Any thoughts? Be kind, please...

mlleelise
on 2/26/13 2:05 pm
DS on 02/13/12

Hi all! I lurk here constantly, but hesitate to post.  I do NOT want to discourage anyone.  I just recently had my 1 year surgiversary, and sadly I am one of the very few who has had inadequate weight loss with my DS, with an EWL of about 33% at 13 mos out.  Still I do not regret my surgery, but I am seriously disappointed. Read on...

I have had a number of things working against me. Before surgery, I had a documented extremely low basal metabolic rate and had been eating 500 cals per day to maintain my 36 BMI. Previously had lap-band; then had DS surgery...self-pay so I was HIGHLY motivated, believe me. I also am the caregiver for a very sick husband, as well as my blind 89 yr old mother who is failing; I recognize that my stress levels are high, which doesn't help. I have written privately to some very successful lightweight DSers here, to make sure I was doing all that I could - and it seems I am. But I was hoping someone here might read my story and have some insight.

 This is my story: A lightweight, I started at only 182 lbs at 5'1/2"...lost 32 lbs REALLY fast, because of c-diff, then colitis after my DS surgery. But after the first 3 mos, I never lost another pound! I carefully track my carbs (between 30-50 per day) - and have from the start.  My surgeon, Dr. Keshishian was concerned that I was worrying too much about eating ENOUGH protein, so he told me to stop tracking what I ate...just eat protein first. He was sure that was the problem, and that I would end up losing too much. So, I stopped tracking last August, but made sure I got plenty of water, proteins, fats - and only mentally tracked my carbs...and what happened?? I GAINED back 10 lbs in the next 3 months!!!  Horrified, I started keeping an eye on my calories ( I know...something we are never supposed to do). and obsessively tracking protein/carbs/fats on Jan 1st.  The scale has not budged even 1 lb downward in the 8 weeks,  since that 10 lbs regain

On the positive side, I do eat roughly 1300- 1600 cals/day, which, in itself, is something I never thought I would be able to do.  I am never hungry, like before surgery when I couldn't  eat more than 500 a day to maintain. My co-morbidites have improved immensely, though not totally resolved. So my surgery was successful in these ways.

But, what am I going to do about the fact that it doesn't seem that I will ever hit 120 lbs, my goal which is reasonable for my height??? My husband & I incurred such debt for my DS surgery, that I would like to be more successful. Dr. Keshishian wants to see me to discuss shortening my common or alimentary channels.  I'm not sure I'm up for that - financially or otherwise - especially after my extended recuperation last year. But I am traveling to CA in March to go over the possibilities.  He's also concerned about my very elevated liver enzymes.  By the way, I do not take any B vitamins or iron - never have because those levels are way high too. Otherwise I faithfully follow Vitalady's supplement regime and all my labs (other than liver, iron and B vites being very high) are awesome.  And  I continue to faithfully track protein, fats, and carbs. 

This is my assessment:  I think my body learned very quickly to extract all calories and nutrients  from food - like in about 3 months, instead of the typical 18 mos. Does that sound about right?? I never have diarrhea or gas, like most DSer's do, which is odd as well.  Honestly, if I didn't have such a vivid memory of my 2 week hospital stay in CA last year, I would seriously wonder if I really had DS surgery (aside from the fact I can eat more per day)


What saddens me is that we all worry that WE might be the one case where the DS doesn't work well - but most EVERYONE is pleasantly surprised when the pounds just melt away.  The DS surgery has approximately a 98% success rate.  Awesome!! Why can't I be one of the 98%, instead of the 2%? Please forgive me for being a downer...I read everyone's GLOWING weight losses and want to cry.  I'm happy for everyone, I really am.  But I desperately need to experience the joy that all of you have.

I recognize that a revision would be self-pay again (meaning, get another loan).  So i was wondering if anyone here has had a revision of the either channels.  If so, what was your experience? Also, my DS surgery was open, not laparoscopic...is a revision of the channels performed laparoscopically? I hope so.  I probably need to wait and see what Dr. K recommends, but I would appreciate any thoughts.  Please don't scold me too much for cutting back on my protein and calories. I tried eating the way DSers do - with over 100 gms of protein with lots & lots of fats - and gained.  I don't know the answer. 
Thank you so much for taking the time to read this.

