Vicki In A Clam Shell
I hijacked all this information from Lori Black's profile - she did all the work and put together everything I have learned during my research and explained it all so well - thanks Lori
I'm putting all of my reasons for choosing the DS in this section so that maybe I can help someone else the way that others have helped me. I'm so glad that I chose the DS. This has been the easiest weight loss I have ever experienced and I have experienced A LOT of weight loss!! I have chosen many articles written by various people and research, these were some of my most valid reasons for choosing the DS. I'm happy to answer any questions that come up for you in your journey! Best of luck to you whatever surgery you choose!
Good links about the DS
http://bariatrictimes.com/displayArticle.cfm?articleID=article110
~This link is an amazing read on the DS....http://www.weightloss-surgery.com ~http://www.epursimuove.com/ds/ Lab rat data http://www.spawmd.com/duodenalswitch.html (Good site that explains the DS) Reasons why the DS is the right surgery for me!
There has been a great deal of discussion across the boards lately regarding surgery types and "mine is better than yours" syndrome. I will be on record that yes, I am a DSer, and a very successful one, but I am merely posting what I believe to be a list of important questions as you are researching weight loss surgery of any kind. Only you can take control of your own health and make the choice that is BEST for you. My list of questions: 1) Ask yourself have you REALLY done your homework about the path you are going down?
2) Did you know about all the weight loss surgeries available to you? Do you understand the differences? Have you read about how successful they are? Have you read about the complications? Have you read about the lifestyle changes each surgery will require? Do you understand how they are different?
3) Did you interview more than one surgeon, especially if that surgeon only performs one of the types of surgeries available?
4) Do you know about the risks? Did you ask your surgeon how many surgeries he or she has performed? What about their mortality rate? What about side effects? Have you visited a weight loss surgery regret site? Do you know about the unhappy as well as the happy people? Did you ask your surgeon how they were trained? For how long? Where? With whom?
5) Do you truly understand this is a life altering event? Are you prepared to do whatever you need to stay healthy and lead a productive life?
6) Is your mind ready for this? Have you been honest with yourself and your surgeon about how you got to your current weight?? Are you ready to hit your food issues head on?
7) Are you financially prepared to supplement appropriately, with vitamins, protein, etc. for the rest of your life?
8) Have you attended a support group meeting or have you met post ops in real life to find out how they live with their choice?
If you answer no to any of these questions, I suggest you take a step back and keep researching before you set that date.
Good luck to all of you.
Sharon
............................................................................................................. Written & Posted by Lola... Hopefully, everyone who has weight loss surgery, makes their choices based on their own personal needs. The following is a comparative list of statements taken from RNYers and DSers posting why they got the surgery they did. The worst thing is getting whatever is offered to you and not being fully informed.
I made this list, not to slam anyone's surgery choice but just to point out how differently we can look at the same thing:
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'.
RNY -- I want the convenience of a close by surgeon.
DS -- I want the convenience of a one-time surgery.
RNY - My insurance would only pay for the RNY.
DS - I fought my insurance long and hard for what I wanted.
RNY - I need to not eat fat because of my high cholesterol.
DS - I need to not absorb fat because of my high cholesterol.
RNY - I didn't want to risk that much malabsorption.
DS - Based on my own diet history, I knew that I needed the added malabsorption to keep off the weight.
RNY - I need help to lose weight.
DS - I'm great at losing weight, what I need is help to keep it off.
