WARNING TO PRE-OPS: Think twice, cut once -- or else!
Ms. Cal Culator
on 11/21/09 8:04 am - Tuvalu
on 11/21/09 8:04 am - Tuvalu
On November 20, 2009 at 5:03 PM Pacific Time, Darlene G. wrote:
Actually, he DOES do the DS, for now. He also does RNY, Lap Band, VSG, and revisions. He's looking at getting away from DS because he has seen too many patients deal with problems like vitamin deficiencies as others have mentioned here, not to mention serious gastrointestinal issues that Gas-X won't touch. His seminar is very unbiased and presents all facts on equal footing; I happened to ask him questions, and that's when he shared his thoughts with me. He'd actually prefer that I get the VSG, and my insurance will cover it. I just know myself well and I feel that a healthy fear and respect of sugar and carbs will serve me better in the long run! lolAs I mentioned before, I have a family member who has had the procedure. It has done amazing things for her and her experience was one of the deciding factors for me to pursue WLS as an option. I applaud anyone and everyone who has success in achieving a healthier, happier, longer life through whatever means works for them.
RNY is what I choose for me, with help and input from 3 doctors (2 of whom specialize in bariatrics) and my aunt, who also happens to be a nurse. What works for you, or Diana, or my aunt though may not be the path that I feel will meet my needs the best, and I really don't like people telling me that my choice is wrong. It's my choice.
And PS: I wasn't necessarily referring to Diana in the "little lambs" statement... :)
Hmmmm...HE provided this information and it says he has done ONE DS procedure.
ONE.
A whole ONE.
www.obesityhelp.com/morbidobesity/bariatric+surgeon+profile+ Peter+F+Lalor+ssp.html
OK, I have not read this whole thread, just yet, but, I wanted to let you know that I had RNY surgery over 7 years ago, and I am seeking a revision. (yup, I did not know the DS exsisted back in 2001-2002). I HAVE VITAMIN DEFICIENCIES with the RNY. I take my vitamins/supplements religiously, it is now a way of life for me, I made a choice to have WLS, and with the choice, came a trade-off.... to take vitamins & get my labs. RELIGIOUSLY.
We have submitted to the insurance once, and I was not approved, but not denied, either. I have to re-submit, once I have further testing, EGD & upper GI.... I think that the insurance company is looking for "mechanical failure" (I think they are looking for a way to deny me!!!!)
What would happen to me if the insurance company changed their policy & WOULD NOT cover a revision..... ANY REVISION??? I would be screwed!!!! That's what!!! To me, this is an informative thread....
Just my two cents
-Jamie
RNY 2/26/2002 DS 12/29/2011
HW 317 SW 263 BMI 45.1
SW 298 CW 192 BMI 32.9~60% EWL
LW 151 in 2003
TT 4/9/2003
Normal BMI 24.8 is my GOAL!!!
GBP (RNY) 2/26/02 298 lbs, TT 4/9/03 151 lbs, DS 12/29/11
HW 317 SW 263 BMI 45.1/CW 192 BMI 32.9/GW 145 ~ Normal BMI 24.8
**Revision Journey started 3/2009 Approved 12/12/11**
I have been involved in the DS world for 7 years, including on the OH and several other sites. I have NEVER seen a single DS patient whose surgery was done by your so-called DS surgeon. I think he's either a liar about doing them, has done fewer than 20 in his whole entire career or you don't understand what he said.
