I would appreciate insight into duodinal switch verus sleve for lightweight
Hi -- I am worried about my husband who is diabetic, 39 on the wheel of weight/height (5' 11' at 278) -- we went to a seminar where they talked about gastic bypass, banding, duodinal switch and sleve. But when I called to get detail on cost (insurance does not cover bariatric surgery), I got a call back from someone in Kentucky who strongly recommended we just do the sleeve because they have done so many reversals with the duodinal switch with pateints getting diarreah and malnutrition. My husband lost 30 pounds on the Atkins diet but said it was because he stopped taking his meds...recently he lost 10 just dieting. Since he has only 70 to loose I am worried about him not healing well from the surgery as his wounds heal slowly. Also he is a tobacco chewer and I am worried that he'll continue and that will be a problem. He wants the duodinal switch instead of just the sleeve because the doctor said he would no longer be hungry because the hormones are gone that make you hungry. I wonder whether maybe trying the switch first might be less invasive and safer? I was so happy to see this site because when I read the articles out there on duodinal surgery from research released 2 days ago it lookedl like it was saying that it's best for those who are superobese and that's not him. He was the smallest one in the room. Thanks so much! Any and all insights happily appreciated. Also is it true what the doctor said that it's impossible to loose weight when you are on insulin without one of these surgeries?
Hi Newbiewife,
I am a LapBand revised to RNY bypass person but I am also a diabetic so I can tell you from experience having myself been on shots and insulin pills, that yes, it is VERY difficulty to lose weight when you are taking those meds. It is not impossible, but it IS much more difficult, especially if he is taking insulin shots.
I am off my shots as of last week but back on Metformin and I can tell you, my weight loss has just stopped since I started back on the Metformin. I am hoping this is just a temporary speed bump in my weight loss journey, but time will tell.
As far as invasiveness, the DS is probably the MOST invasive of the bariatric surgeries with the RNY being a close second due to re-routinh of the intestines with both surgeries. The sleeve would be next with no re-routing, but removal of most of the stomach.
They can make a larger stomach and/or reattach the intestines at a different point to lessen the malabsorption with either the DS or the RNY. That may be something to discuss with the surgeon.
You may also want to check out DSfacts.com, and I'm sure some of the DSers on this board will chime in with advice for you.
Best of luck to both of you!!!!
HW 287, GW 150, CW 168 ** Band to RNY 05/29/12 **
Starting BMI between 35 and 40ish? Join us-Lightweights Board!
I see you live in NY...you have some EXCELLENT DS surgeons there...Pomp (who did my husband's), Roslin (listed on DSFacts.com). Try one of those two.
Okay: I got a call back from someone in Kentucky who strongly recommended we just do the sleeve because they have done so many reversals with the duodinal switch with pateints getting diarreah and malnutrition.
We get diarrhea early on due to liquids in/liquids out but once on a normal eating plan, that tends to disappear and MOST of us end up being constipated cause we don't eat enough fat. Nutrition is handled by being anal about vitamins and getting and tracking your own lab work...understanding the levels, etc.
my husband who is diabetic, 39 on the wheel of weight/height (5' 11' at 278)
I was a 35.2 BMI, insulin pump dependent type 2 diabetic and my diabetes is now controlled by diet and exercise alone. My current BMI is 22. I am 5'4" and weighed 203 when I started my journey. I only had 58 lbs to lose to get to a normal BMI. Dr. Pomp was going to do mine but my insurance company said I had to stay IN state. And if it had not covered the surgery, it wasn't gonna happen. But my husband's insurance company allowed him to go where he wanted. He was 5'9" and weighed 265. (about the same BMI as your husband). Pomp did his and we could not be happier. He now weighs 152 (a 22.4 BMI)
Atkins is the perfect way of eating for the DS...we just seem to be eating all the time, LOL.
I wonder whether maybe trying the switch first might be less invasive and safer?
One surgery is safer than two, ALL the time...so don't consdier the sleeve as just the first step...consider it as your only option or go for the DS but not as a two step thought.
articles out there on duodinal surgery from research released 2 days ago it lookedl like it was saying that it's best for those who are superobese and that's not him.
While the DS is best for the superobese, it is also a GREAT option for those of us who don't need to lose as much. What the article says is that for the superobese, it's the better option. Not that it isn't a good option for us lightweights.
