Question:
Why isnt there more duodenal switches done?
I am deciding if I want wls or not and if i do what would be best for me. I must say from my resaerch that it sounds like the duodenal switch has many more advantages than the rny except for problems with malabsortion and the procedure being more complex. like: more stomach left, able to eat more and a variety of foods, better succees with weight loss longterm, no dumping. I also noticed that persons on this site w/ ds seem to post less complications. Can anyone share with me why so many people choose the rny over ds? Also I would like to see post or hear from folks that have had the DS and are at least one year post op. All responses are gratly appreciated. — [Anonymous] (posted on June 22, 2001)
June 22, 2001
The duodenal switch is not only a more complex surgery, it is also more
expensive to perform, so given the fact that it costs more and takes
longer/more complex, it means surgeons make less money doing the duodenal
switch instead of the RNY. Given those factors, it will be a few years
until the duodenal switch becomes as mainstream as the RNY. For information
about the duodenal switch, post-op patients, the Hess profile (10 year
study), etc.. goto http://www.duodenalswitch.com
Good luck with your research!
Anita
Pre-op BPD/DS
— Anita N.
June 22, 2001
In regards to the part of your questions concerning complications being
posted following DS surgeries? My understanding is that there is an
unwritten (or maybe it is written) rule that DSers are not to discuss their
complications in order to make this surgery seem less risky than it really
is. Rest assured, there are many DS patients with complications, but you
will rarely hear about them. There are only a few brave enough to discuss
them. Because when they do, they are slammed with negative e-mails for
going against the "code". For accurate complication information
DO NOT depend on this or any other board dedicated to DS. I would recommend
independent research and to discuss your questions with a surgeon.
— [Anonymous]
June 22, 2001
I too was interested in DS, since the surgery sounded exactly what was best
for me. But as I remember, the Doctor closest to me wanted $4000 out of
pocket for follow up care... I also would have had to travel a great
distance to see him.
The RNY was my second choice, but I am happy with it and don't know what I
am missing- either way :) Pretty sure my RNY cost me approx. $100 out of
pocket.
So, yes, it all came down to money for me, otherwise I probably would have
signed up for DS.
— Karen R.
June 22, 2001
Most Insurance companys won't cover DS, they consider it
exparenmential....A friend of mind got turned down from her Insurance
Company, and she had to pay out of the pocket...
— Marie B.
June 22, 2001
I choose the RNY over the DS because the RNY is fully reversible, it has
been around longer, the dumping effect, and the malabsorption of the DS
scared me. The thought of enabling myself to eat a lot of food and then
malabsorb seems so unnatural. It's like I can be a glutten and then
malabsorb. In the process, I'd be losing vital vitamins and nutrients from
food. The RNY has taught me to eat to live; not live to eat. Eating has a
purpose now. To nourish. That's why I choose the RNY. It isnt always
easy, and I have to remain focused on my behaviors, but I am happy with my
choice.
— Jeannet
June 22, 2001
Okay, sweetie, you asked for it. LOL...I am probably the only person on
this site that will tell you anything unfavorable about the BPD/DS because,
possibly the other people aren't posting who had problems. Possibly
because I am the only one that has had problems but I sincerely doubt it
because I get email from people often who are having problems but don't
like to post them. Okay as for me....I am two years postop from the
BPD/DS. At one year postop I felt pretty good and had lost all my weight
and then some. Actually I started losing too fast and too much and had to
try and gain some weight finally. I am 5'4, 42 years old, and was down to
112....too low for me. I am now at 128 and feel good about that part of
it. Here's the story though.
I sacrificed my health to be thin. I honestly didn't really have many
co-morbidities beforehand except I got out of breath alot. not a good sign
but far less problem than what I have now. I will list my problems since
one year ago.
Severe anemia (was rushed to the hospital in a semicoma)
Severe Arthritis
Severe dry eye syndrome
depression
calcium deficiency (losing teeth)
dry mouth
scabs on head (severe dry scalp)
I have just been diagnosed with sjogrens disease
I have just been diagnosed with Lupus and Lupus can be caused by
malnutrition and surgery.
I have a hernia too, the size of a grapefruit but can't have surgery on it
because my iron level and BP put me in danger of a stroke on the table. I
also cannot have a revision for this same reason. It's a catch 22.
Most, if not all of these problems have been a side effect of the
malnutrition. Dont' get me wrong, I took everything I was supposed to
but...I didn't absorb them and for a year, the surgeon kept telling me that
I just needed to up my iron intake. He never thought that I couldn't
absorb this. It just never occured to him.
