Randy B.
My name is Randy. I'm ready for surgery and ready for a new, healthy and pain free outlook on life. This is really my last hope in being normal again. I Have a ferret named Toot who is my best friend in the whole world. He loves me no matter how fat or painful I am. He makes me laugh.
I am lucky enough to have the world's most awesome friends but have no family. My friends have been my family for a long time and I am so happy to have them!!
I gained over 100 lbs after being hit by a transport truck on the highway 5 1/2 years ago. I'm still in a lot of pain but believe this weight is contributing to my pains.
Posted by ~~@ Lola @~~
It never ceases to amaze me that one persons reason for getting a particular surgery, is another persons reason to NOT get that surgery.
RNY - I got the surgery so I'd dump and the fear of that would keep me away from sugar.
DS - I got the surgery so that I wouldn't dump.
RNY - I needed the restriction to correct my relationship with food.
DS - I didn't want the restriction because I want to enjoy my relationship with food.
RNY - I wanted/needed to change my eating habits.
DS - I've dieted my whole life -- I want to quit dieting.
RNY - I'm sick of dieting and failing.
DS - I'm sick of dieting and failing.
RNY - I want a tool that I can work.
DS - I want a surgery that does the work.
RNY - I didn't want to be able to cheat the surgery.
DS - I want to be able to 'cheat' from time to time.
RNY - I want to be healthy.
DS - I want to be healthy.
RNY - I didn't want someone cutting off my stomach.
DS - I don't want a blind stomach.
RNY - I don't want to have to eat massive amounts of food.
DS - I want to be able to eat what I want.
RNY - I needed to change my habits.
DS - I've been trying to change my habits my whole life!
RNY - I never want to eat sugar or fat again!
DS - I don't want sugar and fat to be 'off-limits'.
The best choice is an informed choice!
RNY compared to the DS ... This excellent comparison was composed by Hayley F.
RNY – expected weight loss
* 50-65% expected excess weight loss (percentage varies in opinion – this is the most commonly seen estimate)
~ Results may vary
* Regain
~ Possible regain: 50% of weight after 5 years
~ 100% regain of weight has been recorded
~ Must follow “pouch rules” in an attempt to not regain
~ RNY must exercise and diet to maintain weight loss after 5 years
DS – expected weight loss
* 85% expected excess weight loss
~ Results may vary
* Regain
~ Studies show little to no regain
~ 20 lb gain from lowest weight has been recorded
~ Highest success rate over 10 year study (78% avg. Excess Weight Loss – EWL)
RNY – have a stoma (stomach made into a pouch – size of an egg)
* Size: 2 oz
~ Stretch to average size of 6 oz in 2 years (possible to stretch up to 9-10 oz)
~ You can eat more as time goes by
~ Average after 1 year is 1-1.5 cups of food
* Stoma: blind pouch
~ Doctor evaluation: cannot use an endoscope (to find ulcers and tumors)
~ Cannot take Nonsteroidal Anti-Inflammatory drugs (NSAID).
* NSAIDs are: Advil, Alka Seltzer, Aleve, Anacin, Ascriptin, Aspirin, Bufferin, Coricidin, Cortisone, Dolobid, Empirin, Excedrin, Feldene, Fiorinol, Ibuprofen, Meclomen, Motrin, Nalfon, Naprosyn, Norgesic, Tolectin, Vanquish
~ NSAIDs are used for arthritis, bursitis, tendonitis, back pain, headaches, and general aches and pains. This could develop into a bleeding ulcer and interfere with kidney function.
* Possible Problems
~ Ulcers (Doctor’s recommend taking prilosec for 1-2 years in an attempt to prevent the ulcers)
~ Possibility of a staple line failure
~ Noncompliance: simply do not lose enough (even with following the rules)
~ Vitamin Deficiencies
~ Narrowing/blockage of the stoma
~ Vomiting if food is not properly chewed or if food is eaten to quickly
~ Dumping syndrome and NIPHS/Hypoglycemia
+ No Valves (pyloric valve that opens and closes to let food enter intestines is bypassed) which means food empties directly into the small intestines and causes dumping and NIPHS/Hypoglycemia
* Dumping: food (most commonly sugar but not necessarily “just” sugar) enters/dumps directly into small intestines and causes physical pain (some people believe this pain enforces good eating habits)
~ Dumping varies in degree of occurrence and discomfort
~ Dumping symptoms:
+ Nausea
+ Vomiting
+ Bloated stomach
+ Diarrhea
+ Excessive sweating
+ Increased bowel sounds
+ Dizziness
+ “Emotional” reactions
* NIPHS (insulin over production): “the body overproduces insulin in response to food entering the intestines at a point where food would normally be more digested already - this part of the intestine is not used to coping with metabolizing glucose in the condition it arrives after RNY, and it is suspected that the intestine signals the pancreas for more insulin to aid digestion, causing a MASSIVE overproduction. The change occurs on a cellular level, hard to diagnose. Treatment: Removal of half the pancreas.”
~ RNY stoma that is created allows food to go straight through the stomach into the small intestine unrestricted so it does not control the flow. Because of that the body reads that it needs more insulin because the food is moving through so quickly and it thinks there's going to be a lot more food. With the DS, the normal peristalsis works because the pyloric valve is in place and can control the movement of food into the small intestines.
~ NIPHS/Hypoglycemia is deadly if not corrected
DS – whole stomach (size of banana)
* “Whole working stomach” - meaning the stomach’s outer curvature is removed as opposed to making a pouch/stoma.
