Not enough small intestine was bypassed? Anyone?

I found this forum last night, and been doing some reading.  I had WLS on 2/25/08, lost 40 pounds, and haven't been able to lose any more since May.  I've been following my doctor's orders to a T, and exercising harder than I have in my entire life.  I only manage to maintain, but not lose.

Then I remembered something my PCP said two weeks ago when I went to see her.  She said she wondered if my surgeon had "reconnected me too high."  I had no idea what she meant.  But now it's starting to make a little sense.  The duodenum is the top and most absorptive part of the small intestine, and that's the part they're supposed to bypass.  If my surgeon cut too high on the small intestine, and inadvertently (I'm sure) reconnected the lower part of my duodenum to my pouch, then my body is trying to digest food in an area that's still highly absorptive!

My body seems to take everything I eat and multiply the calories several times over.  For instance, I ate a slice of pizza yesterday.  Obviously that’s not my usual diet, but I’m trying to prove a point to the doctors.  I got on the scale this morning.  I had gained over a pound since yesterday.  That’s crazy.  It takes 3500 extra calories (i.e. 3500 plus the other 2800 that it takes to maintain my weight) to gain a pound.  I would have had to have eaten 6300 calories yesterday to do that!  I didn’t even eat 1/3 of that yesterday!  It’s either a problem with insulin (back to the PCOS issue, which is something I also have) or it’s an absorption issue.

Since the small intestine is all one piece, I don’t know if the duodenum looks different than the other two sections down below it or not.  Since I found this forum with so many people who have the same symptoms as I do, it leads me to wonder if figuring out where the duodenum ends and the jejunum begins is a guessing game.

 

Eating less doesn’t help either, because that only serves to cause malnutrition problems (especially protein), not to mention hunger!  I thought about starting to drink with my meals again to see if that would help wash food down to the less absorptive part of my intestine.  But then I realized that my pouch is made of part of my stomach, not the duodenum.  So drinking with my meals again would only serve to wa**** into the duodenum sooner.  Eating simply protein only maintains me where I am; it doesn't allow me to lose any weight.

I tried to order some tests (endoscopy, upper GI) yesterday through my PCP -- but found out she's out for four months because she had some surgery herself!   So I'm getting in to see another Internal Medicine doctor this morning to see what she can do for me.  I sure hope I get some answers soon, and a listening ear.

Sheryl, get a copy of your surgery report to find out how long or short your bypass is.  I have a short bypass, 80 cm, and I've been successful.  Please don't think I'm trying to say this is your fault because it's not.  All of us are so different.

I often worry about doctors performing the surgery, are they taking into count everything on the individual surgery or do they do "cookie cutter" surgeries, i.e. everyone the same?  The PCOS can most definitely play into how quickly you lose.  One of my friends that has PCOS has struggled to lose weight, she has lost but much slower and it took much more work than it did for me.  She actually talked to her PCP just recently and has gotten back on Metaform, she said it has helped allot with the hunger.

Best wishes,

Thank you Dana for your reply!

I saw my PCP for the second time two weeks ago this coming Tuesday.  I was diagnosed with PCOS 15 years ago, but the only Rx I was ever given for it was birth control.  I found out about Metformin by doing research these past five months on reasons why I wasn't losing weight after having my surgery, but not from any doctor.

When I saw my PCP (well, her stand-in; my real PCP had surgery and is out for 4 months), she sort of blew me off and said she thought my fasting blood sugars were fine since they were "within normal limits."  The breaking point is at 99, and I was at 94.  I mentioned to her that I thought it was something to think about since it was very close to being too high, and again, she made light of that.

She prescribed Metformin, which I never mentioned to her.  Unknown to her, I already knew the ins and outs of the medication.  I think she prescribed it to pacify me, not really thinking it was going to do much of anything.  I started it that night.  The next morning I'd lost 1.5 pounds.  The next morning, 2.3 pounds.  The next another 1.5 pounds.  Within a week, I'd lost 9 pounds.

When I went to see her, I already had an appt to see an endocrinologist.  I saw him this past Friday.  He said everything else about my labs were absolutely excellent.  But when he got to the 94 number, he turned the computer screen toward me and said, (and I quote), "Now, this is a very interesting number.  It's within normal limits, but it's actually on the high side."  I wanted to scream for joy!  I said, "That's EXACTLY what I said to my PCP last week!!"

When I told him I'd been on Metformin for the past 10 days and had lost 10 pounds, he said there was obviously something to that, because I'm actually on a very low dosage of Metformin (500 mg once before bed).  Most people are on 1500 mg or more a day.  He said for me to lose 10 pounds in 10 days on such a low dosage of it, something was obviously wrong that Metformin is correcting.  I very nearly floated out of his office.

They are going to run some labs on me tomorrow.  Instead of testing my blood sugar, they're actually going to test the amount of INSULIN and TESTOSTERONE in my blood, and then he plans to increase the dosage of my Metformin.  When there's too much testosterone, my female hormones are surpressed.  Thus why I've had no periods.  Miracle of all miracles, after starting this Rx, I'm actually having the first period I've had in the past five years.

This whole time, the doctors have only tested my thyroid, and kept telling me my thyroid was fine, so then the problem must be with me.  I never argued with my thyroid test results.  My argument was, "Okay, so my thyroid's fine.  Now we know.  Now, what's next, because's there's still SOMETHING's wrong.  We just know now that it's not my thyroid."  They've always stopped short and never took the initiative to look any further.

Anyway, I'm just glad to have found the answer.  It's been maddening.  But the lesson I've learned is to never stop reading.  Never stop asking questions.  Don't take "no" for an answer.  If I had, I'd still be struggling.

i just saw an GI for my horrible BM issues and he said the same thing to me that my surgeon most likely didnt bypass me enough. I only lost 67 pounds in the 11months since surgery and i'm SO sad about it. No matter how little or much i eat i am not loosing. I am even on the medifast diet program at 300$ / month and ITS NOT WORKING i'm miserable and so mad at my surgeon. I see him next month for my 1 year and i want him to bypass me more! i'm so discouraged.

thanks to the other woman who said she was bypassed shorter. My doc did tell me not to give up because it will take a good 20 months before i reach goal so i'm praying thats really all it is

When I had my revision surgery, it was found that I was only bypased 30cm, which is only a foot.  It is not even the standard 100 cm bypass.   It could be that you were no bypassed enough.