I dont' tell people this to terrify them..just to educate them on what
"might" happen or what "could" happen. I guess it
usually doesn't happen like this and many people are thrilled with this
surgery but...Just please keep in mind that there is still this slight
possibility that you might be like me. It's great that people tell you all
the wonderful things that happen to them since surgery and I am SO HAPPY
for them. But I truly think that you must go into this knowing what you
might be doing to your body and that you will have to live with this
forever no matter what happens good or bad.
I wish you luck and happiness in whatever choice you make and I am always
here for anyone who needs me. Hugs
— Barbara H.
June 22, 2001
Barbara: I've seen you post before about your problems and they truly
sound horrendous, but I cannot understand how you could have had all these
vitamin deficiencies over this length of time and your surgeon didn't know
it. Didn't he run regular blood work on you and correct your deficiencies
as they arose? The watch word, and the responsibility of all WLS patients
(since ALL of us have malabsorptive procedure to some extent) is to be
committed to our aftercare and ensure that our levels don't get us into
trouble. I really don't understand how a reputable surgeon could let you
get into such terrible shape.
To correct some of the other comments, there is no CODE that prohibits DS
patients from posting negatives to this or any other board. On this board
the overwhelming number of RNY posters, and their complacency that RNY was
the best and ONLY procedure (usually not even identifying the type of WLS,
but acting on the assumption that all WLS was RNY surgery) used to make me
feel like I was swimming upstream -- the oddball in the crowd. Since I
researched so much before surgery, found a solution that has, indeed, for
me at least, been everything that it was purported to be, and since I don't
have any of the problems that RNYs have, or that are sometimes unfairly
attributed to DSs (foul smell, diarrhea, deficiencies), I have become an
advocate for the DS. I simply want every other morbidly obese person who
could benefit from this surgery to have the same chance of success and
happiness that I have had.
I am on several other DS lists and attend a monthly DS support group.
Everyone is not as lucky as I am (no gas, no bathroom problems, perfect
bloodwork with minimal supplemenation, great weight loss, fabulous quality
of life and no food restrictions), but I know NOONE like poor Barbara. We
all have our blood taken at 3 weeks, 3 months and then every 6 months
postop. Some may be low in one area for and our nutrionist adjust the
iron, calcium, A or D, etc. It may take a few months, but I know of NOONE
who hasn't been able to get their levels adjusted.
The comment about DS people being rewarded for being gluttons is an
indication of how skewed MO people become afer lifetimes of deprivation and
dieting. No thank you, not for me anymore. I am not a glutton now, and
probably eat less than most normal people still, being 20 months postop.
But when the cake is cut, I can eat an entire piece, like all the other
people in the room, I don't get deathly ill from 2 bites. I also don't feel
better that I deserve to punish myself with ongoing punitive effects of
surgery. No food is intrinsically better than another -- the "good
food, bad food" conundrum is what made us MO and one I glad don't deal
with anymore.
There was other misinformation, but sometimes people believe what they want
to believe. For the record, "dumping is a RNY feature, not present in
the DS". the DS is completely reversable, more so than the VBG or RNY.
I know this as I am in contact with many people who are being converted
from RNY/VBG to DS, and while the lower or intestinal part of the operation
can be done, surgeons often have limited success trying to fashion
mutilated and/or transcected stomachs into a normal and intact (only
moderately smaller) DS stomach.
I am not defending my choice of surgery because I had it and am stuck with
it. Believe me, I researched prior and am still closely connected to the
WLS and DS community (I have been posting to AMOS for 2 years now). My
only motivation in continuing to do so now is to save other MO person's
lives and to offer them information on a quality of life that is superb!
Hope that Barbara's problems are resolved, and I, for one, would like to
now the name of her surgeon, so that he gets the recognition he deserves.
If you had been in our support group, Barbara, we would have made sure you
were getting your blood works done in a timely way!
— Jill L.
June 22, 2001
More people have the RNY because there are hundreds and hundreds of
surgeons who can perform the surgery, and there are only a handful who can
perform the DS. The RNY was popularized long before the DS procedure was
developed, so it is better known. I suspect the DS will catch up over the
next few years, but it will always be a more complicated procedure, and it
is more drastic, since it comes with a distal component. As far as hearing
from DS patients, I celebrated my one year anniversary this week. Gee - I
had no idea there was a secret club which prevented us from talking. I'm
always left out of everything!!! Much like Jill, I simply have very few
problems to talk about. In my year, I have never thrown up, never had
embarassing bathroom accidents, never been in pain (after the first few
weeks of surgery, that is). I take 2 multi-vitamins and 3 calcium pills a
day, which I consider pretty minimal supplementation. I do use a protein
shake most days, so I don't need to worry as much about food. My blood
work is great, I've lost 80% of my excess weight. For me, the surgery has
been the perfect choice. I still struggle with some of the mental stuff,
so I can't claim I'm a completely new person, but dang, it's close enough!.
