Doctor has proposed Duodenal Switch

Good morning all -- I am nearing the "end" of the beginning process on the road to weight loss surgery. I've seen the nutritionist, taken the exercise classes, had the upper endoscopy, had the labs done, had the psych eval, and have seen my primary care provider... I'm almost there! :)

Based on the research I'd done, and knowing people who've had either the sleeve or the gastric bypass, I went into this thinking/believing I would have the Roux-en-Y. It seemed like a better choice in that it has better documented results than the sleeve alone. Higher weight loss, better chance of keeping it off. Great!

When I saw my bariatric physician, however, he presented a third option I hadn't heard of before - the biliopancreatic diversion with duodenal switch. He said he believed I'd be a good candidate for both the RNY or the BPD-DS...he wanted me to take time, research both, and think about it, and come back to discuss further.

Well -- I've done the reading and research, and the BPD-DS *does* seem like a great choice. Even more weight loss in the beginning as well as higher success managing/maintaining weight loss in the future. So I went back to the doctor thinking that.

When I went back to see the doctor, I was actually just seeing the PA, who was checking on the status of my labs, how much of the pre-op oupatient work I'd gotten done. She did ask if I was leaning one way or the other toward any particular surgery. I did tell her I was seriously considering the DS, and she did say that it was a good, very effective surgery. She did, however, talk about several of their current DS patients (not naming anyone, of course, but in a very general way), and that the main issue many of them seem to have after the surgery seem to be bathroom related -- specifically, with very loose stools. She described it as not being to the point of incontinence, but that people generally were unable to be without access to a bathroom especially when they ate, because of the loose stools that almost immediately followed eating.

To a group of people who may be familiar with such a phenomenon: is it as dramatic as she made it sound? Granted she is only telling me what her patients are telling her, and she did not seem to be trying to sway me away from the DS -- she just seemed to genuinely want to make sure I was aware of some of the "side effects" that I may not have read about.

I do not have any co-morbidities, save for moderately high blood pressure. I'm healthy otherwise, outside of morbid obesity. My BMI is 46. I suppose my issue is is that I can gain weight easily, and quickly. I've lost massive amounts of weight (80-110 lbs) at several different points in my life...however, it always comes back, and I almost always end up heavier than before. THAT, to me, is the main reason to go for the DS -- It wasn't until my most recent weight gain that I finally got to "that place" in my mind where I knew I was ready to commit to weight loss surgery.

Sorry if this is rambling or so long -- I'm just looking for some words of advice, experience, guidance, etc. from people who are more familiar with this topic than anyone else I'll speak to.

Thanks! :)

Amanda, you are so very fortunate that your doctor told you about all your options and urged you to research further. The DS, as you are learning, has the best statistics of any bariatric surgery not just for percentage excess weight loss, but also for maintenance of that weight loss. We see so many people do well initially with other operations, but after a few years (sometimes even less) the weight comes back. The DS also has the best statistics for permanent resolution of almost all comorbidities.

For most of us, what we choose to eat makes all the difference in the "side effects" area, so to speak. Of course your stools will be loose right after surgery, but once you get onto a solid diet, most of us poop once of twice in the morning, maybe once more later in the day, and that's about it. If you eat foods high in sugars, yes, that will lead to more frequent and more loose poop. And while we can eat fat freely because we don't absorb most of it, if you eat too much fat that will also cause loose stools. These are decisions you control.

On the other hand, with gastric bypass you might - or might not - suffer from dumping, which is a very nasty potential side effect some people get that is NOT a weight loss tool. Also, NSAIDs can be taken safely with the DS, while they are contraindicated for the rest of your life with gastric bypass. Even if you don't need them now, you may at some point in the future, as they are one of the most commonly prescribed and otc classes of drugs.

I hope you will continue your research. You're doing a great job already.

Larra

Ah the ole **** yourself stories....yeah Im calling it that. Thoes people need to question what they are eating if its that bad (usually carbs).

To be honest only people Ive ever know having such bathroom problems usually were not eating right. You may have looser stool but not omg im not gonna make it to the restroom, but I hear more complain of the opposite, lol.

Im shy of 12 years post DS and I wouldnt change it for nothing. Havent had any such issues with bowel movement. I go once maybe twice a day (morning/evening).

Eating....here is today so far

2x greek yogurts, 2 string cheese sticks, handful baked cheddar and sour cream chips (I have to have some starch or bread carb in the morning my stomach gets angry otherwise....long story as to why, and its not a mental issue)

Lunch

4 chicken fingers, 1/2 cucumber sliced with ranch to dip, black olives, 2 oreo cookies. Yup just admitted to eating 2 oreos....funny I bought a 4 pack.....its called moderation. But Ive already made it to 85grams of protein for the day.

Ans dinner is always protein and veggie

Haha, yes -- that describes it perfectly! I did ask her if this was something the patients seemed to suffer right after surgery, or if it was a "lifelong" issue -- she implied that while everyone has loose stools following surgery because of the all-liquid diet, that DS patients had "more" bathroom/poop issues in the long run than other WLS patients.

