Dr Stewart - how is his follow up care
(deactivated member)
on 8/1/11 2:43 am
on 8/1/11 2:43 am
I'm only a couple weeks out so I haven't had much follow up care yet. The multivitamin is high ADEK but not sufficient on it's own. His plan also includes 50k of D, calcium and A but I don't remember the dose. Iron only for those who are deficient. I am doing VL's plan.
His nutritionist was replaced in May so I only met with her once. His NP, Sue is very anti VitaLady for some reason but she does seem to have a grasp on the proper diet.
His nutritionist was replaced in May so I only met with her once. His NP, Sue is very anti VitaLady for some reason but she does seem to have a grasp on the proper diet.
That's not a good bet. You need to read this board very thoroughly and compare what DSers really need with what you are being instructed to take. Maybe it's fine - but maybe not.
One thing you MUST do as a DSer is arm yourself with information and do not trust any single doctor to provide everything you need.
One thing you MUST do as a DSer is arm yourself with information and do not trust any single doctor to provide everything you need.
I am 15 years post op. I had a multi-surgery approach, that is not being done now, but worked.( The surgery I had is broken up into several components now...that's why you have all these different forums on this one site.) THat said, ... DO NOT depend on just your doctor or his group to give you...ie spoon feed you the information you will need to stay healthy.
the health field and the research continues to be done re: the surgery types that are being done and the effects it has on our bodies and no one person responds the same. Listen to your body and it's response. Get all your instructions in writing and make a copy to put in a safe place. as you change up your vitamin regimine, be sure to keep a record of what you have changed, why you changed it and the response to the change. Keep copies of all of your labwork. especially from before surgery...
You must be pro- active to maintain your health and your weight control from now on. If you are not going to be pro-active in your own care you need to re-think what you are doing.
the health field and the research continues to be done re: the surgery types that are being done and the effects it has on our bodies and no one person responds the same. Listen to your body and it's response. Get all your instructions in writing and make a copy to put in a safe place. as you change up your vitamin regimine, be sure to keep a record of what you have changed, why you changed it and the response to the change. Keep copies of all of your labwork. especially from before surgery...
You must be pro- active to maintain your health and your weight control from now on. If you are not going to be pro-active in your own care you need to re-think what you are doing.
NO BITE INTENDED. I had an effective "one stop" bariartric surgery.It was effective and we had no immediate surgical complications....... and the surgery I had includes many elements of what is being done today....by different surgeons.
If I understand the procedures being done today it would include the pouch or mini by-pass and a DS, plus some..including..hernia repairs , both hiatal and duodental,.appendectomy, cholescystectomy
I am guessing that the surgeons who do them today have just chosen aspects of the surgery to perform so they don't have the added trauma being done of laying your guts out on a table and re-peicing them back togather again.
I am sure that the laproscopic versions are much easier on both the doctor and the patient.
.I know from what I have read the "down" time is much less.(I could not lift more than 5 pounds for over 3 months.)
I have a pouching with bands both above and below the pouch, a shortened intestine both small and large bowel. I also have a port installed in my old stomach, so that in an event of inability to swallow, it could be acessed for feeding or medication useage...It has never been opened and I hope to never use it, but Dr Cowan explained that to install it at the time of surgery would cost about two dollars, and afte surgery was completed the cost to install one would be in the tens of thousands.It would also reverse many of the effects of the surgery.
The gastric chanel I use includes...
. a pouch, which holds approx 4-6 ounces,
a section of straight gut, which does not digest that is 6 feet long,
a 10 foot section of digesting smal intestine
and a 2 foot length of colon. ( I also have a length of gut that connects my old stomach to the small intestine at the digesting section beginning,ie, 6 feet into my intestinal loop )
My surgery was done in Memphis in October 94, by the chief of Biartric surgery at UT.He performed it for several years. DR. COWAN called this surgery " the Memphis by-pass " .
