Considering DS & Have Some Questions

Hi all! I see the doctor at the bariatric clinic in February 2015. I posted in General Discussion and was suggested I consider DS. Prior to surgery, I have been diagnosed with pernicious anemia and vitamin D deficiency. I have done a little bit of research and am concerned with developing worse deficiencies after WLS, even osteoporosis. 

What caused you to choose DS over the other available surgeries? What kind of complications have you experienced? Is there a chance of weight regain? Where did you have your surgery performed? How did you find your surgeon? Would you choose DS again in hindsight? What makes DS a better option for those with BMI's over 50? My current BMI is 75-ish.

Thanks for your time! 

Happy Holidays!

The DS has the best statistics  of any bariatric surgery presently available for percentage excess weight loss, for maintenance of that weight loss, and for resolution of almost all comorbidities. While it is a standard of care operation and works well for even the "lightweights" of the bariatric surgery community, it is esp valuable for patients with higher bmi's, for whom the failure rates for other operations are even higher than for lighter patients. This is not to say that you can't fail even with the DS, but the failure rate is much lower than with other operations. Many people do well initially with gastric bypass or sleeve but find it neigh unto impossible to maintain their weight loss long term.

Not every bariatric surgeon does the DS, that those that don't will sometimes try to discourage people from having it either by never informing them about it or by misinforming people as to the risks. While there are of course risks with all major surgeries and the DS carries more vitamin requirement than other operations, it also has the most benefits for many people. Given your bmi, it is far and away the most likely operation to help you regain your health.

Of course no bariatric operation will cure your pernicious anemia. I assume you are supplementing B12 via injections or sublingual form already, and you will need to continue this. But I wouldn't think that the DS would make this condition any worse. Gastric bypass MIGHT (I can't really say for sure) make your pernicious anemia worse by bypassing whatever portion of your stomach still makes intrinsic factor to help you absorb B12. Or, if your stomach is already shot for this, it might not make any difference at all.

As far as Vitamin D goes, many people are D deficient and don't even know it. The fact that you are already aware of your deficiency is a good thing, and you can supplement D aggressively to compensate for this. With the DS, we do malabsorb the fat soluble vitamins, whi*****ludes D (and A, E, and K) so we definitely need to supplement very aggressively. We take the "dry" form of D as the usual form, packaged in oil, will be poorly absorbed. If that isn't sufficient D can also be given by injection. It would be best to start supplementing now.

I won't get into all your questions, but will say that I had the DS almost 9 years ago and have absolutely no regrets. We get moderate restriction from the sleeve part of the operation, but it is the malabsorption, esp selective malabsorption for fat, that helps us sustain our weight loss so much better than with other operations  Gastric bypass gives people very little caloric malabsorption, just problems absorbing B vitamins (esp B12) and calcium and iron. Our malabsorption is substantial and permanent, though somewhat less with time.  I don't know where you are so I can't suggest any surgeons, but the best list you can find is at dsfacts.

Larra

I too am 9 yrs post op from DS and concur with Larra has offered already.  Because of the statistics of weight loss, it's very highly recommended to people with BMI over 50 (but anyone who qualifies for wls can get it).  While a little regain is realistic, 15-25% regain of your weight lost is the average amount (I'm at 14% myself).  I had no complications and am very happy and healthy today, thanks to my DS.  Check out dsfacts.com to learn more if you've not found it already.

Hi Lea,

For me I picked DS and my bmi was 32 or 35? can't remember,  I was a band to DS conversion.  I had no complications-none.  no mater what surgery you pick there is always regain, DS has the least regain.   I found my surgeon on dsfacts.com.  Yes for sure pick DS over and over again.  It is the ONLY choice for BMI over 50 it will give you the best chance to reach some type of normalcy, something I am sure you have lost sight of.  Don't worry about pernicious anemia or Vitamin D deficiency those are easily taken care of post op DS.  You do have to take your vt/min blood work etc post op.

Happy Holidays to you

I was lucky that my surgeon offered me the DS as the best alternative to losing all the weight I wanted
and to keep it off. I went to the Cleveland Clinic bariatric program and had Dr. Schauer as my surgeon. 

