Scared newbie

Hi there. I just had my first consult with my surgeon. I told him I was thinking gastric sleeve would be best, but he told me I should get a duodenal switch. I'm a little dazed by that. I never considered DS and it's not a very common surgery. I guess I'm lucky in that my doc, who is close by, actually does the surgery. Still, trying to get my mind around DS after thinking I'd be having a sleeve is a bit daunting Are there people out there who've had DS who would be willing to tell me that it wasn't a hideous, gut-changing operation (that's how I'm thinking of it right now)?

Help! Tell me I shouldn't look at this as a set back. Please?

Hideous? No.

Gut changing - yes. You have a serious problem with morbid obesity. In order for that to change, something about you has to change.

Life changing - yes! and in a great way.

Change is scary, and you heard advice you weren't expecting, which is upsetting. But in reality you are so very fortunate that your surgeon took your specific needs into consideration. What happens more often is that surgeons who don't do the DS either act as though it doesn't exist (which is a failure of informed consent) or present it in a totally negative light.

The DS has the best statistics of any bariatric surgery not just for percentage excess weight loss, but also for maintaining that weight loss, which is crucial, and for permanent resolution of almost all comorbidities. It works well for anyone who qualifies medically for bariatric surgery, but is particularly valuable for patients with higher bmi's. It does come with the responsibility to eat plenty of protein and to take various vitamins and minerals for the rest of your life. This commitment is vital to your health, but not difficult once you get into the swing of it. It simply becomes part of your daily life.

You do need to make sure your surgeon is offering a real, standard of care DS with 2 anastamoses, and not a newer, experimental variation with a whole bunch of names - loop DS/aka SADI/aka SIPS and maybe a couple others - that only has one anastamosis and a lot less malabsorption. It is the malabsorption that helps keep the weight off, and all of the documented long term data on the excellent results of the DS are based on the standard of care operation, not this experimental one.

More info for you in a pm, so watch for it.

Larra

That was the way I first heard about the DS. Went to my surgeon and he laid out the options of VSG, RnY, and DS with the DS being his recommendation.

It's scary but after 4 years I am grateful every day that I made this decision. There were several issues that were important to me pre-op.
Statistical chance of regain (DS had best numbers)
Chance to eliminate co-morbidities (Diabetes type 2, sleep apnea, high BP) - all resolved for me.
Total amount of weight I needed to lose. The surgeon said overall people with the DS lost more in total than other surgeries. I was over 500 at the time and surgery weight was 464 so that was important to me. I'm around 235 today so I'm happy with that.

It's not a set back just another option to consider. You have to think if the sleeve would help you get to where you want to be and stay there or if it will turn out to be just one more yo yo diet option. I always did well on diets over the short term but couldn't hold on to my success so the fact that the DS left me with a tool that keeps on working was a comforting thought to me. You may decide the sleeve will do it for you. That's OK there are people that succeed and fail with every WLS, you make the decision that is best for you.

While I guess it's not a common surgery just based on numbers between the DS, sleeve, and gastic bypass there is a robust community here and other places to help with questions and fears.

Not to say I wasn't an emotional/psychological mess at times over the firs 3 - 6 months as I was getting used to a new way to look at everything and recovering because I was. At about 2 months I finally was able to feel the progress and that got me through the rest.

Vitamins, protein first, hydration all became things for me to track and investigate but it was worth it.

Let us know as more questions come to mind. There will be plenty. :) You might also explore the archives here. I spent a lot of time doing that pre-op as questions occurred to me and then I posed questions to the current group if I saw stuff that troubled me or I didn't understand.

Pete

Wow - your weight loss is so impressive! I'm at a very high BMI and, now that I've slept on it, I realize that my surgeon, who is very knowledgeable, was recommending what he knew was best. I'm glad to hear that you were so successful - that gives me a lot of hope.

Thanks for responding to my post.

Hi GenJones - if you are even thinking about the DS, you must do your research so you understand exactly what you're signing up for. You don't say how old you are, how much you weigh and how much you want/need to lose.

Hideous - I wouldn't use that word

Gut-changing - absolutely. They shorten your intestines, which is where you absorb your nutrients. The key to the DS is that you will always have malabsorption, so your chances of regain is lessened. The downside of malabsorption is that you will, for the rest of your life, not absorb all the nutrients, which means you have to supplement with vitamins, eat a higher-protein diet, get labs done on a regular basis (at least once a year and then stay on top and make adjustments of any deficiencies).