He was continually making small modifications in it based on the metabolism studies and other info he had available at the time of surgery. It was one of the first surgeries that insurance would cover and has been effective for the long term for several persons that I know, including my Mom who has lost a total of 170 lbs(.May 1994 )
.My loss has been and continues to be in the 120- 130 lb range. Both Mom and I have absorbtion issues, with lactose intolerance, that I had before surgery. Neither of us tolerate many milk products, and she has had more gastric milk intolerances..ie diarrhea than I have had, mine being mostly a gas issue.
We both have some bone issues, with arthritis a common factor before surgery and bone weakness a problem now. Neither of us have had fractures..
We both take D suppliments and calcium in addition to sunshine. and I suppliment with Zinc losenges to combat the hair loss, that seems to afflict most gastric patients..about two doses always stops it for me.
We also take the other things that He prescribed in the way he said to take them.
. Mom has a pacemaker now for ten years. She thinks that without the surgery and her massive lost she would be dead without it, and I feel pretty much the same way. We are both fairly active, we work in our yards, I mow some yards , and we both work a garden....and take care of others.
I am working on loosing the another 20 lbs, with the increased activities of summer and attention to getting the proteins in.....I really want to get to 160.where I have been for most of my post -op time...changes are due to an activity change.from a very hard physically challenging job to one that is not.
Mom is below her goal weight, and neither of us have had any plastic surgery for the flab effect.
I have had no medical insurance for 4 years continuous now, need to have a bone scan done to detemine if my bones are re-building with my supplimentations. ( My husband has medical coverage, but even with it, his costs are almost half of our income...we simply can't afford that amount for me as well).I have a possibility for coverage at an affordable amount that may be available to me in the fall. I have yet to check it out.as soon as we can afford it, I will do that.
Hope this answers your questions.
If I understand the procedures being done today it would include the pouch or mini by-pass and a DS, plus some..including..hernia repairs , both hiatal and duodental,.appendectomy, cholescystectomy
I am guessing that the surgeons who do them today have just chosen aspects of the surgery to perform so they don't have the added trauma being done of laying your guts out on a table and re-peicing them back togather again.
I am sure that the laproscopic versions are much easier on both the doctor and the patient.
.I know from what I have read the "down" time is much less.(I could not lift more than 5 pounds for over 3 months.)
I have a pouching with bands both above and below the pouch, a shortened intestine both small and large bowel. I also have a port installed in my old stomach, so that in an event of inability to swallow, it could be acessed for feeding or medication useage...It has never been opened and I hope to never use it, but Dr Cowan explained that to install it at the time of surgery would cost about two dollars, and afte surgery was completed the cost to install one would be in the tens of thousands.It would also reverse many of the effects of the surgery.
The gastric chanel I use includes...
. a pouch, which holds approx 4-6 ounces,
a section of straight gut, which does not digest that is 6 feet long,
a 10 foot section of digesting smal intestine
and a 2 foot length of colon. ( I also have a length of gut that connects my old stomach to the small intestine at the digesting section beginning,ie, 6 feet into my intestinal loop )
My surgery was done in Memphis in October 94, by the chief of Biartric surgery at UT.He performed it for several years. DR. COWAN called this surgery " the Memphis by-pass " .
He was continually making small modifications in it based on the metabolism studies and other info he had available at the time of surgery. It was one of the first surgeries that insurance would cover and has been effective for the long term for several persons that I know, including my Mom who has lost a total of 170 lbs(.May 1994 )
.My loss has been and continues to be in the 120- 130 lb range. Both Mom and I have absorbtion issues, with lactose intolerance, that I had before surgery. Neither of us tolerate many milk products, and she has had more gastric milk intolerances..ie diarrhea than I have had, mine being mostly a gas issue.
We both have some bone issues, with arthritis a common factor before surgery and bone weakness a problem now. Neither of us have had fractures..
We both take D suppliments and calcium in addition to sunshine. and I suppliment with Zinc losenges to combat the hair loss, that seems to afflict most gastric patients..about two doses always stops it for me.
We also take the other things that He prescribed in the way he said to take them.
. Mom has a pacemaker now for ten years. She thinks that without the surgery and her massive lost she would be dead without it, and I feel pretty much the same way. We are both fairly active, we work in our yards, I mow some yards , and we both work a garden....and take care of others.
