Got Approval from Cigna for RNY, but had to say.... No Thanks, I pass.

I know that WLS is the only hope I have to live a more pleasurable and longer life. And like most first learning about WLS, we become familiar with the Lab band and RNY surgery.  I'm now trying to get Approval for the Duodenal Switch surgery.  

 

 

 

Here are just some of what I discovered about the Duodenal Switch surgery and why I switched.   I changed to DS because it seemed to offer a more "normal" lifestyle.      It’s looked to me that RNY patients have to diet for the rest of their life As a RNY’er it seems one would have to shun sugar and fat for the rest of their lives.  To me this is a "punishment." not a lifestyle.  Another plus with DS is you keep your pyloric valve, which allows food to pass from the stomach into the intestines in a controlled manner. Because you essentially keep a "normal" stomach--albeit about 75% smaller than it was before--you don't have some of the problems associated with the RNY and it's "pouch" i.e. dumping syndrome.   

I chose the DS for many reasons:  I want to be able to drink with a meal. I didn't want to chew chew chew my food into mush.   I wanted to be able to eat a piece of cake,pie,candy or some ice cream once in a while. I want to not fill fearful of wanting something and not be able to have it ever again.  

Advantages of the DS over the RNY are: (1) it allows the person to eat a much more reasonable amount of food at each sitting (people with a RNY are given a stomach pouch that accommodates just one or two tablespoons of food); (2) it allows the person to eat a wider variety of foods (essentially, there are no restrictions); (3) it maintains the pyloric valve which allows food to pass naturally from the stomach to the duodenum which means significant quality-of-life differences such as: (a) greater ease in swallowing (and therefore greater enjoyment of food and compliance with prescribed protein, vitamin and mineral intake); (b) fewer painful, life-threatening blockages (which occur with the RNY when food such a bagel is either too doughy or it is not chewed thoroughly enough); (c) no "dumping syndrome" which is an extremely unpleasant feeling of nausea, sweating and heart palpitations that people with the RNY experience when they eat too much sugar (sadly, many RNYers feel they deserve this "punishment" for eating sweets); (4) virtually no vomiting (a person who has had a RNY will typically vomit when he or she eats more than his or her tiny stomach pouch can accommodate); (5) it allows a person to lose between 70% and 90% of his or her excess weight (versus the 60% to 80% of the RNY); (6) and perhaps most important of all, it does not allow the person to regain any weight whereas it is not at all unusual to hear of a 60- pound weight regain of a person who has had the RNY. The two key disadvantages of the DS are: (1) the consequences of non-compliance with the required intake of protein, vitamins and minerals are more severe (i.e., malnutrition).  (2) the person may have more frequent bowel movements/bad Gas 

 For more info go to www.duodenalswitch.com  or to the duodenal switch forum.

 

 

 

 

 

Hey there. You have to chose the surgery that is best for you so it is good that you finally found the one that you want. I would think if you got approved with an RNY, that they can just change that to the DS without having to go through the whole process agian. Have you asked your surgeon about it so that you can go ahead and go through with it? The only problem would be if your insurance carrier has an exclusion from the DS but most who approve the RNY will approve the DS. Hopefully you can get it changed to DS without jumping through any hoops. Good luck and congrats on the approval.

Thanks Misty, My first doc/Dyer doesn't do DS. It looks like the first  hoop is to get my first Doc's office to fax's all my paperwork to the new Doc's office. .

 