When talking to a DS surgeon, any one that says the because they have done so many reversals with the duodinal switch with pateints getting diarreah and malnutrition is not a DS surgeon...they don't want to do it cause it takes longer to do than the other surgeries and that is code for "I don't want to spend the time in the OR to do one cause I don't get paid enough" They can do 2-3 of the other surgeries in the same amount of time as ONE DS.
Also is it true what the doctor said that it's impossible to loose weight when you are on insulin without one of these surgeries? No, he's not right...what IS correct is that you can lose the weight but KEEPING it off is the almost impossible part...only 5% of the MO (anyone over a 35 BMI with a co-morbid) manage to lose weight and keep it off. But I am on a diabetes list where those who are on insulin do manage to lose weight. But they are usually not MO. I was excellent at losing weight but the second i dropped my guard, it came back and brought friends.
Liz
Okay: I got a call back from someone in Kentucky who strongly recommended we just do the sleeve because they have done so many reversals with the duodinal switch with pateints getting diarreah and malnutrition.
We get diarrhea early on due to liquids in/liquids out but once on a normal eating plan, that tends to disappear and MOST of us end up being constipated cause we don't eat enough fat. Nutrition is handled by being anal about vitamins and getting and tracking your own lab work...understanding the levels, etc.
my husband who is diabetic, 39 on the wheel of weight/height (5' 11' at 278)
I was a 35.2 BMI, insulin pump dependent type 2 diabetic and my diabetes is now controlled by diet and exercise alone. My current BMI is 22. I am 5'4" and weighed 203 when I started my journey. I only had 58 lbs to lose to get to a normal BMI. Dr. Pomp was going to do mine but my insurance company said I had to stay IN state. And if it had not covered the surgery, it wasn't gonna happen. But my husband's insurance company allowed him to go where he wanted. He was 5'9" and weighed 265. (about the same BMI as your husband). Pomp did his and we could not be happier. He now weighs 152 (a 22.4 BMI)
Atkins is the perfect way of eating for the DS...we just seem to be eating all the time, LOL.
I wonder whether maybe trying the switch first might be less invasive and safer?
One surgery is safer than two, ALL the time...so don't consdier the sleeve as just the first step...consider it as your only option or go for the DS but not as a two step thought.
articles out there on duodinal surgery from research released 2 days ago it lookedl like it was saying that it's best for those who are superobese and that's not him.
While the DS is best for the superobese, it is also a GREAT option for those of us who don't need to lose as much. What the article says is that for the superobese, it's the better option. Not that it isn't a good option for us lightweights.
When talking to a DS surgeon, any one that says the because they have done so many reversals with the duodinal switch with pateints getting diarreah and malnutrition is not a DS surgeon...they don't want to do it cause it takes longer to do than the other surgeries and that is code for "I don't want to spend the time in the OR to do one cause I don't get paid enough" They can do 2-3 of the other surgeries in the same amount of time as ONE DS.
Also is it true what the doctor said that it's impossible to loose weight when you are on insulin without one of these surgeries? No, he's not right...what IS correct is that you can lose the weight but KEEPING it off is the almost impossible part...only 5% of the MO (anyone over a 35 BMI with a co-morbid) manage to lose weight and keep it off. But I am on a diabetes list where those who are on insulin do manage to lose weight. But they are usually not MO. I was excellent at losing weight but the second i dropped my guard, it came back and brought friends.
Liz
Duodenal Switch (Lap) 01-24-11 | Surgeon: Stephen Boyce | High weight: 250 in 2002 | Surgery weight: 203 | Lowest weight: 121 | Current weight: 135 | Goal weight: 135
What Liz said, plus the DS offers the best long term resolution for diabetes out of any WLS. It offers a 99% cure with significant improvement in the remaining 1%.
Not everyone that gets a sleeve loses the hunger (you'll see quite a few on the DS boards as they often revise to get the DS). Note that with the DS you still have a sleeve.
Despite my being a 2 stepper, I still agree that a one step DS offers the best solution for successful long-term weight loss. It's also a lot cheaper as sleeve + part 2 DS = A LOT more than a full DS (in most cases unless specifically agreed upfront).
Not everyone that gets a sleeve loses the hunger (you'll see quite a few on the DS boards as they often revise to get the DS). Note that with the DS you still have a sleeve.
