DS v. RNY -- PA doctors

Hi All,

I am currently in the process of getting RNy with Temple University Hospital in Philadelphia.  My chart is heading for insurance review with a tenative surgery date of 2/26/13.

I keep wondering if I should reconsider and have the DS but I'm afraid to stop the wheels in motion for me to have my surgery.  I am a dental hygienist and have all cleared my schedule i March for this.  it would be a big hassle to stop this process now...

BUT my biggest reason for WLS is resolution of diabetes, sleep apnea and high cholesterol.  My BMI is 40.5.

Some reading I've done suggests maintenance becomes hard at the 2nd year and weight gain probable.  I'm wondering how you can gin weight after WLS if you don't have a stomach big enough to eat alot?

What is the biggest lifestyle differences between DS and RNY? Success?  Supplements?

I've asked my doctor, but he tells me that DS is more for people with larger BMIs as a journey to RNY if I understood him, but I am wondering if he does many DS surgeries.

I've also read the term "vetted DS doctor".  What does that mean and are there any recommended DS doctors in SouthEast PA?

Thanks, appreciate any feedback.,

Deb

First have you been to www.dsfacts.com? It explains alot. With the RNY you lose your pyloric valve which is the syphinctar at the end of your stomach. With the RNY food just falls through and you can eat alot more often. With the DS and retaining your pyloric valve you have a "preasurized" system which keeps you fuller longer and food moves slower. Also, with the DS the mal-absorption is perminent. Studies suggest that the mal-absorption with the RNY fades over time. I have a friends who have had the RNY and are now bigger than they were before surgery. I have a friend who had it and has struggled with regain and her diabetes has returned. The best resolution of diabetes come from the DS hands down. As far as cholesterol with the DS you only absorb 20% of the fat you consume. I know of no DS patient with elevated cholesterol and I've met a lot of them. My surgeon will rarely recommend the RNY anymore. I'm not sure what insurance you have. Some require a BMI of 50 or a lower BMI with at least 2 co-morbidities which you seem to have. Most insurance companies have the same standard process for all the surgeries then you ask for the specific surgery so you may not be looking at prolonging your time, but if you do it will be worth it. Check out the revisions board and see how many end up getting revised from a RNY to a DS. You really only want to go into the OR once so choose wisely now. 

Here is what DS Facts has as far as vetted surgeons.

Fernando Bonanni, MD *
Gintas Antanavicius, MD *

Abington Memorial Hospital
Institute for Metabolic and Bariatric Surgery
225 Newtown Rd, 2nd Floor
Warminster, PA 18974
Phone: 215-441-6800
Fax: 215-441-6810

 

Good luck.

Seriously, think twice, cut once.  This is a lot more important than a scheduling issue.  The DS is simply your best chance to lose the weight, keep it off and get rid of your diabetes for good.  Docs are in business to make money and whatever surgery he/she does becomes the one you need.  Just like the guy who sells Toyotas isn't going to tell you about the Nissan that's a better product.

 

There are lots of people here who are RNY to DS revisions.  I don't know of anyone who has ever revised from the DS to the RNY.

 

Dsers can eventually eat a normal meal.  And we don't have to worry about dumping or throwing up all the time.  I would never trade my DS for a RNY.  And I'm 10 YEARS post op.

There IS one I know of...but even she admits she didn't use the DS right. And rather than fight it, she opted to go the RNY route.

 

I am a DS revision. I have had the DS for 3.5 years. I cannot say what surgery is best. I cam only give my experience...i mad the outdated VBG in 2006. I had a horrible pouch but no malasorption. It was the worst experience ever!! In 2009 i had a revision to the DS. So...life for me is: i eat whatever i want (protein first) but..nothing gets stuck!! I am at 128 pounds and holding steady...i personally have no side effects from food, gas, etc...not saying that is always the case...just for me.

In my personal experience, i would never ever want a pouch...for me the DS was the best decision ever!!! My advice to you is....make sure you get what you want! Don't settle. A revision is not easy and not always possible!!!!

Good luck with whatever you decide!!!!

I was just on the Facebook page for DS OH family and was reading someone's post about her revision and how slow her loss is and thought about your post. Please go to the revisions board and seek out some of them and their experiences.

Check DSFacts for the list of vetted doctors. They are vetted by LONG term vets for their ability to stay true to the DS. We would add others as they show but most of the ones who do the DS are not yet on the list.

Mine won't make the list...he's a good cutter but lousy followup and tends to think RNY in his office. All the advice given is RNY based. He also sells his own line of vitamins which are NOT good for DS'er's.

Schedules can be adjusted...I was on track to get a RNY and derailed myself to get the DS...GLAD I DID! I am almost 2 years out now. I could be over 2 1/2 years out if I had stuck to the RNY and fighting regain about now. Also NOT able to take NSAIDS as needed.

