Hi there lasolas... you have a long journey ahead but it will be the trip of your life!!! There's so much ahead, you can't even imagine it right now. Where this journey is going to take you, you just have to get started and find out where the path will lead you! I think one of the trippiest things that happened to me was getting used to my face. It was like my mid-40s face simply EMERGED rather than having aged into it. My mid-40s body turned out different than I thought it was going to be. My big butt turned into my dad's flat butt and my grandmother's straight thick legs have become muscular and shapely. I still look at my own reflection sometimes with what I can only describe as a sense of wonder. Extremely rigorous exercise has become a major part of my life and to this day I discover physical accomplishments I never would have dreamed in my wildest I'd be able to push myself to do! And sometimes when I think about where i've been and how I got here, I can still get emotional about it and cry for reasons I can't quite articulate.

I've been EXTREMELY fortunate and I'm grateful for that every day. I hope your journey will be healthy and positive in every way. I hope your path will lead you to a wonderful place.

Wow. That's all I can say! :) 

lasolas -
I hope this thread has not scared you away..  It is rare that we have negativity on this board.  As I said before, take what you like and leave the rest.

With you just starting out on your journey, I would recommend staying on the IL board, asking questions and doing your research.

Christina

Hijack, lasolas.

Since you have just been diagnosed with Type 2 diabetes, I want to make sure you know about the duodenal switch bariatric surgery. I had it about 2 years ago and it CURED my Type 2 diabetes. I was freshly diagnosed, like you, so my body was still capable of producing  insulin. I effortlessly have lost almost 200 pounds eating foods I love, from cheese to meat to desserts.

It's one of the four available bariatric surgeries today:

-Duodenal switch
-RNY (Gastric bypass)
-Vertical sleeve gastrectomy
-band (LapBand or Realize)

The DS has the best long-term resolution of Type 2 diabetes. It is not related to the amount of weight you lose BUT the metabolic shift the DS creates in your  body. Once regain happens with the other surgeries, the diabetes often comes back with a vengeance.

Please check out jillbean720's profile here on OH. Just search for her name under "People" to read all of the scientific data and studies on diabetes and the DS and RNY.

Here are just some studies for you to review if you have not yet:

(The first one is by Dr. Prachand at the University of Chicago, the ONLY hospital in the Chicago area that REALLY does the DS--unless you talk to a REAL DS surgeon, you will NOT get accurate, current info on the DS. The Lexus dealer will not tell you positive info about the Ford cars and vice versa.)

J Gastrointest Surg. 2009 Nov 24. [Epub ahead of print]

Duodenal Switch Provides Superior Resolution of Metabolic Comorbidities Independent of Weight Loss in the Super-obese (BMI >/= 50 kg/m(2)) Compared with Gastric Bypass.

Prachand VN, Ward M, Alverdy JC.

Section of General Surgery, Department of Surgery, University of Chicago Medical Center, 5841 S. Maryland Ave. MC 5036, Chicago, IL, 60637, USA, [email protected].

OBJECTIVE: Increased body mass index is associated with greater incidence and severity of obesity-related comorbidities and inadequate postbariatric surgery weight loss. Accordingly, comorbidity resolution is an important measure of surgical outcome in super-obese individuals. We previously reported superior weight loss in super-obese patients following duodenal switch (DS) compared to Roux-en-Y gastric bypass (RYGB) in a large single institution series. We now report follow-up comparison of comorbidity resolution and correlation with weight loss.

METHODS: Data from patients undergoing DS and RYGB between August 2002 and October 2005 were prospectively collected and used to identify super-obese patients with diabetes, hypertension, dyslipidemia, and gastroesophageal reflux disease (GERD). Ali-Wolfe scoring was used to describe comorbidity severity. Chi-square analysis was used to compare resolution and two-sample t tests used to compare weight loss between patients whose comorbidities resolved and persisted.

RESULTS: Three hundred fifty super-obese patients [DS (n = 198), RYGB (n = 152)] were identified. Incidence and severity of hypertension, dyslipidemia, and GERD was comparable in both groups while diabetes was less common but more severe in the DS group (24.2% vs. 35.5%, Ali-Wolfe 3.27 vs. 2.94, p < 0.05). Diabetes, hypertension, and dyslipidemia resolution was greater at 36 months for DS (diabetes, 100% vs. 60%; hypertension, 68.0% vs. 38.6%; dyslipidemia, 72% vs. 26.3%), while GERD resolution was greater for RYGB (76.9% vs. 48.57%; p < 0.05). There were no differences in weight loss between comorbidity "resolvers" and "persisters".

CONCLUSIONS: In comparison to RYGB, DS provides superior resolution of diabetes, hypertension, and dyslipidemia in the super-obese independent of weight loss.

