS, it's not because Illinoisans do not get the DS--plenty of them do, including me and the 20-30 in my monthly DS support group meeting, and those are only the people who want support IRL--they just do not hang out on a board where there is no one else who has the DS. I hang out with about 8 DSers from the DS Forum in person regularly.

Go over to the DS Forum here on OH and see just how many people from Illinois have the DS there. We hang out there because--duh--we all have had the same surgery. The nutritional and post-op advice we get here on the Illinois forum does not usually apply to us. I hang out here because I like the people (have been to some events with these folks and have some PM relationships with a few) and share some of the post-WLS questions and concens that we all share. Most people have time for just one board and they choose to spend it on their main surgical board--that's not unusual. If every person who had the LapBand hung out on their state boards, there would be no way to get a word in edge-wise. People go where they want to go on these boards, as in life.

And yes--my biggest reason to be here is to "pay it forward" on the DS. Whenever a DS-related question comes up, I like to share what I have experienced, which BTW, the OP on this thread was more than likely asking people who actually HAD the DS to chime in on their opinions of the DS and their experience, NOT people who want to spread unsubstantiated-by-any-science rumors from people who have NOT had the surgery in question.

3) When you have a BMI of 35 and a life-threatening comorbid like diabetes (since the DS has a near-perfect record of curing Type 2 diabetes), most insurance companies will capitulate and approve the DS for those willing to fight a little. It is proven again and again by successful appeals on the DS board. The US government's Medicare program has been covering the DS for about three years now, so many insurance companies, including mine, now cover it. It's only a matter of time until more do.

4) And as to why more surgeons do not do the DS, as in most things in life, it's money.

The DS is a more complicated surgery to do, because you have to keep the pyloric valve intact and cut lengthwise, up the stomach, instead of a straight lop, straight across the stomach to make a pouch. Then you have to rearrange the intestines. That part is harder than the rearrangement of the RNY innards, as well.

A surgeon usually proctors with a DS surgeon for about 6 months to learn it. Most docs do not want to take the time off from their busy, cash-cow practices to learn it. It's hard to blame them.

Even the world's best DS surgeons can only do 1-2 DSes a day at most and it requires regular follow-up appointments for years. (Many argue Lap-Banders and RNY patients should have regular follow-up appointments for years too, but it is not always the case, sadly. Some are just given a pat on the head, told to take a multivitamin and sent on their way until the first signs of malnutrition pop up. And by then, it's a crisis. DS docs require frequent follow-up with their patients to stay on top of their care, which takes away from time they could be doing new patients.)

Most docs do not want to jeopardize their profit margin. They can do lots more Lap-Bands and RNYs in the same amount of time, with minimal follow-up. And now, Lap-Bands require lots of quick fills and unfills, which are easy to do and provide lots of profit for the docs. Keep `em coming back for more at hundreds of dollars a pop. Why would you want to stop doing this type of business?

5) As to your lightweight issue, that would not be an issue for an experienced DS surgeon who would have made you stomach a little larger (or not touched it) and your common channel a little longer. A qualified surgeon does not have a one-size-fits-all mentality. But you'd know that if you'd done all your exhaustive DS research and inteviews with qualified DS surgeons, right? And since you have done exhaustive research, you probably know that the DS is routinely done in other countries in Europe and in India for people of NORMAL weight to cure their diabetes. They do not lose weight because their common channel is made longer than the typical DS patient. So a BMI of 35 is child's play in the right surgeon's hands. Finding one who actually does the DS would have been a start.

6) As to the email I sent you when you were bellyaching on the boards about your diabetes and the RNY, no need to find it, here it is in its entirety, as everyone can see, it is not long nor drawn-out and I was exceedingly polite and did NOT insist that you do anything. I tried to help you, and you rebuffed my help and now you are pissed that your diabetes is not "cured".

Date Sent:	May 15, 2009 - 5:46am
To:	Heather S.      Click here to add this user to your friends list
Subject:	RE: RE: Diabetes
It is unfortunate your doctor feels that way. There are plenty of "lightweights" like you who get the DS. In fact, it is used routinely on normal weight people (BMIs in the 20s) in other countries to cure their diabetes. It's more likely that your surgeon does not do the DS, or if he does, he has done so few (less than 50 or 100) that it wouldn't be a good idea to have him do the more complicated DS. Best of luck to you, Heather! Nicolle Heather S. wrote: Hey, I would love to do it but my surgeon requires a BMI of 45 or higher to qualify. I am at 34.9 BMI.... :-( Heather Nicolle wrote: Hi, Heather. Not sure if we have spoken before or not, but I just wanted to make sure you knew about the duodenal switch (DS) as a weight loss/metabolic surgery. The reason I thought you may want to learn more about it is your diabetes.  It has a 98.9% cure for diabetes versus the RNY (gastric bypass) which, at best, has a 83% cure rate but usually cited as in the 70% area. The DS cured my newly-diagnosed diabetes. There is one DSer who is especially passionate about this issue and has lots of info, including clinical studies, etc. on her blog at: http://www.obesityhelp.com/member/jillybean720/. For more info on the DS, please visit the DS forum or www.dsfacts.com. Plus, the post-op lifestyle with the DS is off-the-hook fabulous! As long as I get my protein in, I eat what I want, from cheese to meats to desserts of all kinds. I have lost 190 pounds eating what I want in 14 months. In Illinois, there are the docs at the University of Chicago and some in the Peoria area. I went to San Francisco to my doc. He comes to Chicago almost every month for our support group. Our next meeting is this Monday in downtown Chicago. If you'd like more info on it, please let me know. Best of luck to you, no matter what you decide! Nicolle

Here's a tip. The next time someone tries to help you, listen to them. Open your mind and see if what they are saying is making sense. Talk to experts. Do some due diligence on your own.

I honestly do wish you the best. I hope you are on the mend soon and your diabetes goes into remission. You're still early out and things are rough in the beginning, incuding your emotions. In a month, you will probably regret your rant here today.

Nicolle
 

Lmao, it's humorous to know you are so full of yourself that you think people (including myself) actually have 15 minutes to sit here and read your novel of a post. I skimmed through it and from what I did see it was "Blah blah blah...you are dumb. Blah blah blah....I know everything"

Funny I didn't realize Doctors replied on these forums.

Good day to you Nicolle, your posts no longer interest me as you clearly think you are above everyone else that has ANY opinions on DS.

Heather

Oh, don't like when you get called out and made a fool of? Too bad. Stop opening your trap about stuff you know NOTHING about, like the DS.

It's THIS kind of immature, lazy, can't be-bothered-with-FACTS type of thinking that got you the surgery you did not want, that may NOT cure the diabetes you have to live with. Go ahead and take the path of least resistance. Bury your head in the sand.

You are beyond anyone's help until you grow up and take care of yourself in a thoughtful way. This isn't a game, little girl. This is the rest of your life.

Your childish arrogance will be your undoing. Best of luck to you. You're going to need it.

And BTW, you are not the only one reading this post. I am sure some newbie, struggling with diabetes, got something out of it and will benefit from it.

And if you ever post unsubstantiated NONSENSE about the DS on this forum again, I will come behind you and clean it up again. So think twice before you spout ignorant know-nothing BS again.

Nicolle