New member with a huge DS / RNY / VSG dilemma b.

Hey All,
I'm glad to have found this board and first I'd like to introduce myself :)
My name is Shai and I'm 27 year old Male from Israel.

I've been overweight for most of my life since childhood. At my most I weighed ~200kg (440lb) but due to my height (1.91cm / 6"3') It doesn't show as much.

When I was 17 (10 years ago), I've had a Restrictive Lap Band surgery which I don't remember much of, since I was very young and most of this came from my parents (who did their best to assist me), and I wasn't as involved and "aware" as I am now. Also, options weren't that various at the time ... Needless to say, that surgery was a bad option to begin with for a BMI of 55 at the time. 

So now, years later - I'm still weighing in around 182kg (BMI = 50) but with much more awareness for the options and some willingness to change, I've been looking for a revision for my Lap Band. 

My HMO "Approving Doctor" recommended the Gastric Bypass (RNY) But I have read a lot about it and the statistics / side effects seem very off-putting. Not only did he recommend RNY, he completely bashed DS as an option. In his words it's "taking one disease (obesity) and replacing it with a different, much worse disease". I think that vision of his is mainly because he's not actually a surgeon and very biased towards the "more standard" operations.

After a while of thinking, reading endless articles and researches, watching YouTube vids of patients etc... I tracked down one of the only two surgeons in my country who do DS (as well as the other operations),  Dr. Andrey Keidar MD, and was pleased to know he's actually DSFacts.com approved, which is a nice touch. I went to him for a meeting yesterday and discussed my options... He said he feels RNY is a bad solution, and he would consider either doing DS or - doing VSG and later on doing just the DS part - But that it's my choice. 

So know I have an actual real dilemma. I have some friends that did DS in my country and they're doing great but I also know of some people who are miserable. You can say that for other surgeries as well but that kinda put a real scare into me. I'm still young and I want to have a long and fulfilling life. I do feel it shouldn't be a problem taking the amount of Vitamins needed but I'm hearing of some people having excessive malabsorption, digestion problem, weakness, etc... And don't want to go for a surgery without feeling completely safe about it.

Since in Israel there are only 150-350 patients who ever got DS (or oldschool Scopinaro BPD without DS), it's very uncommon to have that surgery here and the "public opinion" about it is very bad (I guess mainly because it still 'didnt catch', here in my country). That's why I'm trying to look mainly in US forums / US patients so I can get actual real experiences - the good things, and the bad things.

I've read through DSFacts and many other researches, etc - but I'd love to hear more from your experiences. I was also interested in hearing about long-term, how many years and weight some of you lost. And am very interested in hearing how well it works for older ages, when we as patients get to the age of 60-70, is the malabsorption still manageable? 

I know it's a long post but it was important for me to give some background and I hope it's fine, my apologies :) 

Many thanks for any help and it's a pleasure "meeting" all of you.

Kind regards,
Shai. 

Shalom and welcome, Shai!

It's clear you've done a great job with your research and you're asking very intellligent questions. You probably already know that the DS has the best statistics of any bariatric surgery for percentage excess weight loss, for maintaining that weight loss, and for resolution of almost all comorbidities. It also avoids many of the negative aspects of RNY, such as dumping and never being able to take NSAIDs again.

I have to disagree with the doctor who told you that with the DS, one disease is replaced with another worse one. There are excellent longterm studies documenting the results of the DS, not just for weight loss but also for maintenance of  nutritional health. In reality, the rate of malnutrition is small, and almost always related to noncompliance. Not always, but almost always. In other words, if you make the lifetime commitment to taking the required vitamins and minerals and eating plenty of protein, and getting regular lab work to make sure your levels are good, most people do great.

Another area of confusion is between the modern DS and the old BPD, which at least in the USA isn't being done anymore. The whole reason the DS replaced the BPD is to avoid the problems the BPD caused. The BPD worked well for weight loss but caused nutritional problems and difficult to control diarrhea. This is because it removed the lower part of the stoma*****luding the pyloric valve, and also used a too short common channel. With the DS we have a sleeve instead, thus keeping the function of the pyloric valve, and a longer common channel, and these problems were largely ameliorated.

My own personal experience is that I'm 9 years post-op and doing great. I'm in the older age group and the malabsorption is still manageable. Malabsorption does not = malnutrition unless you let it.

I will also send you a pm with info about the long term studies. And while of course I have no personal experience with Dr. Keidar he does have a good reputation.

