Question:
What is the truth about this procedure
Most of what I have read about the DS surgery looks promising to me - I want to be able to eat and live normally without the miniature stomach pouch, and to be able to keep the weight off over the long range. However, in my reading and emailing about it, I'm getting some conflicting information. For one, on the DS web page and on the MyWLS web page, I don't see anything about calcium problems, but one person has warned me, "severe calcium deficiencies and the fact they could be in a wheel chair in 5 years". Is this true? She also says that "some DS members hide facts", and that there is weight regain and severe deficincies after the DS. This same person also says that insurance doesn't pay for this surgery, and that I might be stuck paying what the insurance won't pay. I thought that's what insurance was for, to pay what they will pay, and then I'm not liable for anything above that. Why would all these DS sites lie about all of this? Who do I believe? I just want the true facts so I can go in with my eyes open about what to expect. — J R. (posted on September 14, 2000)
September 14, 2000
My Michigan BCBS PPO picked up the entire cost of the DS procedure and all
pre and post-op medical and psych assessments. As for the calcium
deficiency, none of the people in my support group, some of whome are 6
years out, are in wheelchairs. Yes, there is a possibility of osteoporosis
if we do not take the calcium supplements recommended. Because of the
amount of bowel that is bypassed, there is less calcium absorption. My doc
has me take 1800mg of Calcium (4 Viactivs or Citricals per day), and a
Vitamin D supplement to help with the absorption. I think the sheer
numbers of satisfied people, who are compliant with their doctors
recommendations prove to me that I made the right choice. There seem to be
a number of people who have a grudge against the DS procedure and DS people
because we seem to be able to shrug off the 'diet mentality' that seems to
continue with the pouch people. I would hate to think that the choice I
made about something so life altering was not the best, but for some
people, when that happens that means they have to run down the alternative.
I think Ava Lee said it best: Educate yourself, do your research, then
chose the surgery that best supports you in your goal. Many people have
opted for the behavioral controls built into the RNY, many people do not
need the aggressiveness of procedure that the DS is. At almost 500 pounds,
I did. I am VERY happy with my results to date and have had absolutely NO
complications or unsettling side effects. But then, I did my research,
including on the various local physicians, prepared myself mentally,
financially, emotionally and made sure I had plenty of friend and family
support. I can only speak from personal experience. Hope that helps...
— merri B.
September 14, 2000
You will get conflicting stories on ANY surgery type.. My best advice to
you is.. 1. talk to many surgeons ask questions..make a list of your
concerns and take it with you. (most seminars are free) 2. Go to some
DS support group meetings talk to those that are 3-8 years post-op.. Ask
questions also ask to see copies of their LABS..That might dispel rumors
one way or another.. One surgeon suggested that to me so I won't take
credit for that.....I understand your confusion and it's very wise of
you to want to know ALL the good, bad and the ugly NOW before you make a
decision.. The deficiency you talk about (calcium) is very serious
indeed and if you're concerned the HESS Brochure details that subject a
little.. Keep in mind this would be a concern with RNY distals as well.
Make notes pros & cons on that brochure and discuss these issues
with a surgeon NOT just a DS surgeon ..like I said get several opinions..
Good luck in your research..
— Victoria B.
September 14, 2000
Well, for starters, you certainly should not be listening to that well
meaning (?) but misinformed individual. I speak from experience as I've had
the BPD/DS on 6/22. It was very important to me to be able to eat and live
as normal individuals do and also to maintain my goal weight once it's
reached. I also didn't want to experience the dumping syndrome that
RNYer's do. Yes it's true, if you don't take your supplements you could get
seriously ill. No one including my physician told me anything about
possibly ending up in a wheelchair due to a calcium deficiency. You must
make the right decision for you. You can't do that until you get all of the
facts---from your surgeon. Please don't consult with a surgeon who only
does RNY, because they're promoting that particular surgery and have
limited knowledge of the BPD/DS. Your consult needs to be with a surgeon
who performs both of these surgeries and that way you get the unmitigated
facts. This surgeon has nothing to lose by telling the facts about both
surgeries. As for insurance, I have BC/BS Personal Choice PPO of PA and all
I had to pay was $260.00. The $200 was for the initial consultation which
isn't covered and the $60 I can't remember at the moment what it's for.