.................................................................. My daily vitamins, month 12-18 (REVISED on 10/12/08) This is what I take everyday... *2 hours before breakfast~ 150mg polycarbonate Iron (Vitalady)
150 mg (6 pills) Vitalady Tender Iron (Carbonyl Iron) (Vitalady)
1500 Mg (3 chewables) Vitamin C (Costco)
2mg copper
*Breakfast~ 1 Costco Multivitamin
2 pills- (630 mg) Citracal Calcium Citrate (Costco)
1 super B-complex (Costco)
400 I.U. Dry E (Vitalady)
1 hair, skin, and nails vitamin (Walmart)
2 Digestive Advantage Lactose Intolerance w/ probiotics *2 hours later~ 2 pills- (630 mg) Citracal Calcium Citrate (Costco) *Lunch~ 1- Costco Multivitamin
2 pills- (630 mg) Citracal Calcium Citrate
2-100mg zinc {Hair} (Walmart)
1 hair, skin, and nails vitamin (Walmart)
1 folic acid 400 mcg *2 hours later~ 2 pills- (630 mg) Citracal Calcium Citrate *Dinner~ 2 pills- (630 mg) Citracal Calcium Citrate
200mcg Selenium (CVS) {Hair}
400 I.U. Dry E
1 hair, skin, and nails vitamin (Walmart)
1 thiamin (B-1) capsule, 100 mg (Vitalady.com)
1 dry vitamin K
1 folic acid 400 mcg *Bedtime~ 1 Costco multivitamin
3 Costco Calcium Citrate + Mag 750 mg
25,000 I.U. Dry A (vitalady.com)
50,000 I.U. Dry D (vitalady.com)
sublingual b-12 2500 mcg (Walmart)
1 Critical Care Probiotic, 50 billion organisms _____________________________ _
Lots of people ask what to eat after surgery, so I kept a record of the foods that I ate for the first two months after my DS so that maybe others could get ideas for themselves. It is up to each individual to decide if they want to follow the nutritionists plan or to devise one that works for them. I chose to do the latter. Unfortunately, the nutritionist taught my DS pre-op class many things that pertain to RNYers, so I chose to do what worked best for me by following suggestions of others here on the boards. I am not a nurse, nutritionist, or doctor, these were just the things that I ate and worked for me the 2 months following surgery.
Here's what I'm eating at two weeks out....
Cottage Cheese
Activia Yogurt
Kraft Cheese Snackables (Ea. piece is 6 g's of protein and only one ounce...colby jack or cheddar)
Egg Salad ( I chop the egg small and add PLENTY of full fat mayo)
KFC Chicken Leg
Rotisserie Chicken from Costco
Turkey breast
Roast Beef Rolls (Deli Roast Beef with Philly cream cheese inside, yum!)
Hormel Beef Roast Au Jus (Pre-cooked in the meat section at the grocery, seriously delish!)
Cheesecake Factory Buffalo Chicken Wings w/ lots of blue cheese
Champion Pure Whey Stack Banana Scream (THE BEST protein shake I've had!) (1.5 scoop=34.5g protein)
42g New Whey Protein vials (Only when I have to, they are yucky! JMHO)
Revival Soy Protein Chips Kraft Cheese Snackables (Ea. piece is 6 g's of protein and only one ounce...colby jack or cheddar)
Egg Salad ( I chop the egg small and add PLENTY of full fat mayo)
KFC Chicken Leg (I eat very little of the breading, but it does add some flavor)!
Rotisserie Chicken from Costco
Turkey breast
Roast Beef Rolls (Deli Roast Beef with Garden Vegetable Philly cream cheese inside, yum!)
Hormel Beef Roast Au Jus (Pre-cooked in the meat section at the grocery, seriously delish!)
Cheesecake Factory Buffalo Chicken Wings w/ lots of blue cheese (These were ok, not now tho)
Champion Pure Whey Stack Banana Scream (THE BEST protein shake I've had!) (1.5 scoop=34.5g protein)
42g New Whey Protein vials (Only when I have to, they are yucky! JMHO)
Revival Soy Protein Chips
Genisoy Protein Chips (At Kroger in the health food section)
Crab Legs (So moist and I drown them in butter)!
Special K20 Protein Water (Gotta be strawberry kiwi)
Very moist, cooked no more than medium ribeye steak
Small amts of popcorn
Dry Roasted Peanuts
Things I'm eating at 1 month out.....
Kraft Cheese Snackables (Ea. piece is 6 g's of protein and only one ounce...colby jack or cheddar)
Egg Salad ( I chop the egg small and add PLENTY of full fat mayo)
KFC Chicken Leg (I eat very little of the breading, but it does add some flavor)!
Rotisserie Chicken from Costco
Turkey breast
Roast Beef Rolls (Deli Roast Beef with Garden Vegetable Philly cream cheese inside, yum!)
Hormel Beef Roast Au Jus (Pre-cooked in the meat section at the grocery, seriously delish!)
Cheesecake Factory Buffalo Chicken Wings w/ lots of blue cheese (These were ok, not now tho)
Champion Pure Whey Stack Banana Scream (THE BEST protein shake I've had!) (1.5 scoop=34.5g protein)
42g New Whey Protein vials (Only when I have to, they are yucky! JMHO)
Revival Soy Protein Chips
Genisoy Protein Chips (At Kroger in the health food section)
Crab Legs (So moist and I drown them in butter)!