I am working on loosing the another 20 lbs, with the increased activities of summer and attention to getting the proteins in.....I really want to get to 160.where I have been for most of my post -op time...changes are due to an activity change.from a very hard physically challenging job to one that is not.
Mom is below her goal weight, and neither of us have had any plastic surgery for the flab effect.
I have had no medical insurance for 4 years continuous now, need to have a bone scan done to detemine if my bones are re-building with my supplimentations. ( My husband has medical coverage, but even with it, his costs are almost half of our income...we simply can't afford that amount for me as well).I have a possibility for coverage at an affordable amount that may be available to me in the fall. I have yet to check it out.as soon as we can afford it, I will do that.
Hope this answers your questions.
This is fascinating! Thank you for sharing this.
"Memphis bypass" got no hits on PubMed. I found the following via Google:
http://members.tripod.com/Daryl_D/Bloodtest.html
"Blood Testing Scheduling for Post-Operative Patients of Dr. Cowan and the "Memphis Bypass""
http://members.tripod.com/Daryl_D/index-2.html
This has a picture of what looks like a pretty standard RNY gastric bypass.
http://members.tripod.com/Daryl_D/page08.html
This is a decription of the surgery this guy had.
From your description, I'm still a little confused - is the picture on Daryl's Tripod site what you have?
The gastric chanel I use includes...
. a pouch, which holds approx 4-6 ounces,
a section of straight gut, which does not digest that is 6 feet long, Is this your biliopancreatic tract?
a 10 foot section of digesting smal intestine Is this your alimentary tract? 10" = ~ 300 cm.
and a 2 foot length of colon. Why did he remove most of your colon? ( I also have a length of gut that connects my old stomach to the small intestine at the digesting section beginning,ie, 6 feet into my intestinal loop So does this mean you have an about 180 cm bypass and an about 120 cm common channel?)
So your biliopancreatic tract (bottom of stomach to RNY anastomosis is 6' of intestine, AND the anastomosis is also 6' from your pouch, or 3/5 of the way down your alimentary tract?
If that is what you mean, it is a fairly aggressive RNY - not as aggressive as ERNY, and a bit less than a distal, I think - except that there is quite a lot of excluded intestine in the biliopancreatic tract compared to most RNYs. No problems with the bands above and below the pouch?
It sounds like the surgeon attached either the remnant stomach to the wall of the stomach, to make access to it (whichever it is) easier - it makes sense to make access easier to the blind stoma*****ase of the need to examine it, e.g., for ulcers or cancer. The pouch can easily be accessed endoscopically.
What kind of vitamin D and calcium supplements are you taking? You SHOULD be using massive amounts of dry vitamin D3 (50K IU per day at the very least, maybe more), and NOT either D3 in oil or D2. You MUST be taking calcium CITRATE, at least 2000 mg/day of ELEMENTAL calcium, likely more, which requires taking 2 regular (not the petites) Citricals (as an example) 4 times/day. Note that the dosage for calcium citrate is 2 tablets at a time.
You need to get your PTH checked, and the bone scan. Replacing lost bone is extremely difficult. Iron and B12 are also particular issues for RNYers.
Hair loss mostly only is a short-term issue in the time period 3-6 months post-op, and that is common to having ANY surgery. I've heard biotin, rather than zinc (although we often need zinc too) is helpful with thinning hair.
While this board is the most knowledgeable one regarding nutrition issues for malabsorptive procedures, and you are of COURSE welcome to hang out, ask questions or just enjoy our stellar company, you should realize that your surgery is much more like an RNY than it is like a DS, especially having a pouch, no pylorus, and no duodenum in the alimentary tract. Many if not most RNYers these days also end up with cholecystectomy and appendectomy (as do most DSers). So you may want to lurk around the RNY board too.
"Memphis bypass" got no hits on PubMed. I found the following via Google:
http://members.tripod.com/Daryl_D/Bloodtest.html
"Blood Testing Scheduling for Post-Operative Patients of Dr. Cowan and the "Memphis Bypass""
http://members.tripod.com/Daryl_D/index-2.html
This has a picture of what looks like a pretty standard RNY gastric bypass.
http://members.tripod.com/Daryl_D/page08.html
This is a decription of the surgery this guy had.
