Why I chose the DS

Nov 22, 2007

Personal stance on why i chose the DS over the RNY:
The DS has:
1. BEST success rate 
> DS loses more
> DS has little reports of regain
> RNY regain (check out revision board) and why would i be any different?

2. Dont like the RNY pouch/stomach
> Dont want to risk Dumping (physical pain from eating sweets or fat) I KNOW i will want sugar again and wont kid myself to think i can give it up for the rest of my life. Why risk having pain for being normal?
> Want to take drugs (NSAIDs). Dont take away my advil.
>  Bypassed stomach is not viewable by endoscope, can form ulcers, tumors, etc. 
> Want my pyloric valve in tact

3. Dont want a revision
> I want ONE surgery
> RNY tend to regain after 5 years

4. I like the DS intestines
>We malabsorb fat which makes fat our friend! Woohoo! 
> Intestines maintain weight loss after honeymoon period more than any other type of surgery. 

5. I like to eat
>Want bigger stomach so i can eat more (want to be as close to a normal healthy person as possible while still having weight loss surgery)
> I want my cake and to eat it too.  If i didnt i would never have gotten fat. 

Why i didnt choose the Lap Band:
1. It doesnt have the success rate i need
>Wont lose enough or fast enough
>You will have to diet like before having surgery (im not paying 10k for another diet and exercise program). If all i needed was an appetite suppressant id buy more diet pills.  
2. Throwing up (PBing aka productive burping)
3. Possibility of stretched out/malfunctioning esphogas
4. Regain
>Easy to out eat the band (can we say sugar and sugary drinks?)
5. May need a revision 
6. Dont want to deal with getting fills (paying each time, trying to adjust to the amount filled can be uncomfortable/painful)
7. Band can erode into stomach (and other problems)

Hayley_Hayley's RNY vs DS chart

Nov 17, 2007

RNY compared to the DS

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: more prevalent after 2-5 years
    • 50-100% regain of weight has been recorded
    • Results may vary
    • Must follow “pouch rules” in an attempt to not regain

DS – expected weight loss

  • 85% expected excess weight loss
    • Results may vary
  • Regain
    • Studies show little to no regain (20-40 pounds recorded)
    • Results may vary
    • 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
  • No Endoscopes on blind stomach/remnant stomach that is bypassed
    • Doctor evaluation: cannot use an endoscope (to find ulcers and tumors)
    • RYGBP construction makes the large bypassed distal stomach inaccessible to standard non-invasive diagnostic modalities. Neither x-ray contrast studies nor endoscopy can assess this potentially important but hidden area.
  • Stoma: pouch
    • Should not take Nonsteroidal Anti-Inflammatory drugs (NSAID).
  • NSAIDs are: Advil, Alka Seltzer, Aleve, Anacin, Ascription, 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.
    • Taking NSAIDs could develop into a bleeding ulcer and interfere with kidney function.
  • Possible Problems
    • Ulcers (Some doctors recommend taking prilosec for 6 months to 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, NIPHS, Hypoglycemia
      • No Valve (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/or can cause NIPHS or 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

  • Eat protein first
    • 60g of protein a day
  • Recommended to chew food to liquid consistency (pureed, soft, thoroughly chewed)
    • This is more important for people early out (new pouch stomach will stretch out with time).
    • Food is thoroughly chewed to prevent blockage (the hole/path leaving the stomach and into the intestine is roughly the size of a dime).
    • To get food unstuck, patients drink meat tenderizer mixed with water.
  • Low carbohydrates
    • Carbohydrates can slow weight loss and lead to possible regain
    • Avoid sugars in particular (to prevent dumping syndrome)
  • Low fat
    • Foods high in fat may cause Dumping Syndrome
    • Fatty foods can lead to slow weight loss or possible regain
  • 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
    • Some doctors do not encourage the use of a straw (pushes food too quickly through the stomach and can cause gas/discomfort)
  • 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.
      • Disclaimer: this is a practice some people use to feel “full” and lose weight. Not a requirement.

DS – Eating

  • Eat protein first
    • 80-100g of protein
    • DS patients can on average eat more food than any other type of weight loss surgery.
  • Low carbohydrates
    • Carbohydrates can slow the weight loss and lead to possible regain
    • No dumping syndrome from eating sugar (or fat)
  • Eat high in fat
    • DS only absorb 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. (this is just an example, measuring absorption is not an exact science)
      • When experiencing a “stall” (slowed weight loss/plateau) a DS patient commonly increases fat consumption to resolve
  • 64 oz of water
    • Can drink with meals
    • Can use a straw

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
    • Dumping in the form of loose stools
  • Reversible procedure (Reversals of any surgery is very complicated)
    • Revision often performed instead of reversal
    • Revising to a different type of surgery is possible.

