thinking of DS and already have date with RNY surgeon

Has anyone advocated for DS after they are on the RNY pathway?
I have an appointment with Dr. Jackson at TWH on August 24th. This appointment is for RNY, obviously.
However, after a good deal of research I really believe DS is my best option. I have a few concerns. If I get a no for DS have I jeopardized my chances for RNY? I ask that because various posts have referred to needing to prove that RNY is not an option in order to have the DS. I do not want RNY ruled out. However, I am Type 2 Diabetic and do not want it to resurface. I have several comorbidities and DS advocates look for that. I am not a high BMI (42 I think). I also have arthritis and may have to have knee surgery after some weight loss. A major factor in my history is always being hungry. I was concerned to discover this would return with RNY. However, as I understand, DS is much more effective in this respect. I also have a situation where most of my teeth don't meet (I have braces at 60!) If I end up with RNY I somehow manage the food getting small enough but I understand that DS is not so drastic the times I could get it wrong.
Should I be trying to be redirected to Hamilton before my appointment or wait until I see Dr. Jackson? If I bring this up with Dr. Jackson will he be in a position to discuss DS and decide with/for me or will he react because his specialty is RNY.
I know DS is not common in Ontario and the Windsor Centre does not even bring it up (at least they didn't with me). I have considered it as an option based on my own research.
I realize this is a long post but any input would be appreciated.

You don't need to prove that RnY is no good for you. just that DS is better. Feel the difference? With type 2 diabetes you have an easy case, since DS has  98% cure rate vs. 68% with RnY. Spin this fact properly and you've got it. I believe you are on the right path. You need to see a surgeon and explain him that you need DS for diabetic reasons. If you convince him -  fine, if not - you HAVE FULL RIGHT to request a second opinion with Dr. Hong in Hamilton. It won't invalidate your participation in the process. No one will exclude you from the process or make you to go through it again - it would be wasteful and illegal. Yes, you'll have to go through extra steps - see another surgeon, transfer your file... and it will cause obvious delays. But IMHO, a few months of delay mean nothing compared with the lifetime with a wrong surgery. And even the best of the best surgery will be wrong if your diabetes returns, right?

Everything depends on your perseverance. If you're easy to confuse and to convince - prepare yourself.
Good luck.
As a DSer and former diabetic I can assure you - this will be the best decision you've ever made.

 I don't know for sure.... I am not an expert at all.

I would think that if you have some reservations (any at all), you need to stop, breathe and regroup.  I would ask for a referral to Dr. Hong and hear from the horse's mouth, so to say, about the procedure and if it is right for you.

I lucked out and had Dr. Hong as the surgeon I met with.  He was very open and honest with me.  He gave me all the side effects - good and bad and asked if I was prepared for them.  We talked at length about who the DS is most effective for.  What type of people make it successful and what type don't.  He was very good.

In the end, WE agreed on a DS.  He had some reservations about old scar tissue and did the VSG first and I will have the switch sometime soon.

Good Luck and keep us posted.

Ann

Hi Ann,
Could you, please, ellaborate on "who the DS is most effective for.  What type of people make it successful and what type don't".
I've never heard about this kind of analysis and would love to learn what doctors, who actually do DS, say about it.

Being a DSer myself, I saw a few people, who practically failed the surgery or significantly regained, yet other folks lost over 200 pounds without much effort, while eating quite liberally (cakes and chocolade wereare NOT off limits on a daily basis). I just wonder what's the secret here... Would love to hear what's the expert's opinion.

thanks.

 Nata - I don't have my notes here with me but this is what I remember....

DS is good for people who have office type work (so they can deal with being near a bathroom all the time), for people who do not have to eat alot of fast food/restaurant food, for people with super high BMI, for people who are diligent and regimented to take the vits and bloodwork, people who understand and are willing to live with the odors.

DS is not a good fit for people who are on the road alot with their jobs because of the bathroom issue and the fast food/restaurant issue, lower BMI people are not preferred (might be an OHIP issue...) and people who are laxidaisy in their routines (this creates other health issues).  

In general, educated and younger people are more successful with WLS as a whole.

Again, this is what I remember - PLEASE don't quote me..... but interesting non the less.

Ann

Thanks a lot!

So it's pretty much the BM/odor/vitamins concerns...

By the way, just from my personal experience, the BM, gas and odor issues stabilized at about three years out to the point of pre-op. Yes, in the first two years there were issues, but they evened out. I guess, it's the colon bacteria "adaptation period", or just my diet is right for DS.

 yeah on the odor issues!

Ann

 I think you have some very good arguments for DS and I'd take them forward but I do think you should be rerouted to Hamilton if that is the case.   You'll really need to be adamant.   Dr hong may try to push you to a VSG with the promise of a revision to DS later.  No offense to others who have done it but I highly recommend pushing for a full DS now than a promise later.  

I do think though you are looking at a VSG or DS if you go in.  Saying "I can't settle for an RNY and then conceding to one later just doesn't make any sense.   You really have to go in wiTh guns blazing.  Talk to Patxyz as she has done the process.

Dawn

Thanks Dawn.

I do agree with your comment that really says I need to commit to the direction I am going in. The more I research, the more I believe that the RNY is not the best option for me.

I have talked to Patxyz and she has given me good feedback.

Now I have to figure out how to get my file redirected.  Anyone out there know who I need to talk to? Toronto? or Windsor?

I did my entire assessment at TWH, even met with the surgeon there. It was then that I discussed with him that I believed DS was the best surgery for me and that I'd like to be referred to Dr. Hong to discuss it and he agreed and signed the referral.

Having the discussion with Dr. Hong about DS does not rule out RNY automatically. He is very open-minded and will give you an honest opinion about the surgery he thinks is best in your case after you tell him about the surgery you are most interested in and why. It sounds like you have an excellent and similar case to myself for DS (need for NSAIDs, type 2 diabetes). If it is what you want, arm yourself with information and make it your goal to get Dr. Jackson to refer you to Dr. Hong for a 2nd opinion. Good luck!