MlleElise

MacMadame
on 2/26/13 2:35 pm - Northern, CA

Well, first of all, the DS success rate isn't anywhere near 98%. That's propaganda! Average EWL with DS  is about 80-90% which means not everyone loses all their excess weight even with the DS. Yes, the DS has the best stats, but it's not perfect or close to it.

Second, if Dr. K is talking about shortening your common channel, is it possible that he made it kind of long because you were a lightweight and he sort of didn't believe you about maintaining on 500 calories? Do you have your OR report? What does it say your common channel length is?

HW - 225 SW - 191 GW - 132 CW - 122
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MajorMom
on 2/26/13 6:56 pm - VA

Not your fault and there are other patients who couldn't get to normal BMI even though they did everything right. "Super absorber", perhaps? Could be. It sounds like you're doing all you can. Listen to Dr K, he's probably seen it all. He may be right about the common channel length being too long. You might ask for that surgery report as Marie suggests. What Dr Greenbaum has found is that revision patients need a shorter common channel to overcome the body's previous adaptations after the first WLS. 

--gina

5'1" -- HW 195/SW 187/GW 115 July 08/CW 121 Dec 2012
                                 ******GOAL*******

Starting BMI between 35 and 40ish? 
Join us on the
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DS on Aug 9, 2007 with Dr. Hazem Elariny

(deactivated member)
on 2/26/13 10:23 pm

I was a "super absorber " too before my ( proximal RNY  ) surgery ... and I developed a few ways to mitigate it .  Please read the  anti -grazing tips ... basically I eat very high volume and very low fat foods .  

I know with the DS you're supposed to have a get-out-of-jail -free card regarding fat , but not everyone does .  My husband who has diabetes and has a distal RNY ( very similar in effect to a DS ) .. lost loads of weight when he ate my healthy cooking  sometimes and only walked a few times per week .  

 

Whatever U try .. I think Ull find Ur  surgery makes it a lot more effective .  

 

(((( good luck ))))) 

Huneypie
on 2/27/13 1:58 am, edited 2/27/13 2:01 am - London, United Kingdom
DS on 07/24/12

I'd want to know what your CC is at present and what Dr K proposes to shorten it to.  The consensus really seems to be that 25cm won't make much difference and you can't make a decision without that info.

You may also want to contemplate re-sleeving.  I read a few years back that can be more successful than shortening the CC, but I don't have that link I'm afraid.  The closest I have is this one http://www.obesityhelp.com/forums/DS/4398034/REPEAT-SLEEVE-F OR-WEIGHT-REGAIN-OH-MY/#36361897

You probably had a mucked up metabolism from that nasty band.  I'm sending you a big ((hug)) for whatever you decide.

Lowish BMI? See Lightweights Board! Lightweight Creed For more on DS see www.DSfacts.com
If you don't have peace, it isn't because someone took it from you; you gave it away. You cannot always control what happens to you, but you can control what happens in you John C Maxwell 
View more of my photos at ObesityHelp.comSleeve 2010 Dr López Corvala, Mexico. DS 2012 Dr Himpens, Belgium

I  my DS  

mlleelise
on 2/27/13 2:34 am
DS on 02/13/12

Thank you everyone for the encouragement! I was really afraid that you would think I must be doing something wrong, which is my nagging concern.  Somehow I have failed, this little voice in my head keeps saying.  I will check out the links you provided too. Thanks!! Grazing isn't my problem, because I'm not really hungry.  I eat at mealtimes and have a snack at night - that's about it. Although I haven't seen my operative report, I do know my channel lengths: my common channel is 75 cm, and my alimentary is 250 cm.  It seems to me that my alimentary channel is extra long compared to others...my common channel is already fairly short though. 

I do believe that Dr. Keshishian - like all other doctors I have seen - seriously doubted my 500 cal/day intake. Eating like that was hell for the previous 10 years - but the fear of reaching 200 lbs at my height kept me in line.  I took supplements for all those years, almost like what I take now. Food - or lack thereof  - was constantly on my mind! I have been freed of that, for the most part, although I still keep thinking I must be doing something wrong...