 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. Generally food related)
  • Reversible procedure
    • The intestinal bypass is reversible for those having absorption complications
      • revision: lengthening common channel (to stop losing weight and/or to absorb vitamins)
    • Stomach is obviously not reversible (part of stomach was removed)

 

RNY - Diabetes

  • 85% cure rate
    • RNY can put diabetes in remission.
    • Diabetes may come back in two or three years--even if the
      patient maintains most of their weight loss.
    • Even a small amount of 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.
  • May take Flagyl or fish zole

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. For both RNY and the DS.
  • 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. (this is just an example, measuring absorption is not an exact science)

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 

 *Some practices may not be used by all patients. Some recommendations will differ depending on a person’s surgeon.  Possible issues are just that, “possible,” and may or may not occur.  

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.

3 comments

8 months post op

Nov 04, 2007

This month has been crazy.   I was getting scared when i thought i would only get to report 4 pounds lost for this month. I literally only lost weight in the first and last week of the month. Nerve wrecking. Im going to watch my sugar intake next month and see if it makes any difference.  It is not that 4 pounds would be bad, but i have so far still to go (50 pounds total as of today) and Im determined to get there in a certain time frame.  

The bad....family drama like you wouldnt believe. It is as if i was put into one of those bad movies that make you greatful your family dysfuntion isnt that bad. Im practically Meredith Gray from Gray's Anatomy tv show.  

The good...I looked super cute at Halloween. I was a sexy witch and received a lot of attention at a party i went to.  I felt like the pretty girl in the place..a feeling i never had before.  Which also meant i needed to be aware that someone was always watching me - no adjusting the bra sort of thing. lol

Oh! On my way to the party, i went to return a movie from the grocery store and i noticed a guy walking toward me instead of toward the entrance.  I tried not to notice but then he was right up on me and he said, "You are very beautfiul."  I smiled and thanked him and kept on walking.  It kind of freaked me out...i think it was how he approached me. Later i was flattered that some stranger thought i was beautful and felt the need to tell me.  

For pictures of me as a witch and to see my cat Merlin's vampire costume see my album.


7 month update

Oct 05, 2007

So it has been 7 months. Im down 126 pounds from surgery and i still want to lose 55-60 more pounds. Need to lose 43 pounds to be normal but i want to be smaller than that. I worry that i may not make it b/c the weight loss will slow down.  So far my weight loss has been EFFORTLESS...and im spoiled at how easy it has all been.  

I can eat anything now (even pasta) and im amazed at how much (quantity) carbs i can eat. I still have low intake days, ofcourse. I havent been shopping so i have no idea what size i really am. Im sick of buying clothes and then having to get rid of them. I hate getting dressed for work. 

 I lose for a 1-1.5 weeks then nothing (or gain) for 1-2.5 weeks and it repeats. When im not losing, i notice that i am also not pooping as much. It is hard to keep your spirits up during these times...dont want it to be over.

before and after pictures

Sep 09, 2007

working on getting some of these together


Progress Report

Aug 31, 2007

                       

3/05/07  SURGERY DAY!
3/12/07 (1 week):    -30lbs       (I was totally shocked!)
3/31/07 (3 weeks):  -40lbs     (Amazing how some days u lose 
                                              nothing or gain a pound and then 
                                              the next day your down 4lbs)
4/5/07 (1 month):    -44lbs 
4/19/07 (~6 week): -55lbs 
5/5/07 (2 month):    -64lbs   (Was hoping to be at 70 but i think
                                           pain meds for my nerve damage 
                                           stalled me -- 20lb loss for month 2)
6/5/07 (3 month):   -78lbs    (I aimed for 80 but got there 2 days 
                                            after my surgerversary --14lb loss for 
                                            month 3)
7/5/07 (month 4):   -89lbs     (I found out my start weight was 3 lb 
                                             less 
than i thought so instead of -91 & 
                                            14lb loss, it is -89 & 11 lb loss)
8/3/07 (century club): -100lbs   (-100lbs in 4 months 3 weeks and 5 
                                                 days!!  Just before my 5 month 
                                                 surgeversay [surgery anniversary])   
8/5/07 (month 5): -101lbs   (The stall was horrible this month took 
                                         forever to break the 100 lb mark.  
                                           -12 lb for the month)                  
9/5/07 (month 6):   -115 lbs    (-14lbs for the month although it did 
                                                not feel like i was losing much. I 
                                               think i lose a lot for a week then stall 
                                                  a week and so on)  
10/5/07 (month 7):  -126 lbs. (-11lbs for the month. Stalls are 
                                                    getting frustrating)                   


Come to the Dark Side (DS)...We have Cookies!


6 Month Update!

Aug 13, 2007

So i am half a year out and down 115 pounds. Im wearing 14/16 tops and bottoms. I havent been back to the gym since my gallbladder surgery (well i went once) so i need to start that back up! 

Somewhere a long the way i discovered i can gulp fluids again.  The first few weeks out of surgery are difficult. It is so hard to sip your water, I remember getting chest pain if i drank too much too soon.  Being able to gulp again is amazing!  

Sometimes i still miss being able to eat like i used to.  I can eat pretty good but sometimes my eyes are too big for my tummy (have to remember that u cant eat all of that like u used to). 

Since surgery, I discard a lot of bread now (ill toss the bottom piece of bread in the trash and pick off a lot of the top bun) why? B/c it fills me up too fast, its a carb, and it could cause gas.  