Special K20 Protein Water (Gotta be strawberry kiwi)
Very moist, cooked no more than medium ribeye steak
Small amts of popcorn w butter
Dry Roasted Peanuts
Chicken Salad
The insides of tacos and meximelts at Taco Bell
Hillshire Farm Lil' Smokies with a little bbq sauce
Homegrown Tomatoes
Pork ribs with bbq sauce
Corn on the cob with lotsa butter!
Mashed Potatoes
What I ate at 8 weeks out...
Wendy's Chili with cheese and onions and sour cream
Hillshire Farm Lil' Smokies with a little bbq sauce
Homegrown Tomatoes
Country Style Pork ribs with bbq sauce
Spare ribs with bbq
Baby back ribs with bbq
Corn on the cob with lotsa butter!
Pulled pork
Jimmie Dean Breakfast Bowls
Val's Ricotta Fluff Stuff
Egg Omelets with lotsa cheese and ham, green peppers and onions
Shrimp cocktail
Starting to eat salads in small amounts
Bacon
Sausage
Very tender pork of just about any kind
Kraft Cheese Snackables (Ea. piece is 6 g's of protein and only one ounce...colby jack or cheddar)
Egg Salad ( I chop the egg small and add PLENTY of full fat mayo)
KFC Chicken Leg (I eat very little of the breading, but it does add some flavor)!
Rotisserie Chicken from Costco
Turkey breast
Roast Beef Rolls (Deli Roast Beef with Garden Vegetable Philly cream cheese inside, yum!)
Hormel Beef Roast Au Jus (Pre-cooked in the meat section at the grocery, seriously delish!)
Fazoli's Submarine Sandwiches, Inside only. The roast beef is really good.
Champion Pure Whey Stack Banana Scream (THE BEST protein shake I've had!) (1.5 scoop=34.5g protein)
Revival Soy Protein Chips
Genisoy Protein Chips (At Kroger in the health food section)
Crab Legs (So moist and I drown them in butter)!
Very moist, cooked no more than medium ribeye steak
Dry Roasted Peanuts
Chicken Salad with grapes and cashews
The insides of tacos and meximelts at Taco Bell
Bob Evans Farmers Market Omelet...TO DIE FOR!
Eatsmart Soy Crisps, Tomato, Romano, and olive oil flavor
Homemade chili, no beans (lowers carb count WAY down!)
Lindor White Chocolate Truffles, 1 at at time is enough and makes me feel like I'm not deprived!
Firecracker salmon rolls from the Cheesecake Factory
Salads made with ham, egg, onion, gr. pepper, tomatoe, bacon bits, cheese and with real ranch dressing
This was a great response that BT wrote today and I had to write it here. Blackthorne has a lot of great info on her profile as well! Click on this link to her account to see more! http://www.obesityhelp.com/member/blackthorne/
Good for you for doing your research. You wouldn't be the first person who heard about the DS at the last minute and changed courses. We have several that were within weeks of their RNY date and switched to a DS.If your doctor doesn't list that he does the DS, he probably doesn't. Check with www.duodenalswitch.com to see where the DS surgeons are. Most of us have had to travel to find one, but it is worth it.I'm going to combine your questions together and answer them because they are inter-related. Why our diet *is* healthy is the same reason why we can eat so much and lose - fat malabsorption.A DS'er does NOT absorb 82% of the fat that is eaten. So if we eat a daily diet that has 100 grams of fat for a normal person, it only has 18g of fat for us. The "Daily Value" found on nutritional labels for fat indicates that 66-67g of fat is "100%" of daily value.....that means we would basically have to eat 5x that to START having a high-fat diet. (This is why my cholesterol dropped dramatically post op, including my triglycerides which went from 650 to 76)Because of this, Dr Hess - the surgeon who pioneered the DS - said "Fat is your friend". We don't have to watch fat in our foods - we can eat full fat bacon, cheese, whole milk, etc for the protein and not worry about the fat. That also affects how we can lose weight because we are almost only absorbing 18% of the CALORIES from fat. So if we have that 100g of fat at 900 calories, we're absorbing 18g of fat or only 162 calories. Because ours is a more malabsorptive procedure than the RNY, we are also left with a larger stomach (and a fully