Thank you again for your compassion and support!

 

    
hollykim
on 2/27/13 9:18 am - Nashville, TN
Revision on 03/18/15

Were you getting 100-120 gms of protein and all the fat you needed when you were tracking and losing? I personally think 30-50 carbs is still too many.  without the Ds,I gain on that amount of carbs. Something else I have recently found out is that dairy products stop my weight loss COLD.

 

Could you share what a typical day's menu is for you? Maybe we can help you tweak it before you have to have another surgery/ it is worth a try,while you are waiting to see him.

 


          

 

mlleelise
on 3/1/13 1:23 am
DS on 02/13/12

Thanks for your reply.  Honestly, when I was losing in that first 3 mos. after surgery, it was mostly due to the fact that I had c-diff and then colitis: food went right thru me, and I was so sick to my stomach.  I hardly ate ANYTHING.  Maybe only 40 gms of protein - and I ate A LOT more carbs, like saltines, because it was the only thing that would settle my stomach.  Still, I lost 30 lbs in 3 mos - again, most because I was so sick. There weren't many calories in saltines!

When I felt better - by late spring - I began to eat around 120 gms of protein and a lot of fat, with very few 20-50 carbs.  My weight loss stopped totally.  In August, Dr. K told me to stop TRYING to eat so much protein and fat - and stop tracking all of it...just eat protein first.  That was deadly.  From August to December, I gained back 10 lbs.

Starting in January, I began tracking everything: around 80-100 gms of protein, a lot of fat, and 20-40 gms carbs....total calories around 1400. And there I sit.  Haven't lost anything in 2 months.

My typical daily diet is: Large coffees with light cream/protein drink slurry - 24 gms protein (sometimes 2 of these) 3 pieces of bacon; Lunch: shrimp, ham or cottage cheese w/cinnamon & truvia; 2 - 3 oz of swiss cheese.  Snack: ham with minute muffin (3 carb muffin) Supper: pot roast or Brock's pizza or other meat. Snack: Greek yogurt w/sugarfree coffee flavoring.  (Obviously it varies daily...but that is about it. Sometimes 3 sugar-free Twizzlers, for a treat. One day was 1240 calories, 29 carbs, 79 fat, and 75 protein.  Another day was:  899 calories, 8 carbs, 46 fat and 101 protein. When you factor in I have the DS, the weight should be falling off of me due to malabsorption...that's the problem: I don't think I AM malabsorbing; hence no gas or diarrhea issues.

I can't imagine giving up dairy  - cheese and cream!! They are the only proteins I enjoy, aside from my chocolate protein coffee.  I don't enjoy meats - I have to MAKE myself eat it. I would rather have further surgery than have to give up cheeses.

So there it is....thank you for your imput! Any suggestions??

 

    
MacMadame
on 3/1/13 11:22 am - Northern, CA

Wow, that's crazy.

I hope Dr. K can help you.

HW - 225 SW - 191 GW - 132 CW - 122
Visit my blog at Fatty Fights Back      Become a Fan on Facebook!
Starting BMI 40-ish or less? Join the LightWeights

Huneypie
on 3/4/13 2:18 am, edited 3/4/13 2:20 am - London, United Kingdom
DS on 07/24/12

I stumbled across the link I mentioned in my previous post to you.  Here you go:

http://www.obesityhelp.com/forums/revision/duodenal-switch-d s-revision-surgery.html

"reductions in stomach size seem to generate superior results over shortening the length of the common limb"

I wish you the best with whatever you decide and hope you keep us posted.

Lowish BMI? See Lightweights Board! Lightweight Creed For more on DS see www.DSfacts.com
If you don't have peace, it isn't because someone took it from you; you gave it away. You cannot always control what happens to you, but you can control what happens in you John C Maxwell 
View more of my photos at ObesityHelp.comSleeve 2010 Dr López Corvala, Mexico. DS 2012 Dr Himpens, Belgium

I  my DS  

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