Doc trying to talk me out of a DS

on 3/13/20 5:01 pm - Etobicoke, Canada

I had a gastric bypass back in 2005 and it's been failing since 2012. I have spent the years since 2012 fighting with one quack after another trying to get a revision surgery.

To make a long story short, I finally had a consult with a surgeon today. I knew going in that he isn't the doctor who can do a DS. I am in Ontario Canada and we have to jump through a series of bureaucratic hoops to get any kind of health care. For bariatric surgery they waste your time making you go to the closest hospital to your home, even if they don't do the surgery you need. That's where I was today. Their surgeon only does sleeves and RNY.

I expected to be turned away "we don't do your kind of surgery" but not to have to fight again to be referred to a surgeon who does. The surgeon at Toronto Western spent at least half an hour trying to convince me that the DS surgery is a bad idea, calling it "nutritionally catastrophic" among other things, and saying that if he was advising a friend or relative he'd tell them not to get the surgery. He tried to tell me that "nobody does this surgery, even in the US" and "it's never done as a revision for a RNY" which I know is pure bull. I stuck by my guns and told him that I know what the surgery entails but it's a lot better than dying young with diabetes, heart problems, fatty liver, needing a machine to breathe at night and suffering from painful joints from carrying an extra 200 lb around. I already use a walker, I was hoping to lose the weight so I wouldn't have to keep using it.

Then he started in about how I don't "need" another surgery. I weighed over 200 lb 3 months ago when I was first referred to their program - only 90 lb less than my max weight. My diabetes is back, so is my sleep apnea, and my blood pressure is going up again. I have a bad back and bad hips and knees. They weighed me and I'd lost 20 lb in less than two months - not healthy weight loss, I'd been through a major stress (my landlord harassing and threatening me) and when I'm upset I don't eat. But Dr Quack insisted that this meant that I'm "doing well" and if I need to lose weight I can do it on my own. Too bad I won't keep it off! And even at 180 I'm still well into plus sizes and most of my clothes don't fit me.

I dug my heels in and told him "I'm not making this decision until I see a doctor who can do the surgery I need!" and "If you think I'm going to sit back after 2 years of fighting to get here, and let myself die young with diabetes and all the other illnesses I had when I was fat - think again!" I told him having diabetes and weight going up and down means I'm NOT doing well. He even tried telling me "you look so thin in those jeans, you're the thinnest patient I've had all day!" Talk about grasping at straws!

So I demanded to be referred to the one surgeon in my province who does the Duodenal Switch. I wonder if anyone else has had to go through the quackery and attempts to talk them out of this surgery? Or is this just another symptom of Canada's woefully dysfunctional "public" health care system?

H.A.L.A B.
on 3/15/20 11:46 am

I get you are upset. And full of very negative emotions and attitude. Being heavy and hurting, and having diabetes and being sick from that is not fun.

Calling your doc a Quack is still little to hard IMO.

You don't mentioned your current diet. Or exercise routine, or things you do to relieve pain.

I have arthritis and deal with pain every day. And I am either at goal or below goal. Losing weight doesn't mean reducing or eliminating pain. Getting DS doesn't mean curing diabetes you have. If you have Type 1, or type 1.5 - DS and losing weight may not get ot in remission. There are people with type 2, at goal, that are still diabetics and need to be on medication or insulin. There are people who had DS who after first few years started gaining weight and need to be on a specific diet to maintain good weight.

You had RNY in Canads, and BOB in Canada. Because of the systyou guys have. A lot of people in USA can't get insurance to pay for that, even if they need it, the surgery is medically necessary.

If you fee5so strongly about DS, you can try to self pay for that. I get it is expensive, but there are many people who needed WLS and paid for it cash.

It can be expensive, but instead of thinking you can't afford it, put your energy into getting, saving, borrowing, enough money to pay for it.

There are a lot of diabetics in USA who can't afford insulin. Their copays are very expensive.

Some of them decided to use their diet to limit how much insulin they use a month. Some, in the group I am member of, were able to reduce their A1C from 10+, to normal A1C around and below 5.5.

At one time post op RNY I had severe hypoglycemia and reactive hypoglycemia (RH). I was, I am insulin resistant. Before RNY my body used to make too much insulin as response to carbs and lean proteins. Even after I got to goal, I was still insulin resistant. And i am probably like that still. To limit insulin my body makes, I needed to reduce overall carbs, all carbs, not net carbs.

I also needed to increase fat I was eating. My menu used to be fat plus proteins, and maybe a few naturally occurring carbs. Reading dr Bernstein diabetes solutions book helped me to understand what is going on. And I went on a very strict diet.

Slowly I started having less and less RH episodes, and afaik while my body got adapted to burning fats not sugars and I lost 15-18 lbs I regained because I had to chase my BS over and over.

I can't tell you it was easy, because it wasn't. But being determined, hard headed, and persistent, I know what and how much 8 need to eat to maintain or lose weight.

It may be a long time before you can see a DS surgeon. So why not try to what is best for you and your body.