I do hope you will not turn into one of those DSers who "flames" other WLS. I sounds like you have bought into some of the most common misconceptions about the RNY that tend to be spread by the DS group though. I researched the DS as well as the RNY before making my decision that the RNY was the better surgery for me. 1. (people with a RNY are given a stomach pouch that accommodates just one or two tablespoons of food) - I am 20 months post-op and I can eat about 3/4 to a cup of food depending on the density. This is a very satisfying amount of food as opposed to the massive meals I used to consume. (2) it allows the person to eat a wider variety of foods (essentially, there are no restrictions) - the DS diet is also protein first and excessive intake of sugars and refined carbs can lead to unpleasant side effects. (3) it maintains the pyloric valve which allows food to pass naturally from the stomach to the duodenum which means significant quality-of-life differences such as: (a) greater ease in swallowing (and therefore greater enjoyment of food and compliance with prescribed protein, vitamin and mineral intake) - Neither surgery involves the esophagus which is what is involved in swallowing. (b) fewer painful, life-threatening blockages (which occur with the RNY when food such a bagel is either too doughy or it is not chewed thoroughly enough) - I have never heard of this one... "life-threatening"? Perhaps if I swallow something whole. Since the tastebuds are in the mouth, I choose to chew my food and enjoy the flavor instead of swallowing it whole. (c) no "dumping syndrome" which is an extremely unpleasant feeling of nausea, sweating and heart palpitations that people with the RNY experience when they eat too much sugar (sadly, many RNYers feel they deserve this "punishment" for eating sweets); - Not all RNYers dump just as not all DSers have bathroom "issues". The misconception that "RNYers feel they deserve this punishment" is a DS statement. I look at the possibility of dumping as another tool to help me avoid eating items that have little or no nutritional value. I still have small but very satisfying amounts of sweets. Since I am, and always will be, a carb addict as well as a volume eater, the restriction and possibility of dumping made the RNY the best choice for me. Also, with IBS, I did not need the bathroom side effect of the DS. I talked to enough DSers while doing my research to know that the DS is not IBS compatible. (4) virtually no vomiting (a person who has had a RNY will typically vomit when he or she eats more than his or her tiny stomach pouch can accommodate) - Again, not true for the majority of RNYers. I have had no vomiting since my surgery. Most RNYers I know who have had an issue with nausea and vomiting find it resolves within a couple of months after surgery, much like DSers. (5) it allows a person to lose between 70% and 90% of his or her excess weight (versus the 60% to 80% of the RNY) - I've lost 92% of my excess weight and am still losing even 20 months out. (6) and perhaps most important of all, it does not allow the person to regain any weight whereas it is not at all unusual to hear of a 60-pound weight regain of a person who has had the RNY. - I was part of a "support group" for 5 months that was mainly DSers. Several of them had not reached their goal weight even 4 or 5 years out and some had regained 25 lbs or more. There was even one lady who had only lost 60% of her weight in the 3+ years since her surgery and was now regaining. She was looking into a revision to "trim her stomach pouch" to see if it would help her start losing again. You have to decide which surgery is right for you. If that is the DS then by all means go for it. Just be respectful of other peoples choice of surgery type while you are at it. Whatever you decide, I can highly recommend Dr. Spaw. He is the only surgeon in TN who does the DS and he is a kind, compassionate and caring person. He also happens to be a wonderful surgeon. You will be in good hands.

Susan,

Thanks for the post, nope, I don’t have any plans to become anything more than what I am, I fat man trying to make a decision that’s going to affected me and my family for the rest of our life’s.

 I could not and would not tell anyone what WLS is best for them, just like you I believe everyone has to decide which surgery is right for them. DS is the one that I have selected for me.

   We all want the same thing, a chance for better health and lives. I don’t give a rat’s patooie which surgery anyone else gets; Knowledge and understanding is the only thing I’m preaching.

My post is just for the understanding there’s more than the two main WLS to choose from. I think people do have the right to be informed about all of the procedures.

Information is a good thing. Misinformation is not. I just want to make sure you understand the difference when posting about the surgery types.

I just wanted to say Fat G that I was also concerned about what you posted concerning RNY.I  KNOW it is important to research all surgeries, as you appear to have done. My concern was that some of your information was off . The info you posted looked as if it might have came directly from an DS page. I do not dump, which was something I wanted so as to be more wary of sweets, my downfall LOL. I really just wanted to advise you that: You are the only one who can decide what is best for you; everything you read about the surgeries...you get better info on ACTUAL results from actual patients; looking at the kind of eater you are with dr/therapist will really help with determining best choice;WE ARE IN THIS TOGETHER & YOU HAVE OUR SUPPORT NO MATTER WHAT YOU CHOSE!!!!! I wish you the best!!!

I can only speak to why I chose RNY.  I was more than willing to make all the sacrifices to become healthy and lose weight. I knew the complications, etc.  and made the decision.  Now what really concerns me is that it sounds like you want the best of both worlds... to lose all the weight but not "pay the price" so to speak.   I hope this isn't true and it may be a misinterpretation of your post.  But good luck and I hope you are able to get approval for the procedure you want.

Hi G, I agree with the other posts regarding RNY vs. Ds.  I am a RNY, I never had any dumping, no gas, the only time I was sick to my stomach is because I am on chemo pills for leukemia.  I have lost over 100% of my excess weight.  I started at 299, my goal for January 2007 at my one year was 130, I am at 115 lbs.  I am still losing inches and pounds.   I hope you find what is best for you, but like the last post you sound like you want the best of both worlds.  I do know that with the DS you stand a greater chance of suffering malnurtionment.  Be careful and really do more research. Kathy

Please don't feel like this post is trying to sway your decision.  It is honestly not.  It is just an opinion. I just want to share a couple of real life experiences that I know of. I know a couple of people that had the DS and they DID regain some weight. 

Not all RNYers experience dumping.  I don't and have had only a mild case from eating greasy food (which I knew I wasn't supposed to).  I don't feel like not having sweets is a punishment.   I am also  patient of Dr. Spaw's.  He gave me a picture of my liver after surgery.  Talking about an eye opener!!!!  My liver had as much fat on it as my body.  I too thought about DS but after seeing the picture of my liver, I am glad that I chose the more "restrictive" surgery.  I took the picture to my PCP and she (and Dr. Spaw) told me that if I had not made the change I would have had serious liver problems down the line. But again, this is my experience and just my opinion. Good luck!!! I hope all goes well for you.