Good Morning. Ugh! I hate the main board

Me TOO !!

Peace love and happiness RULE !!

I can't understand why people can't say what they like/don't like about their paticular surgery without knocking another one.  Just as every surgery is different so is every individual. 

I love my RNY but I would have considerd a DS if I had known about it several months earlier but I didn't want to switch surgeons or postpone my date until I had time to check it all out.  I'm very happy with my RNY!!!!

Believe me if you are anything like me, an RNYer can be a stinky person too!   I would have to be practically fat and carb free (which I'm not willing to do) to be immune to it. 

I'm another stinky RNY'er!  LOL

I'm forever tooting away all day long, it's especially bad when I'm exercising.  Which is a bummer as I can't take any exercise classes because of it.

For me it's Protein shakes that are the cause.  When I was on vacation this past spring and didn't drink any shakes (but did eat bread and "GASP" the occasional piece of cake or chocolate!) I had no gas issues at all.

I really wasn't knocking anyone else's surgery just answering the original question based on i guess mostly hearsay in truth.

But hearsay has its place too ... people discuss all the surgeries in the OA groups I attend and I have LOTS of friends who had surgeries of all kinds over the years .

I was just trying to help and answer her question regarding the ( relatively few and probably pretty uncommon but still POSSIBLE ) negatives of DS surgery .

Very few people who had a negative experience with a DS are here on OH talking about it ... that still doesnt make the DS a perfect surgery for everyone .

I too probably would have gotten a DS given a choice .. and may get revised to one if I regain in the future . That doesnt change what in my opinion are the DS 's minimum requirements ...

a willingness to closely monitor Ur vitamin levels for life .. to supplement daily and aggressively .....and be VERY responsible and hands on advocationg for Ur own health now and forever .

U perhaps DO take a bit more risk with Ur long term health by choosing a somewhat more aggressive WLS - particularly one that is not widely practiced whose practitioners are a mere handful across the country and internationally . Very few physicians have ANY experience bringing back DS patients to good health whose well being has run aground .

There ARE far more bariatric centers and bariatric physicians experienced treating RNY patients in trouble large and small because HAS been the gold standard and the go-to surgery for YEARS .

I have seen people with DS es and Rnys and band surgeries get jumped all over when they come here asking for help a few years post op when they are ill and havent taken perfect care of themselves .

Could it be that deep down a lot of OH ers dont want to acknowledge the risk theyve taken on long term and are effectively blaming the victim for what is not their fault or only very partially their fault ?

It was this group of people who are generally driven AWAY from the main board who i was trying in sense to speak for .

They DO exist .. risks of ALL of these surgeries are REAL .... and sticking our heads in the sand and saying its all rainbows and pattycake for everyone years post op is just not a TRUTHFUL answer when someone requests information about the potential negatives regarding a specific surgery .

Ava,

There are only two points of all your reasons that I have issues with.

U  perhaps  DO take  a bit  more risk with Ur long term health by choosing a  somewhat  more aggressive  WLS - particularly one that is not widely practiced  whose  practitioners are a mere handful across the country  and internationally .     Very few physicians have ANY experience  bringing back  DS patients to good health whose  well being  has  run  aground . 

We might but part of that reason is that a vast majority of DS'ers are far more morbidly obese...typically in the 50 + BMI as many insurance companies wrongfully thought it was only appropriate for those individuals...and many baratric surgeon's agreed...mainly those with little experience with the DS. So if you start with a much less healthy group of individuals, obviously you will get skewed results.

There ARE  far more  bariatric centers and bariatric physicians experienced  treating RNY patients in trouble large and small because HAS been  the gold standard and the go-to surgery for YEARS  .  

That's true but the reason is monetary for the most part. It takes an average of 2 hours to do a RNY, 4 -6 hours to do a DS. If a surgeon wants to make money, obviously he will opt to do 2-3 RNY's in the same amount of time he would spend doing ONE DS. Plus add the learning curve...it takes more skill to do a DS, especially a revision.

