Did any of you consider Duodenal Switch before having RNY...........

If so why did you not go through with DS ? I'm curious because I'm leaning toward DS at this time. I'd like to hear from you on the subject. Thanks !

I would have liked to have had a DS. Kaiser will not do them. There is a great post about the DS I will try to find for you. David

Thanks David. My HMO will pay for WLS however their in-network surgeons do not perform DS. I'm going to request DS and when they deny me I'll take it to the next step. I want to make then give me the surgery I want and not just what's convenient to them. Would appreciate the post if you find it.

This is alot of stuff and get past the CA stuff there are some great points about the DS. While there are LOTS of reasons for doing your research on ALL surgery types, those of us who live in CA have even more reason to freely and openly research ALL of their weight loss surgical options. The reason is that we have a VERY progressive and proactive State Department of Insurance, which oversees insurance companies who conduct business in CA (for fully funded programs -- they still cannot override decisions of employers who are self funded, which are governed by federal ERISA laws). In particular, the CA Dept. of Ins. and its subdivision the CA Dept. of Managed Health Care which governs HMOs, is VERY pro-DS; what that means is that even if your insurance company SPECIFICALLY EXCLUDES the duodenal switch as a surgical option -- including KAISER! -- the DOI or DMHC will almost certainly overturn the denial once you get to external medical review. You of course have to qualify for surgery, and jump through the hoops that the insurance company requires, but if they are willing to pay for the RNY for you, they can be forced to pay for the DS if you want it. As a corollary to the above, PLEASE do all of your research into ALL of your surgical options. Not only do you as Californians have more rights in this respect than those in most other states, there are also more EXCELLENT DS surgeons in CA than anywhere else in the country: In San Francisco, you have the Drs. Rabkin at paclap.com; Jossart, Cirangle and Feng at lapsf.com; in Delano, Dr. Keshishian (who probably has the best self-pay option) at dssurgery.com; in Los Angeles, Dr. Crookes at http://www.surgery.usc.edu/foregut/bariatric/ (and Dr. Kaufman works with him?). I don't want to start a "my surgery is better than your surgery" flame war -- I just want to "Pay it Forward" by making the DS better known, as I promised I would do when someone pointed me to the DS when I was pre-op and doing my research and realizing that I could NOT live with what I saw were the restrictions and side effects of the RNY, as well as the potential for post-op regain. I had just about despaired of having WLS at all until I read about the DS, which made so much more sense to me. I am now two years out and I have not been disappointed with ANYTHING about this surgery. I eat what I want -- although I WANT more protein than I ever did before -- and I do not diet AT ALL. This is not "a diet with a scar" -- this is substantial freedom from dieting AT ALL. In particular, with this surgery, over 80% of the fat we eat goes right through us, allowing us to eat delicious full-fat foods without guilt or repercussions. In the average DS diet, this means over 1200 FREE FAT CALORIES per day. I do NOT have uncontrollable gas or diarrhea -- I poop once or twice first thing in the AM (and quickly and easily and without the pain of IBS that I had before surgery -- which is all but gone), and some days once again just before bed. I eat dessert when I want (which is almost every day) and it doesn't make me sick. I eat fruit and vegetables WITH SKIN. I can take NSAIDs and blood thinners if I need them. I can eat a normal small meal, and I can drink with my meals. I have never felt so free of my food issues in my life -- I have been on a diet since I was 13, and I am almost 52 and I've never been so comfortable about my relationship with food ever before. Also, while the DS is CLEARLY the better surgery on average for people with a BMI over 50, due to its superior weight loss percentage, it is also a primary surgery for ANYONE who needs WLS. The surgeons know how to tailor the lengths of the alimentary and biliopancreatic limbs and common channel, as well as the size of your smaller -- BUT NORMAL -- stomach, to ensure that you maximize your needed weight loss without risking malnourishment in the long run. Long term studies have shown that DS patients are no more likely -- and in fact LESS LIKELY -- to have malnutrition issues than RNY patients, in part because we can eat significantly more food and more TYPES of food than RNYers. Since we retain our intrinsic factor producing stomach tissue and part of our duodenum in the alimentary tract, we have FAR fewer issues with vitamin B12, iron and calcium absorption. I take one prenatal and four calcium citrates a day, and that's IT. Is the DS right for you? You won't know unless you research it. Don't be discouraged by your insurance company's exclusion -- you WILL win if you appeal it to the DOI or DMHC. If you want to see how these decisions are being made, take a look at the DMHC website and read them -- in the last year, almost EVERY appeal for the DS has been won by the patient, with the exception of the times (the most recent case is an example) when one specific reviewer reviews the case by him or herself -- when it's a three person panel, the overturns are 100%. http://wp.dmhc.ca.gov/imr/results.asp?optFormat=html&cboMC=Morbid+Obesity&cboDiagnosis2=0&cboDT=0&cboTreatment2=0&cboType=0&cboDetermination=0&txtDetails=switch&cmdSearch=Search

