1,050,000 Calories PLUS Malaborbed or not eaten...I love my DS!!!!!

Well at the stroke of midnight tonight, it will be my 2 year surgiversary.   2 years of being "cured" of obesity, though the miracle of the duodenal switch.    I've currently lost 300 lbs, and have maintained just under my goal weight for the last 6 months or so.    There is a saying in personal fitness that says I lb is equal to 3500 calories, so if you want to lose 1 lb you need to not eat 3500 calories...well after losing 300 lbs I figure that I have either not eaten or malabsorbed over a million calories!!!!!!! (trust me it is more likely malabsorbed....lol).  I can't tell you how grateful I am to have had the DS.  You know 2 years seems to be the "turning point" for most surgeries......it's at 2 years that RNYers realize that they will have to "work their tool" for the rest of their lives, it's at 2 years that banders finally realize that band either will or  won't work for them...but at 2 years post DS, I can tell you my DS is allive an kicking!!!!!!   Trust me there is no working a tool....5 day pouch test or any other crazy post op diet thing  like trying to live on 1200 calories a day...hello...I eat that before lunch most days....lol.  Actually on average I eat about 4000 to 6000 calories a day.....I can eat whatever I want...and at this point post op...as much as I want....when I want to drop a few lbs, all I have to do is restrict my carbs a bit, and the weight comes off.......there is no counting of fat grams or calories.....it's been the easiest weight loss of my entire life......   I LOVE MY DS!!!!!!  If you are a preop and considering a WLS...consider the DS. Scott

Scottie:
Thanks for the update on how you are doing. Also congrats on the remarkable journey you have been on. Happy 2 year rebirth as well

I feel it is imperative to keep people educated and informed on all their options. I agree for many 2 yrs is that turning point although some do get it at 7 months (their body adapt real well and malabsorbtion stops!) others 3-5 years (RNY) bandsters tend to be all over the map in my personal encounters.

My RNY point was 3 years...but typically I concur 2 yrs seems to be loss of the 'rosecolored glasses' for RNyers (they tend to realiize no they won't likely lose that last 30# and be a normal weight and no it is not 100# gone forever sadly!)..They see what they did not want to believe....Its only a tool. (darnitall!)

I have seen BPD/DS'ers regain though (see the wlsrevisions or ossg_offtrack groups on yahoo), I am curious about that. What I had heard from some was it was either one's body adapting in a strange way or most likelh a matter of surgical technique perhaps the gastric sleeve needed to be a certain size/created in a certain way (size for right amount of intake/shape creation for correct way to cause hormonal/checmical changes for hunger/satiety/metabolic reasons in general) and of course the common channel needing to be not to long or too short. Or maybe they are carb eaters/some having other addictions such as alcohol...lots of calories there potentially...

I am curious what you may of read/heard about this? Thanks again for sharing, wishing you well and keep on keeping on!

PS How is your nutritional status, the vits/minerals/bone density. How is that going? Supplements you are on and any exercise in your life...not for wt loss just general health benefits?)