functioning one at that). My starting stomach was 4 oz. The average RNY'er gets about 1oz.I love my DS. I am not quite 22 months out, and have gone from a 26/28 to a 10/12. I can ride a motorcycle now, spontaneously run (even upstairs), and look/feel a whole lot healthier than I was back then. I am still tweaking my supplements to find the right program for my body - but long term research has shown that (after the 2 year mark) annual bloodwork is sufficient to catch & correct any issues that may show up before they become problems.Our list of requirements are few, but not optional:Eat 90g-120g of protein a dayDrink LOTS of fluids - many of us shoot for 90oz or more.Take vitamins & supplements daily (My routine right now includes Dry D, Prenatal vitamins, Calcium Citrate and I'm taking extra protein supplements to boost my numbers before plastic surgery)Get regular bloodworkExerciseThat's it. Last night, I took a pre-op friend out to the Melting Pot for dinner, and ate everything she ate in only slightly smaller quantities......that included a virgin pina colada (since I was on my motorcycle, I bypassed the alcohol), part of a salad, the Feng Shui cheese course with apples & bread, the main course with vegetables, filet mignon, lobster, shrimp. teriyaki beef, ahi tuna, and chicken. For the chocolate course, we had the Cookies & Cream version (with Oreo cookies stirred in), dipping strawberries, bananas, pineapple, coated marshmallows, cheesecake, pound cake and brownies into the chocolate. It was a delightful meal and a very special occasion. As you can see *NO* food is off-limits. One of my favorite DS sayings is "I can have *anything* I want. I just can't have *everything* I want." For places to research, I would recommend www.pubmed.com and www.duodenalswitch.com. Here are some articles I've bookmarked as well:
http://www.medpagetoday.com/PrimaryCare/WeightManagement/tb/4162
http://www.americansurgical.info/abstracts/2006/28.cgi
http://www.breasthealthonline.com/cgi-bin/mwf/topic_show.pl?tid=10392
http://www.mgwater.com/calmagab.shtml
http://www.dssurgery.com/generalinformation/comparison.php
http://sri.sagepub.com/cgi/reprint/12/2/115.pdf
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1360120
http://www.harvardmagazine.com/on-line/050465.html
http://www.nature.com/ncpcardio/journal/v2/n11/full/ncpcardio0349.html
Good luck in your decision. And keep in mind that just because you HAVE a date, doesn't mean you have to KEEP it. Even if you just want more time to research the DS, and then still decide to have the RNY, you can always reschedule when you're sure you're making the best decision for you.--BT
------------------------------- ..........................................................................................................
Comparison of DS v/s RNY (thanks LeaAnn!)
· Rarity of dumping syndrome (a potentially-dangerous, sudden jump in blood-sugar level caused by undigested food entering the intestines through a man-made opening), commonly seen with the Roux-en-Y (RNY).
· NO stomal ulcers commonly seen with the Roux-en-Y (RNY).
· The DS patient retains their naturally functioning stomach (although the volume is reduced) along with the pyloric valve or natural exit from the stomach to the intestines rather than a problematic, man-made “pouch” as with the RNY.
· Better sustained long-term excess weight loss and, unlike the RNY, a low failure rate.
· A 98 percent cure rate for type II diabetes.
· The ability to take NSAIDs, non-steroidal anti-inflammatory medications.
· The entire stomach and duodenum can be visualized by endoscopy, unlike the RNY which divides the stomach into an upper and lower pouch, the lower of which cannot be visualized via endoscope.
· DS surgery results in little to no nutritional or metabolic complications as long as the supplementation regime (required for any weight loss surgery) is followed carefully.
· DS surgery results in a superior quality of life to RNY in that patients are able to enjoy eating a normal, balanced diet with no specific food restrictions.