- Kate -
— kateseidel
June 22, 2001
I have NEVER heard of any code or anything that DSers are not supposed to
discuss their complications... Maybe I missed something in my two years of
research...... I chose to have the DS, rather than the RNY because I wanted
to be able to eventually eat a normal size portion,(not indulge myself)..
couldn't even if I wanted to.... I wanted to NOT have the dumping syndrome.
This is something I considered for two years. Both surgeries have
successes, and both surgeries have complications. Most people think their
surgery is the "best." It probably is, to each individual who has
been successful with their surgery. I had the DS about 2 months ago, and
everything has gone very well for me, and I am happy with my decision. I am
NOT NOT NOT able to indulge myself because my stomach is bigger, but I am
able to eat enough to get in most of my nutrients. My stomach is about the
size of a zucchini or a bananna as opposed to the size of a thumb. I DO NOT
have dumping syndrome whatsoever, and have never had a problem with it. I
do, however, need to be careful with eating sugar, because I don't get
dumping to rid myself of it, and my body will absorb most of it, therefore
hindering my weight loss. I would recommend research research, research!!
This is a life time decision so make sure it is right for you. Both
surgeries, with the right doctors, can be successful. Good luck with your
decision! Feel free to e-mail me personally.. Everything's still pretty
fresh in my mind!
— Kim B.
June 22, 2001
Why is it people who post ridiculous rumors do so anonymously? Well, I
guess I just answered my own question. I wouldn't want my name associated
with such claptrap either. I had the DS, paid the $4,500 "program
fee" gladly, heavily researched both types of surgery, including
meeting with docs who did them. The main reason I had the DS: I wanted to
keep my pyloric valve in my stomach. Nature put it there for a reason (to
regulate food flow into the small intestine), and I wanted it. The
re-routing of the small intestine is very similar to the RNY and is also
reversible. My stomach has stretched post op to the post where I can hold
about 1.5-2.0 cups of food. I can no longer compulsively overeat, but I
could graze, just like the RNY's can graze. I currently follow the
Overeater's Anonymous concept of abstinence to avoid such grazing and to
help me with learning how to avoid eating as a stress response. For me,
abstinence is 3 meals and a bedtime snack. I can have an occasional sweet
without "dumping". In my opinion, the concept of surgically
creating the possibility of 'dumping' is barbaric. I have had NO
complications, and my only side affect has been occasional bouts of gas,
totally controlled by avoiding those foods that produce the gas. I do have
to be aware, just like both DS and distal RNY's alike that calcium
difficiency is possible, so I take calcium and vitamin D supplements and
have annual bone density tests. I have had blood testing about every 6
months, so I have the opportunity of early warning before I have some of
the symptoms Barbara indicated that she had. But, so far, all has been
perfect. I am in better health than I have been in since I was 22. Good
Luck to you!
— merri B.
June 22, 2001
Hey, who broke our code of silence? Hmph. Let's see -- with 35+ DS surgeons
across the United States and abroad, and thousands upon thousands of DS
patients in the world, it'll be tough to track down the rascal who broke
the code and uttered a negative word about the DS. But we'll do it, by God.
Watch outl, you big mouth -- we will hunt you down and shut you up.
— mmagruder
June 23, 2001
Okay Jill, you have succeeded in making me cry like other DSers have.
Happy? For the record, I have had every bit of bloodwork done in a timely
manner. Every bit of it. My surgeon, and the second one I went to see,
both told me to "up" my vitamins and iron orally for a whole
year. What they were unwilling or unable to see, is that I was absorbing
non of them. The only way now, that I am able to get vitamins and iron
into me is intraveneously. That I do every week by the way! You are like
so many others that assume that the doctor's are Gods basically and know
everything there is to know. It's not so Jill and others. They know
surgery but follow up? Not a chance. I am not saying all doctors but,
those that I have had, this has been my experience. Nutritionists? Yep saw
them too. Went on all kinds of supplements. That didn't work either. My
doctor did not even put in his records how long my common channel is. Not
a word. When asked about this he said "oh I must have just left that
out." Please ask Michelle Curan about what I have been going through.
she knows what has been happening and I am NOT the only person out there
like me. There are plenty but who wants to hear from you
"perfect" people, that we are somehow to blame? Why not just
accept the fact that "some" people have problems? Why does
everyone have to make it seem like this surgery is a miracle cure for
everyone? I sincerely hope it is for everyone from here on in, and that
they have much success like you did. I just think that it's important for
people to know that, like with any other surgery, there "can" be
problems. Not once did you hear me say "don't do this".
