So far my research points to Duodenal Switch, but it's not done near me
I can't tell you why not to as choosing a surgery type is an individual thing. When I was doing research for my WLS I looked at the Duodenal Switch and decided that I did not want it for myself. One of several reasons was that I did not want that much malabsorption. Everyone has to look at the different surgeries and make the decision for themselves.
There is a DS board here, I'm sure if you post your question there someone can help you with surgeons. Click on Communities then choose the DS board.
Hi Jim,
The only thing that I can tell you is that according to the book "The Real Skinny on Weight Loss Surgery" , the Duodenal switch is not done as often because there appear to be complications due to malabsorbtion-- vitamin and mineral deficiencies and problems losing a sufficent amount of weight.
Truthfully , I wanted the possibility of the "dumping" because I felt that I needed to be warned that I was doing the wrong thing, and I consider "Dumping" a teacher of a sort.
I don't want anything that will allow me to eat TOO" Normally".
I have been eating "normally " and that's how I ended up this way. I didn't want to make this too easy for me---and I really want to live a long and healthy life.
You too , want good health and long life --or you wouldn't be considering WLS. So you have to decide--and find a surgeon who is EXPERT in the type of surgery that you decide upon!
So, to each, his own--you have to decide what is best for you!!
Be blessed ,
Marian S.C.
WOW, Marian, That is really sad!!!
I don't mean to offend or upset anyone, but have you thought about what you are saying? Are you such a bad person that you require lifelong punishment now? Isn't that buying into the general misperception of obese people as lazy, glutenous etc. and the notion that all we need do is get some control over our eating and exercise and we won't be fat anymore - do you really believe that you became overweight because you are lazy?
You said: 'I didn't want to make this too easy for me'
Why on earth would you not want your life to be as easy as possible? Since when is it better to choose the hard way? If the DS is the easy way, in my book it must then also be the best way, because I believe in making my life as easy and straight-forward as possible.
The things you said are the reasons why I DIDN'T choose the RNY. I didn't want to be 'punished' for having eaten too much in my life. I wanted a 'normal' life. I had had enough of dieting and to me the RNY was one long permanent diet!! I haven't been a 'bad' person, I don't need to dump if I enjoy my birthday cake!
Anyway, this is all just my opinion, I really don't mean to be difficult,
Anne 
Hi, Jim: I had a DS at Cornell. I am shocked that it isn't the most performed procedure. It cured my type 2 diabetes. I'm within 20 pounds of goal at just 8 months out. I eat well and often. I take my vitamins and keep an eye on my blood levels, and I plan on being healthy!
It is technically a more difficult surgery that requires surgeon experience and training. There's a lot of money in weight loss surgeries for the surgeons and the sooner you can start doing it, some think, the better.
If you come over to the OH board for DS, or to duodenalswitch.com, you'll find there are a number of PhDs, lawyers, executives, nurses, and medical writers who have had the DS.
Certainly, the long-term results are the best with DS. I hope everyone who goes for an RNY knows what the 10-year data are showing. After 10 years, the weight loss is in the range of 44-66 pounds (Maggard et al 2005 Annals of Internal Medicine).
Since I needed to lose 130 pounds, I wasn't going to put my life at risk during surgery without knowing that 10 years from now I would not qualify for surgery again! I have no complaints about my DS. The results speak for themselves.
Good luck with your decision. Ignorance abounds about these procedures. I feel sorry for people who get railroaded into one choice or another without really knowing the differences, just because the surgeon knows he can make a fast buck. Nancy
Hi Jim -
I was directed to this thread from the DS messageboard here on OH - you're welcome to come join us and ask all the questions you want. http://www.obesityhelp.com/forums/DS/
I've had it (I'm 4 weeks out so far), and so far so good. I've had good days and bad, but that's natural for the healing stages. You're welcome to click on my profile for links to posts while I was in the hospital and immediately post-op.
As for why it is not done more - two reasons:
1) The insurance companies still fight paying for it, because it is a more expensive surgery. Because of insurance hassles, many people who WANT the DS either must resort to self-pay (like myself) or settle for their second choice of either RNY or Lap Band.
2) It is a MUCH more complicated surgery than the RNY, and has a greater learning curve. Because of this, it takes more time to learn and perfect it, and surgeons are naturally very busy people.
Combine these two factors, and you'll find that surgeons would prefer to stick with the RNY knowing they'll get paid, and they don't see an advantage to taking time away from a busy practice to learn a surgery that will have a greater denial rate by insurance. There are some *fantastic* surgeons out there who would love to, but medicine is a business just like any other, and they have to produce profit margins for their shareholders just like the rest of us.