Not sure why the RNY is the gold standard but by default of being more profitable, it is. One day that may change.

Okay, this comes up a lot so I'll explain what it means when something in medicine is considered the "Gold Standard".

It means that the results are acceptable enough vs. the risks that whenever a new procedure or modification is proposed, it is measured against this "gold standard" way of doing things to determine if it's viable.

That's it.

It doesn't mean the procedure is better. It doesn't mean the procedure is the one everyone should get no matter their individual circomstances. It means you need to be at least as good as it in order to be considered viable.

To give a less controversial example than WLS types: Body fat % tests.

Hydrostatic weighing (dunk tank) is the Gold Standard in that. All other methods are measured against it. But DEXA scan is actually more accurate. Hydrostatic weighing came first and its accuracy is adequate for its cost. Therefore it's the standard the others are measured against.

Why isn't DEXA the Gold standard? Because it's more expensive. The idea is that to be a viable alternative you have to either be more accurate or less expensive or both. If DEXA scan was less expensive, it would be the new Gold Standard.

It's the same with WLS. RnY gives acceptable results with acceptable risks. For a surgery to be considered by ASMBS (and similar groups in other countries) as viable, it has to give results in the ballpark of RnY. If a procedure is riskier, it has to be more effective (i.e., DS). If it's less effective, it has to be safer (i.e., lapband).

VSG is interesting because it's about as effective as RnY, but less risky. Therefore, VSG is in line to some day be the Gold Standard but only if long term results continue to show it being as effective with less risks. Even then, if the medical profession considers the risks of RnY to be acceptable, it may remain the Gold Standard as a way of saying that any new surgery can be as risky as RnY and still be okay as long as it gives similar results.

On October 31, 2011 at 3:07 AM Pacific Time, MajorMom wrote: I can't see most of the posts you guys are complaining about... Block is a wonderful thing, sometimes!

I really hope it changes too .

And I totally agree w Ur two points just for the record ...

it isnt fair to us as the patients that a profitable , easy surgery is much more often done than a complicated one which better serves the majority of this populations needs.....

add lapband to the equation its even MORE skewed in the surgeon's vs the patients ' favor ..

But there IS another side to this too . The physicians oath says first and foremost ..I swear to do no HARM.

Last night I thought about the immediate group of patients I went into surgery with . This being NYC we basically had our own floor and we saw the anesthesiologist /preop appointments at the same time so we had many hours to get acquainted in the waiting room before and after when we were supposed to be walking the halls.

There was one construction worker from another country ( male ) *****fused to follow the docs diet post op and got severely dehydrated and scared ... he just wouldnt or couldnt EAT . The way he looked REALLY scared me at our three week follow up appointment . I think he finally ended up turning back to the fast food that got him that way ...

There was a very young rebellious almost SMO female who wouldn't STOP eating even right up to the surgery ( and we had a doc mandated liquid diet ) and she was non- stop snacking and eating in the waiting room even the day before . I never saw her AFTER surgery ...

There was a SMO diabetic guy with a persistent deep foot infection who almost didnt get his surgery because two days before ourscheduled bariatricsurgery cellulitis related to his foot infection put him in the ER and on CIPRO .

He did outstandingly well weight loss wise and his infection also went away post op ... but I wonder if he would have SURVIVED a DS . He sure didnt look good when i sawhim waiting for the anesthesiologist ... I was shocked ( but very happy ) to see him as a post op !

I believe he was given a distal RNY or a sleeve . He went into surgery just wanting ANY surgery to save his foot which would allow him not to get over the weight threshold where U CANT get surgery anymore ...

I wasnt the queen of diet compliance post op either ... I did a LOT of experimentation . But at least i walked and walked some more .

And finally there was a very ill older man from a nursing home who had had early strokes and had MANY co mordbidity type health complications tothe pointthat he could no longer live alone .