Good Luck to you. If you have anymore questions feel free to email me and I
will answer your questions as best I can.
— PrettyHotAndTempting
September 14, 2000
The mechanistic details of the effects of calcium on the skeleton are
complex. Calcium alters the bone-related hormones and possibly the local
hormones induced by mechanical stress. Calcium could alter the
physical-chemical properties of the bone mineral. The major mechanism
whereby calcium effects bone is probably through inhibition of PTH
secretion. Many people would like to believe that they could prevent
osteoporosis by increasing their calcium intake. Calcium excess does not
necessarily result in bone gain or even in prevention of bone loss,
<b>but calcium deficiency certainly will make bone loss
worse.</b> There are other concerns besides calcium in procedures
that depend on malabsorption.. The term (malabsorption) alone can be
defined this way:
<p>
MALABSORPTION (Malabsorptive Syndrome)
<p>
Description Malabsorption means poor absorption of nutrients from the
intestinal tract into the bloodstream. The intestinal tract, liver, and
pancreas are involved. Appropriate health care includes:
<p>
Self-care after diagnosis. You must get LABS done ... Not routinely and
as Michelle once suggested to me, keep a copy of all your LABS, compare
them yourself keep a watchful eye , don't depend on your surgeon to
find every desending figures ... Point out those values that concern
you... LAB work should not be done just at one year post-op.. this is a
forever thing...
<p>
Physician's monitoring of general condition and medications. (VERY
IMPORTANT)
<p>
Signs & Symptoms of malabsorption:
<p>
Diarrhea.
Weakness.
Weight loss.
Gas and vague abdominal discomfort.
Bad-smelling, copious stools.
Mild anemia (sometimes).
<p>
Causes: Deficiency of intestinal enzymes.
Inadequate digestion caused by disease of the pancreas (such as cystic
fibrosis), gallbladder, or liver.
Change in bacteria that normally live in your intestinal tract. Disease of
the intestinal walls, including worms or parasites, tropical sprue, and
celiac disease.
<b>Surgery that reduces the intestinal tract, decreasing the area for
absorption. </b>
<p>
if you want these web address to this information just email me.
— Victoria B.
September 14, 2000
OOPS TYPO: .. (Not) routinely and as Michelle once suggested to me, keep a
copy of all your LABS, compare them yourself keep a watchful eye , don't
depend on your surgeon to find every desending value...... <b> Drop
the word (NOT)</b>
LABS should be done routinely... I get mine done every other
month..and I keep a copy of all.. I want to know if there is even a
slightest of change and you should too!!
— Victoria B.
September 14, 2000
Hi J Roberts...I praise you in your efforts to clear up this confusion.
Researching WLS is a very difficult task. I had the DS surgery 10 months
ago and have first hand experience with this procedure. I'm also the proud
owner of the website you mentioned, <a
href="http://www.myWLS.com">myWLS.com</a>. I designed
my website to track my personal journey through my experience with the
Duodenal Switch surgery. Everything on my website is true & factual,
as it pertained to me. I see the calcium part of your question has been
answered quite well by Melanie who simplified the facts. The DS, though it
doesn't absorb as much calcium as a non-surgery patient, we do absorb more
calcium than other procedures. My surgeon, who has 10 years experience
with postop patients, perscribes two Viactiv/day for his patients. He
finds this to be more than adequate for his post op patients. Not bad if
you ask me! They're pretty yummy too! As far as insurance goes, I think
the problem comes with the "billed" amount VS. the "paid
contracted amount." Doctors, hospitals contract their survices with
Insurance companies of their choice. That means that they will agree to do
a certain procedure for a "set, contracted fee." So even though
a surgeon might charge, or "bill" one fee, he knows that he is
going to be reimbursed his "contract" fee, no matter what. For
example, my doctor bills $9,400 for his services, but my insurance paid him
$2,200 because that is the amount he agreed to, under his contract with
United Health Care. Now, my surgeon would be
— [Deactivated Member]
September 14, 2000
Sorry!! (Pushed the wrong button I guess)....Anyway... my surgeon would be
IN BREACH of his contract if he were to ask me to, say, pay the difference,
or pay a set fee, or to get one more penny above his contract fee. So,
though my Insurance didnt pay his $9,400 "billing" rate, they did
pay 100% of the contract fee of $2200 leaving me with my $10 copay. Does
this make sense? All I ever paid was $10. No hassles, no phone calls,
this is all agreed before hand with my surgeon, hospital, etc & the
Insurance company. Many people who have had the Duodenal Switch procedure
have emailed me with the name of their policy that approved and paid for
their surgeries. I put that list on my website and it is growing everyday!
