Duodenal Switch: Bariatric Surgeons' Ethical and Legal Obligations

If I had been in your position, I likely would have gone with VSG.  Please don't think that I am anti-VSG, as a matter of fact, I think that it should be the only other WLS available.

I happen to have one of these smaller sleeves (32F bougie) that all of the VSGers like to tout as the reason to disregard the longer term studies on VSG, as the sleeves were somewhat larger prior to this "new thinking".  I know that my sleeve is not what keeps me between 165 - 170 pounds.  I know I would be dieting and fighting like hell right now to stay at my current weight, if I had even gotten to this point.... and I would be miserable.

That aside, what you asked about was the surgeons.  You happen to have used a surgeon who is capable of doing a DS, so you likely got better information than I read about on the VSG forum and others, from surgeons who have been in the RnY & Gastric Banding game for a long time and can now do the VSG, so play the same games of not presenting the DS as an option, not providing accurate information (whether it is EWL% or misrepresenting the reality of post-op life -- quality as well as nutritionally).

I don't think you have missed anything -- I think that we don't know the long-term outcome for VSG (although, I do tend to think the current 4 year studies by your surgical practice, that show weight gain around the 4 year mark are going to be more accurate than people want to believe) -- and I think there are a LOT of surgeons mis-representing this based upon what I read people saying about what their surgeon told them (about the VSG & the DS).

When I see someone in their 40s, long time yo-yo weight fluctuations, with a BMI well over 50, AND T2D being told that the VSG (RnY or GBing) is a great option for them.... that is beyond unethical, it is malpractice, IMO.  Yes, other factors figure into this, but that is just an example that I see over & over again.  I also read where people are told that getting "part 2" is an option if VSG alone doesn't work -- and it is, but insurance will likely NOT cover it, they have to be obese for a period of time before an ethical DS surgeon will even touch them, and they have missed the opportunity of what having both parts at the same time would have brought them.

Thank you for your thoughtful response to my question.  It is true, I am only five months out and it has been very easy for me to lose these pounds so far.  I am stalled now at 129lbs. for two weeks and it is a bit discouraging.  I am only 5'1".  At this point I can only eat about 3oz. of solid food and I have very little hunger.  I believe eventually I will eat closer to 6 oz. at a time and my hunger might increase but should never be the same ravishing, all consuming hunger I had before.  Only time will tell if I made the right choice.  I hope for myself and all the other VSG people that the 4 year stats are wrong, but we will know more in a few years.

None of us has the magic crystal ball, which is why being given the factual data, upfront, is so important.  Truly evaluating our reality, and not what we "just know" surgery will help us change (as in those that hope they dump to keep them from sugar and/or fats), is not an option most people get when consulting with the majority of bariatric surgeons.

The ravishing hunger returns --- the difference is it can actually be satisfied, quickly and with little volume.  And for me, it is only 2-3 days per month.  Most other days I still work to get food in, and still rely on protein powders because they are just easier and I am not hungry.

All of the four major WLS options address volume at any given time, but with our sleeves we have that extra component of the ghrelin being reduced significantly, and there is no doubt in my mind that it is one of the major components of our obesity.  That, and I really don't think stretching is a major issue with the current way the sleeves are sewn back together.

But as I realistically looked at my situation, at 370+ pounds, immobile & in constant pain -- I could lose weight, I just could never keep it off without it coming back with a vengeance.  Every time, the scale would climb higher and my health would deteriorate.  I just didn't have the luxury to go with anything but the best available at keeping this weight off long-term.  And, I say this as someone who never defined success as any certain weight or size --- anything beyond getting rid of that pain was a gift.

I see people in the situation I was every single day, and they don't know about the DS or are pursued to think it isn't a good option for them based upon inaccurate information.  These are the people I am concerned about.  You lightweights with no major co-morbs and a metabolism that isn't damaged to the point of needing the switch -- hell ya, give the VSG a shot if you really think that is all you need and you know that if it isn't, you will likely gain at least some weight back over time and all the co-morbs that come with it, and that the option for the switch is something you will likely pay for out of pocket.

Had I been in your situation, I would have likely gone for the VSG, because I was scared of the malabsorption (my surgeon does the DS, but paints a grim picture -- likely because his after-care program for DSers sucks donkey balls).  Now that I actually have lived with it for two years, I know that for the most part *I* am in control of that picture, and it doesn't have to be grim at all.