As you know surgical techiniques change over time and surgeries become more advanced as time goes on...even the DS I had 2 years ago is "outdated" ...back in the day a majority of surgeons would use the greater outter curvature to be the cutting point for the stomach.  and a person would get a 2-8 oz stomach basically depending on how large their natural stomach was preop.   Now the more common method  is to actually use bougies (sp?) to form a measured stomach.  In the old style surgery, a less experienced might leave too much stomach.  The issue with that is that over time if a lot of the outter curvature is left in tact, it will stretch....it's the stretchy part of the stomach....allowing a person to eat far too much. I know currently in Italy they are doing the switch part on diabetics to "cure" diabetes.....now if it's a cure or not...people disagree.....but what is clear is that diabetes goes into remission at an extremely high rate with the switch part.  Now because the stomach is left intact, apparently a person may lose a 20 to 40 lbs post op...but then over time they will regain that weight because they have no restriction.  In addition to the stomach mechanics, there is the issue with common channel lengths...again every surgeon has their own method.  Dr. Antone out west likes to give a person a very small stomach, and a much longer common channel....over 150 cm.   Other surgeons give a standard amount 100 cm or in my case 75 cm...and still others use the Hess method which basically takes a percent of your total intestinal length and thats what you get as your common channel.  Hess in his study said that if a person didn't get to goal, his method of revision was to shorten the common channel.  There is some adaptation with the DS, eventually you can eat more, and just like with the RNy you absorb more, although it seems from studies like the Ganger poop study, that even at 2 years out DSers malabsorb 81 percent of the fat they eat.....and that 2 years seems to be where the bodies maxium amount of adaptation occurs.  I've heard urban legends of how a persons intestines have grown many cm....but honestly I've never read an actual report or peer reviewed study on it.....so it could be just "urban legend" or it could be truth.  Vitalady (michelle) has a 100 cm common channel RNY....kind of a high breed of the DS and RNY, and she said that the body tries to adapt to vitamin deficiencies so the way to compensate is to take enough suppliments so that your body doesn't get deficiencies and that your body doesn't try to adapt.  Then of course with regain you have the issue with sugary drinks and such.  No WLS will defend against 3000 extra sugar calories a day.  Simple sugar digests in the mouth, and starts to absorb almost immediately.   I have read about people regaining with the DS, but if you ask them why....it's almost always rooted in sugar intake, more importantly sugar intake from soda or other liquids.   Mechanical failure is very uncommon with the DS, although I have read about it. ....although  the mechanical failure is normally the opposite of the RNY in the sense that a DSer may lose too much weight and need to have a revision to lengthen their common channel...i've heard that happens in about 2 to 5 percent of DSers.   Overall the weight loss maintence is pretty high, but not at 100 percent of EWL.  The hess study puts it about 95 percent reaching/maintaining a 70 percent excess weight loss at 10 years out.  There is a reality that people have to face...WLS doesn't gurantee that you will lose 100 percentof your excess weight......I have met many DSers who've "only" lost 70-80 percent of their excess weight, and are extremely unhappy about it, because even with that much weight lost, they are still 50 or 60 lbs overweight.   One lady in particular "only" lost 150 lbs and has maintained that loss for a few years, but was unhappy because she had another 100 to go...her issue was soda...and while she was happy that she lost over 50 percent of her excess weight (a te*****ial success) she wanted to be somewhat thinner.   I guess there is a bit of perspective here for all of us....I think those of us who have gotten to goal are part of a fortunate minority in the WLS community.   My labs are good...and I'm due for my 2nd bone density test...i had one last year..and I'll have one this year after my physical....last year my bones were great, in the normal range.  I do expenct some bone loss, because I'm not carrying around 300 extra lbs...and I dont' have that weight burden anymore making my bones naturally thick.   I have tried to compensate by doing a lot of weight baring exercises...and making sure my D levels are good.....and that I take enough calcium.   But even at 2 years out, I'm still learning what my body needs in terms of suppliments.   Many DSers don't need iron suppliments....but since I rarely eat red meat...i became slightly iron deficient a few months ago.   I have learned that it is better for a post op DSer  (and RNYer) to have high D levels  in the 70s and 80s range, then to just  being boarderline normal....same goes with B vits (esp B12).     Scott

Yes that is what I heard a too large tummy not cut right=regain/failure in some cases. Of course even Vitalady teells you with her radical distal sugar=regain (she had a peep addiction I hear)...

The regrowing of intestines, growing of more folds and cilli for absorbtion of CALORIES never vits...or minerals is not a urban legend according to:

FROM "UPDATE: Surgery for the Morbidly Obese Patient" by Dr. Mervyn Deitel MD CRCSC FICS FACN DABS INTERNAL FEDERATION for the Surgery of Obesity Editor in chief OBESITY SURGERY & Dr.George S.M. Cowan JR, MD FACN Professor of Surgery, U of Tennesseee College of Medicine. 2000 ISBN 0-9684426-1-7

CH 25 limb Lengths (oh how they can grow!)
Pg 271.

As general surgeons we know that mid-gut volvulus resulting in the loss of as much as 50% of middle small intestine does not result in permanent nutritional harm. Patients usually adapt to the loss and are able to maintain adequate nutrition while experiencing only one or two extra, soft bowel movements daily. Thus like the Kidneys and Lungs, the average small intestine possesses approximately ONE-HALF of its length as BACK-UP or redundancy, if the remaining length is normal and an ileocecal valve and intact stomach are in place. The small intestine has the ability to more slowly adapt to even shorter lengths of intestines if necessary. This explains why Brolin's & Cowan's series of extended alimentary limb lengths each filed to increase long-term weight loss. Their patient's common limbs were too long, after intestinal ADAPTATIONS of ELONGATION, DILATION, ENLARGED FOLDS (Valvulae conniventes) and LONG HYPERPLASTIC VILLI occurred.

