Advice to a newbie on Biliopancreatic Diversion With Duodenal Switch

I have chosen to have the Biliopancreatic Diversion With Duodenal Switch as my surgery. Chosen is a lose term really, it was strongly recommended and then rarely talked about any more. My Surgeons office reticently hired a new Nurse Practitioner who is very new to all of this and does not seem to have many answers. Well ok she doesn't have any answers other than "I will have to look in to that an get back to you." I find this oddly uncomforting and even a little nerve racking at times.

Because of this lack of knowledge it has lead me to do my own internet research, every video so far goes like this' 3 minutes of good things and 45 minutes of everything that can go wrong. This tends to freak me out so I go and ask more questions and he says she has more stuff to lookup, this vicious cycle of lack of information we share never seems to lead to any followup information! So maybe others here can help me understand what to expect i]from the weeks, months and life time following this surgery?

1. How soon after you eat do you need to go poop? I have this image of only making it to the bathroom like 50% of the time and exploding the other 50%.

2. How many times a day will I have to go? Should I carry a man purse now with toiletries for emergencies and spare underwear?

3. I was told that when you do go #2 it smells god awful. Will I need to tart being extra conscious of this start looking for water sanitizers to mask the smell?

4. Will I feel any different; meaning will i notice my plumbing has been rewired and it makes me lean to the right or walk different or anything like that?

5. What can I expect for pin levels right after the surgery and how long did they typically last

I will have many more questions as these are answered but honestly I just want to know what I am getting myself in to from those who have already gone through it. Any advice will be incredibly helpful. I ask with love and respect and fear.

Hi Jason,

I am also brand new to this.  I just had my revision for lap band to DS done on the 29th.  I will answer the questions I can up to this point.  At least it will give you a perspective of what you could expect very early out.  

1. I think timing will be different for everyone.  It is several hours for me before I have to use the bathroom.  I have not yet had any explosions.  I believe urgency will change when I'm eating more variety of foods though.

2. Right now I am going 2 times a day.  I carry extra things with me everywhere, but I haven't needed them yet.  

3. Mine doesn't smell god awful yet....I'm waiting for it though.  I've ordered my "poo-pori"  for when(if) it does get bad and I'm out in public.  

4. I wouldn't say that I notice anything feels different.  Definitely no leaning or special walk.  :)  This could change for me once all my swelling has gone away, however I really doubt it.  

5. Day one - on a pain pump, I was in pain, but it was tolerable.  I actually did most of my walking in the hospital on this day - two hall way laps 4x.

Day two - off pain pump and switched to loratab.  The pain was significant, I was VERY uncomfortable.  However, I was actually having more pain in my back from laying so much than from the surgery.  It finally got to the point I had to ask for different meds because the loratab wasn't doing it for me.  They switched me to percocet.  It helped.  Much less walking this day, 1 hallway lap 3x.

The following two days in the hospital gradually got marginally better.  

I left the hospital on day 4 and flew home on day 5.  

At this point, as long as I stay on top of the meds every four to six hours, I feel pretty good.  If I wait to long to take something I regret it.  

Hope that helps!

Hi Jason, congratulations on your decision to have the DS.  It's an amazing life-changing surgery.  Yes, there are many things that CAN happen, and those things are often posted.  You don't hear so much from those DS'ers whose lives are normal, predictable, and uneventful.  

I read posts from this forum going back several years to be informed of what might happen.  Due to the positive quality of life that many enjoy after the DS, I decided to go forward.  I have no regrets.  Here are the answers to your questions based on my experience.

1 & 2.  I go once a day in the morning.  Never any accidents, surprises in the middle of the night, or immediate urges to go.  I don't carry anything extra when I go places.

3.  Our poop does smell different.  And it's definitely more in quantity than pre surgery.  (Yay, malabsorption rocks!)  Of course any poop stinks.  But a little air freshener or PooPourii and you're good to go.

4.  I don't feel any different.  Except when I eat, I can only eat maybe half a hamburger, part of a chicken breast, never more than one taco, etc.  You just fill up fast and you know it's time to stop, otherwise your tummy is uncomfortable.  I eat a little something every couple of hours.

5.  Pain from the lap surgery itself was not much at all.  The most pain for me came from intubation -- the placement of a flexible plastic tube into the trachea (windpipe) to maintain an open airway.  Maybe a 6 out of 10 on the pain scale for the first few days.  My esophagus area felt overly stretched and sore for a few weeks after.  

Right after surgery I did fine on 3 or 4 ready-to-drink protein shakes per day. I didn't start vitamins until 6 weeks post surgery, per doctors orders.  Getting going on those will help stabilize your bathroom habits due to the added calcium, iron, etc., you will be getting.

Best of luck to you!