The DS is a relatively new surgery, having been performed for the last 21 years, and the first few years it was routinely done quite differently, with a much shorter common channel. It has been refined over the years, and is now routinely optimized on a patient-specific basis (how much intestine is put into the alimentary, biliopancreatic and common channels, as well as the size of the stomach). To say that the DS is the former gold standard is utterly ludicrous and laughable, if it weren't so stupid -- the DS has struggled to be accepted by the medical and even bariatric community because of:
* confusion with the old JIB
* confusion with the old Scopinaro BPD (which was better but still had problems)
* early results with a too-short common channel (another problem with the BPD with which it is constantly and deliberately confused) that were ameliorated when longer common channels were show to be as effective but with less nutrient malabsorption
* DELIBERATE obfuscation of information by insurance companies which don't want to spend the extra money to surgeons, because it is a more difficult procedure to learn and perform
* DELIBERATE obfuscation of information by non-DS surgeons, who don't want to spend the time to learn how to do the procedure, because it is a more difficult procedure to learn and perform, and thus not as remunerative as LapBand and RNY mills which can churn out multiple surgeries per day
The DS is only NOW becoming recognized as the PLATINUM standard in bariatric surgery, with far better long term results in excess weight loss, maintenance of excess weight loss, CURE of type 2 diabetes, resolution of hypercholesterolemia, hypertriglyceridemia, hypertension, and sleep apnea. For those who are super morbidly obese, the data is overwhelming that the DS is better than Lapband, VSG or RNY. However, the data are also clearly better for people with BMIs between 35-49. More and more insurance companies are accepting the accumulated evidencr demonstrating this over and over again and are covering the DS. Medicare has covered the DS since 2006. The Federal Employees Blue Cross/Blue Shield plan has covered the DS since before I got involved; several other random Blues have started covering it over the last few years, including California; and this year a bunch of other Blues simultaneously changed their plans to start covering it as well
So if your surgeon told you what you said he did, I'm publicly calling him out as a liar, or pathetically uninformed at the very least. And I don't believe he is a qualified DS surgeon in the first place.
But please, don't let me stop you from doing whatever you want -- that wasn't the point of this thread in the first place, if you would try putting whatever reading comprehension skills you have to some use.
The DS is a relatively new surgery, having been performed for the last 21 years, and the first few years it was routinely done quite differently, with a much shorter common channel. It has been refined over the years, and is now routinely optimized on a patient-specific basis (how much intestine is put into the alimentary, biliopancreatic and common channels, as well as the size of the stomach). To say that the DS is the former gold standard is utterly ludicrous and laughable, if it weren't so stupid -- the DS has struggled to be accepted by the medical and even bariatric community because of:
* confusion with the old JIB
* confusion with the old Scopinaro BPD (which was better but still had problems)
* early results with a too-short common channel (another problem with the BPD with which it is constantly and deliberately confused) that were ameliorated when longer common channels were show to be as effective but with less nutrient malabsorption
* DELIBERATE obfuscation of information by insurance companies which don't want to spend the extra money to surgeons, because it is a more difficult procedure to learn and perform
* DELIBERATE obfuscation of information by non-DS surgeons, who don't want to spend the time to learn how to do the procedure, because it is a more difficult procedure to learn and perform, and thus not as remunerative as LapBand and RNY mills which can churn out multiple surgeries per day
The DS is only NOW becoming recognized as the PLATINUM standard in bariatric surgery, with far better long term results in excess weight loss, maintenance of excess weight loss, CURE of type 2 diabetes, resolution of hypercholesterolemia, hypertriglyceridemia, hypertension, and sleep apnea. For those who are super morbidly obese, the data is overwhelming that the DS is better than Lapband, VSG or RNY. However, the data are also clearly better for people with BMIs between 35-49. More and more insurance companies are accepting the accumulated evidencr demonstrating this over and over again and are covering the DS. Medicare has covered the DS since 2006. The Federal Employees Blue Cross/Blue Shield plan has covered the DS since before I got involved; several other random Blues have started covering it over the last few years, including California; and this year a bunch of other Blues simultaneously changed their plans to start covering it as well
So if your surgeon told you what you said he did, I'm publicly calling him out as a liar, or pathetically uninformed at the very least. And I don't believe he is a qualified DS surgeon in the first place.
But please, don't let me stop you from doing whatever you want -- that wasn't the point of this thread in the first place, if you would try putting whatever reading comprehension skills you have to some use.