From your description, I'm still a little confused - is the picture on Daryl's Tripod site what you have?
The gastric chanel I use includes...
. a pouch, which holds approx 4-6 ounces,
a section of straight gut, which does not digest that is 6 feet long, Is this your biliopancreatic tract?
a 10 foot section of digesting smal intestine Is this your alimentary tract? 10" = ~ 300 cm.
and a 2 foot length of colon. Why did he remove most of your colon? ( I also have a length of gut that connects my old stomach to the small intestine at the digesting section beginning,ie, 6 feet into my intestinal loop So does this mean you have an about 180 cm bypass and an about 120 cm common channel?)
So your biliopancreatic tract (bottom of stomach to RNY anastomosis is 6' of intestine, AND the anastomosis is also 6' from your pouch, or 3/5 of the way down your alimentary tract?
If that is what you mean, it is a fairly aggressive RNY - not as aggressive as ERNY, and a bit less than a distal, I think - except that there is quite a lot of excluded intestine in the biliopancreatic tract compared to most RNYs. No problems with the bands above and below the pouch?
It sounds like the surgeon attached either the remnant stomach to the wall of the stomach, to make access to it (whichever it is) easier - it makes sense to make access easier to the blind stoma*****ase of the need to examine it, e.g., for ulcers or cancer. The pouch can easily be accessed endoscopically.
What kind of vitamin D and calcium supplements are you taking? You SHOULD be using massive amounts of dry vitamin D3 (50K IU per day at the very least, maybe more), and NOT either D3 in oil or D2. You MUST be taking calcium CITRATE, at least 2000 mg/day of ELEMENTAL calcium, likely more, which requires taking 2 regular (not the petites) Citricals (as an example) 4 times/day. Note that the dosage for calcium citrate is 2 tablets at a time.
You need to get your PTH checked, and the bone scan. Replacing lost bone is extremely difficult. Iron and B12 are also particular issues for RNYers.
Hair loss mostly only is a short-term issue in the time period 3-6 months post-op, and that is common to having ANY surgery. I've heard biotin, rather than zinc (although we often need zinc too) is helpful with thinning hair.
While this board is the most knowledgeable one regarding nutrition issues for malabsorptive procedures, and you are of COURSE welcome to hang out, ask questions or just enjoy our stellar company, you should realize that your surgery is much more like an RNY than it is like a DS, especially having a pouch, no pylorus, and no duodenum in the alimentary tract. Many if not most RNYers these days also end up with cholecystectomy and appendectomy (as do most DSers). So you may want to lurk around the RNY board too.
Diana,
after doing a long answer..my computer connection lost it... so I will give quick responses...I tried to answer the questions you raised.
Darryl's surgery was completely different from mine...
Mine was done 6 years before his by the SAME surgeon, we are both members technically of the same support group, George's Angels.
I didn't think of the procedure I had, as an RNY, I didn't think the description fit my surgery.I didn't find one that did fit it. SEE if you see the similarities in any of them.
I often go to several of the boards the DS one, the RNY and the mini by pass and the main board. I have problems common to each of them.and sometimes I can help someone who is having a problem...
I don't tolerate milk, eggs or cheese, or oils, fats of any kind.
.I occasionally dump(if I eat something stupid)
I don't tolerate certain textures mixed with liquids, like cereal and milk, or oatmeal...I like everything...it just doesn't like me..
..and occassionally I still have problems with my pouch...especially if I drink cold liquids before a meal , even 30 min or more before.or if I eat foods that are extremely dry, like chicken..
.I can't swallow anything big.. no calcium I can find, I can't even swallow the petites, they are too big! They give me the sensation that they are hanging up for hours.( I guess you could say this is a result of the upper band)
I use sunshine for my vitamin D and am using massive calcium chewable, rolaids or tums.I alternate. Doing this has reduced my bone pain. so it must be helping.We'll see when I get my next Dexa scan...