Thank you for your reply! I am glad for someone to say that it *can* be controlled with what you eat. I would've thought that would be the case -- thank you for confirming. :)

Yes Amanda, it is more controlled with what you eat, a lot of DS people have more frequent bowel movements based on eating higher fat and carbs, which is what I call our Dumping syndrome! If I eat some ice cream, it will come out rather sooner than later and won't stop for a few BM's to put it lightly or not so grossly, but its facts. If I eat more protein and veg, it will be soft, I have never had my old normal formed BM since Sept 28, 2016 when I had my DS. Overall, the success of no regaining the weight ever was what made me decide 8 years ago to research DS. I was afraid of surgery for 8 years, up until I was put out by my CRNA, I was terrified of surgery. Post op was painful, 7 incisions via laparoscopy, they get you up around 3 hours post op. It hurt like the dickens to move, unable to care for myself hygienically, so I needed help. I am an RN, so for me being a patient was different. I kept walking and doing my deep breathing exercises because I did not want to get sick, I had a minor temperature afterwards but it went away because I coughed and deep breathed my lungs out. lol. I did not want complications. I had none. I was so glad to be done with surgery that it was like a rebirth for me. I have lost 70 lbs so far and love it. I eat what I want and still have to take vitamins, and protein as main source of food, but its not bad. If you need anymore help, just let me know, I will give you my email also. [email protected] Dr. Zeni out of St. Mary Mercy in Livonia MI did mine and I think he is awesome!!

Thank you for your reply! Yes, I agree -- I was so glad he proposed the DS as a possibility, as I really liked what I read about it. And that is good advice about possibly needing NSAIDs in the future... The visit a couple of days ago just kind of threw me a little bit with how strongly she stressed wanting me to know about the "pooping" issues. I am going to keep reading further, but in the back of my mind I already know what direction I am strongly leaning towards... :) Thanks again!

Normal poop for a DSer is sort of like pudding. Sorry! Yes, you will have some diarrhea in the beginning but it goes away.

I had my surgery way back in 03. Along with 9 of my co-workers who had the RNY. Guess what, they are all heavier than when they had surgery. The RNY in my opinion is cruel. They bypass just enough to help you lose the weight and get a taste of normal. Then right around the 2 year mark, your body has adapted to the bypass and the regain starts. Sad!

Postop, I rode a horse across Mexico, and kayaked the Amazon. I could not have done these things if I was chained to a toilet...

Today I am back to always on a diet and always trying to lose weight. The honeymoon doesn't last forever. But I still look like a pretty normal old lady. If I had done nothing, I would either be dead by now or 600lbs. I know I would have gained back everything plus if I had had the RNY. I am glad every day I held out for the DS. There is no better WLS available today.

Thank you for this! Yes -- this is one of the main reasons I am leaning towards the DS, because of the long-term success rate. I know I can lose the weight, I don't mean to say it's not the hard part, but I don't think for me it will be the hardest -- what will be the hardest part is maintaining that much of a weight loss for the rest of my life. Also, thank you for the real-life reply -- not "chained to a toilet!" I didn't necessarily think it would be like that, but with the way the PA made it sound for some of her patients, I wasn't sure! My greatest quality of life will be for me not to weight 400 or 500 lbs by the time I'm 40 or 50, which is where I am headed now if I don't do anything. A high quality of life will include watching what I eat and knowing it will make me go to the bathroom (quickly or not), and just planning for that, but being at a normal/healthy weight. Thank you for your reply!!

I am wondering about your statement of "Today I am back to always on a diet and always trying to lose weight." Is it because you eat more carbs? I am scheduled for surgery in June and want this to be my last surgery and thought I wouldn't have to always be on a diet or always trying to lose weight with the DS. Thank you PattyL

Most likely it is because I am a superabsorber. I got my first diet at 6 weeks old and I was a breastfed baby. The doc told my mom to replace one feeding with a bottle of water. I knew the meaning of the word obese when I was 2. My history is abysmal. Chances are you will do better than I did. Most do!

Supposedly, my CC is 75. Short! But I have my doubts because I never had a single deficiency. So I am obviously absorbing more than enough. I never made it to goal but most do. All I wanted was a normal BMI but not for me.

Plenty of us maintain pretty effortlessly but it's a lot of work for some. There's no way to tell where you will end up. That's why all these years later, my advice is still the same. Just lose the weight. As much as you can as fast as you can. When you reach goal, lose 10% more unless you are actually underweight. You will have the rest of your life to find out how many carbs you can eat. Just get to goal or below. Until then, the only good carb is one you don't eat.

Next, you need to remember I am 15 years postop. And old. Every year it gets a little harder to lose and maintain. But the DS is still the best WLS out there. There is nothing better. Someday there will be something better but not today.