- HEALTH TRACKER
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Jeffrey Lord, M.D.
Never In My Life have i Ever Seen a Doctor/Surgeon who is so through, caring, Understanding and Willing to Help.
One Week Ago Yesterday so im 7 Days Post Op, I Have a Revision done to a WLS that was the one that got all this started, as mine was back in 1974, Called the JIB (intestinal bypass) or juliano lenal intestinal bypass, i was 17 at the time and weighed over 500 pounds, alot of that i feel due to my family situation.
Anyway for years i maintained my weight, and had few problems and stayed around 280 for 25 years, then as ive aged the problems quoted below really came to light.
Fast forward to 1994. I began to suffer from something called dermatitis-arthritis bypass syndrome. Every few months, I would get a red pox on my arms, legs, and thighs and experience excruciating migratory arthritis for about 7 to 10 days. First one joint, then another, would stiffen and become inflamed and very, very painful. The syndrome is caused by bacterial overgrowth in the disconnected small intestine. You see, the bacteria present in the small intestine is not found anywhere else in the body, and it is normally removed from the body through the normal elimination process. However, the disconnected small intestine laying atrophied, but still kept alive by the surrounding environment in my abdomen, continues to produce this bacteria on some marginal level until it reaches a critical level.
This bowel, though, has no outlet, so the bacterial overgrowth dumps into my bloodstream, where it provokes an immune system response. These immune complexes (antigen and antibody bound together) circulate in the blood stream and are deposited in tissues and joints....this it what causes the inflammatory reaction, the arthritis. Treatment consists of hitting the bacteria with an antibiotic and taking anti-inflammatory drugs to ease the pain. This worked for about two years. Until August 1996.
In August, I began experiencing increasing arthritis pain. No longer did the arthritis continue its "hit and run" tactics of the past....it attacked many joints at once and did not disappear after a week or so. I completed three, 10-day courses of antibiotics, each one progressively stronger, to no avail. In September, I visited the doctor to have my annual blood work-up to see if all was well. All was not well.
The blood chemistry tests came back within normal limits. However, my liver enzyme count was over six times normal (normal is about 30...mine was 198). By this time, I was suffering arthritis pain in the ankles, toes, knees, and hips and my mobility was significantly impaired. My doctor prescribed a different antibiotic, 800 mgs. of Ibuprofen three times a day, and took more blood tests. A week later, my liver enzymes rose to 495 and I was diagnosed with autoimmune hepatitis. More anti-inflammatory drugs were prescribed, another, stronger antibiotic. I also received what I now consider to be a life-saving referral to an rheumatologist who began other bloodwork.
Some of The Other Symptoms were:
JIB is the classic example of a malabsorptive weight loss procedure. Some modern procedures utilize a lesser degree of malabsorption combined with gastric restriction to induce and maintain weight loss. Any procedure involving malabsorption must be considered at risk to develop at least some of the malabsorptive complications exemplified by JIB. The multiple complications associated with JIB while considerably less severe than those associated with Jejunocolic anastomosis, were sufficiently distressing both to the patient and to the medical attendant to cause the procedure to fall into disrepute.
Listing of jejuno-ileal bypass complications:
Mineral and electrolyte imbalance:
Decreased serum sodium, potassium, magnesium and bicarbonate
Decreased sodium chloride
Osteoporosis and osteomalacia secondary to protein depletion, calcium and vitamin D loss, and acidosis
Protein calorie malnutrition:
Hair loss, anemia, edema, and vitamin depletion
Abdominal distension, irregular diarrhea, increased flatus, pneumatosis intestinalis, colonic pseudo-obstruction, bypass enteropathy, volvulus with mechanical small bowel obstruction
Arthritis (cannot be controlled by conventional methods)
Severe pain issues that are not fully understood
Liver disease, occurs in at least 30%
Acute liver failure may occur in the postoperative period, and may lead to death acutely following surgery.
Steatosis, "alcoholic" type hepatitis, cirrhosis, occurs in 5%, progresses to cirrhosis and death in 1-2%
Erythema nodosum, non-specific pustular dermatosis
Hyperoxaluria, with oxalate stones or interstitial oxalate deposits, immune complex nephritis, "functional" renal failure.
Peripheral neuropathy, pericarditis, pleuritis, hemolytic anemia, neutropenia, and thrombocytopenia
The multiple complications associated with JIB led to a search for alternative procedures, one of which was gastric bypass, a procedure that is described in detail later. In 1983 Griffen et al. reported a comprehensive series comparing the results of jejuno-ileal bypass with gastric bypass. 11 of 50 patients who underwent JIB required conversion to gastric bypass within 5 years, leading Griffen to abandon jejuno-ileal bypass. 
JIB can be summed up as having: a. Good Weight Loss, b. Malabsorption with multiple deficiencies, c. Diarrhea, d. Severe Pain Issues That are not fully understood, e.Possible Death
As a consequence of all these complications, jejuno-ileal bypass is no longer a recommended Bariatric Surgical Procedure. Indeed, the current recommendation for anyone who has undergone JIB, and still has the operation intact, is to strongly consider having it taken down and converted to one of the gastric restrictive procedures.
Anyway Doctor Lord, never having done this when i had it looked into it for me and gave me a revision i can honestly say This Man is The One I Would Be Contacting if i was having WLS Today, thee operation i had in 74 was very very dangerous, and the revision was in return but who better to attempt to do this then someone so skilled in wls, if across you web journeys in forums or where ever although most of those who had this in years past died from it (I was Very Lucky) you run across someone needing help with this tell them Dr. Lord is the man and Now He Has Experience doing them aftr me anyway, Any How Thanks Dr, Lord You Saved My Life if i can helop you in any way done hesitate to ask.
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