CH 23 BPD 2 decades of experience
pg 229 During the first postop months all patients due to food stimulation in the ileum, have reduced appetite, and they have early satiety, occasionally in association with epigastric pain & or vomiting. These symptoms characterize the postcibial syndrome that is caused by rapid gastric emptying with subsequent distention of the post anastomic loop. All of these symptoms, the more intense and lasting the smaller the gastric volume, rapidly regress with time, most likely due to intestinal adaptation. ONE YR after an operation the appetite and eating capacity are fully restored and the patients mean reported food intake is one and a half times as much as preop, independent of gastric volume,


NOW I know that's a lot of medical jargon, I know the 2nd message is re BPD (without DS) but the intestines adapt no way around that, HOW MUCH no one knows for sure...We know some get mineral and vitamin deficiencies while others don't. We know some get protein deficiencies and others don't. Who will u be? Dunno, labs are important, as is life long follow up. Other research I have states if common channel more than 200cm then risk of protein malnutrition is less than 1%. proxy RNYs have a common channel greater than 200cm. More like 400cm....

I knew about the intestines thickening (extra folds) in order to absorb more ....but I was refering to extreme regrowth of the common channel area.  I'm not saying it doesn't happen...but I've heard "ledgends" that it can grow almost to a preop length... As for protein deficiency...DSers in general have to be more guarded against deficiencies then a proximal RNY....more malabsorbtion.  It's a blessing but one with a double  edged sword.  I currently take in about 150-200 grams of protein a day.  I'm actually shooting for 200 because I've been working out and I'm trying to get some muscle mass.  Weight lifters in general eat 1 gram per lb of ideal body weight.   Even most of the women who have had the DS shoot for at least 90 grams of protein per day as opposed to the general number of 60 grams for proximal RNYs (I'm using the general thrown around number on the forums, realizing that every surgeon has their own protocols).    The one thing I'm learning is that yes there is the standard protocol that my surgeon gave me, but that was only a base...and that based on my labs I have to tweak my suppliment regime. it's not that hard, except  when i'm trying to figure out exactly how much of X I will need to make a Y amount of change on my labs.  I've been chasing a low D level for about 5 months now....and while my nutritionalist wanted to slowly increase the levels, I finally got "fed up" and started taking the doses Michelle told me I needed....lol.  I just took my  labs on thursday, hopefully my D levels will come up.  The are at the old normal level of 20 or 21 the last time I tested, but now the new "normal" level is over 30.  That would have been difficult for me to get preop...because I've avoided the sun all my life (very fair skin...burn easily). Sugar right now is helping me stablize my weight. If I didnt' eat as much as I do ...I'd start to drop weight again.  I'm aware that things can change...and that I need to monitor this very carefully (i weigh in several times a week).   I'm hoping that my body will settle at this weight and then matinence will be a bit easier then it is right now.     Scott

Hey Scott, Congratulations on your 2 y ear surgervisary!  I am sooo happy for you!    I was wondering what ever happened to you. When you you finally post some pictures of yourself either as an avatar or on your profile?  You have MUCH to be proud of,,,,so, what the heck are you waiting for? Question for you...if you don't mind me asking????  The only negative thing I've heard about DSers are that most post ops have a bad odor problem (and I'm not talking about only while in the bathroom!).....even with daily bathing and deodorants...just curious on your experience and if you feel this is true with others you've met?   Thanks in advance for your honesty...otherwise, it sounds as if you're in heaven!  good for you! Best of luck to you!

I have actually avoided posting a picture publically because i didn't let anyone know I had WLS...i do have some pictures available for friends. .....but even that I restrict because I had a Stalker here on OH. As for the odor issue, no actually i've never met anyone who had the DS and experienced an odor issue in terms of natural BO...EXCEPT for  new post ops.   Their bodies go into ketosis and that smell seems to bother some people .....although it really seems to bother the person who is experiencing the ketosis more so then the people around them.  Ketosis happens to RNyers and lapbanders as well...so it's a WLS issue, not a DS issue persay.   If anything, I know I smell 100 times better now then I did at almost 500 lbs, at that weight I would break into a sweat in the middle of winter, standing outside in a snow storm with no jacket....yes true story. Scott

Had to LOL when I read this! I never had any weird odor since my DS - I never smelled anything nor did anyone I was around..I too have heard of the ketosos but that happens to anyone even non ops. One cool thing tho regarding BO and WLS? When I had my brachioplasty all of my armpit hair was removed! And a few sweat glands with it- so I dont ever get sweaty or have BO anymore LOL What a bonus- I dont need deodorant anymore. Now I did expect to lose weight- but talk about a BONUS- who knew!! LOL Ok- just thought Id share.. TMI?