Is DS an option for a lightweight in Ontario?

Hi All,

I'm new to this board and have a question about DS vs. RNY. I'm 5'2" and about 230lbs. I qualify for WLS and in Ontario (I'm in Toronto) the standard surgery is RNY unless there are health issues that require an alternative surgery. My understanding is that DS was usually reserved for people with BMIs over 50, and I'm only at about 42. I have been reading though about reactive hypoglycemia and how it may be related to the removal of the pyloric valve in RNY and also that statistically, in the long run, DS seems to result in a higher proportion of excess weight lost and kept off. I'm curious about whether any people with BMIs in the low 40s have had DS and whether anyone has had it done in Ontario and what the process for approval was? If you have any articles or papers on it I would appreciate it you would pass them along. Thanks everyone!

 This was just posted in the main forum.

http://www.obesityhelp.com/forums/amos/4392492/X-Ontarians-m ay-be-approved-for-DS-through-OHIP/

Yeah, I know, I read it but it doesn't say anything about what the requirements are. That's why I'm asking specifically whether any lightweights have been successful in having this covered through government (in Canada) or insurance (in US).

Canada? Don't know. US? Yes. There are some here. Maybe they'll chime in once they are done celebrating the holiday weekend.

In the meantime, this is my personal take on why I got a VSG and not a DS (or anything else) and on picking a WLS in general:

Statistics are not predicative to the individual. So, yes, DS has the best stats overall. But some people do above average for every surgery type and some people do below average. That means some people don't do well with a DS too. So you need to know YOU and what you think will work for YOU. You have to be realistic and honest with yourself so you get a WLS that works with you and not against you.

I am great at dieting and only fail at maintenance due to a voracious appetite. So I figured I'd rock any WLS when it came to *losing*. Therefore, the losing statistics of each WLS weren't a big factor in my decision.

The big question was: how was the hunger control? I knew, without good hunger control, I'd gain my weight back. I didn't want to pay for surgery and take on the risks of that particular surgery type and then end up white knuckle dieting to lose my weight and eventually gaining it all back. Or having the hunger control "wear off" after a while so I went back to being hungry all the time and gained my weight back. I figured I could do that without surgery. Therefore the risk of not getting true restriction and the hunger control that comes with had to be under my personal threshold for risk.

So... my bottom line was: I wanted the surgery with the most hunger control with the least risk. I was willing to go with something less effective on paper to reduce risks but only up to a point. There had to be a minimum threshold of certainty that I'd get hunger control and avoid regain.

For someone else, the equations are going to be completely different. Someone on the main board said yesterday something to the effect of "DS has the best weight loss stats and that's the most important thing." Well, as you can see, that's not the most important to ME. But clearly it was for her.

Oh and just because someone is a lightweight, doesn't mean they don't *need* malabsorption. I didn't need it. But some people have metabolic conditions that make weight loss difficult. Others have exercise restrictions. And some people just *want* it for whatever reason and that's okay too.

Welcome aboard!  I didn't have my DS in Canada but I remember LWs getting approval in Canada back in 2007-2008 by stressing their comorbidities and their need to be able to take NSAIDS for the long term due to arthritis. NSAIDS are not to be taken after the RNY and that got several LWs over the restrictions. Is it a given that they will fight you if your BMI isn't above 50? I think that  may be a different rule than many of us have seen in the US.

Wishing you good luck in your fight and I hope you'll stay here for support regardless of what happens.

--gina

Thank for the response. I have also heard from a LW on the Ontario board that spent thousands of dollars and a full year fighting in Ontario for a DS and even with expert testimony from the leading surgeon on DS, she was denied as her BMI was only 46 - my understanding is that it simply is not done in Ontrio under any cir****tances if you are under a BMI of 50. Someone suggested getting a VSG which I would be eligible for due to my need for NSAIDS, and then self-paying to have it switched to a DS, which would cost less. Any thoughts on the viability of that as an option or what the cost might be?

That could be an option, getting the VSG first, but you would likely lose too much too quickly to qualify with a reputable surgeon for the intestinal switch after the first year. If you're looking for an affordable self pay solution, you might want to look at Dr Ungson in Mexico or Dr Marchesini in Brazil. www.DSFacts.com may have contact info on those 2 surgeons.

--gina
 

Yeah, if you want the DS, it's probably better just to get it. Every surgery has risks so you want to avoid having more than one of them if you can. Plus, I don't think you'll save that much money. Most surgeons charge more do to a revision than to do a virgin surgery.

Would you consider VSG as a stand-alone rather than going all the way and having DS? It just might work for you. 

I have considered it, but I am truly skeptical of my body's ability to lose weight without some kind of malabsoption. I am even skeptical of it's ability to maintain my weight without it, my metabolism is severely broken and I am slowly, constantly gaining weight. I can't find any explicit medical reason for this, I am 'low' but not pathologically low in thyroid function and some nutrients and have been supplementing to help with my energy. It's been a long, slow problem since puberty and I've finally just last year past the line into qualification for the RNY. If DS is just not an option, I will try the RNY, I just fear that once proper absoption comes back I may gain slowly, but uncontrollably again. My one hope is that I'll be able to get by on radically smaller meals without the fear of hunger induced headaches and I might be able to maintain my weight loss with just the pouch. I'd like to be able to take NSAIDS due to my migraines, knee problem and gyno issues, but I'm willing to manage them with narcotic pain meds if necessary, so it's not a deal breaker for the RNY. I'll bring up my concerns with my surgeon and see if he offers any hope, but I'm doubtful. I've just been quite surprised by how well the DS outperforms the RNY in the long term and am most interested in a long term fix.