I can't get any labs done or dexa scan or mamogram, until I am able to get some insurance. No one will do labs and tests with out money on a self pay patient. Bob's medical needs are half our income with insurance most months. We don't qualify for low income and there is not enough except for my basic health needs.
I see the Doctor for infections , usually a sinus or arthritis flare...I have Lyme arthritis, which tests out like rheumatoid, but Septra stops the flare.... labs one time a year if I am not sick too many times in that year.
I have major problems with my Iron, but I keep that up by eating liver three times or more a week... I can't absorb iron without it I have to get the intrinsic factor and liver is the only natural source. there are liver capsules that are available. by Carlson labs.
Dr. Cowan had done the research which showed when patients had hair loss their Zinc levels had dropped. even tho we were already taking Zinc, Mom and I both still use a losenge when hair loss occurs. It works and stops hair loss in a day or so.. I usually use one a week and no longer take tablets. but if my hair loss begins I'll take three for one week, three in the whole week, not three a day...and the hair loss stops. I have tried the biotin I didn't see a change.
See if this clarify's it any.... Look at my description again... think of the stomach and pouch as being side by side and a length of small intestine from each, the duodenum and it's bilary attachments from the old stomach and a fresh length of small intestine from the pouch.
THINK OF IT...like the TOP arms of a Y... and they join (at approx the same place and to the bottom of that same Y.)to the digesting small intestine, a 10 foot section that is my only digesting intestine and below that I have only 2 feet of colon.... the rest was removed. I have a total of 12 feet of digesting small and large intestine combined.
I know the length of intestine from my pouch to digesting small intestine beginning is 6 feet... I do not know the length of the small intestine that is a conduit for digestive enzymes.including the pancreatic and bilary...but they join at the same place to the small intestine that begins digestion, this digesting length... is where I have had two intestinal twists, one from lactose intolerance combined with carbonation and the other from acute gastritis. 5 years and 11 years post op respectively.
I have had one episode of banding problem with the band below my pouch ...I got bacon hung in it ....,just after I came off of baby foods.
I know the blind stoma has an X-ray clip on it for easy placement of a tube....and could be accessed for a scope...they almost had to do this on Mom......
We saw these clips on Mom's x-ray when she had what they thought at first was a second gall bladder... turned out to be gastritis and an internal bleed, from a fall, that resolved....she came off the coumadin and is using cod liver oil and vit e, garlic to thin her blood now...and feels better.
WHY colon resection with removal.?.. Doc said that our systems were too efficient at pulling out calories. He did metabolism studies on both of us. He said Mom could be placed on a diet of one half bologna sandwich and a half gallon of water a day and maintain her weight of 310 lbs. She had to go on a supervised diet of 400 calories for about 6 months to loose the 50 lbs before he would do surgery.
I lost 30 lbs in the three months before my surgery was done by going on all proteins, with less than 30 grams CHO's...after we stabilized my blood sugars that were routinely dropping to 30.
I had 10 surgeries at least in one, with these procedures... removal of appendix and gall bladder pouch with two bands, small bowel resection, large bowel resection, vagotomy, 2 hernia repairs and removal of multiple cysts both ovaries and a grapefruit sized fibroid and endometriosis removed...
I told someone, if he didn't take it out he played with it... The surgery was radical but it worked.Immediate post op Neither of us had problems that weren't easily solved... no complications, but we took every effort to follow all our surgeons advise and orders. We think this is why both of us have pretty much kept the weight off without rebound....
after doing a long answer..my computer connection lost it... so I will give quick responses...I tried to answer the questions you raised.
Darryl's surgery was completely different from mine...
Mine was done 6 years before his by the SAME surgeon, we are both members technically of the same support group, George's Angels.
I didn't think of the procedure I had, as an RNY, I didn't think the description fit my surgery.I didn't find one that did fit it. SEE if you see the similarities in any of them.
I often go to several of the boards the DS one, the RNY and the mini by pass and the main board. I have problems common to each of them.and sometimes I can help someone who is having a problem...
I don't tolerate milk, eggs or cheese, or oils, fats of any kind.
.I occasionally dump(if I eat something stupid)
I don't tolerate certain textures mixed with liquids, like cereal and milk, or oatmeal...I like everything...it just doesn't like me..
