ObesityHelp

Years of eating lowfat and going untreated for hyperthyroidism caused my thyroid to eat through the protein in my body and destroy my muscle mass.  I had become bedridden and for the first time in my life, it had become virtually impossible to lose weight on my own anymore.

In the midst of addressing these health issues and having -- once again -- reached 300 lbs plus, I started looking into weight loss surgery.  I knew that I couldn't possibly take another massive trip down the scale without something to stack the deck in my favor so I wouldn't start climbing it again.

I was no stranger to willpower and trying to eat right.  In fact I overdid it so often that I blew my metabolism to bits.  Nothing short of a "catabolic effect" was going to change that.  Now instead of going to bed hungry every night like I almost always did when I was fat, I go to bed having eaten about five small meals a day and I'm a size 2 (at 5'7"). 

Unlike many others who come to OH, Carnie Wilson was never a role model for me.  Because of our similarity in age and life story, I was more inspired by Sharon Osbourne, who had a lap band (even though she refers to it as her "gastric bypass").  I thought I too would have a lap band but my bariatric surgeon wasn't very enthusiastic about the band.

Then I found out about the DS (Biliopancreatic Diversion with Duodenal Switch) ... It sounded like the optimal weight loss surgery for me because of the longest sustained weight loss results and the most normal of post-op lifestyles. 

Fast forward through insurance battles and trials and tribulations, hiring lawyer Gary Viscio, and accumulating volumes of information from "switch siblings," I created a binder of 369-pages and 81-documents that eventually proved to Empire BCBS that it is NOT an investigational procedure ... a claim they like to make to avoid approving it.

The lengthy battle was so worthwhile that if I knew then the life I would enjoy now, I would have put up with twice as hard of a fight.  When you read some of my entries prior to surgery, you will see how herculean a task just getting up in the morning and trying to face the day could be.  So the fact I say I would have gone through twice the battle is really saying something.

Through the grace of God, a very skilled surgeon, applying some diligence to how and what I ate, some extraordinary advice shared by fellow WLSers on the OH boards, love and support of family and friends, and incredible luck, I am now enjoying the life of my dreams.  My health is not 100% but my hopes are and there are some days I scale heights I never thought a 51 year old could reach.  Life isn't perfect but it usually is damned good. 

Why the DS?

There are times when a poster asks the question on the main message board about DS v RNY. Those who have had - or want - the Biliopancreatic Diversion with Duodenal Switch (DS) and have done extensive research, often encounter an incredible amount of misinformation that many have received from their surgeons or via word-of-mouth. Our efforts to correct that information are often perceived as trying to “sell the DS” and I find that disconcerting.

We have absolutely nothing to gain by promoting the DS. Our enthusiasm for the procedure compels us to inform others about their full spectrum of options and to let them know that if they don’t fight for the DS – if that’s what they want – then everyone will continue to be persuaded by self-serving sources that it’s a bad or unsafe procedure (in spite of the voluminous clinical information that grows by leaps and bounds daily, proving quite the contrary). Hence insurance companies will continue to justify their denials for the DS, even when in the long-term they would improve their bottom line by approving it universally.

Unfortunately, some seem to be intentionally misled by their surgeons because they are simply not skilled in the intricacies of the DS. Remember, it is a more detailed procedure and not every doctor capable of performing an RNY can pull it off. This is not to diss your surgeon, it is a statement of fact.

In my instance, my surgeon performs both the DS and RNY. I went into my consult having surfed my way into DS awareness only the night before. In my opinion, that's where the luckiest part of my journey began -- especially since he is skilled at both procedures and my $500 out-of-pocket wasn't wasted.

Dr. Roslin's office gives the impression that the surgeries are practically interchangeable, yet the more I research, look and hear, they have distinct and glaring differences. The only negative the doctor voiced as a concern regarding the DS was the potential for lack of calcium absorption in a woman my age (48) -- which threw me for about twelve hours until I did more research. For the most part, he left the decision in my hands since it essentially didn’t matter to him which surgery I chose.

Personally, I wish Roslin's office assisted more in the fight for the DS because it would likely make my battle for insurance approval easier. Nonetheless, it's everything else that was said during our consult that stuck in my head and convinced me the DS was the option for me.

The DS is especially desirable to me for two very important medical reasons:

(1) My father had stomach cancer. If I have an RNY pouch, I cannot be adequately monitored for cancer without having open exploratory surgery. Since the DS simply cuts away the fundus (curved part of the stomach) versus creating a pouch, surgery would not be necessary if cancer were suspected. (BTW, my father’s cancer was “cured” by having the equivalent of a DS – and so was his lifelong battle with obesity; he has not gained any appreciable weight in over ten years); and

(2) I am nearly bedridden due to an autoimmune disease that leaves me constantly weak and fatigued. Because dumping is unpredictable in RNYers – ie, some dump on a variety of foodstuffs and for a variety of reasons - including but not limited to ingestion of sugar, fats, starches, and overeating. My system simply cannot take (possible) continual episodes of dumping. My pre-op life is already like dumping 24-7!