Just added another one... Congratulations Debbie W! Debbie was just
approved with code 43847 through Mountain State BC/BS,PPO of WV! I do
realize this sounds confusing...if you have any questions, please email me
at <a
href="mailto:[email protected]">[email protected]</a>.
Wishing you the best luck in sorting out all this information!! Take care
for now... heidi
— [Deactivated Member]
September 14, 2000
I just thought I'd add my $.02 to the great information you
have already received. I'm scheduled to have the BPD/DS on
September 26th with Dr. Gagner and I just received my
approval from Mountain State BC/BS (thanks for your kind
words, Heidi! I am too psyched!). They are paying for
everything except my $10 copay for the initial consult, and
my paperwork references the 43847 long-limbed bypass. One
reason I chose Dr. Gagner as my surgeon is because he does
both the DS and the RNY. He had nothing to gain by pushing
one surgery over another. Without a doubt, this is the best
surgery for me. As for the potential calcium deficiency,
whenever you bypass part of the digestive system there is a
chance for deficiency. That is why it is critical to
commit yourself to post-op follow-up with labs and supplements
as necessary. It seems ridiculous to me to think that my
insurance company would agree to pay something in the range
of $35,000 for me to have a surgery if there was any proof
in existance that it would cause such a severe calcium
deficiency that I would be wheelchair-bound five years later.
And I have to second Melanie M's assertion that calcium is
absorbed in the duodenum, which is not completely bypassed
in the DS as it is in the RNY. Keep researching and good luck!
— Deborah B.
October 30, 2000
Hi, I know this is an older post, but I have a point about the subject.
I've seen a lot of 'misinformation' on the BPD/DS surgery -- Mainly
negative comments about patients who suffered from severe nutritional
deficiencies with the old "BPD" surgery or, it can be referred to
as the 'Scopinaro method/BPD'! If one isn't aware that the surgery
performed today, the BPD/DS, is a marked improvement on the older surgery
and the malapsorption factor has been minimized, one might conclude that
the BPD/DS is a 'dangerous' surgery with great risks. The best place to
start, as has been mentioned before, is duodenalswitch.com This site
outlines how the earlier surgery (the bilio-pancreatic diversion or BPD)
was first performed by Scopinaro. This is the surgery that carried greater
potentials for nutritional deficiencies, etc. The reports that one should
look at are done by Hess and Marceau (these can be found on the
duodenalswitch site as well). These are long-term studies of the BPD/DS --
the revision of the older BPD that is performed today. I recently saw one
such testimony from a woman who had the BPD and suffers from extreme
nutritional problems on the mini-gastric bypass site. If one didn't
realize that this testimony has nothing to do with the BPD/DS performed
today and that nothing negative is even MENTIONED about the BPD/DS (just a
brief mention of it as 'the other surgery'), one may be extremely concerned
about such problems. Another point, which was mentioned, is that the
distal RNY also carries malnutrition risks.
— Teresa N.
October 30, 2000
I just wanted to add that, when I mentioned misinformation about BPD/DS, I
DID NOT mean on the AMOS site! :):) I don't want anyone to think that. I
mean that I've found misinfomration on other sites that I ran across in my
research (informational sites). I don't want to start any kind of debate
on the subject, just mention that people should be careful when researching
about the information presented on many websites about the BPD/DS method.
There may be frequent mention of the older BPD surgery and the negative
effects that many have unfortunately suffered. These problems ARE NOT
inherent in the BPD/DS. That's why one should look for reports/mentions of
Hess, Marceau when reading quotes or information about this procedure. A
red light should go on when negatives are mentioned about 'BPD' and/or
'Scopinaro method' because this refers to the older surgery, not BPD/DS.
:)
— Teresa N.
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