· NO stomal plugging and less vomiting. Here are some disadvantages of the RNY that your RNY surgeon might not tell you about:
· Sugar is not always the cause of dumping· Many people don't dump at all
· Many people are vitamin deficient because their food intolerances do not allow them a varied diet
· A lot of RNYers drink meat tenderizer mixed with water because food gets "stuck"· A huge number of diabetics are not cured by RNY, many improve but not many are cured
· About 68% of those with RNY vomit frequently
· Many people gain at least 50% of the weight back Just in case you're still reading this and wondering what made me consider the DS, here is an article I hi-jacked from Leslie's profile that really seals the deal for me. If you are looking for answers about what surgery to have for yourself, this is a great resource, one of many that you will find along your research journey. PLEASE READ THIS BEFORE MAKING YOUR DECISION ON WHICH SURGERY TO GET! It is a sad truth that there is a lot of misinformation being circulated about the duodenal switch (DS) procedure. Even more sadly, much of it comes from RNY surgeons and their patients, who have various degrees of vested interest in promoting their surgery (or in certain cases, dissing WLS altogether). I would hope that each and every potential WLS patient who is researching what to do about treating his or her morbid obesity has access to the FACTS before making the decision about which surgery to have. For a number of years, insurance approval has been the vehicle by which access to the DS procedure has been limited -- most of the largest insurers, including Blue Cross, Blue Shield, Aetna and Cigna, have cited misleading information and each others' policies to claim that the DS is "experimenal," "investigational" or "unsafe and inadequately studied." However, the papers cited by these insurance companies to support this allegation are often not even related to the correct procedure. When the DS was introduced, it was an improvement over the Biliopancreatic Diversion procedure, or BPD -- unfortunately, this led to the procedure being called the BPD/DS, which is a misnomer. While the intestinal part of the BPD is essentially the same as the DS, the stomach part is VERY different. The problems with the BPD are much more like a distal RNY than the currently practiced DS, as the BPD involves removing much of the lower part of the stomach, including the parts that absorb vitamin B12 and iron, and the pyloric valve, and BPD issues include potentially serious malnutrition issues. What insurance companies often do is to cite papers discussing the very real problems with the BPD (which is rarely performed anymore) against the DS, which is quite inappropriate. In addition, they completely ignore the growing body of scientific evidence that is approaching 20 years of study on the DS and the wonderful results that have been established. Over the past several years, and due in no small part to the steady pressure exerted by patients demanding the DS procedure, there have been numerous inroads made into educating both the insurance companies and the external reviewers who end up ruling on the appeals of die-hard DS wannabees. The tide appears to finally be turning, as one after another insurance company is beginning to acknowledge the beneficial effects and safety of the DS. Blue Cross of California has recently changed their official policy to permit the DS, and it seems from recent legal challenges that Blue Shield will not be far behind. The national Blue Cross/Blue Shield Technology Evaluation Center assessment of the DS is currently being reviewed as well, and there is a good possibility that they will reclassify the status of the DS. The most recent CPT Code book for 2005 has given the DS a new, Category I, code number, indicating that it is now a generally recognized procedure and not still being evaluated for safety and efficacy. In addition to the many published articles that have come out recently praising the DS procedure (available on request), there is now an almost astonishing new source of analysis and validation of the procedure -- the external reviewers of the Center for Health Dispute Resolution of Maximus. This organization has been contracted to perform external reviews for 25 states, Federal government employees and Medicare/Medicaid appeals. They now appear to be taking the position that essentially ANY patient (including those with a BMI under 50) should qualify for the DS, and that insurers are improperly refusing to acknowledge this. One of the most available sources of information about this sea change is the published decisions of the California Department of Managed Health Care, which is the agency to whom California HMO participants appeal denials of coverage. Needless to say, organizations such as CHDR are inclined to be very conservative, since they are hired by politically influenced state agencies -- as you can imagine, it is likely that the insurance companies will have SOME input to how such state reviews are conducted. In addition, these organizations are also performing PRIVATE external medical reviews for insurance companies which are able to chose who will perform the external reviews of their own decisions. So it is in my opinion a significant fact that CHDR is now supporting the DS and overturning almost every denial that comes their way, at least in California (which is the only source of published opinions I have found -- I will be happy to provide the link to it on request, because putting it here will make this posting difficult to read, since it will stretch out the entire posting and all posts in response sideways to accommodate the entire link). (*Leslie's Edit: This is the link: http://tinyurl.com/9ufl3 ) Here are some quoted comments on the DS in these published decisions by CHDR, which has NO vested interest whatsoever in seeing this procedure being more commonly performed, other than their own intellectual honesty: * Techniques in duodenal switch have been available since the 1980s. There is now sufficient data to show that duodenal switch has a superior long-term outcome when compared to gastric bypass.