Sometimes I want to say that but, I am logical and look at all of you who
are doing so great and are so happy and I can't say that. I can only say,
please know everything that "could" happen to you and then make
your decision. After two years, I seem to be the only person who has
stayed in here and is willing to put up with this bashing. You have
succeeded in pushing the others away. Not me. Go ahead because worse has
been said to me. I stay because I think it's fair that people know all of
the risks and all of the successes. That is how people make informed
decisions. (by the way, like I said, people with problems now write me all
the time but are unwilling to put it in here because of this very thing).
This probably won't even get posted because there have been a few times
when I write about the dangers that they censor it but I am trying and will
continue to try.
— Barbara H.
June 23, 2001
In reading the post about the "code", I was not sure that I
believed it. However, after reading the subsequent posts, I must admit that
I can see where the poster is coming from. As an RNY patient, I am not the
least bit defensive when someone posts about a problem they are having. I
am concerned and want to help them if I can. I don't take it as a personal
slam, that my choice of surgeries was wrong. I have found that when a DS
patient posts about problems they are immediately attacked and made to feel
as if it were their fault. So, as far as an official "code", I'm
not too sure. But what I perceive happening is that DS patients with
problems are too intimidated to post. They fear the negative comments and
e-mails. So, maybe not an official code, but definitely unofficial
intimidation. I don't feel that one surgery is better than another. To each
his own. Why are some DS patients so defensive? You just don't get this
same reaction with most RNY patients.
— Shelley.
June 23, 2001
Well, it's a shame that one ANONYMOUS poster can come in and manage to
single-handedly cause the degeneration of this otherwise worthy question
into an exchange of unfounded assumptions.<p>
<p>
Now, to answer the original question: "Can anyone share with me why so
many people choose the rny over ds?", I think it's a simple matter of
supply and demand. There are simply more RNY surgeons than DS surgeons. It
doesn't mean the DS is any less worthy than the RNY. It's like asking the
question, "Why are there so few Latinos in North Dakota?" --
well, there just aren't as many people there from Latin America. See what I
mean? It doesn't mean that North Dakota shuns Latinos. OK, analogies aside
now. :)<p>
<p>
You also wrote, "...I would like to see post or hear from folks that
have had the DS and are at least one year post op. All responses are gratly
appreciated.". I am 20-months post-op from mny DS surgery, and things
have been great for me all around. I have truly been blessed. No
complications, not post-op problems. Click on my name to see my AMOS
profile and pics. When you're on my profile page, click on the URL to my
Duodenal Switch website page for even more about my journey.<p>
<p>
Hope this helps. Feel free to write me privately if you have any questions
at all.
The DS is a good Also I would like to see post or hear from folks that
have had the DS and are at least one year post op. All responses are gratly
appreciated.
— mmagruder
June 23, 2001
Barb H, I am SO GLAD YOUR HERE.
The danger here is that failures and those with problems leave. This turns
the site into one of everythings great, and all is fine, But the problem is
that there are failures, underweight folks, those who nausea never goes
away, and those who are forced to try reversal to fix their problems. Its
not just DS, its RNY and VBG. every surgery has its risks, and not everyone
is happy, and some even die.
This week one of our members is getting a reversal.
Now everyone who visits here needs to know this! At least that way they
will know the risks, as well as benefits of surgery.
They need to know too that if things go bad their surgeon will probably
refuse reversing them. I think this is because the docs depend on insurance
approval and it would look bad if they started changing some back. But
thats just my theory.
Surgery is successful for MOST, and a lifesaver for many, but a percentage
DO fail.
Everyone needs to know that.
Failures leave here because they tire of all the good news from others and
negative comments about why they failed.
Its too easy to blame the person when really its the surgery, because we
ALL want to believe it will be perfect for us.
I will add that after talking with hundreds of folks who are post op and
their families I have asked questions like do you dump / vomit? The post op
often says no never, while the spouse family members response is
different.
