Read this question carefully
Thanks, Anita... but just Rockne to you, girl. ;-) The only one person alive I insist on addressing me as " Mr." is my father and only because that's a running joke between us.
As to your pondering the following:
"Then why do insurance companies mostly only do the RNY and Lapband? It's the radical malabsorption, I would think. I honestly just do not know. " But for a few hard-line resistant companies, it can now be generally said that if you meet their criteria qualifying for ANY WLS, the DS is just a valid an option as the more commonly done types and WILL BE COVERED. In the event appeals are necessary they are being won in countless numbers. That said, there are far fewer surgeons that offer the DS.
Why? $ and skill.
The DS is a technically difficult operation to master. The duodenoileal anastomosis being the most difficult part of the surgery to do and do well. Frankly, the skill level for all other WLS types requires only a mastery of fundamental surgical technique. I would qualify that a bit more in suggesting those surgeons who do other WLS types laparoscopically learn a unique set of skills that are not easily so mastered and those skills performed well are to be admired quite apart from whatever surgery they endeavor to do.
The DS is also time consuming by contrast. An RNY can be knocked out in a mere 45 min by many practitioners. My open DS and the standard removal of the gallbladder took 3.5 hours which is fairly typical. Do the numbers... as in the number of operations one can do in a day/month and yearly. Hospitals, surgeons are not immune to making a pretty penny, and the whole field of Bariatrics is rife with revolving surgical mills designed to maximize profits. With managed care these days, it's a sad fact but true. The DS commands only a slightly higher cost to the insurance companies but it doesn't follow that DS surgeons make any more than other bariatric surgeons just by the numbers. I would argue in many cases, less, unless they are also performing other types of WLS interventions, and frankly most do. They have to, to stay solvent. So your out of Med school, owing hundreds of thousands of dollars in school loans, but not quite wet behind the ears having just finished a general surgical residency and you know bariatrics equates to making some pretty good money with a relatively short learning curve to mastery. Hmmm? Now what WLS types are you going to take the trouble to learn? You'll spend an inordinately longer time mastering the DS over any of the others and damn it... you've got bills to pay and maybe a family to support by then. Why the hell bother even learning to do the DS? Simple but hard. Why? Because you really care about your patient's outcome. Not just the short term gains where you are beloved by your patients the first few years they lose but you also care about their long term benefits. FAR LESS, IF ANY SUBSTANTIVE REGAIN with the DS and you have the long-term logintudinal peer reviewed studies to support the work you are doing. Better metabolic profiles years out with your patient's supplemental compliance. "Quality of Life" long and short term for your patients as a practitioner actually has meaning to you. You believe in this technique and bottom line, you F**king CARE and refuse to readily blame your patients for failing once again on yet just another DAMN DIET... A DIET FOR LIFE after your careful surgical intervention. But you as a practitioner not only are seeking to give a person's health back, but a permanence thereto. And a life of NORMALCY. No, not a life in continued existence of living on nothing but junk and gluttony, but a life where all things can be enjoyed in moderation quite naturally and food becomes secondary to the PUNISHMENT that is the forever DIET SYNDROME. As for me. I've been there done that, like for a lifetime, and frankly, I have better things to do with my time. Diets are NOT for losers... Or those serious about losing weight permanently... at least from my viewpoint and the statistics bear me out here. If I want a fat burger, fries and a chocolate shake, I have it without beating myself up. It's likely I won't feel like that again for another month. Doesn’t even sound appealing right now. Tonight's menu... a simple greygoose martini followed by my own beef stroganoff with a few egg noodles. A gourmet's delight ...with milk, a fruit and green salad... and I may have either a slice of cake or a bit of ice cream later. Not the whole cake or a quart of ice cream like before, but a reasonable portion to satiation... Couldn't eat that much if I wanted to with my surgical restriction, but you know, .... Eating like normal people Tomorrow... Out for Sushi I think... Doesn't matter all that much, it's pretty much whatever I feel like and that's what NORMALCY and the DS is about. So I'll happily leave the four letter word "Diet" to other people's vocabulary... Rockne
As to your pondering the following:
"Then why do insurance companies mostly only do the RNY and Lapband? It's the radical malabsorption, I would think. I honestly just do not know. " But for a few hard-line resistant companies, it can now be generally said that if you meet their criteria qualifying for ANY WLS, the DS is just a valid an option as the more commonly done types and WILL BE COVERED. In the event appeals are necessary they are being won in countless numbers. That said, there are far fewer surgeons that offer the DS.
Why? $ and skill.