Now, we are having more success every day getting approvals for the DS, and the tide may one day turn. But for now, it's just the way it is.
I believe Dr Gagner is in NY, and he's an excellent DS surgeon. He would be the man I would recommend that would be closest to you.
--BT
The malabsorptive component of the DS is less worrisome than with the RNY. DSers can digest and absorb more nutrients from the food they eat because of a normally functioning stomach with access to digestive juices, etc., in addition to the fact that they can just EAT more period and actually enjoy eating meat rather than having to get their protein from protein shakes. Your research is correct, Jim, but you may have to join us on the OH DS forum to find like-minded people. We can point you in the right direction:
http://www.obesityhelp.com/forums/DS/posts.html
Among the advances of the DS procedure are the following:
· Rarity of dumping syndrome (a potentially-dangerous, sudden jump in blood-sugar level caused by undigested food entering the intestines through a man-made opening), commonly seen with the Roux-en-Y (RNY).
· Rarity of stomal ulcers commonly seen with the Roux-en-Y (RNY).
· The DS patient retains their naturally functioning stomach (although the volume is reduced) along with the pyloric valve or natural exit from the stomach to the intestines rather than a problematic, man-made "pouch" as with the RNY.
· Better sustained long-term excess weight loss and, unlike the RNY, a low failure rate.
· A 98 percent cure rate for type II diabetes.
· Less stomal plugging and less vomiting.
· The ability to take NSAIDs, non-steroidal anti-inflammatory medications.
· The entire stomach and duodenum can be visualized by endoscopy, unlike the RNY which divides the stomach into an upper and lower pouch, the lower of which cannot be visualized via endoscope.
· DS surgery results in little to no nutritional or metabolic complications as long as the supplementation regime (required for any weight loss surgery) is followed carefully.
· DS surgery results in a superior quality of life to RNY in that patients are able to enjoy eating a normal, balanced diet with no specific food restrictions.
For WAY more information, please check out my profile.
LeaAnn
Please do not simply accept the contention that malabsorption, and the implication that there are severe malNOURISHMENT complications, as fact without doing some research.
Ultimately, the issue for your health is how well nourished you are, and that is less directly related to the degree of malabsorbtion than you'd think.
There are other variables in play here: the ability to eat an overall higher volume and wider variety of foods helps, as does the fact that many nutrients are available post-DS by virtue of a working lower stomach and duodenum that doesn't exist post RNY.
Ultimately, the record shows that DS allows not only a higher quality of eating afterward, but actually LESS malnourishment. So the argument that there is more malabsorption doesn't have much weight. Both surgeries require close attention to nutritional status post-surgery.
I came to the conclusion that I want DS after hanging around the main board for a couple of months and became dismayed at the prolific number of posts where people talked about dieting, diet pills, diet plans...all because they were regaining. HUH? The reason I wanted WLS is because I wanted a tool that would work PERMANENTLY to keep me at a healthy weight - one that would let me live life without counting calories or deprivation and guilt. That's not to say that I am unwilling to embrace a healthy lifestyle, just that I have been fat forever and am SICK of a fat lifestyle.
This is going in all caps, not because I'm yelling, but because I can't say it strongly enough: A HEALTHY LIFESTYLE AND NOT COUNTING CALORIES OR LIVING IN DEPRIVATION ARE NOT MUTUALLY EXCLUSIVE!
This is an area I have been flamed about anywhere on the internet that I have posted about DS. People seem to think that the only reason for choosing it is so they don't have to change anything, but the consequences are removed. In other words, it's for fat people who don't want to be healthy, they just want to be thin.
So don't let anyone tell you that, because it's BS. There's nothing wrong with wanting a superior quality of life AND with being at a healthy weight without being perpetually punished because you once were fat.
Most of us who get DS find that it isn't done 'near' us. There just aren't that many DS surgeons yet. When I first started this journey, I was going with RNY. It's all I knew anything about, and in one of my earliest posts I mentioned that distance is a deal-breaker for me. The more I learned along the way, the more I realized that hingeing the rest of my life on a decision that would only encompass a few weeks (as far as travel distance goes) wasn't going to be in my best interest at all. In fact, if we had $25K at our disposal, we'd be self-paying to go either to Brazil or Spain and my husband and I would both have our surgeries while we were there.
Denise in Ark
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