Maybe its pride or something, I have no way to know. Now if this also
occurs here then there are lots of folks with minor livable problems who
for one reason or another dont tell the entire truth. I HOPE that doesnt
occur because pre ops need to know the whole truth.
— bob-haller
June 24, 2001
Hi, I'm sorry but the rumor of a "code" is one of the stupidist
things I have heard on this site!!! I had my BPD/DS on 4/11 and as yet
experience any problems.If I did I would come to other DS patients for
their experiences. I take 1 flintstone 3x day, ADEK's 1 3x day, calcium 1
3x day. I'm waiting for my 1st set of blood tests soon. I feel wonderful, I
have yet to experience any problems or symptoms or anything. I don't dump
and can eat whatever I choose. It's about choices and learning to make not
only the right one but the better one. Are there times I didn't make as
good as a decision-of course. this is life and I'm human. I don't beat
myself up about it either. I can eat sugar and I don't dump=never have. I
do have to be careful about fats as I also had my Gall Bladder removed.
Many DS patients in my opinion don't post here because of the attitudes of
Some "other" surgery patients.(not just RNY) Of course they all
think their surgery is the best. Of course they would-that's why they had
that surgery. Many DS patients go to the DS site at Duodonal Switch.com at
yahoo and get their suppor from one another-without any criticism from
people who are clueless!!!In regards to the number of surgeries. Many ins.
co.,'s still consider DS to be experimental altho it's proven not to be.
Also, the cost. Why pay for DS when you can get away with the less
expensive surgery and all. My Dr. suggested BPD/DS for me as the RNY was
potentially life threatening(for me)due to prior surgery.My ins. dsn't
cover DS but since medically it's necessary they approved it. I'm so glad I
had it. I know people that had the RNY around the time of my surgery and
they still can only eat soup or their stoma's have closed and need
dilation. Does this make the RNY a bad surgery-no, it's just not what I
want. I think the DS patients are more tolerable to whatever surgery is
best for you is fine vs. that surgery isn't ok,mine's the best type of
thing. All surgeries have their good and bad and different surgeries work
for different people. Some don't work at all and I've see these poor soles
just beat up over this. For whatever reason their bodies couldn't handle
the surgery. We should feel compassion instead of criticizing something
that is beyond their control!We need to encourage everyone no matter what
their choice to research until they are blue in the face. Also, check out
the names of folks in different states and e-mail about their surgery and
any complications. If and when they should occur for me than I would tell
whoever what I'm experiencing. I did speak with someone(maybe Barbara)about
her negative experience but it's the only one I encountered out of several
dozen. There are risks with each procedure and this is not the magic pill
everyone wants it to be. Sometimes people stake their hopes so much then
are let down because they only lost 45 lbs in 2 weeks kind of thing.
Anyway, e-mail if you like and even keep track of my progress because
their's nothing to hide here. Best of luck. Sorry I rambled
— Linda M.
June 25, 2001
My My My.....This reminds me why i don't bother with this site much. I had
the DS ( hiding my head in shame...LOL). I am extremely happy with it. I
don't feel the need to justify my surgery and bad talk other peoples
choices....let alone do it anonymously...pretty sad. Sounds like you are
unhappy with your choice and trying to make yourself feel better. I
researched all surgeries for about 6 months and chose the one that fits in
with my lifestyle. As far as being a glutton??? HAHAHA.....maybe some are
just a little jealous that we are able to have our cake and eat it too???
— bobbie B.
October 14, 2003
I'm new to this site, and a pre-op, too. After doing a LOT of research, I
too feel that the BPD/Ds is the surgery that I can best live with---but I
can only decide that for ME, and only you can decide that for YOU.
I'm having a tough time finding a surgeon anywhere near me who does the DS,
much less one that will accept Medicare---because, I'm told, Medicare will
only pay the surgeon $900.00 for this proceedure! (Less than they pay for a
gall bladder removal, if you can believe it!)
As to possible bad results----there are risks with any surgery, and they're
going to vary from patient to patient. I think THE most impostant thing is
to choose a good surgeon, AND a good primary care physician. The two will
need to work together to keep you healthy! Barbara's profile lists Dr.
Daniel Booth as her surgeon. On another site, I read that he has since
retired/stopped doing surgery. I'm not making any judgements here, but just
maybe he was poorly qualified to begin with. Reading Barbara's profile
certainly indicates to me that he wasn't giving her adequate follow-up
care, and I certainly don't think that SHE is in any way at fault for her
bad results.
— MsBatt
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