Let me start out by saying that I am nearly 11 years post-op, and I honestly may not remember all the details of the first few months post-op. Also, just call it a DS---the whole BPD part is 1) unnecessary, and 2) inaccurate, but that's a story for another time. (*grin*)

1) Poop. 95 days out of a hundred, I poop twice in the early AM, usually about 30 minutes apart, then I'm finished for the day. I then start eating, and I eat every 2-3 hours all day long. I don't poop again until the next AM.

2) Man-purse. As I said, I usually only go in the early AM, while I'm still at home. Some people do go more often, especially during the first six months or so, while learning their new plumbing. Those who are especially smell-sensitive and/or afraid of offending others do carry sprays, but they come in small enough containers you can keep one in your man-pockets. (*grin*) Spare underwear *might* be good, again, for the first few months. The only time I've ever needed a change of undies was during the first 10 days, and I was at home at the time.

3) Smell. Again, the first six months will be the difficult time. Once you learn how YOUR new body works, you can eliminate 95% of the stench by watching your diet. Most of us pretty much know what's going to give us foul-smelling gas and BMs, and we avoid eating those at a time when we'll have to be in public at the correct time. A friend of mine talks about Tvioing her carbs so she only has stinky farts in the evening, at home. (*grin*)

4) How it feels. I have never noticed ANY difference in how my stomach feels, other than it's not hungry all the time, and it gets full and satisfied by a small-normal amount of food. My guts don't feel any different now, but they did ...wait for it...for the first six months.

(Seeing a trend here? *grin*)

5) Pain. Yep, it's gonna hurt. I had mine done open, and I had mentally prepared myself for it to hurt like the very devil. It didn't. Getting out of the bed the very first time was the hardest part, and that might be because I didn't get up until the day after surgery. (I stayed overnight in Recovery because there wasn't a bed available for me on the bariatric floor.) As for how long it lasted---I was discharged on Day Five, and was sent home with Bextra---a prescription NSAID---for pain, at the rate of ONE A DAY. I have extensive arthritis, and that was hurting me more than the surgery did. After about two weeks, the specifically surgical pain was pretty much gone, and I went shopping.

I'm not surprised that your NP doesn't know diddly about the DS. Sadly, few medical professionals do---I think of the DS as "the best kept-secret" of the WLS world.

Who is your surgeon? I read your profile and this concerns me: "

My 'diet change' of choice has been green drinks and smoothies. The more I learn about the various berries, seeds and vegetables the more fun it becomes. Kind of like a game of what can i add to make my magic potion stronger while losing the negative stuff (i.e. sugars, fats, carbs ect.)"

I'm not sure what "green drinks" are, but post-op smoothies are not going to be a good choice. They remove all the fiber from fruits and veggies, leaving only the things you don't want, like sugar carbs. Also, fat is going to be your FRIEND. DSers only absorb about 20% of the fat we eat. Humans NEED about 30 grams of fat a day in order to function properly. This means that the average DSer needs to EAT about 150 grams of fat in order to ABSORB that 30 grams. Most of us suffer from constipation if we don't eat plenty of fat. While you're in the weight-loss phase, you'll want to eat a 'diet' that's high in protein and FAT. Fat makes us feel full and satisfied, and protein is what we're made of. Veggies, fruits, and some carbs all come AFTER you've reached the point where you can eat 100+ grams of protein from REAL FOOD each and every day.

"Who is your surgeon? I read your profile and this concerns me:

My 'diet change' of choice has been green drinks and smoothies. The more I learn about the various berries, seeds and vegetables the more fun it becomes. Kind of like a game of what can i add to make my magic potion stronger while losing the negative stuff (i.e. sugars, fats, carbs ect.)"

I'm not sure what "green drinks" are, but post-op smoothies are not going to be a good choice. They remove all the fiber from fruits and veggies, leaving only the things you don't want, like sugar carbs. Also, fat is going to be your FRIEND. DSers only absorb about 20% of the fat we eat. Humans NEED about 30 grams of fat a day in order to function properly. This means that the average DSer needs to EAT about 150 grams of fat in order to ABSORB that 30 grams. Most of us suffer from constipation if we don't eat plenty of fat. While you're in the weight-loss phase, you'll want to eat a 'diet' that's high in protein and FAT. Fat makes us feel full and satisfied, and protein is what we're made of. Veggies, fruits, and some carbs all come AFTER you've reached the point where you can eat 100+ grams of protein from REAL FOOD each and every day."

