My Timeline:

First Contact with Surgeon: December 17, 2007
Pre-op Diet Started: January 14, 2008
Consult with Dr. Schweitzer: February 4, 2008
Pre-op Diet Finished: March 31, 2008
Insurance Submitted: April 15, 2008
APPROVED: May 5, 2008
Surgery Scheduled: May 8, 2008
Pre-op Blood work: June 14, 2008
Pre-op PCP Visit: June 16, 2008
Surgery!!!:  June 26, 2008

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My Story is probably one you have heard many times before. It may even be your story. :)

I've been fat all of my life. I used to hate that word... fat. But it's what I am and what I've always been. I can remember being maybe 7 or 8 and stepping on the scale at 120 lbs. I was over 200 lbs by 7th grade, over 250 lbs in High School. In my early 20s I stayed around 265 lbs or so. And I was fine with that! I didn't have image issues or self esteem issues. I was pretty, I was healthy, I had a ton of friends, I was happy.

Fast forward 5 years... I'm over 300 lbs. I am starting to feel the effects of my weight. I'm tired all the time, I can't walk far before I get winded. I'm 29 and I feel like I'm 89. I'm NOT happy with myself. I have a wonderful career, a wonderful family, wonderful friends, and yet I'm starting to not like myself. And I've ALWAYS liked myself. And it's not good to not like yourself, because it permeates into every other area of your life.

I've tried it all. Let me think. Atkins, South Beach, Slim Fast, the Zone, Body for Life, Weight Watchers. The most I've ever lost is 30 lbs. The lowest I've ever been as an adult is 262 lbs. That's crazy when you think about it. But I just thought I was destined to be fat. Not any more. I can do this!

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My Top 10 Things I Look Forward To:
(Inspired by Jazzi )

1.  More energy to live my everyday life

2.  Stilettos, peep toes, pumps, boots, flats, and every other kind of shoe imaginable
 
3.  Not feeling controlled by my weight anymore

4.  Getting married on a beach barefoot in a sleeveless gown

5.  Not feeling like the fat person in every situation
 
6.  Dancing like Beyonce in the club all night

7.  Riding all the rides at Great Adventure

8.  Getting rid of asthma (hopefully)

9.  Crossing my legs

10. Shopping!

DS Regrets  --  Diana Cox

There have been people who have had severe and life-threatening complications.  People have died.  People have had issues with eating and food that have lasted beyond the expected few weeks.  People have become malnourished.  People have had problems with gas and loose stools and incontinence that have made them homebound.  People have not lost nearly enough weight and/or regained.  People have lost weight and become severely depressed and have even commited suicide when their lives didn't improve the way they thought they should have.

There, we've put it on the table.  The DS isn't a panacea for all that ails you.

Having said that, the above issues are rare and/or mostly easily manageable:

* All surgeries, especially those on MOs and SMOs, have a non-trivial rate of complications and dying.  You can minimize that by (1) going to the BEST DS-experienced surgeon you can find, with no fewer than 100 DSs under his/her belt; (2) performed in a facility that is beyond reproach; and (3) get yourself in condition for surgery as best as you can: quit smoking, start walking, start taking vitamins; use an inspiration spirometer or blow up balloons pre-op; get your ass out of bed ASAP after surgery and WALK; don't worry about protein the first month or two, but DO worry about fluids.  And taking your supplements, and following up with your surgeon and doing all your blood work REGULARLY. 

* The surgery has a long term weight loss statistic of 75% of excess weight lost.  That isn't 100%.  It is a bell curve that means that there are 50% who do better and 50% who do worse.  Be prepared to deal with that statistic.  By the way, it ALSO has a long term weight loss statistic of 94% "success rate," by which is meant, that 94% of all patients kept off at least 50% of EWL.  Yes, the measure of success is only 50% EWL.  But that statistic in particular beats the hell out of the long term RNY statistics.

* If you are in danger of losing too much weight, there are strategies for coping and adapting short of revision surgery.  Eat more is an enjoyable one.  Take fistfuls of pancreatic enzymes with each of several meals a day is less appealing, but should only be necessary for a few months until your body adapts.  Only about 3% of patients need revisions to their DS, usually to lengthen the common channel when these methods fail, which is a relatively easy lap surgery.

* Stinky gas and loose poops usually can be treated.  For some of us, that's as easy as taking probiotics and TiVo'ing our white flour or other carb food choices to more convenient times (i.e., only eat them at dinner or on the weekends so you can fart to your heart's content in the privacy of your home).  For others, it can be more of a struggle, but still manageable -- taking Flagyl prophylactically, avoiding trigger foods, using medications to ameliorate smell or absorb bile acids.  It is quite rare that this is an intractible problem, and even then, revision is an option.  More commonly, people who have the DS and then lose touch with their support community and surgeon support think nothing can be done and give up trying -- THAT is almost always wrong.  There are LOTS of strategies that can be tried and usually one or more will help.

* Some people can sabotage even the DS and not lose enough.  The DS is not a free ride in particular for sugar and alcohol.  There are one or two surgeons who have or have had a reputation for having way more than the average number of patients who fail to lose enough -- my understanding is that asking whether your surgeon uses the Hess method of measuring the intestines is critical to reducing the likelihood of this problem.

* If you are depressed before surgery, you will likely be depressed afterwards.  Get treatment.  Psychological treatment is a good adjunct to a post-surgery program, especially if you suffered from mood disorders, addictions, sexual abuse, eating disorders, a marriage that was sucky before surgery, etc.  Weight loss isn't going to cure the problems in your life, and in fact may bring even more of them to the surface if you buried them in food and fat.