I hardly eat pasta at all (sometimes ill have Stoffer's frozen lasgna but that is about it).  So i eat pretty low carb, i eat the insides of a burrito (and maybe take 1-2 bites of the tortilla) or the insides of one of those egg rolls u can buy in the frozen food section. You get the idea. The only really bad carbs i eat are potato chips - yum! 

And i do drink soda...and not diet.  Havent found a diet soda that i like yet.   I can NOT handle coke - too hard on my tummy. I drink Big Red, Welch's Strawberry, Rootbeer, Dr. Pepper, and any clear soda like Sprite. Mostly though, I drink a Big Red for breakfast (never was a coffee girl - coffee always put me to sleep. Maybe b/c it is warm?).

I have found some good multivitamin products.  I like VitaBall (walmart) which is bubblegum...i chew it at work and it is yummy! The first time u try it is a little weird but then you become hooked (it starts off kind of hard and then goes to super soft - chew for atleast 20 minutes).  I let a guy at work try one and he also said "weird" but sure enough the next day he asked for another one b/c "they are good!" LOL

I also like Gummy Vites from L'il Critters...they are gummy bears and they taste great! It makes taking vitamins fun and tastey. 

Vitamins i currently take:
Calcium citrate
Centrum Complete (walmart brand - multi vitamin that has adek)
Dry A & D (i take this most of the time)
Vitaball and Gummy bears


gallbladder surgery

Aug 13, 2007

I got my gb removed and it was horrible. I was in more pain from this than when i had the DS. I also have shoulder pain (from the gas they used to pump my stomach up to perform the procedure laproscopically).  The doctor NEVER came and checked on me. The nurse REFUSED to give me any pain medicine and i sat in my room from 11 - 6:25 begging for pain medicine. I even cried out of frustration at one point. The nurse eventually called the doctor and he told her to give me some drugs and release me. So i was given pain meds at 6:25 and sent home at 6:27.  I am so disappointed in my surgeon for dropping the ball.  This hospital sucked, the staff sucked, and the doctor sucked for not checking on me! I'll let it go and not be bitter but this shouldnt have played out the way it did.

It is also imperitive that YOU remind the office to get you started on Actigall for your gallbladder.  Some of my friends were not given anything. You MUST be your own Advocate.  This surgery requires that YOU stay on top of things...dont rely on anyone else when it comes to managing your health.  Be informed!

This has been a hard recovery for me.  Im suprised, since so many people told me how getting your gb out was such a breeze. Guess it just goes to show you...

Century Club / Early 5 month update

Aug 03, 2007

I made it to the century club. Meaning i have lost 100 pounds.  I had a stall during month 3 and 4 and was moving very slowly the closer i was to making the century mark.  I think the exercise (LAFitness) is helping. I feel good after exercising (if u told me a year ago that id join a gym and like it, i would have called u a bald faced liar).  

I am eating low carb for the most part.  I can eat sugar goodies but i dont feel the need to eat it all. Im eating healthy and tastey foods. I love that i do not have to worry about fat content (can only absorb 20%)...too bad i cant say the same thing about carb absorption (it is 100% which is why i eat them in moderation). 

- 100 lbs in 4 months, 3 weeks, and 5 days. Right before my surgeversary (cute way of saying surgery anniversary) which would make 5 months.  



Health:  My tightness in the chest did turn out to be my gallbladder (which all my helpful support group gals predicted) and it will be removed 8/10/07 by the same surgeon who performed my DS.  This is a common occurence (gb going bad) and i expected this might happen.  

What the attacks feel like:  Behind my breast bone felt tight..like i was wearing belt that someone kept cranking tighter.  Similar to what i expect a heart attack might feel like.  The first 3 attacks stayed in that area and tums seemed to help it go away. The latest attack was the worst (pain wise) and the pain radiated to my back.  I went to the ER and had an ultrasound.  I had two more attacks that day (which i dont normally get).  Since then i havent had an attack and im glad that the gb will be gone soon.  

My hand (nerve damage in thumb, index, and tip of middle finger) are still not 100% better. It acts up sometimes and i really hope it will get better one of these days.  The doctor said i was the first patient to have this happen in his experience. Atleast it is tolerable. All for now.


Month 4 update

Jul 12, 2007

Well its about 8 days since my surgerversary (instead of anniversary).  I went to the doc for acne (side effect of losing weight: hormones released from depleting fat cells) and saw that i weighed less going into this than i thought. My start weight was 3lbs less. So to be accurate i changed my weight loss counter (hence it hasnt moved for a while lol).  I joined LA Fitness and have gone 2 days so far. It is hard work.  I did 20 min of cardio and went into the pool. Today i did 20 min cardio and weights.  I probably havent really exercised since highschool. 

My hand (index and thumb fingers) are still bothering me from the nerve damage.  I also have had 3 attacks (tightness in the chess) and im not sure if its heart burn or a bad gallbladder.  

Eating is okay but i still cannot eat pasta (feels my tummy instantly). Drinking is great!  Bathroom issues: for the most part it is fine.

About Me
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Surgery
03/05/2007
Surgery Date
Feb 13, 2004
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