Here is another post from the same person. I noticed you are from CA also so this may be of great news to you. David See this review from the California Department of Managed Health Care (which is part of the Dept. of Insurance, which presumably has the same standards, but I can't find them online -- DMHC is a much more transparent agency): http://www.dmhc.ca.gov/boards/cap/BariatricREV.pdf "No institution that has recently published data on bariatric surgery describes a protocol requiring weight loss between identification of the need for surgery and the surgery. Many institutions in California have published results of surgery with particular focus on factors that contribute to morbidity and mortality. No paper from a California institution mentions mandated weight loss before bariatric surgery. Nor does any literature regarding the treatment for the morbidly obese recommend continued weight loss during the period between identification of the need for bariatric surgery and the surgery. Mandated weight loss prior to indicated bariatric surgery is without evidence-based support. Mandated weight loss prior to indicated bariatric surgery leaves the patient at increased risk from the patient's comorbidities. Mandated weight loss prior to indicated bariatric surgery is not medically necessary. Mandated weight loss prior to indicated bariatric surgery would be deviant from the standard of care practiced in the United States and other published countries. The risks of delaying bariatric surgery, while not entirely known in the short-term, are real and can be measured. Any potential value of losing weight prior to bariatric surgery is theoretical and not supported by any data. An experimental study including fully informed consent to determine if there were a reduction in risks or other benefit from mandated weight loss prior to bariatric surgery is indicated." What this means is, if you don't want to do the pre-op dieting mandated by most insurance companies, you shouldn't have to do it -- but the catch is, it may take you just as long to appeal this improper requirement as it would to go through the motions of qualifying for the improper requirements in the first place. BAH!!

Thanks so much ! This knowledge will deffinately come in handy for the battle ahead. I know I'll have a fight on my hands. Thanks again.

I had the Duodenal Switch Dec 27, 2004.I have lost 93 pounds and could eat mostly anything, except in smaller portions. Definitely look at both the operations. Once I did the research, I knew the DS was the right one for me. Feel free to email with any questions. [email protected]

You should check out the "Duodenal Switch" message board they have here on this website. that helped me out tremendously

Thanks Lori. Yes I have popped on over to the DS board and have found them to be pretty knowledgeable about DS. Fun people as well. Thanks for your input. I'll certainly e-mail you if I have questions. Thanks!

Hell yeah I considered the DS...that was My ONLY pick, but unfortunately there weren't any docs in AL to perform the surgery safely at the time, and well, I was dying and desperate. However, as much as people regard the DS as the "rolls royce of surgery" I would have the RNY (laporascopic) done over and over and over ANYDAY because it has saved my life. Despite the dumping, gallbladder probs and just well basically dealing with protein insufficiency the rest of my life (and other vitamins) I would do it (RNY) over in a heartbeat! HTH