~ Part of the stomach removed is where most of the hormone called Grehlin is produced.
~ Grehlin gives the sensation of hunger so by removing most of that section of the stomach a DSer is not as hungry as before.
* Whole working stomach: no blind stomach. Endoscope can be used.
* Can take NSAIDs
* Do not need to take Prilosec to prevent ulcers.
* Valves are in tack: no Dumping Syndrome or NIPHS
RNY – Eating
* Recommended to chew food to liquid (most important early out)
~ Foods need to be thoroughly chewed to prevent blockage (the hole/path leaving the stomach and into the intestine is the size of an eraser).
~ To get food unstuck, patients drink meat tenderizer mixed with water.
* 64 oz of water
~ Stop drinking within 15-30 minutes of a meal
~ Do not begin drinking after a meal for 1-1.5 hours
~ Not encouraged to use a straw (pushes food too quickly through the stomach and can cause gas/discomfort)
* Low carbohydrates (carbohydrates can slow weight loss)
~ Avoid sugars (to prevent dumping syndrome and slowed weight loss and/or weight gain)
* Low fat
~ Foods high in fat can also cause Dumping Syndrome
* Eat protein first
~ 60g of protein a day
* Water Loading
~ 15 minutes before the next meal, drink as much as possible as fast as possible.
~ Water loading will not work if you haven’t been drinking over the last few hours.
~ You can water load at any time 2-3 hours before your next meal if you get hungry, which will cause a strong feeling of fullness.
DS – Eating
* 80-100g of protein
~ DS patients can on average eat more food than any other type of weight loss surgery.
* 64 oz of water
~ Can drink with meals
~ Can use a straw
* Low carbohydrates (carbohydrates can slow the weight loss)
~ No dumping syndrome from eating sugar
* Eat high in fat
~ DS only absorbs 20% of fat (do not need to eat low fat)
+ If a taco has 20g of fat, a DSer only absorbs 4g while a person without surgery or RNY absorbs ALL 20g.
+ When experiencing a “stall” (slowed weight loss/plateau) a DS patient commonly increases fat consumption
RNY – Possible Issues
* Vitamin deficiencies: Must follow a vitamin regime for the rest of your life
~ Common vitamin deficiencies found in vitamins B12, iron, and zinc
~ Calcium must be supplemented for the rest of your life
* Bathroom issues
~ Gas
~ Constipation
* Reversible procedure (Reversals of any surgery is very complicated)
~ Revision often performed instead of reversal
DS – Possible Issues
* Vitamin deficiencies: Must follow a vitamin regime for the rest of your life
~ Common vitamin deficiencies found in vitamins A, D, and iron
~ “Water soluble”/ “water miscible” / “dry” vitamins absorb best (in other words get vitamins that are not fat/oil based)
~ Calcium must be supplemented for the rest of your life
* Bathroom issues
~ Gas
~ Loose stool (Most common in the first few weeks of surgery. Food related)
* Reversible procedure
~ The intestinal bypass is reversible for those having malabsorptive complications
+ revision: lengthening common channel
~ Stomach is obviously not reversible (part of stomach was removed)
RNY - Diabetes
* 85% cure rate
~ RNY does not cure diabetes but puts it in remission.
~ Can come back in two or three years--even if the
patient maintains most of their weight loss.
~ Even a small weight gain long-term can cause a diabetes
relapse.
DS – Diabetes
* 98 % cure rate for type II diabetes.
DS – Myth or Fact
The DS is only recommended for the super morbid obese (BMI over 60) = Myth / Not True
* To be eligble for ANY type of weight loss surgery, a person has to be 100 lbs. over weight or have a body mass index (BMI) of 40 or more.
* BMI’s under 40 have also been approved (usually require a comorbidy/health problem - an example is sleep apnea).
The DS is “experimental and investigational” = Myth / Not True
* Medicare approves the DS
* Many insurance companies are starting to cover the DS.
* DS has been performed since the 1970s
DSer will have a problem when they become old = Not True
* We wont need to eat as much when we are older b/c our bodies will adapt
* The little hair-like villa located in the intestines grows longer to adjust to the new digestive system (grows longer to increase absorbtion).
DSer’s gas stink = true
* The gas does smell. (This is true for the DS and RNY)
* There are products called air fresheners that a person can use.
DSers may need to wear a diaper = Myth / Not True
* That is silly
Skin color turns yellow or pallor = Myth / Not True
* Patients who follow their regular vitamin regime (keep up with blood work) do not turn pallor
* If someone looks pallor, they could have a vitamin deficiency. This applies to any type of weight loss surgery.
* Vitamins and blood work must be monitored for life. For both RNY and the DS.
DSers will have a heart attack from all the fatty food they eat = Myth / Not True
* Cholesterol levels lower after having the DS.
* 80% of the fatty food is not absorbed – the fatty food is healthier to eat as a DSer than a person without surgery.
* If a taco has 20g of fat, a DSer only absorbs 4g while a person without surgery or a person with the RNY will absorb ALL 20g. Good meal for the DSer.
Dsers don’t need to exercise = Myth / Not true
* DSer’s are aware of the benefits of exercise (body and soul).
* Exercise helps in losing weight and maintaining goal weight
Not every surgery will be right for everyone. Not every surgery will be covered by insurance. Good luck to everyone and thank you for reading my comparison chart. Hayley F.