Diana, add to your list of reasons:
* DELIBERATE LYING AND OTHER SCARE TACTICS by actual surgeons who perform the DS but don't like to. Surgeons can usually crank out 2-3 RNYs or laps in the same amount of time it takes to perform one DS. It's much less lucrative for them to do the DS, and, as everyone knows, bariatric surgery is a BUSINESS! My surgeon falls into this category and will say and do everything he can, including lying, to scare patients out of a DS. Fortunately, if you hold your ground, he will eventually agree to do it, and he IS a very competent surgeon and I have no hesitation in letting him cut into me. After surgery, I have no further use for him or his office! Me and my PCP and OH can handle my follow up needs.
But he is living proof that some surgeons will say whatever they can to talk people into their preferred surgery. Several of his DS patients and I are getting together now for a little support group, and are amazed at the cummulative lies he has spouted (which we can dispute with research studies from accredited, peer-reviewed medical journals). Maybe he truly believes his own lies and skips over the bariatric journal articles about the DS so he can pretend he's not lying. I don't know.
Just saying.
* DELIBERATE LYING AND OTHER SCARE TACTICS by actual surgeons who perform the DS but don't like to. Surgeons can usually crank out 2-3 RNYs or laps in the same amount of time it takes to perform one DS. It's much less lucrative for them to do the DS, and, as everyone knows, bariatric surgery is a BUSINESS! My surgeon falls into this category and will say and do everything he can, including lying, to scare patients out of a DS. Fortunately, if you hold your ground, he will eventually agree to do it, and he IS a very competent surgeon and I have no hesitation in letting him cut into me. After surgery, I have no further use for him or his office! Me and my PCP and OH can handle my follow up needs.
But he is living proof that some surgeons will say whatever they can to talk people into their preferred surgery. Several of his DS patients and I are getting together now for a little support group, and are amazed at the cummulative lies he has spouted (which we can dispute with research studies from accredited, peer-reviewed medical journals). Maybe he truly believes his own lies and skips over the bariatric journal articles about the DS so he can pretend he's not lying. I don't know.
Just saying.
No one here is saying "everyone, go get the DS, people!"
In fact, most people should NOT get the DS, as they will not be compliant enough to even get their labs drawn regularly and too stupid or lazy to take their vitamins. We see it here all of the time with banders and RNYers and the results are horrific.
What people ARE saying to newbies is to consider ALL of your surgical options. I think the OP is warning newbies to "make sure you consider ALL of your options today because once you pick, this may be the one you're stuck with for the rest of your life even if it fails, thanks to cheap-ass insurance companies."
As to your surgeon's assertion (he is a RNY mill operator, so I am not shocked), it is clearly wrong. The RNY has been around a lot longer and has long been called the "gold standard" and now the DS is being called the "platinum standard." Even your doctor's medical group, the ASMBS, says it gives the best long-term results. Read on.
Here is an oldie but a goodie from 2008: a consensus document from the American Association of Endocrinologists, the Obesity Society, and the American Society for Metabolic and Bariatric Surgery that describes post-operative medical guidelines for care. These docs do ALL of the surgeries, so there is no obvious bias.
http://www.aace.com/pub/pdf/guidelines/Bariatric.pdf
There is a lot of decent info in there about the various surgeries. We could all quibble with parts of it. But I think the best parts are pages 9 and 10.
On page 9, they have a simple chart that demonstrates the remission rates of type 2 diabetes with each surgery. The DS gives a 95-100% resolution rate, compared to 83-92% in RNY and the bands at 40-47%.
On page 10, the document has a simple chart that outlines the average LONG-TERM EWL rates for each of the surgeries. After 7-10 years out:
--The DS has a 60-80% EWL rate
--The RNY has a 25-68% EWL rate
--The gastric banding has a 14-60% EWL rate
--The VSG is still too new as a stand-alone WLS, but the 3-6 year EWL rate is only 66% (I will let the sleevesters jump in here and describe how today's sleeves are made smaller and they will be wildly successful in the long-term from here on out.)