Then my surgeon said to me, verbatim: “With the RNY - in the worst case scenario - you’ll be 230 pounds for the rest of your life.” I’m approx 315 now. Having major surgery to lose 80 pounds was not my idea of a successful outcome.

Those of you who are at this weight and are happy there, please do not take offense. However, by my own devices, I have reached the 140 lb mark FOUR TIMES in my life but gained all the weight back each time to once again become SMO. So hitting 230 for a lifetime in spite of major surgery was not my idea of something with which I could be satisfied.

Then the fact that – again, in my surgeon’s words – “RNYers tend to start gaining weight at about one year to 18 months out; we don’t know why” further influenced my decision. He said only those who have completely modified their eating behaviors and avidly work out were able to maintain their full weight loss over time. Well, that's what I did the last time I lost weight and still managed to gain it back. To me, surgery is supposed to give me an edge I cannot otherwise attain, I felt no certainty that the RNY held for me the same edge that the DS does.

I'm having this surgery because of my thyroid-influenced autoimmune disease which now inhibits me from losing weight by less drastic methods. Ultimately, I expect to take the weight off once and for all and keep it off. I will work my tool like nobody's business but cannot accept that medicine recognizes the strong potential for weight regain in the RNY when there is an alternative surgery that does not pose as high a percentage rate of weight regain.

After my consult in December 2003 I researched my butt off and digested everything I could about the DS – good and bad. I challenged myself to find everything negative about the DS there was to find. I contacted former DS patients of my surgeon to find out about their successes or problems. They were all former and no latter.

I went to the different DS websites and Yahoo groups and examined the outcomes of patients’ surgeries and long-term successes of those patients. I compared that to their RNY and lapband counterparts, factoring in my personal experiences – including having been a participant in obesity studies at Rockefeller University twenty years ago - and my years of research and understanding of obesity (e.g., Did you know that you never lose fat cells? ... When you lose weight they change shape from round and fat to oblong and thin but continually cry out to be satiated -- that's why maintaining weight loss is such an uphill battle).

I found one case of seriously bad labs which resulted in a reversal of the DS (out of hundreds of patients I researched) – and that was an OH member who admittedly was not compliant with her vitamin and supplement protocol. (A must for all of us – whether RNY or DS. This cannot be stressed enough!)

Bathroom issues with the DS in 90% of the instances were directly related to what a person eats: Eat a lot of fatty food, spend considerably more time in the bathroom, often with loose movements (because the oils are not absorbed and essentially go right through your body); eat a lot of starchy and sugary simple carbs, you are gassier. But then my research shows this is almost identical with what a distal RNYer experiences.

Please know that regardless of my determination to have the DS and only the DS, I do not knock any other procedure and support whatever decision a thoroughly educated WLS-wannabe makes ... But please, before giving what you believe to be helpful advice about a procedure you do not really understand, do what most DSers have done … Research and find out for yourself.

What is a DS and What Can You Expect?

In a nutshell, there is no pouch. The fundus (most curved part of the stomach) is actually removed (instead of having a pouch fashioned) and the pyloric valve remains intact, allowing for a more natural elimination and digestion process. Essentially the intestines are rearranged like with a distal RNY but it's a little more complex than that. There is no potential for post-op complications such as a stricture (a narrowing of the stoma, which connects the pouch to the intestines).

Vomiting is possible with the DS but is more common when one eats too fast too early out when compared with many RNYers who tend to vomit more frequently because foods are not properly chewed to a puree consistency or the item eaten doesn't sit right in the pouch.

Dr. Hess, who was one of the first surgeons to perform the BPD/DS procedure that modified the BPD (without the DS -- aka the Scopinaro technique -- which did have more serious malabsorption problems) released data in July of 2004 regarding his ten-year study of DS patients and found that: "Compared to other bariatric surgeries, the DS is found to be superior in our practice. There are no foreign materials used. The pylorus is retained and controls the stomach emptying. There is no small stoma that could dilate causing failure, allowing the patient to eat normal meals."

In layperson's terms, this means that you will definitely eat less post-op than you did pre-op but with less restrictions than those who have the RNY. The malabsorption feature of the DS plays a very big part in the hows and whys of keeping the weight off. Still, the likelihood of malnutrition is almost a non-issue if the proper vitamin/supplement regimen is followed -- especially because you are actually able to gain more benefits from real foods ingested.
 
Check out these sites for more info and resources:

The Obesity Help DS Forum

A side-by-side comparison of the most widely-performed weight loss surgeries

The Duodenal Switch Information Zone
 
Duodenal Switch Yahoo Group

Read more about my personal weight loss journey by clicking here for my Duodenal Switch Information Zone Profile

DS Insurance Authorization Yahoo Group

DS Post-Op Problems Yahoo Group

Think I'm exaggerating? ... See The Ups & Downs of Being Me (with pictures)