Think twice, cut once. IF after you read all there is at DSFacts and on here (include the revision and the regrets boards) and then decide on the RNY, at least you will have made a fully informed decision. And that is all we ask.

Liz

 

 

 

 

Cross posted from my reply on the main board:

 

Before making a decision, you need to watch this video and read this transcript on why the RNY (and LapBand) can fail and need to be revised.  Weight regain is a real possibility with the RNY, and contrary to popular belief is not always the fault of the patient.  There are real mechanics of the surgery that can lead to the regain.

If you qualify for WLS, you qualify for the DS.  A good DS surgeon can customize limb lengths for you to balance your lower BMI.  The reason why your surgeon is not recommending it is because he doesnt perform it.  The DS is a more complex surgery and not all surgeons know how to do it.

 

http://www.obesityhelp.com/forums/amos/4416773/quotDoes-the- Patient-Fail-the-Procedure-or-Does-the/

Hi, Deb. I got your PM, but I can't reply to it---OH has had me on 'two week moderation' since the fall of 2011, which means I can't use the PM function. (Looong story.)

The DS is simply the BEST surgery for the treatment of diabetes and high cholesterol. Period.

Maintenance with the RNY becomes difficult for two reasons. At around 18-24 months, pretty much all malabsorption of CALORIES is gone. So little is bypassed in the proximal RNY (the form that nearly all surgeons do these days, due to some bad nutritional outcomes with the distal RNY) that the body can overcome it pretty quickly by growing additional villi. (Villi are the little hair-like projections from the intestinal wall that do the actual absorbing.) Also, the RNY uses an always-open stoma as a connection between the pouch and the small intestine, and all too often this stretches to the point where there's no longer any real restriction. Doesn't matter how large or small the pouch is, if the stoma doesn't keep anything inside of it.

On the other hand, the DS retains the pylorus and a fully-functional stomach. Yes, over time you WILL be able to eat more, but you'll never be able to eat like pre-op---and you'll always malabsorb a significant per centage of the calories you eat, especially those from fat.

The biggest difference between the RNY and the DS? Well you'll get a better answer from the many people who've had their RNY revised to a DS, but when I was researching, these are the differences I noticed post-ops talking about:

Pouch vs. stomach

Frequent intolerance of food, especially MEATS, vs. good tolerance of pretty much everything

83% resolution of diabetes vs. 98+%---which seems to be PERMANENT

1500 calories a day vs. 2500-3000

No drinking during or immediately after meals vs. drinking at will

Vitamins 2-3 times a day vs. vitamins 3-4 times a day

Strict eating plan vs. liberal eating plan

65% EWL at 5+ years post-op, vs. 80% EWL at 10+ years post-op (EWL=excess weight lost)

 

As for the DS being for people with high BMIs---we have a lot of posters here who had their DS with a BMI between 35 and 40. And as for it being part of a 'journey' to the RNY??? BULL**** I suspect your surgeon has never done a DS.What does he think about all the folks who get their RNY revised TO a DS?

Being "vetted" simply means that a surgeon has good experience doing the DS, and has shown good patient results. There's not a hard and fast rule about how a surgeon gets vetted, since there is no governing body---it's a term applied to surgeons who've met with the approval of the DS community at large. Surgeons are constantly being added, as they gain experience, and being dropped if they 'drop the ball', so to speak.

 

 

 

Ms. Batt and others have covered this so well that I have just a couple little things to add:

 

1. resolution of type 2 diabetes with RNY is not as good as used to be thought. It turns out that for a lot of people, the diabetes goes away for a few years and then returns, making the real rate of permanent resolution somewhere between 40-50%, not 83%. This is fairly new info. With the DS, resolution of type 2 diabetes is not guaranteed, but the rate is somewhere between 95-98%, depending on what study you read, and it rarely returns.

2. Daily calorie consumption with RNY is probably lower than the 1500 calories Ms. Batt stated, though I'm sure it varies from person to person. People I've met IRL with RNY tell me they need to stay around 800 calories/day, maybe 1000 at most, or they regain.

3. I bet that surgeon didn't mention the failure rate for RNY. Now keeping in mind that with any bariatric operation, success is defined as losing just 50% of your excess weight (a very loose definition of success IMHO), the failure rate for RNY is 30%. Sure, there are some people who don't follow the rules, but most of the people I've met who are struggling are genuinely trying their best to follow the diet and exercise program.

4. comorbidities - not only does DS have the best rate of resolution for type 2 diabetes, but also for sleep apnea. Improvement in sleep apnea is dependent on how much weight you lose. An operation that gives you more weight loss, as the Ds does, will also give you the most improvement in your sleep apnea.

     Sorting out your time off work is a pain, but not that big a deal in the greater scheme of things. You will live with this decision for the rest of your life. If you believe that the DS is the best choice for YOU, put yourself first for a change and do whatever you need to do to take the best care of yourself. You won't regret it.

Larra