So, if you have ONLY 100 pounds to lose, with each procedure, here are examples of what you can be expected to keep off for the long-term:
--DS: 60-80 pounds
--RNY: 25-68 pounds
--Band: 14-60 pounds
--VSG: unknown
Maybe you should send this to your doctor so he can keep more up-to-date.
Hope this data helps you with newbies with their decision. To find a qualified DS surgeon, visit www.dsfacts.com.
All the best,
Nicolle
In fact, most people should NOT get the DS, as they will not be compliant enough to even get their labs drawn regularly and too stupid or lazy to take their vitamins. We see it here all of the time with banders and RNYers and the results are horrific.
What people ARE saying to newbies is to consider ALL of your surgical options. I think the OP is warning newbies to "make sure you consider ALL of your options today because once you pick, this may be the one you're stuck with for the rest of your life even if it fails, thanks to cheap-ass insurance companies."
As to your surgeon's assertion (he is a RNY mill operator, so I am not shocked), it is clearly wrong. The RNY has been around a lot longer and has long been called the "gold standard" and now the DS is being called the "platinum standard." Even your doctor's medical group, the ASMBS, says it gives the best long-term results. Read on.
Here is an oldie but a goodie from 2008: a consensus document from the American Association of Endocrinologists, the Obesity Society, and the American Society for Metabolic and Bariatric Surgery that describes post-operative medical guidelines for care. These docs do ALL of the surgeries, so there is no obvious bias.
http://www.aace.com/pub/pdf/guidelines/Bariatric.pdf
There is a lot of decent info in there about the various surgeries. We could all quibble with parts of it. But I think the best parts are pages 9 and 10.
On page 9, they have a simple chart that demonstrates the remission rates of type 2 diabetes with each surgery. The DS gives a 95-100% resolution rate, compared to 83-92% in RNY and the bands at 40-47%.
On page 10, the document has a simple chart that outlines the average LONG-TERM EWL rates for each of the surgeries. After 7-10 years out:
--The DS has a 60-80% EWL rate
--The RNY has a 25-68% EWL rate
--The gastric banding has a 14-60% EWL rate
--The VSG is still too new as a stand-alone WLS, but the 3-6 year EWL rate is only 66% (I will let the sleevesters jump in here and describe how today's sleeves are made smaller and they will be wildly successful in the long-term from here on out.)
So, if you have ONLY 100 pounds to lose, with each procedure, here are examples of what you can be expected to keep off for the long-term:
--DS: 60-80 pounds
--RNY: 25-68 pounds
--Band: 14-60 pounds
--VSG: unknown
Maybe you should send this to your doctor so he can keep more up-to-date.
Hope this data helps you with newbies with their decision. To find a qualified DS surgeon, visit www.dsfacts.com.
All the best,
Nicolle
I had the kick-butt duodenal switch (DS)!
HW: 344 lbs CW: 150 lbs
Type 2 diabetes and sleep apnea GONE!
No one here is saying "everyone, go get the DS, people!"
Really, they're not??? That's not how many people come across, including most DS posters on this particular board. And when people start trying to force-feed information down your throat and convert you to their religion - because that's how they come across, as zealots - well you're going to get a lot more people irritated and reactive rather than disseminating good, honest, factual, and supportive information.
For the record some of these discussions have this "stupid and lazy" person digging deeper, as much as it galls me to admit that to these particular people. I still think I will be sticking to RNY, but one more look at ALL options won't hurt a thing.
Seriously folks, if you truly want to help people you need to change your methods. Starting arguments, condemning people and calling folks names not only makes you look childish, but your message gets completely lost,
thereby helping nobody and nothing but egos. And isn't that what you really want to do, get education out to others? I think it's kinda sad that someone has to make a comment "The DSers are out in full force tonight". You're not establishing a great reputation for yourselves or your message. I sincerely hope you continue to spread the word, as I never realized DS was so uncommon. But I'd love to see the delivery of your message take on a more helpful and supportive tone, and I guarantee you that I am not the only one who feels this way.