..and occassionally I still have problems with my pouch...especially if I drink cold liquids before a meal , even 30 min or more before.or if I eat foods that are extremely dry, like chicken..
.I can't swallow anything big.. no calcium I can find, I can't even swallow the petites, they are too big! They give me the sensation that they are hanging up for hours.( I guess you could say this is a result of the upper band)
I use sunshine for my vitamin D and am using massive calcium chewable, rolaids or tums.I alternate. Doing this has reduced my bone pain. so it must be helping.We'll see when I get my next Dexa scan...
I can't get any labs done or dexa scan or mamogram, until I am able to get some insurance. No one will do labs and tests with out money on a self pay patient. Bob's medical needs are half our income with insurance most months. We don't qualify for low income and there is not enough except for my basic health needs.
I see the Doctor for infections , usually a sinus or arthritis flare...I have Lyme arthritis, which tests out like rheumatoid, but Septra stops the flare.... labs one time a year if I am not sick too many times in that year.
I have major problems with my Iron, but I keep that up by eating liver three times or more a week... I can't absorb iron without it I have to get the intrinsic factor and liver is the only natural source. there are liver capsules that are available. by Carlson labs.
Dr. Cowan had done the research which showed when patients had hair loss their Zinc levels had dropped. even tho we were already taking Zinc, Mom and I both still use a losenge when hair loss occurs. It works and stops hair loss in a day or so.. I usually use one a week and no longer take tablets. but if my hair loss begins I'll take three for one week, three in the whole week, not three a day...and the hair loss stops. I have tried the biotin I didn't see a change.
See if this clarify's it any.... Look at my description again... think of the stomach and pouch as being side by side and a length of small intestine from each, the duodenum and it's bilary attachments from the old stomach and a fresh length of small intestine from the pouch.
THINK OF IT...like the TOP arms of a Y... and they join (at approx the same place and to the bottom of that same Y.)to the digesting small intestine, a 10 foot section that is my only digesting intestine and below that I have only 2 feet of colon.... the rest was removed. I have a total of 12 feet of digesting small and large intestine combined.
I know the length of intestine from my pouch to digesting small intestine beginning is 6 feet... I do not know the length of the small intestine that is a conduit for digestive enzymes.including the pancreatic and bilary...but they join at the same place to the small intestine that begins digestion, this digesting length... is where I have had two intestinal twists, one from lactose intolerance combined with carbonation and the other from acute gastritis. 5 years and 11 years post op respectively.
I have had one episode of banding problem with the band below my pouch ...I got bacon hung in it ....,just after I came off of baby foods.
I know the blind stoma has an X-ray clip on it for easy placement of a tube....and could be accessed for a scope...they almost had to do this on Mom......
We saw these clips on Mom's x-ray when she had what they thought at first was a second gall bladder... turned out to be gastritis and an internal bleed, from a fall, that resolved....she came off the coumadin and is using cod liver oil and vit e, garlic to thin her blood now...and feels better.
WHY colon resection with removal.?.. Doc said that our systems were too efficient at pulling out calories. He did metabolism studies on both of us. He said Mom could be placed on a diet of one half bologna sandwich and a half gallon of water a day and maintain her weight of 310 lbs. She had to go on a supervised diet of 400 calories for about 6 months to loose the 50 lbs before he would do surgery.
I lost 30 lbs in the three months before my surgery was done by going on all proteins, with less than 30 grams CHO's...after we stabilized my blood sugars that were routinely dropping to 30.
I had 10 surgeries at least in one, with these procedures... removal of appendix and gall bladder pouch with two bands, small bowel resection, large bowel resection, vagotomy, 2 hernia repairs and removal of multiple cysts both ovaries and a grapefruit sized fibroid and endometriosis removed...
I told someone, if he didn't take it out he played with it... The surgery was radical but it worked.Immediate post op Neither of us had problems that weren't easily solved... no complications, but we took every effort to follow all our surgeons advise and orders. We think this is why both of us have pretty much kept the weight off without rebound....
Most Active
Recent Topics
