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Why the DS instead of the RNY?
· Dumping. This is caused by certain foods passing too quickly into the intestines. Usually sugar is the culprit, but this can happen with fats or other types of food—even sugar-free foods! It varies on what will make you dump and in what amounts. Some people do not dump at all, while other people can dump after eating as little as 5 grams of sugar! Can you commit to never being able to eat a little treat ever again?
· Food getting “stuck”. Fibrous foods like chicken, beef, lettuce, and raw vegetables can sometimes be difficult for people to eat after the RNY because they become lodged in the pouch with no ability for stomach muscles to help move the food through.
· The stoma (the exit hole from the pouch) getting stretched (which causes food to exit too quickly and thus the person to become hungry again too quickly.) This has become a common enough problem that new procedures have been invented to try to resize the pouch for RNYers who are always hungry with stretched-out stomas.
· Strictures. (The stoma becomes too narrow so that food can no longer pass through.) This problem requires another visit to the surgeon.
· The malabsorption of certain vitamins and minerals that rely on the pyloric section of the stomach to be absorbed: iron and vitamin B’s.
Another fear is malabsorbtion. While the DS results in more overall malabsorption, the RNY completely bypasses important absorption sections of the gastro-intestinal system, actually resulting in worse malabsorption for some specific nutrients than with the DS. This study, for example, found no difference between the nutritional deficiencies of RNYers versus DSers except with iron levels, which were worse for RNYers: http://www.springerlink.com/content/p73087r79056k454/ . Part of the reason why so many people think that the DS results in dangerously low nutrient levels is because the DS is often confused with some of the older procedures from which it developed. Improvements that led to what the DS is today have vastly reduced problems of this nature. Even many well-meaning doctors who specialize in the RNY instead of the DS don’t really “get” that the DS is different from the old JIB and other malabsorptive procedures that aren’t performed any longer. Unfortunately, uninformed people are continuing to perpetuate some of the misunderstandings about the DS being “dangerous” or too drastic. Just like the RNY, the DS will require regular supplements to be taken every day for the rest of your life.
Other myths about the DS include:
· It’s only for super morbidly obese people.
Fact: when the DS was new, it was often reserved for the people with the highest BMIs. But that was then. It has now been shown to be an excellent option for morbidly obese patients of BMI with the same criteria used to get an RNY. It hasn’t been shown to cause people of lower BMIs to drop to dangerously low weights. Even patients who had a DS with a starting BMI of 35 have stopped losing at a normal weight and have done wonderfully with the DS. Many people (and even some surgeons who aren’t thoroughly educated on the DS) still mistakenly think it’s just for the highest BMIs.
Several articles have recently been published about how much better the DS results are for the super morbidly obese compared to other procedures. This may explain why some people believe that the DS is only for the super morbidly obese. These articles were merely pointing out that the DS should definitely be the “operation of choice” for the super morbidly obese, but they weren’t meant to discount the fact that it also has the best results for morbidly obese as well.
· It has a higher death rate.
Fact: Studies have shown that the mortality rate is not different enough from the RNY to be statistically significant (http://www.ncbi.nlm.nih.gov/pubmed/18219767?ordinalpos=5&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum ). Of course, selecting an experienced surgeon is always extremely important.
· It can’t be reversed.
Fact: While it’s true that the stomach, after being trimmed down, can’t be enlarged again (it does stretch to a much larger size on its own anyway); the intestines can be reversed to their normal pre-malabsorptive arrangement. Also, while it’s very rarely required, it’s possible to lengthen or shorten the intestinal channel to slow down or boost weight loss or to increase absorption if necessary.
· Insurance doesn’t cover it.
Fact: The government insurer Medicare covers the DS under the exact same criteria as the RNY.