The hardest part of the surgery (really post-op) is re-learning to eat. With the DS you ultimately need to learn how your body is affected by certain foods. It's a learning process. Probably the same with the sleeve but since there's no malabsorption, it's all about restriction and not stretching out your sleeve. I know my sleeve is completely stretched out. I don't eat as much as I did pre-op, but I definitely eat more knowing that the malabsorption is what keeps the weight off.

They say we DSers absorb about 50% of what we take in, which is why the high protein and large number/amounts of vitamins are so important. Also consider costs. Vitamins, supplements, protein are all expensive, and is really non-negotiable.

You can always have the sleeve, and if later down the road you feel you need more help, you can always get the switch (since the sleeve is what they consider as the "top part" of the DS).

Good luck.

Thanks for your response. I spent last evening reading everything I could find about the DS and was surprised that so few surgeons perform it. I guess I got lucky with the guy I chose.

When you say, "re-learning to eat" do you mean just trying to get food down and keep it there, or learning to only eat what is nutritious before you fill up. Are you constantly eating small meals?

So your sleeve is stretched - does that mean you feel more hungry than you did when you were first post-op?

Sorry for all the questions and thanks again for answering my post.

I eat every 2 hours. Most always, it's heavy on the protein. I just finished 4 little cheese and salami. Sliced cheese into 4 pieces and then put 2-3 pieces of salami between 2 quarters. So, 10 grams of cheese, and about the same of salami. Ate 1 pork/chicken sausage earlier 12 grams. Ate some soft jerky 2 oz or so, another 20 grams. Just finishing up a couple slices of cheese with smoked salmon. I'm 9 yrs out. Sometimes I can eat more, sometimes less. If I'm really hungry, can't eat too much unless I take an hour or so to eat.

After your DS, the first month is very hard, you can only eat a few bites at a time. The goal is 30 grams of protein the first month, then 60 the 2nd, and 90 the 3rd month. At times, I use a Premier Protein drink that's 30 g. I did supplement with shakes early out. Search for Ricotta Fluff here. Lots of protein, soft and easy on the little new tummy.

Drinking water is the biggest thing --- you need to stay hydrated. Every 5 min, sip, sip, sip. You can't gulp like you use to. At least for quite a while. 64oz at least every day.

The DS is a very complicated surgery and it takes an expert. Also many surgeons don't like the DS because too many patients refuse to be compliant and then fail, so they simply would rather not perform the surgery at all.

When I say re-learning to eat, it's everything. You tastes will change after surgery. You also don't know what will agree for you and what won't (will it make you queasy, will it taste terrible, etc.), how much to eat at any one time, etc. It's just a learning process and IMHO with the DS it's a little more because of the malabsoption. Learning the signs of when to put the fork down. The first few months are simply figuring how to get in the amount of protein needed (usually a combination of food and shakes) and then getting water and vitamins in as well. The rule of thumb is 30 grams of protein by the first 30 days post-op, 60 grams by 60 days post-op, 90 grams by 90 days, until you get to your protein goal.

For the first few years I was always eating. Yes, small meals (if you even want to call them meals). So it's finding the balance of meals and snacks. I tend to eat three meals a day and always snack in between. The choices are what's key - most of my snacks are protein snacks. Deli meat, cheeses, nuts, yogurt - things like that.

Hunger has nothing to do with the size of the sleeve. I'm always hungry - lol. I actually try not to get too hungry because that's when I get into trouble - speed is bad. Generally for me, if I get too hungry, when I do finally eat, I tend to eat faster, which in turn doesn't always sit well with my gut/tummy. That's the reason for the snacks.

I view my eating habits (besides the added protein) as that of a "normal" person. For the first few years I weighed and measured my food because I had to learn what 3 ounces of food looked like.

It's all a learning process!

Thanks, Janet - it seems like the DS is the most complicated of the surgeries, so my thinking just automatically goes to "there must be a LOT of complications", which means most DS people must be somehow "food-crippled" for the rest of their lives, doomed to drinking protein shakes forever. It's good to know that people do come out the other side and that, ultimately, their lives resemble normal lives. Just newbie thoughts.

The DS gives you the best chance for success. There is no better WLS out there. Obesity is a metabolic disease and the DS fixes it. And what is the sleeve? It's just another diet with a smaller stomach. And how have diets worked for you?

You are very lucky your doc suggested this!