Kimberley, if I was in your situation, I would have chosen the DS.  I have to doubt that it was the best choice for you and for many in your situation.  I agree it is important that the pre-ops learn the truth about all the surgeries and DS has not been publicized enough.  My surgeon did talk about the possible dangers down the road with DS but I think someone with a high BMI can take that risk.  I am sorry to hear that the ravanous hunger returns, but it's good to hear it is only for a few days a month.  You must be very proud of the changes you have made to your life.

 

...'bout damned time.  

The arrogance of the "Don't you worry your pretty little head, Honey, Dr. Daddy will take of everything" is straight out of Little House.  (Well, it CAN be found in other countries even today.  I remember several years ago...some woman who went to a doctor for a band and woke up with a gastric balloon.  Seems the doctor decided it was a better choice.  No conversation about it...he just decided.)

The complaints from the doctors' groups are cute...poor, sick patients can't figure it all out.  I guess that means that we're too stupid to ASK, too, right?  I can't TELL you how many times I have asked, "And if this hand/cervix/knee/funny little growth were happening on your sister/mother/goofy favorite aunt, what would you recommend SHE do?  And, why might a colleague disagree with you on that recommendation?"

I love these decisions...they suggest that the courts think that we might be grown ups!

As I mention ad nauseum, I live in a small city of 9,000 and the closest  "big" city is 70 miles away.   I go to my ob-gyn and tell him that the ablation he gave me last year has failed....I'm still having lots of problems with pelvic pain from mid-cycle on, tremendous bloating and cramping and heavy bleeding.   He gives me a pelvic and says "Your fibroids are bigger, we need to give you a hysterectomy.   I can fit you in on Monday."   When I got my jaw off the floor, I asked, "Can you at least leave my ovaries? I have osteoporosis and I'd like to not go through instant menopause."  He looked at me like I was from outer space.  "Why would you want to hold on to your ovaries?  I suppose I can take them - I've never left anyone's ovaries before."   So, I call my mom and tell her that my doctor suggested I have a hysterectomy.  She thought that was a ridiculous proposition and immediately called her Ob-gyn in Detroit to make an appointment for me to see him.    You gotta know my mom.   So, I drive the 4.5 hours to Detroit, this guy gives me a pelvic, and says, "You are a very small women and I can feel your fibroids perfectly.  They aren't large enough to do a hysterectomy. "   I must have looked surprised.  He said "Look - I'm in a financial position in life where I don't have to 'sell' surgeries.   All you need, this close to menopause, is maybe a low-dose birth control pill.  Let's try that for a few months and see how you do before we try something as drastic as a hysterectomy. You've had enough surgeries for now."     Fast forward four months on the pill.  I have NO PMS, a one-day period and the bloating and pain are gone.   People are so very naive when they think the doctor is always, without hesitation, looking out for our best interests.    Sometimes he just needs to make a yacht payment.   

Yes, the 'science of medicine' is  'practiced'.. Doctors are not infallible. They are not perfect, and by all means, they are NOT GOD. Don't get me wrong, where would we be without them, I love the dedication and passion of most. But you cross the line ethically when your 'medical opinion' becomes the only, and best option so you deny me the opportunity to have a well-informed choice. I want ALL of MY options on the table, then I will decide. Three yrs ago the DS wasn't even presented as an option, which angers me greatly. I deserved the right to know. PERIOD. 

 

And Mr. Sue asks if this means that--at least in those states--an anti-choice ER doctor has to tell the rape victim about RU-486 even though he doesn't want her to choose that option.  Hmmmm.

OOOOH.  I certainly hope so.

Nothing twists my knickers more than medical professionals *****fuse to provide or give info on all options.  Right now, my current least favorite is pharmacists *****fuse to dispense certain things based on their religious beliefs.  DUH, dispensing EVERYTHING that exists with a valid prescription is your job, whether or not you agree with it is none of your business.  If you can't or won't do your job in an unbiased manner, you need a new one. 

 (Sorry for the hijack/rant!)

LOVE IT!

And I think you should consdier taking your legal career in this direction - it's new territory - yours for the taking and I can't think of anyone better suited to do so