Green drinks are whole blended vegetables typically

1 cup spinach (some times kale or various 'greens' instead but I dislike their bitterness)

2 Tbs Chia seeds (5 times higher in Omega 3's than salmon)

3 Tbs Raw Hemp Hearts (roughly 30 grams protean, high in potassium and a good amount of fiber.)

1 Cup Blue Berries

1 Tbs Flax Seed

1 Tbs whole psyllium husk

2 Tbs Caco powder

2 Tbs Goji Berries

depending on the day of the week 1/2 a banana (they go bad fast here so not often bought any more. I am funny about bananas if their is one brown spot I will not touch it)

Carbs: 90g (higher than I like but balanced out with insane amount of fiber, vitamins, minerals, Omega 3's and antioxidant)

Fats: 20g (all essential fats and omega's)

Prot: 30g

This is typically my getup and go morning meal. I do see what you are saying about not enough fats from this meal and maybe not enough protean after the surgery either. The reason I started making these is i wasn't happy with all the 'crap' in the tub protean powders I see on the shelves.

Okay, at 90 carbs, you're NOT going to want to use these after surgery! That's more carbs in one drink than a lot of new post-ops allow themselves all day long.

I'm not saying that you shouldn't use protein powder, if you can't meet your protein goals. Most people can't immediately post-op. My surgeon went by the 30-60-90 rule---30 grams of protein by 30 days out, 60 grams by 60 days, and so on. In all my life, I've had ONE protein shake. I eat 140+ grams of protein every day, and at least that many grams of fat.  I don't count carbs, and yes, some days I eat too many. I pay for it by having excessive gas the next day. If I carb-pig for too many days, I gain weight.

Eat bacon instead. (*grin*)

1. How soon after you eat do you need to go poop? I have this image of only making it to the bathroom like 50% of the time and exploding the other 50%.

It varies, depending on what you eat.  I have made it to the toilet 100 percent of the time.

2. How many times a day will I have to go? Should I carry a man purse now with toiletries for emergencies and spare underwear?

It depends on the person.  I usually have a major poop in the AM.  Sometimes I have one or two more before being finished for the day.  I don't carry spare underwear.

3. I was told that when you do go #2 it smells god awful. Will I need to tart being extra conscious of this start looking for water sanitizers to mask the smell?

I take acidophilus with psyllium, which is a probiotic, in the AM.  If I have to go out in the late afternoon or evening, then I take another one. I purchase mine at The Vitamin Shoppe, which is a couple miles from my home.  Mine don't smell that bad; otherwise, I would have heard about them.

4. Will I feel any different; meaning will i notice my plumbing has been rewired and it makes me lean to the right or walk different or anything like that?

The only difference in my walking is that I walk faster than when I was heavier.  I have much more energy even though I have a very bad back and very bad knees, all from past injuries, plus balance issues.

5. What can I expect for pin levels right after the surgery and how long did they typically last

I have never heard of pins being installed during any WLS surgery; therefore, I wouldn't have any answer for that.

Well Jason, at least the NP admitted to not knowing the answers.  You'll find that many medical professionals will feel absolutely confident in giving you incorrect information, mostly in nutritional, supplements, and eating suggestions.  I'm glad you found your way over here.  There is also another active group of DSers on Facebook, too.

1. On a typical day, I poop first thing in the morning and it includes everything from the day before.  It's a giant deposit, but I'm done for the day.  The only exception is if something I eat takes me by surprise.  That doesn't happen very often at all.  
2. See #1
3. It does small awful, but who's doesn't, really?  Much depends on what you eat and calcium you took the day before. 
4. Once I was healed, the only significant difference I've noticed is some occasional gurgling after I eat.
5. Pain is pretty intense the first few days, but the morphine drip takes care of it.  When I came home 4 days later, I was on pain meds for another week and came off quickly.  I would say my level of discomfort was great, but pain wasn't terrible.

1.  cant say I have ever had to go to the bathroom after I eat.  I go once in the am within 15 mins of waking up then again about 10 mins, that's it.

2. I have never carried anything, and have never needed to. 

3.  yep it sure does, a probiotic helps, find bathrooms that are not right near someone, etc, but not an issue since for me I am still at home, when you travel that is interesting.

4.  nope-

5.  I many not be typical I have had 6 abdominal surgeries, and DS was a freaking piece of low carb cake compared to 2 other ones I have had, my IV infiltrated in the hospital and so after that I was off morphine, went home, never took anything for pain medication.

Dont be scared, we all were, it is not what is posted that you are going to be crapping your pants all over the place, no one does a cchannel < 50cm, and actually they are being made longer the last few years.  the smell you will learn little tricks, what you eat, probiotics, poopouri, location of bathrooms etc. I was nervous about that too, now years later I think how stupid to worry about that. 

So reading everyone's posts.... now I have questions and might post them in the forum as a topic as well but..... what fats do you eat? And what did it mean that the smell depends on calcium the day before?? I haven't been to the nutritional class yet and hope they will answer those questions but maybe you all could too. And carbs smell the worst? Help!