Larra

Thank you so much Lara! you've answered most of my fears and it's great finally having answers from people who've done it already. In my country the number is very low and there's no "community" to be a part of , so this forum would help for sure :)

What kind of foods do you eat to get to that level of Protein ? 

Also, what is the length of the common channel in your DS? I think Keidar is doing 80-100 if I'm not mistaken ...    About Keidar, he's the most (and probably only) competent surgeon for this kind of surgery in Israel. Especially when done laparoscopically.    Again thank you so much for the assistance.
Its highly appreciate and you can't tell how much it helps reassure some of my fears.   Shai.

I agree with everything Larra said, and the common channel Dr. Keidar is using is also pretty standard to US lengths.  To keep up with protein requirements (100-120g on average), many start with protein shakes until they can eat enough real food to eliminate them, while others still have one or two shakes as part of their ongoing routine.  Meat, eggs, and cheese are where I get the majority of my protein from. 

Another thing you'll have to learn on your own is keeping nutritionally healthy.  Many doctors and even nutritionists just don't (or refuse) to understand what our ongoing needs are and how to achieve them.  I highly recommend that you learn how to read your lab results and always get a copy and compare to your last labs.  You will likely notice downward trends before the docs do.  With that knowledge, you can adjust your vitamin regimen to your own needs.

You'll need to find a resource of dry (water soluble) vitamin A, K and D3 in ridiculous doses.  A compounding pharmacist may be able to get it for you if you cannot locate a commercial resource.  These vitamins are usually dispensed in an oil-filled gel cap, which we malabsorb 80% of.  The dry formulation is a power inside of a vegetable capsule.  Y

Thank you very much as well Vallery ! 

What are the main Vitamins/Lab Results you would be looking out for ? I guess B12, Iron, A, E, D? 
I already started taking 2000 units (5drops) of Vitamin D since it's low even before the operation, so that is pretty much covered.

I also heard that in the US there are many of these vitamins that can be packed into a single pill and not 4-5 different ones. 
How many pills do you currently have to take a day? And how much is your monthly expense on vitamins/additions?

Thank you again so much
Shai

The bariatric multivitamins are useless to us, so don't fall for those.   Many of us take 12-30 pills per day of vitamins.  In my regimen, I take a double-dose of a good multivitamin, double-dose of zinc, 2500mg of Calcium Citrate, 50,000iu of D, and 25,000iu of A.  Others add extra iron, B, and other vitamins depending on their needs.  I scope out specials and sales and spend around $40/month, while others may spend nearly $100/month for vitamins. 

Many are experimenting with vitamin patches, which transmit transdermally, thus not requiring extra dosage since they are bypassing digestion. I just recently jumped on the experiment to see how they do for us.  Patchmd.com is a place to research about this technology.  Check Facebook and other forums to learn more, too.

Hey Valerie.

Will definitely check the patch option. 

50,000iu a day of Vitamin D? Are you sure? that sounds weird ,

Currently my surgeon told me to ake 2000iu a day which are 5 drops 

Just got an answer back from my Insurance and apparentally Weight Loss Surgeries in general aren't part of my insurance policy ... I'm pretty depressed about this but trying to keep my chin up... 

Will have to go through the regular HMO program and hope they let me work with Dr. Keidar 

Hi Valerie,

Just wondering which patch md's you are currently using? Any advice is appreciated. DS surgery set for March 26, 2015.

Thanks!

Shai, as far as protein sources, we can eat anything. Because we absorb only 20% of the fat we consume, we can eat either lean or fatty types of protein. So we eat beef, chicken, turkey, fish, cheese, nuts, as well as some that may not be so readily available in Israel (port, shellfish). We can also use any cooking method because we don't have to worry about cooking with oil or butter. With RNY, people have to follow a low fat, low carb, low calorie diet for life to succeed. We need to watch carbs but can otherwise not worry about fat or calories.

As far as vitamins go, yes, 50,000 units of D sounds like a lot, but we really do need that much, or more. On the other hand, many of us don't need B12 other than what's in our multivits - we don't have the problem with B12 that people with RNY have. the combination vitamins you are reading about in the USA do NOT work for someone with the DS. You would end up with too much of some vitamins and not nearly enough of others. They are designed more for RNY than DS, and the concept of taking more of the same thing doesn't work because the operations, and what is malaborbed, are completely different. I'm not even sure those products work well for someone with RNY, but definitely not for the DS. You really need to take each vitamin separately (except for multivits of course) and then track your lab results to make sure each vitamin level is staying good. It's a big commitment but not difficult.

The patches are new, so we don't know yet how those will work out.

Larra