Despite my being a 2 stepper, I still agree that a one step DS offers the best solution for successful long-term weight loss. It's also a lot cheaper as sleeve + part 2 DS = A LOT more than a full DS (in most cases unless specifically agreed upfront).
Lowish BMI? See Lightweights Board! Lightweight Creed For more on DS see www.DSfacts.com
If you don't have peace, it isn't because someone took it from you; you gave it away. You cannot always control what happens to you, but you can control what happens in you John C Maxwell 
Sleeve 2010 Dr López Corvala, Mexico. DS 2012 Dr Himpens, Belgium
I 
my DS 
I really have no information on the switch but I thought I'd chime in anyway.
I also am a type II diabetic who was on insulin. My blood suger numbers before my preop diet, on 80 units a day of Lantus Solostar, 20mg of glipizide and 2000 mg of Metformin, were in the mid 200s. 3 Weeks a ago I had the sleve. I'm off all my meds. My daily numbers since the surgery average to around 150 and today's average is 133. This is all without meds and only 3 weeks post op.
I agree with the comments on losing weght on the meds. I'm 5'11" too and was 350 for the last 10 years or so. I tried diets. I exercised (swam 40 mintes a day for 4 days a week for two years) and I could never get the weight off. My surgeon and I had a discussion about insulin because I was worried about how going off all my meds would affect my blood sugars. He said something to the effect of "The goal of insulin is to reduce blood sugar. To do this it causes the fat cells and liver to store it as fat. This is counter productive to weight loss." (not an exact quote). So he feels and I agree that it's difficult to loose weight while on meds. I'm a convert I didn't believe at first that my blood sugar would come under control so quickly.
As to hunger. It's only been a short while but I haven't been hungry at all. It seems crazy to me but it's true. Again according to the surgeon. The portion of my stomach that was removed made the hormones that account for hunger. BTW, I believed him because he had the surgery himself.
Since the sleve is the first part of the original DS (I do know that much). I'd agree with the comment above that perhaps all that is needed is a sleve.
One final thought. I did consider a DS as a fall back if things did not work out. My surgeon and I talked and they can still do the bypass if things don't work out. I realize it's two surgeries but hopefully I won't need to second.
Speaking only for myself. I think having a Vertical Sleve Gastrectomy (VSG) was the best thing I ever did for myself.
Sorry to hear about the insurance. I was in the same boat. I had to pay for this all myself.
I wish you luck and hope the you and your husband are successful in your efforts.
I also am a type II diabetic who was on insulin. My blood suger numbers before my preop diet, on 80 units a day of Lantus Solostar, 20mg of glipizide and 2000 mg of Metformin, were in the mid 200s. 3 Weeks a ago I had the sleve. I'm off all my meds. My daily numbers since the surgery average to around 150 and today's average is 133. This is all without meds and only 3 weeks post op.
I agree with the comments on losing weght on the meds. I'm 5'11" too and was 350 for the last 10 years or so. I tried diets. I exercised (swam 40 mintes a day for 4 days a week for two years) and I could never get the weight off. My surgeon and I had a discussion about insulin because I was worried about how going off all my meds would affect my blood sugars. He said something to the effect of "The goal of insulin is to reduce blood sugar. To do this it causes the fat cells and liver to store it as fat. This is counter productive to weight loss." (not an exact quote). So he feels and I agree that it's difficult to loose weight while on meds. I'm a convert I didn't believe at first that my blood sugar would come under control so quickly.
As to hunger. It's only been a short while but I haven't been hungry at all. It seems crazy to me but it's true. Again according to the surgeon. The portion of my stomach that was removed made the hormones that account for hunger. BTW, I believed him because he had the surgery himself.
Since the sleve is the first part of the original DS (I do know that much). I'd agree with the comment above that perhaps all that is needed is a sleve.
One final thought. I did consider a DS as a fall back if things did not work out. My surgeon and I talked and they can still do the bypass if things don't work out. I realize it's two surgeries but hopefully I won't need to second.
Speaking only for myself. I think having a Vertical Sleve Gastrectomy (VSG) was the best thing I ever did for myself.
Sorry to hear about the insurance. I was in the same boat. I had to pay for this all myself.
I wish you luck and hope the you and your husband are successful in your efforts.
Paul...
HW: 360 SW: 342 GW: 175 CW: Click to find out
"Life is what happens while you're making other plans." - John Lennon
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