Hala. RNY 5/14/2008; Happy At Goal =HAG

"I can eat or do anything I want to - as long as I am willing to deal with the consequences"

"Failure is not falling down, It is not getting up once you fell... So pick yourself up, dust yourself off, and start all over again...."

on 3/15/20 3:58 pm
RNY on 08/21/12

Docs that do a DS are hard to find, anywhere. It just isn't commonly done, at all. But you can find a DS surgeon if you look hard enough.

The real problem is, you are not trying to get a DS. You are trying to get a revision from RNY to DS. Finding a doc who is qualified to do one of those is incredibly rare. As in, you can count on one hand the surgeons who have any real experience doing it. I think, maybe, there is one such surgeon in all of Canada.

To revise an RNY requires dismantling the bypass and putting everything back together the way it began. THEN they do a sleeve, then the switch part.

Taking down an RNY and doing a DS is incredibly complex and risky, both for you AND the surgeon.

Be really careful who you go to for this kind of revision. It is very risky.

You may very well have to travel and self pay if this is the only avenue you are going to pursue.

6'3" tall, male.

Highest weight was 475. RNY on 08/21/12.

M1 -24; M2 -21; M3 -19; M4 -21; M5 -13; M6 -21; M7 -10; M8 -16; M9 -10; M10 -8; M11 -6; M12 -5.

Janet P.
on 3/16/20 5:05 am

Grim, you make an excellent point. Revising from RNY to DS is a very complicated procedure and even many surgeons who do the DS will not do RNY-DS revisions.

I do know that my surgeon, Dr. Elariny, has done this type of revision.

Janet in Leesburg
DS 2/25/03
Hazem Elariny

on 3/16/20 10:09 am

There are very few surgeons who do RNY to DS revisions. I am not sure if there IS a surgeon in Canada who does this surgery routinely. I haven't heard of one. I do believe there is a procedure in place to be allowed to go to the surgeon who does this procedure, even if you have to travel out of the country. Check on what's available in your province.

on 3/16/20 6:38 pm - CA

At one time, Dr. Gagner in Montreal was doing them, but I don't know if he still does, or if he is still practicing in CA. I've seen several come through Rabkin and Keshisian who have done well, but they are a couple of the handful who are noted for being able to do the procedure.

What the OP is experiencing is not unusual, even here in the States, as most surgeons are not inclined to look favorably to procedures that they themselves don't perform, and it is rare to get one to offer a referral. One thing to watch for are those who advertise doing the DS on their practice profile or CV but don't actually perform them, instead badmouthing it and selling the prospective patient on one of the procedures that they do offer (the so-called "bait and don't switch" approach.)

When one is under the restrictions of these limited HMO or NHS type of plans, one does have to push hard to get what one wants and needs out of the system. I suspect that the best one can do without leaving the country would be a distal RNY which has a similar level of malabsorption as the DS but in an RNY configuration; I don't know if it is any better on diabetes remission than the normal proximal RNY (that would probably be your key factor in appealing to get permission for the DS revision.)

1st support group/seminar - 8/03 (has it been that long?)  

Wife's DS - 5/05 w Dr. Robert Rabkin   VSG on 5/9/11 by Dr. John Rabkin


White Dove
on 3/16/20 11:43 am - Warren, OH

The was a young guy on here years ago who can his RNY converted to a DS. He died shortly after the surgery.

Real life begins where your comfort zone ends

on 3/16/20 6:42 pm - CA

This isn't overly useful, as one can find examples of patients who have died from any of these prodedures - RNY, VSG, bands, balloons, etc., or any other surgical procedure. The basic lesson to keep in mind is that the more complex and lengthy the procedure, the more risky it tends to be - and revisions in general are more complex and tend to take longer than virgin procedures, so one must weight the risks vs. prospective benefits.

1st support group/seminar - 8/03 (has it been that long?)  

Wife's DS - 5/05 w Dr. Robert Rabkin   VSG on 5/9/11 by Dr. John Rabkin


White Dove
on 3/18/20 5:14 am - Warren, OH

I was a member here when it happened and it was useful to me. I was one of the people who was considering reversing RNY to DS. I spoke with several surgeons who told me that there was no difference in the two procedures are far as controlling diabetes.

The person who had the surgery and then died was very vocal here about how we were all fools for not reversing to DS and I remember him telling me how sorry I would be with my RNY in a few years.

Around 2008, there was a very strong group on this board who ridiculed anyone who did not have DS.

Obesity Help finally banned them from this board.

Real life begins where your comfort zone ends

on 3/17/20 11:31 am - Putnam, CT
Revision on 02/04/15

You sound like a kid who hasn't gotten their way. Calling doctor's quacks because they don't give right in to what you want is very childish.

Your "dysfunctional public health care" has already given you TWO WLS and you appeared to have failed both of them. You want what you want and it very well could cost you your life. As others have said there are not many surgeons who perform the take down of a RNY and then do the DS. It is a very long complicated surgery.

Maybe you should look at why the first two WLS failed, because if you think you will not gain weight with the DS then you are in for a very rude awakening.

Dr. Sanchez Lapband 9/12/2003
hw305/revision w280/cw197/gw150

Revision from Lap Band to Bypass on 2/4/2015 by Dr. Pohl


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