Calling all DSers! Your input is needed. Please reply ASAP!

Mark, I'm over 9 years post-op and have absolutely no regrets about my DS. The DS has far and away the best statistics of any bariatric surgery for percentage excess weight loss, for maintenance of that weight loss, and for resolution of almost all comorbidities. And while no one at Kaiser is going to tell you this, there is actually a Kaiser SoCal surgeon who does the DS for the occasional patient who learns about it through their own research, as you have clearly done, and demands it. His name is Dr. Gary Belzberg and he works at Kaiser in Harbor City. He has a good reputation.

Whether or not Kaiser would pay for a revision to DS, and whether or not Dr. Belzberg would do it, I have no way of knowing. But you certainly lose nothing by asking. And to me, revising to DS makes much more sense for a couple reasons:

1. both sleeve and gastric bypass work almost entirely via restriction, though they have different anatomy. You have already fought a losing fight with one operation that works by restriction. You get a minimal amount of malabsorption with RNY, but not much. You would benefit far more with the malabsorption of the DS, and the rate of nutritional complications with the DS is minimal IF you are compliant with your vitamin and protein requirements. I've done it for 9 years not and it's a crucial commitment but it isn't difficult. It simply becomes part of your routine for each day.

2. If you have revision to the DS, you  already have the sleeve. Your surgeon just needs to add the "switch" part. Makes more sense to me.

It is a shame that Kaiser fails to fully inform its patients about all the standard of care options for bariatric surgery. OK, I'll get off my soapbox now!

Larra

No, Larra, please stay on your soapbox!  It's OK. Really.  I understand you have no agenda other than to share your positive experience with a kindred spirit so it's all good. 

I have heard of Dr. Belzberg as I read some of your posts (and a few others).  I know he's a good doctor, still there's a part of me which prefers someone who does several a week and believes in it (like Dr. Ungson or Rabkin), not someone who has to be pushed against his judgement.

I've been told I'm persuasive when I need to be.  But I'm wondering if at 37 BMI Belzerg would even consider it, or if I have to go through a whole rigmarole of appeals.

Dr. Ungson will do it for $9,000 but I'm wondering if Kaiser would then cover me in the event of complications. Do you know?

Finally, do you know how many DSs Belzberg has actually done, to date?

Thank you for sharing your experience.  I really do appreciate it. 

Mark

Good news.  I finally got an answer, in writing, from kaiser about whether they would cover any complications and/or follow up related to a surgery outside the Kaiser system.

Here's the answer I got:

Kaiser will cover you for services related to the follow up of the 
surgery when determined to be medically necessary and ordered by a 
Kaiser physician. This would include any lab services that you may need 
in the future. It would be necessary to speak to your Kaiser physician 
to discuss your concerns for the tests, as needed. 

So I guess that's a yes.

Now it's just a matter of seeing if Dr. Belzberg will do it, or, if not, spending $9k for Dr. Unsung. Although that's a lot of money, I like the fact that Unsung does it every day and I only live a few hours away. 

My stats are similar to yours, I'm 6'1 and was about 287lbs pre surgery. I had high cholesterol and acid reflux but otherwise healthy. 

My insurance turned down the Sadi DS twice but then abruptly approved. It was about a 45 day process that included my surgeon getting on the phone with the insurance company. If you appeal, they eventually cave.

In 9 months I'm down 130lbs, a little too light, and get regular exercise which I couldn't do at 287lbs. Since the Sadi DS includes a longer common channel than a standard DS, you take less vitamins (2 times per day for me with no issues to date) and have fewer side effects. 

Feel free to chat me if you'd like more info.

Hi Mark.  I had BPD/DS 15 years ago; I'm now a senior citizen.  I can't say that things are any different for me now than they were 10 years ago regarding life after surgery.  The hypertension and diabetes that resolved with surgery have not returned, despite my moving on in years.  My bowel habits are regular, every morning, and usually formed.  The smell is no worse than anyone else in my family.  There is a bit more flatulence, especially in the morning.  My labs started to show a downward trend in vit D and iron stores starting at about 2 years.  I foolishly relied on doctors to "fix" me, and as a result I'm still deficient in those areas.  A few weeks ago, I decided it's time to take charge of my health and I'm researching and asking vets for help so that I can finally reverse those deficiencies.  I have really not experienced any symptoms from the iron problem, but I do have muscle spasms that I believe are related to low vit D making my calcium/magnesium absorption less than satisfactory. 

