Finally got MeritCare's surgery price quote for DS

I expected that it would be in the low $20ks, hoping for upper teens.  Nope.  $24k - $27k with no complications & other program requirements (psych eval, nutritional classes, dr appts, etc) NOT covered.  This is with the new surgeon, Matthew Fabian.  I figured he would be cheaper due to less experience.  Who knows?  It's his fee, the anesthesiologists, & the hospital all in one.

It took the lady 4 weeks to get the info together for me.  Thank good God that I didn't wait for that!

I should be getting my surgery date for Dr. Ungson in Mexico tomorrow for ALL TOGETHER $14k & unlike Dr. Fabian who has ZERO unsupervised experience with the DS, Dr. Ungson has done hundreds.  Literally hundreds.

End of rant . . . & I'm excited about my upcoming surgery!!!!!!!!!!!!!!!!!!

Hi,

Just wondering... did you get your surgery date then?  I read in a previous post that you are from Grand Forks; so am I.  This May will be 4 years since my surgery (I had the RNY) here in GF with Dr. MacColl.  It is the best thing I ever could have done for myself.  I'm still trying to lose some baby weight (she is 13.5 months!!), but other than that, I still currently weigh much less than anyone predicted for me.

Best of luck to you; I hope everything works out for you in Mexico and you have a brand new start for a wonderful life.

Take Care,
Tanja

ETA:  I see now that you have a surgery date listed in March... best of luck to you.

Thanks!  I'm very excited about it.  I have been considering going to the bariatric support group in town.  Did you ever go or do you still go?  I'm just wondering what it would be like.  I'm glad to hear that you're doing well & your little one - in the picture? - is very cute! 

I did go to the support group after surgery.  I guess they require you to go to all these classes and stuff before surgery now, but I didn't have to do any of that when I had surgery.  I went to the meetings for quite awhile after, though, until I had pretty much lost the bulk of my weight and no one really seemed interested in what I had to say.  Everyone at the meetings then was either about to have surgery or just had it and seemed to know everyone else, and I just basically felt out of place. . So... I stopped going.  I still stay on top of my blood work and stuff like that, though.  You might find the support group helpful since you are just going to be having surgery.  I have considered going again just to check it out; we'll see, I guess.

Yes, that is my daughter in the picture.  I doubt I would have had her had it not been for the surgery.  If you go to the meetings, let me know and tell me how it was. 

Tanja

Lisey, are you in Fargo or Grand Forks? If you're in Fargo, please feel free to come to our support group. The next one is March 16 at 6pm at Innovis Health hospital. Its a patient run program, so it doesn't matter where you had surgery.

Wow, that would scare me to go to a surgeon with little experience no matter the price. I'm lucky the surgeon I had came with lots of experience and the price was right. I learned about this program after waiting many weeks for my inquiry to the local program (Fargo) to get back to me. Its all about doing what's best for us, and it sounds like you have the connection to a good program and appears to have some good references for Dr Ungson.

I live in Grand Forks, but work in Thief River until 6:00pm on Mondays.  March 16 is actually my b-day!  Thank you for the invite, I appreciate it :}  It's soooo darn cold again!!!

Happy Almost Birthday! You know, your 'rebirth' will come on the day of your surgery. It will change your life.

I'm curious, I don't know anyone else who is having or have had the DS. What are the factors that brought you to this procedure versus the more traditional RNY? What are the advantages or disadvantages? What kind of weight loss do you anticipate? I don't think there's too many of us in ND that know that much about the procedure. Do tell!

I also had never heard of it before deciding to have WLS.  When I initially decided to get WLS, my thought was to have the lap-band, but once I went to the info seminar of the MeritCare Bariatric Center, the dr told us that they were moving away from doing to bands in favor of the RNY b/c of high long-term failure rates/ failure to lose or maintain at least 50% of their excess weight.  That spurred me to start reading the research on WLS's.

I think that there are definitely people who are successful with thhe RNY, but the long-term stats are better for the DS, especially once you get into the 5-10 year post-op range.  At 10 years post-op, 20% of those who had an RNY have regained at least 50% of their excess weight that they had either never lost to begin with or had lost & then regained.  Only 5% of those who got a DS have regained at least 50% of the weight (or never lost it - HIGHLY unusual) by 10 years post-op.  The main reason for this is that the RNY has A LOT of restriction due to the pouch size & regulating stoma and it has some malabsorption.  Over time, it is expected that the pouch will stretch out some & that puts more of the responsibility of regulating food intake on the person, hence they fall back to dieting.  I'm really successful at dieting & always gain the weight back.  I do have instances where I eat way too much food in one sitting.  I know I do & I also think that most obese people fall into that category/habit.  Why the DS works better for long-term success for the average person is because it has some restriction (3/4 of stomach is removed), but it has A LOT of malabsorption.  Fat is absorbed at 20%, protein at 40%, complex carbs at 60%, & simple carbs/sugars at 100% - so you still can't eat sugary crap all day long & expect to lose.  You'll lose some, but not that much, if you eat sugary crap all day.  However, due to the high malabsorption feature, that is why the long-term stats are better b/c that doesn't change, unlike the RNY's pouch expanding.  I also like the fact that you can eat more.  There seems to be a good bit of variability by patient for this, some people can eat a lot 3-5 years out of surgery & others typically eat like a normal 2000 calorie per day person - neither of whom tend to gain weight.  There are exceptions, but it's very rare & difficult to mess up with the DS - I LOVE that.  I would feel devastated having lost all of this weight & then regain it back.  Horrible, unacceptable.