I would do the DS again, only without all the emotional turmoil. My BMI was 72 at my first pre-op appointment
and 66 the day of the surgery. I had to get it down before they would do the DS in one step instead of 2. 
Surgeons all seem to have their own guidelines about what they consider acceptable as requirements.

There is always a chance of regain but much lower for the DS and usually less of a regain. That was pretty 
important in my choice of the DS. I did well on many diets but always regained even more. I credit this to 
the increased malabsorption.

If you don't feel you can be pretty tough on yourself about vitamins then the DS is not for you. I consider them
a lifeline and they are a high priority for me every day. If you don't supplement correctly you could develop 
worse deficiencies although some people get osteoporosis because they need more than the average. It's very
important to track your labs and head things off before they get bad.

I'm not sure about the anemia but there are a more than a few people that end up doing iron infusions. Not a majority
by any means - mainly the people that didn't seem to absorb iron orally well even before the DS.

I hope this helps  - ask away as more questions come to mind.

Pete

Thanks to everyone for taking the time to respond!

I have never heard of an iron infusion. Is it like a blood transfusion or is it more a concentrated tonic you drink? I hope I don't sound silly for asking yet my mind has always been thirsty for information; hence, the questions. I have done some reading and watching videos on DS as I have only heard of it recently. I like to follow up with lots of research and ask other people about their experiences instead of taking one doctor's opinion and making a decision to have a surgery performed under pressure from an MD. My family learned the hard way about surgery disasters with my sister. So for me to even consider WLS means I have reached a point of exasperation and great concern about my health so I appreciate those who take the time to answer my questions.

Thanks again guys! you are awesome in being so open to help a newbie. :)

I haven't had an iron infusion but from what I know it is more like hanging a bag of saline that drips into
your blood system. With no real knowledge at all I would consider a blood transfusion much more serious.
I know there are several different types of iron that different Doctors use, something that a hematologist
would recommend based on your iron and ferritin levels.  It seems to be more related to how you absorb oral iron.
Most of us never get that far but  I think some people find it an easier way to go rather when they have 
trouble supplementing. You might start a different thread to get some more comments from people that have gotten 
infusions.

The bariatric clinic here did not have the DS as an option. Yet, I went through 2 years of jumping through insurance hoops to have the RnY .  I kept researching that entire time and knew I wanted the DS to give me  the greatest chance f getting to my goal weight and keeping it off. Also, I wanted a good "after" surgery life. I had dieted my entire life and was tired of it. Would I do it again? Every year if I had to! For higher bmis the DS is the surgery that will provide the greatest success. 

Now- about those vitamins. You MUST take them for the rest of your life. It is not optional. I became non compliant at about 7 years out. I was able to put things right and am now fine. 

I chose to self pay for my DS rather than have insurance pay for a gastric by pass. Best decision of my life besides marrying my hubby.

I was self pay in Mexico and I do not regret it for a second.  I consider myself incredible blessed that I didn't have to spend two years fighting with the insurance company or jumping through medically questionable hoops.  Self pay was very roughly $15,000 in a top of the line hospital in Mexicali and I priced it around $30K in Seattle. 

I felt horrible for the 2.5 months after the surgery, although it got better everyday.  Four months out and 70 lbs gone and I feel better than I have in a decade.  By the time my surgery anniversary comes up, my guess is that my average level of pain and suffering for the entire year will be a 10%of normal.  Other than a swallowing problem, I haven't had any other problems, but honestly, death from this is really, really, really, really rare and the rest you just roll with and fix. 

There is a saying "there is no such thing as a free ride" and in that spirit I think it is crazy not to get a DS.   You only commit to three things and you will be doing the same three things no matter what decision you make.

1.  Take pills.  Either vitamins after a DS or drugs for your comorbidities.

2.  See your doctor, at least annually.  Blood work is part of any modern physical.  You will have two extra draws your first year.  This is actually better after a DS because they pay for all the extra tests so that you are truly in touch with your body.

3.  Diet.  Oversimplified, after the DS you will want to be on an Adkins + fat diet, but without the surgery you would probably still be on some kind of diet or another.  There is a honeymoon period for around twelve months after the surgery that is important to knuckle down for, but realistically, at a very high BMI, you will probably be knuckled down to some diet or other. 

So, next year could be the year you do the same things (pills, doctor & diet) and lose 70% of your fat or it could be yet another year losing ground.  Damn your fears and do it.