Since February 2007, I have embarked on the journey that I truly believe will change my life for the better. I started the 'multidisciplinary' plan that my insurance, Aetna Open Choice POS II, would require for the new WLS patient in addition to their requirements for the revision patient. I chose the open choice insurance plan at work because their plan specifically states WLS is a covered benefit under my plan as long as it meets the medical necessity requirements...and for me, it is certainly medically necessary.
I have been attended to by the WeightWise Bariatric Program in San Antonio at least once (sometimes 2x) a month with the exception of April. I have regular appointments with the nutritionist, and either the Dr or the PA. I've had an EKG, still need to get the Upper GI/Endoscopy, possibly a sleep study and definitely the psych evaluation. I've met with the exercise physiologist 2x and have begun walking 30 min a day, 2-3x weekly. I could do more but child care with twins is an issue and the gym at my job doesnt have childcare. I am considering joining Golds Gym around the corner from my apartment or getting a treadmill of my own for home so I wont have a reason nor excuse NOT to get off my a** and exercise.
I was considering Dr Naaman in Houston , but now I'm unsure. I am now considering one of the Dr's Rabkin in San Francisco , simply because their experience is astounding. Their website is extremely informative and all the information I need is there for me to prepare before I finally meet with them. At first, when I found out surgery was covered, I wanted to rush it. I wanted it done 'yesterday'. It was only recently, within the last day or so, that I realized I may need to wait til early 2008 (January) for the revision. In addition to allowing me more time to get all my ducks in a row before presenting to the insurance, it gives me time to get my finances in order as well. I just discovered that Dr Rabkins office charges an up front fee of at least $8400 for the DS surgery--even if the insurance will pay. And there isn't a way around it apparently. So, I will once again, apply the funds to my FSA account and use that toward the payment. This year, I put in $4000 on my account in the hopes it would cover any and everything my insurance didnt cover. Now, I will just continue to use the card to cover all of the preop testing and appointments and anything else I can possibly think of.
So, here we are in the last half of the year. It needs to be productive in the sense that if I can lose at least 10% of my excess weight, I will have a better surgical outcome and recovery than if I maintained the same weight.
When I began this revision journey (officially), I weighed 302; I now weigh 293. I know I can lose weight. That is not the problem, for me, its KEEPING the weight off. This is why I believe the DS is going to work for me. Since I cant spell malabsorption (?), I wont, but that's the aspect of the surgery that I truly believe is going to get me the results I need for successful long term weight loss and maintenance.
Luv Sharon *
(I Copied this from the DS board because WOW! Hell, I didn't know half this myself! It was written By http://www.obesityhelp.com/member/hayley_hayley/)
On December 9, 2008 at 8:29 AM Pacific Time, hayley_hayley wrote:
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)
- Regain
- Possible regain: more prevalent after 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
- 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
- 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
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- 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.
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- May take Flagyl or fish zole
DSers may need to wear a diaper = Myth / Not True
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.
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- 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
*Possible issues are just that, “possible,” and may or may not occur. Not every surgery will be covered by insurance. Good luck to everyone and thank you for reading my comparison chart. Hayley F.