The 1/4 of stomach that is left with a DS (sleeve) also stretches some with time - this just is a normal process.  At least the stretchiest part of the stomach is the outer curvature, which is the part that is removed, so it doesn't stretch quite as much.  The hunger hormone ghrelin is also mainly produced in the portion that is removed.  I understand that ghrelin production decreases with RNY patients b/c the stomach isn't being used, but some is still produced by the stomach b/c the stomach's still there. 

One huge advantage of the DS is that all of the food intake & outtake regulating portions of the stomach are left intact, specifically the pylorus valve is left intact, which is removed with the RNY.  Because this valve is remvoed, food passes in an uncontrolled fashion out of the pouch directly into the small intestines - that's what causes dumping symptoms in many of those who have the RNY.  DS patients never - none of them - experience this, at all.  This also means that you can take whatever medication you need to that has anti-inflammatories with NO risk of marginal ulcers b/c it's dissolved in your stomach before hitting your intestines b/c the pylorus valve still regulates food passage into the intestines.  Both rheumatoid & osteo arthritis run in my family completely independent of weight (they're normal weight) & I already have joint pain in several locations & I'm only 31, so I'm likely to need to take NSAID's.  My dr already advised me to start taking OTC anti-inflammatories.

The more I read, the more my reaction was, well holy **** why isn't this done more???  It's a very complex procedure & not that many surgeons know how to do it, so of course, if someone goes to the typical WLS surgeon, they're not going to coo about the positives of the DS when they can't do it!  It would be like convincing their potential customer to go elsewhere.  Sadly, I have heard of a # of surgeons who know about the DS purposely spread factually incorrect information, which I think is unethical, such as your body will literally smell or that you will poop 10-20 times per day - both are not supported by research or the many, many people on the DS boards.  I've also heard the rumor that you need to wear a diaper - not true.  Generally, people do have some awfully smelly farts & poop, but air freshener works.  Aside from that, people on the DS board state that it's typically things that have white flour & processed sugar (not fruit) that causes gas, so people usually just avoid eating much of those things while out in public.

BC/BS would pay for an RNY for me, but not the DS b/c they will only do that if your BMI is 50 or higher.  The "catch-22" is that Dr. Fabian, who is in network for BCBS is reserving doing surgeries on those with a BMI up to 45 until he gets more experience (which makes sense), but he's also the only one in ND who has been physically trained in how do them.  So, that's why I'm forgoing my paid RNY for the DS.  I don't want to risk being a failure when I have a much better chance of success with the DS, I want to have a fully functioning regular stomach where I can eat regular normal-sized people amounts of food, I don't want dumping, & I want to be able to take anti-inflammatories.

With all that said, I know that there are RNY people who are successful & I certainly wish anybody who goes through WLS success.  It really saddens me that there's so much misinformation out there & people who don't even know it's an option b/c data shows that there's going to be people who aren't succesful with the band or the RNY who would have been successful with the DS - not all of them, but most.

 

Very, very interesting! In my family, there's about 12 of us that have had the RNY. There's only two of us who have problems with dry food items, such as chicken. In my case, I just had supper with about 4oz of prime rib, corn, mashed potatoes and pie. There's not much I can't eat, but make sure I don't go crazy and overeat (I don't think I could if I tried).  I'm over two years out and have been at the same weight for a year, after the weight loss stablized. I'm at 120. I've also read some of the information about the weight gain, but I'd like to believe its because the individual might return to old habits that got them there in the first place.
 
However, I can see you're very committed even willing to spend your own dime to have it done. It will be very enlightening to hear of your progression through this, because the process sounds very logical for success. You're right, there is a lot of misinformation out there. I also don't feel positive about programs that lead the patient to believe that their vitamins are the only ones they can take for life (of course, they buy them from the program) and they have to go through weeks of preop Optifast (that they also buy through the progam). Research doesn't support those two procedures, only the program marketing department does.

In what part of Mexico is your surgeon?

Oh yes!  I had forgotten about the needing to buy X vitamins & Y shakes from the MC program, & to be fair, it's probably pretty common in a lot of bariatric programs.  Yes, I personally think that's unnecessary.  There certainly will be a fair # of people going through WLS who want the end result *****ally don't know much about how to prepare or care nutritionally for themselves & having the shakes & vitamins be required purchases will ensure that everyone gets what they need nutritionally, but not everybody needs to be held by the hand in order to obtain comparable products for less $$.

My cousin had the RNY about a year ago now.  She had a 38 BMI &, at least on my mom's side of the family, she was the second biggest person following me.  I win hands-down for that one.  My mom has a big family too!  She has 6 full siblings & 3 half siblings.  Of course, all of these siblings are now in their 20's - 30's & have kids of their own, lots of people every Christmas!  She's doing great with it & loves it.  She dumps big time on sugar - 2 cookies is enough to make her dump for 4 hours, but she likes it for the behavioral modification effect.