. He was basically charming ... and WANTED To follow orders very badly but realized he'd have ridiculously little control over his food in the long term institutional setting he was returning to . The hospital itself understood the post op liquid diet the doc prescribed to mean NOTHING LITERALLY but clear broth three times a day . I thought i was gonna DIE of starvation !!

When i think of him I also wonder how he possibly could get all the necessary post op vitamins in the institutional setting he was returning to .

Incidentally I have seen NONE of these people on OH though I told them all ( except the young girl ) about it and how to find it .

So when I think of docs making the " easier to operate " choice ... I also have to take into account the reality of the patient pool . We're nowhere as articulate , self advocating and have as many options for post op care as the average OH er .. at least judging anecdotally by my fellow patients .

My roommate was another lady ( a lightweight) originally from another country who had chosen a lap band . Again she barely spoke English and went right home after one night . I think I DID see her at a patient party the next year and she hadn't lost much . I suspect there were quite a few Spanish speaking lapband patients who I never spoke with who only spent one night in the hospital recovering . All the other patients I've desribed were RNY's or " ill take what he gives me when he opens me up" in the case ofthe diabetic guy .

Do I HAVE to tell you that I was the ONLY patient out of my patient group who actually walked the halls regularly as told was VERY important for healing ?

Just putting myself into my surgeons ' shoes im AMAZED he took the risk to operate on many of us at ALL . Every one of us had an astounding array of co morbidities- long term diabetes , high blood pressure ..SERIOUS medical histories like heart attacks , arrythmias persistent infections and breathing complications .

I think bariatric dioctors judging by this patient group really are the heroes of a VERY challenging group of patients many of whom have SERIOUSLY daunting co morbidities and also language and often willingness challenges .

If Ure not going to get up and WALK post op to ensure U don't get blood clots how compliant are U likely to be with changing Ur diet forever ?

Which in a weird way makes the DS make the most sense ... but if I put myself in the shoes of the surgeon ... no way would I risk getting sued for malpractice to give an even MORE complicated surgery to this group of patients ... none of whom honestly gave me the impression they could reliably manage a TENTH of the long term requirements of a DS .

Anecdotally again .. I heard from my surgeon and his nurses that VERY few of the patients he operates on ever return for follow up appointments much less support groups ( because i offered to start one ) . This is NOT because they are not totally caring and sweet I can assure you . And the average copays insurance wise are TINY or nothing at all. Again .. scary .

Here's another aspect of things ... just to lay it all on the table .

How compliant are we vitamin wise after surgery .. HONESTLY ?

I may be somewhat younger than the average OH er ... but I took vitamins long before my WLS surgery which was NOT the case for any of my fellow patients .

That said and given that I read and learned on OH for a full two years before my surgery .. I SHOULD be totally vitamin compliant now right ?

Well .. honestly I take my calcium maybe once a day if Im lucky ( in a mega dose and who knows how much ofthat gets absorbed ) more realistically every two days when i remember .. i keep running out of my chewable childrens multi vitamin sour gummi bears so i inadvertently take holidays with them too ...

and too often back myself into a vitamin corner where I am getting charlie horses from some kind of deprivation late at night ...

What im trying to say is SOME Of us actually need the Punishment of feeling bad to really take our vitamins .. including me *****ally knows better .

But I have way too many OA acquaintances who NEVER supplemented at all post WLS . They've lost inches in height and maybe years of good health...

Again do I think it would have been responsible to hand them a DS with all of its SERIOUS post op requirements ? Uh Uh . I 'm not SURE I could have been responsible enough with one MYSELF !!

We really forget that like minded intelligent educated articulate involved OH ers do NOT accurately reflect the WLS patient pool .

Also self - reporting errs notoriously on the POSITIVE side ( im sure other folks Ud NEVER guess arent 100 % compliant with their vitamins either ... ) so we may have a far more positive impression of our fellow OH ers compliance than the reality actually warrants ...

If we're pushing for a general acceptance of the DS based on frequently responding OHers as a pool ... and based on their self reported rates of vitamin and post op compliance ... we may be VERY inaccurrate regarding the REAL WLS population .