As far as losing and keeping off weight, my BMI went from 61 to 29.  I lost 88% of my excess weight and, except for two brief periods when I indulged in carbohydrate binges for a few months, I have maintained my weight all these years.  For me, overeating carbs causes rapid weight gain, so I do have to watch that, but I typically eat protein and fats as much and as often as I desire.  Cutting back on the carbs causes a rapid drop right back to my low point.  I also make sure to take in at least a gallon of water daily.  That's what works for me.

I have no regrets about having had the DS.  Best of luck with your revision.  If I can be of further help, just ask.

Vicky, I'm so glad you replied.  Thank you.  Hearing from vets who are seniors is really the best assurance anyone can get, I think. Thank you for your willingness to share your experience.

I do have a few more questions for you:

1. Do you know of any other DS vets who are older?  Has their experience been as good as yours?

2. Not sure what you meant when you said, "I foolishly relied on doctors to "fix" me, and as a result I'm still deficient in those areas." So starting just two years after your surgery you became deficient in vitamin D and Iron and  all the supplements in the world didn't get your levels back up and they tired something else?  What did they try that failed?

I'm actually new member on this forum, so I don't know for sure whether there are many seniors here.  Personally, I don't know anyone my age who has had DS surgery.  My sister is a bit younger than I, and she had a Fobi procedure (small pouch and a longer common channel).  Her high cholesterol never fully resolved, and she is still diabetic and hypertensive.  She has a lot of trouble with food getting "stuck."  Due to the longer common channel, however, she has fewer and more easily resolved deficiencies.

Yes, my downward trend in vit D and iron started in year two.  Traveling to my original surgeon's office for follow-up care was not an option for me, so my PCP monitored my labs.  He wasn't knowledgable about unique DS nutritional needs, and treated me with fat-soluble prescription vit D periodically for a while, until I insisted that I needed dry D.  He was concerned about toxicity, so he wanted me on a low dose over a long period of time rather than on the high dose I actually needed to bring it up more quickly.  I say I was foolish because I knew better, but deferred to his wishes.

The iron is a different story.  My hematologist did have me try several forms of iron -- sulfate, fumarate, carbonyl -- and we got no results.  He concluded that the DS anatomy simply does not allow for iron absorption at all and advised me not to bother taking it.  Over the years, because my hemoglobin has remained within normal limits, he has told me not to worry about the fact that my iron stores are depleted.  If the hemoglobin drops, he will order an iron infusion.  In retrospect, I regret accepting this treatment plan because, although I feel fine at present, I really don't want to be an anemic old woman reliant on infusions.  I'm now trying other forms of iron to turn it around.  From this low point, it may not be possible, but I'm going to give it my best shot.

As you are considering having the DS, I offer the above as a cautionary tale NOT to take falling lab values in your stride, but to recognize them and take immediate action. 

I'd like to add one more thing, Mark.  Not every DSer has nutritional deficits.  With consistent and appropriate follow-up, and with knowledge and determination, many DSers never have difficulties such as I have described.

Correction to my first post above:   ½ gallon of water a day (not a gallon)

 

I'm not sure I qualify as a senior, although AARP thinks so.  

i had the DS at 55 and now at 57 I've had several health issues. None of them can be attributed to the DS directly (most not at all). I'll go through my sordid tale and you can decide. 1) Post-op I started with Hemerroids, what I thoght was a second occurrence was really the formation of an abscess that needed to be drained several times and left me with a fistula which was eventually fixed with a fistulotomy by a GI surgeon. Every Doc says it was just bad luck and I'm at that age where this can happen.  2) During that time my blood tests showed I was borderline anemic - hard to say if that was the DS or the bleeding that went along with the abscess. I responded well enough to oral iron that I am currently off iron to let my ferritin levels get back to normal. 3) Last comprehensive labs showed low thyroid and I started on synthroid to even it out. 4) I had high levels of protein in my urine. Kidney Doc did a biopsy and says it is just scarring from my days as a diabetic pre-op. For some reason blood pressure meds help that and that is what we are monitoring.
    None of my Doctor's would say the DS caused any of this and based on the threads I've read the only common thing is the heme problem and even that is not all that common.

    Vitamins 4 times a day usually 3 hours apart.- synthroid at night. If it is a good day time wise I may split up some of the doses just based on the thought that staggering even my individual doses might increase absorption but not something I do on a regular basis.

    Past the first 6 months, and disregarding the effects a pint of Ben and Jerry's might have I usually go once in the morning and again an hour or so later after my morning tea. At 2.5 years I no longer have any surprises when I eat out although I know it is a possibility if I try something new and different. Smell is usually manageable but heavy carb consumption can make it worse. I'm a big believer in ozium and citrus magic air fresheners with an occasional dash of poo pourri.