Kimberly M. - Yes, my surgeon does actually perform all 4 options, as well as revisions. I wish some of these web listings were updated, Dr. Lalor took over in Bowling Green, OH for Dr. Douglas Hess when he retired. You can check out my center's website (or not) at http://www.bariatricprocedures.org/AVP/Web_pages/?id=120 You can choose agree or disagree with what they say. That's one thing I love about all of this, we all have a lot of choices.
I honestly wish all of you a great day, and the best of luck in battling your weight issues. Because bottom line, that's why we're here to begin with.
Really, they're not??? That's not how many people come across, including most DS posters on this particular board. And when people start trying to force-feed information down your throat and convert you to their religion - because that's how they come across, as zealots - well you're going to get a lot more people irritated and reactive rather than disseminating good, honest, factual, and supportive information.
For the record some of these discussions have this "stupid and lazy" person digging deeper, as much as it galls me to admit that to these particular people. I still think I will be sticking to RNY, but one more look at ALL options won't hurt a thing.
Seriously folks, if you truly want to help people you need to change your methods. Starting arguments, condemning people and calling folks names not only makes you look childish, but your message gets completely lost,
thereby helping nobody and nothing but egos. And isn't that what you really want to do, get education out to others? I think it's kinda sad that someone has to make a comment "The DSers are out in full force tonight". You're not establishing a great reputation for yourselves or your message. I sincerely hope you continue to spread the word, as I never realized DS was so uncommon. But I'd love to see the delivery of your message take on a more helpful and supportive tone, and I guarantee you that I am not the only one who feels this way.Kimberly M. - Yes, my surgeon does actually perform all 4 options, as well as revisions. I wish some of these web listings were updated, Dr. Lalor took over in Bowling Green, OH for Dr. Douglas Hess when he retired. You can check out my center's website (or not) at http://www.bariatricprocedures.org/AVP/Web_pages/?id=120 You can choose agree or disagree with what they say. That's one thing I love about all of this, we all have a lot of choices.
I honestly wish all of you a great day, and the best of luck in battling your weight issues. Because bottom line, that's why we're here to begin with.
294/302.5/287/177.8/195/175 - consult/highest/surgery morn/now/dr goal/my goal
I beg to differ with you on the "tone" stuff. Look how many hits this thread is getting. People love a good dogfight. And it educates people. So think about THAT every time you keep posting to a thread like this. YOU, and your kind, enable this thread to take on a new life, reach new people.
And yes, after a thread like this, we on the DS forum get a bunch of people coming over and asking about the DS. I already got on PM from someone asking about the U of C DS docs (whom I did not use, even though they are down the street from me) because of this thread. So, yep, it works. Keep `em coming! We love it!
Oh before I reposnded to you the first time, I checked out your doc's site because his OH profile was laughable--only 1 DS? Come on! And if your doc REALLY does the DS, why does he not put it on his web site instead of pushing the two surgeries he DOES do, front and center? He does not even have it in his bio. Answer: easy money, less work. A couple hours' work and he's done. And with the band, those fill patients keep bringing hundreds of dollars to his door each time, kind of like a bank's deposit window. The DS requires more skill and time. Not profitable.
He may have "taken over" for Hess, but he is a joke. If Hess were dead, he'd probably be rolling over in his grave at what has become of his pioneering work in his old office. Like pearls before swine.
Nicolle
And yes, after a thread like this, we on the DS forum get a bunch of people coming over and asking about the DS. I already got on PM from someone asking about the U of C DS docs (whom I did not use, even though they are down the street from me) because of this thread. So, yep, it works. Keep `em coming! We love it!