If you want to avoid regrets, learn everything you can, with an open mind, before you chose a surgery and before you commit to a surgical program.  This includes reading here, on your surgeon's chat site, and at:
http://health.groups.yahoo.com/group/DS_PostOp_Problems/
http://health.groups.yahoo.com/group/duodenalswitch/
http://www.duodenalswitch.com/forum/forumdisplay.php?f=25

But for me, the almost effortless weight loss, ease of maintenance of that loss, quality of life, my ability to feel SATIATED for the first time, ablity to eat pretty much what I want, including fat and protein to my heart's content, is beyond worth the risk I took to have this surgery in the first place, and is all the impetus I need to do the modest amount of work that it takes to stay healthy (eat protein, take my supplements, go to the doctor once a year or when I need it).  It is my gift to myself.

Good luck, and work hard at preparing and informing yourself fully.

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DS vs. RNY - Blackthorne

Both the DS and the RNY have two parts to the surgery - what is done to the stomach (restrictive part) and what is done to the intestines (malabsorptive part).

In the RNY, they section off the majority of the stomach which remains in the body, but unused (thus the term gastric bypass). Because this area is 'blind' - not accessible via oral medication or endoscopy, RNY'ers are advised to avoid NSAIDS or non-steroidal anti-imflammatory drugs such as aspirin or ibuprofen due to the potential for ulcers. DS'ers don't have this problem because there is no blind portion - the unused part of the stomach is removed instead, so we can take OTC drugs. For people with *other* problems, such as lupus or migraines or a family history of ulcers, this can be an important factor in their decision.

The remaining portion (nicknamed The Pouch) is anywhere from 1-3 oz. (About the size of a large egg). This then feeds directly into a newly restructured part of the intestine with no valve regulating how quickly food moves from the stomach into the intestine.

Instead of a valve, there's simply a hole - kind of like a doorway - which leads into the intestines. This is called a stoma. The stoma is not flexible, so it cannot expand if you try to put something through it that is too big. This is why RNY'ers are told to chew their food VERY well, and are advised AGAINST having fluid with meals, because just like a sink drain, solid stuff will go down easier if you 'flush' it down with water.

Because there is no regulation there, three-fourths of all RNY patients suffer a syndrome called Dumping. For some people, dumping just makes them feel a little bad. Others vomit. Still others have a more severe reaction that feels more like a bad case of the flu, and a rare but potentially dangerous reaction can be like a diabetic attack.

Dumping Syndrome can be both a positive and a negative factor - if you immediately suffer a REALLY bad reaction to eating sweets, you're going to learn (the hard way) to avoid foods that aren't good for you. It's called Aversion Therapy, and if you learn better from the stick than you do from the carrot, this will keep you on the straight and narrow.

In the DS, they literally do a gastrectomy, removing the outer curvature of the stomach (making it physically smaller), but leaving the actual functionality of the stomach intact as it was before surgery. The remaining portion of the stomach is kind of "banana" shaped, and you start with about 3-5oz stomach - a little larger than the RNY, but still MUCH smaller than it is now.

You have multiple places in your body where you have a sphincter type muscle - the one everyone is familiar with is your anus, at the 'bottom' (pun intended) of your intestines. Well, you have a similar 'ring of muscle' at the pit of your stomach called the pyloric valve. Because this valve remains in use, DS patients do not have any dumping because the pyloric valve is still regulating how often food moves into the intestines as it does for you right now.

In both surgeries, the stomach/pouch will expand over time to about twice it's post-surgery size. This leaves long-term RNY'ers with about 3-5oz and long-term DS'ers with about 10-12oz.

Then we move into the lower portion of the surgery, which is essentially the same for both with a few small, but significant differences. The small intestine has three sections/phases - called the jujuneum, the illeum and the duodenum. (Forgive my spelling if it's wrong - it *is* 4:30 in the morning)

Right now, it is one continuous line. What they do is cut it in two and reattach them in a Y formation. One branch of the Y comes down from the liver with the digestive juices. The other portion comes down from the stomach (DS) or the pouch (RNY) with food. The two them come together into what is called the common channel which then has both digestive juices and food. It is in the common channel that most digestion takes place. (Some digestion takes place all throughout the whole digestive system, starting from saliva in the mouth, all the way to the colon)

The primary differences between the two in the lower part are this:

1) In the RNY, the common channel is generally longer - perhaps 275cm. In the DS, it's generally shorter - about 100cm. Everyone absorbs carbs like a non-WLS patient, but we malabsorb for protein, fat and calories - DS more than RNY, again due to the shorter common channel.

The 'big' problem this causes the DS'ers is too much fat can cause bad-smelling gas and/or diarrhea - and it's the one thing everyone who has every heard of the DS has heard of. However, for MOST people, this isn't a huge problem, is easily controlled with products like Beano, and watching what they eat.

2) The Duodenum is bypassed in the RNY, and it is functional in the DS. What makes that important is that this is where protein, calcium, iron and vitamin B12 are absorbed. So even though the DS has a greater malabsorptive factor (the shorter common channel), it actually has more normal nutritional absorption than the RNY because the duodenum is still involved in the digestive process.

Now - BOTH types have to watch what they eat, and be aware that they are susceptible to nutritional deficiencies. For the most part, these can be controlled with diet, but if your diet is out of control, you can do *severe* damage to your health if you ignore this.

DS patients specifically need to make sure they take calcium & protein, and the fat soluable vitamins. RNY patients need to make sure they get protein, calcium, iron & B12. (Some need B12 shots, but not all). A person who has never had surgery needs about 60g of protein a day. RNY need about 80g. I've seen recommendations for DS patients of 90-120g.

Everyone should take a multi-vitamin, and get exercise, with or without WLS surgery. A low-carb, high protein diet is recommended to make sure you get in your protein, and you'll find LOTS of suggestions on what to eat on every board - both food, protein shake and supplement-wise.

Hope that helps.