Hey everyone,

I had my DS by Dr. Hess 8.5 years ago.  Had some terrible complications in the beginning but got everything on track and was doing well.  But for about 7 years I've been drinking about 2 to 3 litres of Coke or 7Up every day.  My albumin, RBC, HCT are low as well as my HbA1C.  Hess retired shortly after my DS so I don't have him as a resource.

On top of that, I have a problem that people tell me about - I can't notice it, myself - that my breath smells.  My sister says it's like the smell of a freshly opened can of corn.  Some poeple have described it as much, much worse.  Every time I test my urine I get no ketone readings, at all.

To top it all off I fluctuate between 160 lbs and 170 lbs.  Even drinking all that Coke and 7Up I never gain a pound other than water weight fluctuations.  It seems to me I'm too malabsorptive.  My PCP is not exactly the most attentive practitioner and doesn't really do much to help and won't refer me to anyone.  It seems like I have to do all the work - and I wouldn't mind that if I knew or had a pretty good idea of where to go with this issue.

Has anyone had a similar experience?  Can this be overcome by any means other than a revision?  I'd prefer not to do that but I'm willing to if it will get things back to normal.  Maybe I'm jumping the gun...  I don't know.  I'm kinda at my wit's end here.

I would certainly appreciate any advice you folks have.  None of us is as smart as all of us so the more advice the merrier :)

Thanks all!!

 Yes, it can.  You can take enzymes, like Creon, that will help you absorb more of what you eat.  And start today replacing some of that Coke with protein shakes.  Make yourself drink 3 or more per day to up your protein.  And all the usual, eat more protein and stop using up your stomach space on soda.  Just cut back as much as you can to get in more food.

I would be trying all of the above before I considered a revision.

Thanks Patty.  I'm going to be seeing my Dr. to get a Rx for Creon 25 in a week.

As for the protein, I eat between 100 and 130g of good protein, daily.  I get a LOT.  At least it seems like a lot to me.

Take into consideration that DS absroption rates are 50-60% for protein, so divide what you take in by about half..and you are getting what a normie should get for optimal health. DSers must eat more quality...and sometimes quantity...to get normal intake levels. Eating solids is difficult at first, because you're still swollen from surgery, and your new stomach hasn't matured to its full capacity.  The first year is when your newly-reduced stomach goes through the maturation process.

I started out at 2.8 oz.  At a year and a half, I could comfortably hold 8 oz.  Now, three years later, it's 9 oz. and holding.  DSer's don't have pouches, they have small stomachs, with esophageal (top) and pyloric (bottom) valves intact.  They are designed to stretch to hold more, and that's why there's more malabsorption, and it's there for life. Villi regrowth, as with the RNY cannot overcome what is essnetially a distal gastric bypass (bottom half of the DS).  The food we eat has a very short exposure to digestive enzymes, basically the last 75-150 cm of small intestine on the way out to the large intestine, and that's the reason for the higher malabsorption.  We eat more, we absorb less.

I say what a normie *should* get, because lets face it, most normies don't pay attention to nutrition.  Many of us first learned proper nutrition, with application to the DS,  as part of our pre-op programs.

That's why pharmaceutical companies make a killing on vitamin and mineral supplements.  I'd lay odds more than half of America is malnourished!

Hey!

Well, I am a newbie but I agree on cutting back on the pop. Holy cow that is a lot of pop!!! That can't be good for you >.< Also just wanted to second the opinion on the protein, I eat 175-200 a day... I am only 7 1/2 months out.

Even though your surgeon is not available, there is lots of great men and women here with tons of info. I am sure with some hard work like you said you will have to fight for the right treatment and the right doctors. Believe me, I am from Montana, when I say DS they look at me cross eyed. Good luck to you:) keep us updated on your progress!

LOL - I totally misread that as " Holy cow that is a lot of POOP" ;-)

@determineddanni -

Not just in Montana!

Say DS or duodenal switch to most medical professionals anywhere, and you get the same reaction! I would go so far as to say "deer in headlights" response.

 The soda is taking up precious space in your system where protein, and nutritious foods should be. Just for fun i have been trying out a wide variety of foods to see if I could maintain, or gain with them. I ate what ever I felt like, along with 3-4 protein shakes or protein fruit drinks. I lost 6 lbs. Eating more high calorie foods did result in gaining 4 lbs. Back to more protein, less carbs, and the 4 lbs are gone. I have an idea now how to utlize my D.S. to the fullest, either way, up or down. Rarely does anyone even think about a revision from the D.S. Most are headed towards revision to D.S.

How about posting a full set of recent lab results to help illustrate where changes should be made?

I shall post my lab results after my Dr. appointment on the 15th.  I've not been too active a participant in managing my levels, thinking that my Dr. would tell me what I needed to do.  Since I know he's not doing that I'm going to have to start getting my hands dirty and worrying about it myself.

I get nine pages with full labs..when I get my own deficiencies solved (see Infusion post), I will post my labs.

Right now, my labs are an example of what not to do!

Most DSers have to be extremely proactive with their health, and able to advocate for themselves.  Personality plays a big part in how my surgeon chooses candidates for the DS. I would love to see the psych profiles of folks who didn't make the cut.  I'd lay odds they're introverts.

 I don't know ANY introverted DSers who came through my hospital's program, and my surgeon is the only one who performs the DS, as well as the other bariatric surgeries in their program.

Thanks for the advice, Sandra.  I actually don't want a revision away from the DS.  I just wonder if a common channel revision to 100cm would give me better absorption of the food I'm eating.  Lately I've challenged myself - as another poster suggested - to injest about 200g of protein per day.  It's a real challenge.  Funny enough, the pop really doesn't seem to fill me up.  At least no more than water would.  I worry a little that if I get off it completely I'll start to lose weight...  Only one way to find out. 

With all that pop, I'm surpised you don't have constant diarrhea from the sugar! I know I would! 

Of course, my common channel is 75 cm, the shortest normal my doctor does.  I asked for shorter, but as it turned out, that's how I measured out.  I'm on Creon for life, and have been since I was three months out!

 Another cause of the breath might be sinus or dental factors.
I'm a diet coke junkie myself, but couldn't imagine ingesting that much sugar.   If you're not underweight, I wouldn't be so worried about considering a revision, for there are risks to going back under the knife.  I'd be working instead on other ways to get up the nutrition.

May sound strange and offend some, but I have always noticed that people's breath, and even natural body smell is different according to diet.
For example, vegetarians smell different to me, not bad! just different.
Asians for example who eat their own cutural foods and spices are the same ( for me) as well as Arabs, Indians,  and your average American junk food junkie.
So your breath may be normal for your body and the diet you eat these days.
Creon may be helpful to absorb more of the foods you eat.
Best wishes.

I met a man in my doctor's office today that had the same issue. He wound up having the revision though. Hopefully you won't need to do that.

I'd highly recommend going on Vitalady's vitamin regime (www.vitalady.com). It would certainly help with your vit levels. In addition, I'd recommend starting to drink 2 or 3 protein shakes per day. It will help you build muscle.

Hey, stranger! How have you been doing?