The DS is a technically difficult operation to master. The duodenoileal anastomosis being the most difficult part of the surgery to do and do well. Frankly, the skill level for all other WLS types requires only a mastery of fundamental surgical technique. I would qualify that a bit more in suggesting those surgeons who do other WLS types laparoscopically learn a unique set of skills that are not easily so mastered and those skills performed well are to be admired quite apart from whatever surgery they endeavor to do.
The DS is also time consuming by contrast. An RNY can be knocked out in a mere 45 min by many practitioners. My open DS and the standard removal of the gallbladder took 3.5 hours which is fairly typical. Do the numbers... as in the number of operations one can do in a day/month and yearly. Hospitals, surgeons are not immune to making a pretty penny, and the whole field of Bariatrics is rife with revolving surgical mills designed to maximize profits. With managed care these days, it's a sad fact but true. The DS commands only a slightly higher cost to the insurance companies but it doesn't follow that DS surgeons make any more than other bariatric surgeons just by the numbers. I would argue in many cases, less, unless they are also performing other types of WLS interventions, and frankly most do. They have to, to stay solvent. So your out of Med school, owing hundreds of thousands of dollars in school loans, but not quite wet behind the ears having just finished a general surgical residency and you know bariatrics equates to making some pretty good money with a relatively short learning curve to mastery. Hmmm? Now what WLS types are you going to take the trouble to learn? You'll spend an inordinately longer time mastering the DS over any of the others and damn it... you've got bills to pay and maybe a family to support by then. Why the hell bother even learning to do the DS? Simple but hard. Why? Because you really care about your patient's outcome. Not just the short term gains where you are beloved by your patients the first few years they lose but you also care about their long term benefits. FAR LESS, IF ANY SUBSTANTIVE REGAIN with the DS and you have the long-term logintudinal peer reviewed studies to support the work you are doing. Better metabolic profiles years out with your patient's supplemental compliance. "Quality of Life" long and short term for your patients as a practitioner actually has meaning to you. You believe in this technique and bottom line, you F**king CARE and refuse to readily blame your patients for failing once again on yet just another DAMN DIET... A DIET FOR LIFE after your careful surgical intervention. But you as a practitioner not only are seeking to give a person's health back, but a permanence thereto. And a life of NORMALCY. No, not a life in continued existence of living on nothing but junk and gluttony, but a life where all things can be enjoyed in moderation quite naturally and food becomes secondary to the PUNISHMENT that is the forever DIET SYNDROME. As for me. I've been there done that, like for a lifetime, and frankly, I have better things to do with my time. Diets are NOT for losers... Or those serious about losing weight permanently... at least from my viewpoint and the statistics bear me out here. If I want a fat burger, fries and a chocolate shake, I have it without beating myself up. It's likely I won't feel like that again for another month. Doesn’t even sound appealing right now. Tonight's menu... a simple greygoose martini followed by my own beef stroganoff with a few egg noodles. A gourmet's delight ...with milk, a fruit and green salad... and I may have either a slice of cake or a bit of ice cream later. Not the whole cake or a quart of ice cream like before, but a reasonable portion to satiation... Couldn't eat that much if I wanted to with my surgical restriction, but you know, .... Eating like normal people Tomorrow... Out for Sushi I think... Doesn't matter all that much, it's pretty much whatever I feel like and that's what NORMALCY and the DS is about. So I'll happily leave the four letter word "Diet" to other people's vocabulary... Rockne
Maybe I need to edumacate myself more on this DS business, but am I understanding correctly? If you have a DS you can just eat whatever you want?
No, not completely. The stomach restriction, which is pretty small in the beginning, relaxes to about 2/3 the size of a normal stomach by about 2 years out, allowing the eating of a small normal meal. Sugar is still 100% absorbed, so that's not "free," although there is no dumping. Complex carbs, in particular refined white flour, can cause gas -- so while you can eat them, there can be consequences later (farting, and for some, bloating) -- but if you WANT to eat them and are willing to deal with the consequences later, you can (I "TiVo" my occasional eating of bread and pasta for dinner or on weekends).
But what you can eat is a lot of protein and a lot of fat, which makes for easy eating -- high density, not necessarily high volume.
Also, the removal of the ghrelin-producing tissue of the fundus of the stomach and the restructuring of the intestinal tract changes the appetite to some degree. Although I was never a sugar addict (salty/greasy'savory is my preference to sweet), I find sweet stuff is even less attractive to me now -- when I'm hungry, I want PROTEIN. It is fantastic that more often than not, what I WANT to eat is what I SHOULD be eating.
So, in that sense, YES, with the DS, I can eat pretty much whatever I want. I just want different things, most of the time! And because the DS is more forgiving, with 80% of the fat I eat passing through me without being absorbed, sometimes, when I want to eat the WRONG things, I just go ahead and eat them.
Most Active
Recent Topics