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Obesity Related Illnesses that Improved/Resolved Following Weight Loss Surgery:

	Gastric Band	RNY	DS
Diabetes Mellitus	47.9%	83.7%	98.9%
Hyperlipidemia	58.9%	96.9%	99.1%
Hypertension	43.2%	67.5%	83.4%
Sleep Apnea	95%	80.4%	92%

Buchwald, H. Bariatric Surgery, A Systematic Review and Meta-analysis. JAMA, October 13, 2004-Vol 292, No. 14

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	Initial Type 2 Resolution Rates	Resolution Rate at 2+ Years Post-op
Banding	56.70%	58.30%
Gastroplasty	79.70%	77.50%
RNY	80.30%	70.90%
DS	95.10%	95.90%

Journal reference:

1. Henry Buchwald et al. Weight and Type 2 Diabetes after Bariatric Surgery: Systematic Review and Meta-analysis. The American Journal of Medicine, Volume 122, Issue 3 (March 2009)

And some interesting quotes from  http://care.diabetesjournals.org/cgi/content/full/31/Supplem ent_2/S290

Diabetes Care 31:S290-S296, 2008
DOI: 10.2337/dc08-s271
© 2008 by the American Diabetes Association
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As far as insurance goes, often, if your insurance company says you are fat enough/sick enough to require WLS, then they usually can be persuaded into giving you the surgery you want on appeal, especially if the issue is either diabetes or that you need to take NSAIDs for chronic pain or inflammation--the DS answers both.

Best of luck to you, no matter what you decide! Feel free to send me a private message if you'd like to talk.

Also, please check out the DS forum here on Oh and www.dsfacts.com for more info.

Nicolle

I now wish I had the choice to get DS.  I know my insurance doesn't cover it but I really wi**** was a choice.  I am so frustrated with my band.  Do you think there will be a time when DS is an accepted as an option with insurance? 

Sorry about your band issues. That stinks.

What insurance do you have, BTW?

Yep, the DS is getting covered more and more by insurance every day. In fact, Aetna covered it for me 2 years ago without batting an eye. Once the federal government starting covering it three years ago under Medicare, things started changing. In fact, BC/BS of IL started covering it in September 2009 and they are notoriously sloooow to cover things.

Clearly, it is making financial sense to the big insurance companies now. The long-term research is in and it's waaay cheaper for insurance to pay for one DS surgery versus a lifetime of diabetes testing materials, medications and hospitalizations, amputations, rehab, etc. Insurance companies had to wait until it made good financial sense to them to cover it.

In the meantime, people may need to appeal a DS denial from an insurance company so that they can get the surgery they want and need to best resolve and manage their comorbid conditions, such as Type 2 diabetes and arthritis.

The bigger issue seems to be in what policy your employer negotiates/buys for its employees. While Aetna may cover it nationally, your company may have decided to not pay extra for a weightloss surgery rider, or even revisions. That you'd have to take up with your employer.

You may have to get creative until everyone sees the light. I was about to take a part-time job with Starbucks because they have kick-booty health insurance for their part-time employees that covers the DS. The regional manager was just picking the store he needed me to go to, and then my hubby got word that his old company hired him back. He wanted to work for his old company again (we had just relocated to DC and back for his previous job) and he knew his old company's policy covered the DS, so it was a done deal. No Starbucks for me, but I sure would have taken the job to get my amazing DS covered. Even at 344 pounds and with an aching body, I would have been a kick-booty barrista!

Nicolle

I have BCBS of MN.  They were really picky about the surgery I could have and what surgeon I could go to.  I know my current surgeon doesn't do DS.  I remember at the informational session he talked briefly about DS, but only to say how it's so dangerous they won't do them.  But I'm not even a year out from my surgery.  I shouldn't be thinking about revisions.  Although, I do and often.  I have buyers remorse 

Yeah, it's definitely dangerous in the hands of someone who has not been trained to do it!

Your surgeon would have to step away from his lucrative practice to proctor with a DS surgeon for several months in order to learn how to do it. Most RNY and band docs do not want to/could not do that, and I can't say I blame them.

Like they say, we have to work the tool we got. We all have experienced buyers remorse, especially in those early post-op days when we are wonderinng what the hell we did to ourselves. The band has always been sold as a "slow, more natural weight loss" tool. Continue to be patient, if you can.

But if you DO think about revising to a DS in the distant future, you will need an experienced revision surgeon. Visit the DS board if it comes to that and get the most current list at that time.

On the flip side, I'll bet you don't need to take 14 vitamins a day like I do. (Eight of them are calcium, one is a multi and one is a Vitamin D, which I should be taking anyway.) It's not a deal breaker for me, but for some people, it would be.

While it has great odds, even the mighty DS is not fool-proof. Each of our bodies has a mind of its own and will react differently to each surgery. If I decide to eat carbs all day, drink sugary soda, etc. I will regain. I do not have the potential for dumping to stop me from doing that. The weight would just creep on, pound by pound. Then again, I feel like that would happen to any normal American woman in my same situation.

Honestly, the WORST part about the DS is suffering the weird stuff people make up about it, like how we DSers have crazy gas, malnutrition, bowel issues, we're at Death's door, etc. It's maddening!

Hang in there!

Nicolle

when i was researching the different types of wls, i read something that said the DS would a more dangeous and complicated procedure.  Personally, i think there are dangers and risks with any one

Hijack!!!!

You can add me in to those who wish that DS had been an option when I had surgery. 

There is virtually no way that I can even think about a revision of the RNY to the DS. 
Not only is it a very complicated surgery, I do not know if my insurance would approve (I AM considered a RNY success by the numbers).  On top of that, we really can not afford the 20% PLUS that another surgery would cost.

I am healthier that I was, but still "obese" by the charts and nothing seems to help.  I am glad to see that my friend Nicolle got the best and I can live vicariously through you!