Oh before I reposnded to you the first time, I checked out your doc's site because his OH profile was laughable--only 1 DS? Come on! And if your doc REALLY does the DS, why does he not put it on his web site instead of pushing the two surgeries he DOES do, front and center? He does not even have it in his bio. Answer: easy money, less work. A couple hours' work and he's done. And with the band, those fill patients keep bringing hundreds of dollars to his door each time, kind of like a bank's deposit window. The DS requires more skill and time. Not profitable.
He may have "taken over" for Hess, but he is a joke. If Hess were dead, he'd probably be rolling over in his grave at what has become of his pioneering work in his old office. Like pearls before swine.
Nicolle
I had the kick-butt duodenal switch (DS)!
HW: 344 lbs CW: 150 lbs
Type 2 diabetes and sleep apnea GONE!
Just because he "took over" for the pioneer of the DS, doesn't mean he gets "credit" for Hess' DS surgeries --- YOUR surgeon DOES NOT, HAS NOT, and is NOT QUALIFIED to do the DS.
He, himself, reports his surgery figures to OH -- which is why nobody can trust the surgeon's information on OH, as many claim to do the DS so they can get you in there & talk you out of it -- but your surgeon doesn't even claim to do the DS on this site (that one DS surgery her reports? probably observed a DS surgery, didn't actually perform it), which is all about surgeon's advertising. So, he gets credit for not lying on this site, but he obviously lies to his patients about doing the DS.
Again, he doesn't perform the DS, and if you truly believe he does, prove it.
~ I am the proud wife of a Guatemalan, but most people call me Kimberley
Highest Known Weight = 370# / 59.7 bmi @ 5'6"
Current Weight = 168# / 26.4 bmi : fluctuates 5# either way @ 5'7" / more than 90% EWL
Normal BMI (24.9) = 159#: would have to compromise my muscle mass to get here without plastics, so this is not a goal.
I 
my DS. Don't go into WLS without knowing ALL of your options: DSFacts.com
On November 20, 2009 at 4:26 PM Pacific Time, Darlene G. wrote:
Actually, I have an e-mail directly from my doctor's office that states DS is the former gold standard, RNY is the new, and fewer doctors are performing the surgery. I can copy/paste the e-mail, if you like...
Seriously, if all of YOUR research (that you advocate others do) has allowed you to believe this, you are an absolute fool.
Find me one surgeon who performs the DS (because these surgeons ARE the cream of the crop in the bariatric world) that agrees with this statement. What you (and your non-DS performing surgeon) has written is utter BS.
When you recommend that people consult with multiple surgeons, what you should really be advising is that people consult with surgeons who are capable of performing the four major WLS. This way, the surgeon has very little financial incentive (which is huge in their world, don't kid yourself) to lie to a patient about the FACTS of peer-reviewed DATA.
You were lied to, bought into it hook, line, and sinker, and now perpetuate the lie as fact. You are doing a great disservice to people researching WLS. Nobody is "preaching" when they are providing FACTS that can be substantiated with DATA; your statement cannot..... but please, prove me wrong.
~ I am the proud wife of a Guatemalan, but most people call me Kimberley
Highest Known Weight = 370# / 59.7 bmi @ 5'6"
Current Weight = 168# / 26.4 bmi : fluctuates 5# either way @ 5'7" / more than 90% EWL
Normal BMI (24.9) = 159#: would have to compromise my muscle mass to get here without plastics, so this is not a goal.
I my DS. Don't go into WLS without knowing ALL of your options: DSFacts.com
Hi Darlene, I'd just like to add that Dr. Lalor - the man you say wrote the blurb above - took over Dr. Lane's Bowling Green practice when Dr. Lane moved to Univ. of Toledo Medical Center - about 20 minutes north of Bowling Green. Dr. Lane did the DS, Dr. Lalor does not. Suddenly, the very moment Dr. Lalor was hired, the DS is no longer the most effective?
With a world class DS surgeon just north of him, Dr. Lalor has a financial motive to discredit the DS.
With a world class DS surgeon just north of him, Dr. Lalor has a financial motive to discredit the DS.
Get the FACTS about the Duodenal Switch at www.DSFACTS.com
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