* In the Roux-en-Y procedure dumping syndrome, stomal ulcers, and vitamin deficiency are commonly seen. * Long-term studies of the duodenal switch procedure demonstrate equal effectiveness with less need for a highly restrictive diet than with gastric bypass.* There is a significant risk of marginal ulceration with the standard gastric bypass that does not appear to be present in the duodenal switch procedure. * The data strongly supports the high failure rate of Roux-en-y gastric bypass in patients who are super morbidly obese.* Review of the medical literature indicates revisional weight loss surgeries have a high complication rate. A patient who has failed a restrictive operation (Lap-Band) is more likely to fail another restrictive operation longer-term unless a malabsorptive element is added. The study cited above reported high incidence of protein and nutritional deficiency after revision of gastric bypass to distal gastric bypass. Furthermore, a patient with a BMI of 48 may have a high failure rate after a restrictive procedure. A more suitable option may be a hybrid procedure such as duodenal switch.* The duodenal switch procedure has a track record greater than 15 years. The anticipated complications associated with other malabsorptive procedures (i.e., distal gastric bypass, jejunoileal bypass) has not been encountered with the duodenal switch.* At the 2003 American Society of Bariatric Surgeons meeting held in Boston, Massachusetts, scientific papers were presented, which indicated there is growing evidence that protein malnutrition is a much larger problem post gastric bypass than was initially suspected.* Techniques in duodenal switch have been available since the 1980s. With duodenal switch, patients lose weight in the range of 69% to 80%.* Complications have been reported to be comparable to other operations. Multiple vitamin deficiencies, mineral deficiencies, bacterial overgrowth issues seem all to be comparable and less than other alternative surgeries. Hundreds of duodenal switch operations have been performed on patients in California and they appear to have a good track record of positive results. In addition to this clarifying information about the safety and efficacy, I also want to make people understand that the "socially unacceptable" side effects of the DS surgery are often exaggerated in the extreme by those who don't have actual information from real patients to be making such statements. Again, sometimes this is confabulation of the problems associated with the BPD to apply to the DS, which is inappropriate. Sometimes, it is purely to steer patients from a surgery the surgeon doesn't perform (the DS) to one they do (the RNY or LapBand). Here is my experience, which I have substantially in common with most DSers: * I have a bowel movement every morning as soon as I wake up. Sometimes, I have another one after breakfast, IF I am still at home. Sometimes, I have another one shortly before bedtime. I NEVER have to go poop outside my house (except when I'm traveling, of course, and then only at the hotel). I do not have diarrhea, uncontrollable need to poop, or anything like that. In fact, my post-op issues with IBS have significantly improved, and my bathroom habits are BETTER than they were pre-op. It smells somewhat worse then it did pre-op, but not that much worse, and a quick spray of Ozium takes care of any lingering smell.* I fart, and it stinks, IF AND ONLY IF I have eaten some of the foods that disagree with me, such as white bread, most pasta, onions, beans and broccoli. This will happen 4-6 hours after eating such foods, so I can still eat them if I know I will not be around people (other than my family) when it kicks in. I can also take Gas-X and smell-reducing agents such as Beano, Devrom or Innermint with the meal to ameliorate the gas. It is entirely dealable with, and not really worse than it was pre-op with my IBS issues. The gas WAS more of a problem in the first 2-3 months after surgery, but it has gotten a LOT better since then, both because I have learned how to manage my diet and because my body has accommodated. Plus, I take a probiotic every day to help maintain my internal flora.* I take the following vitamins at 15 months out, and my one year labs were perfect: One prenatal vitamin, and 4 calcium citrate pills. That's it. No malnutrition or protein or vitamin deficiencies. I don't even need to supplement the fat soluble vitamins A, D, E or K.* I don't diet anymore. I eat what I want, starting with protein. I can eat about 2/3 of what I used to eat and I feel full -- comfortably -- when I'm done.* I don't barf, ever, even if I overeat (which I'm less inclined to do, though sometimes I eat reflexively while watching TV). At worst, I get a little uncomfortable, and I immediately stop. No nausea, ever, either. There's more, but you get the picture? The so-called "socially unacceptable problems" that you probably have heard about the DS are for the most part, scare tactics, a myth and I daresay a LIE. Other facts that should be understood (from a preprint of an ongoing study by Hess et al.): * The DS is a CURE for type II diabetes. In Europe, the intestinal part of the DS is being performed on people who are not obese to cure type II diabetes. There is data going out over 10 years now demonstrating the cure rate is 98%.* The average excess weight loss at ten years is 76%. * 94% of 10 year out patients are in the satisfactory category (50% or more excess weight loss). * There are no foreign materials used. * The pylorus is retained and controls the stomach emptying. * There is no small stoma that could dilate causing failure, allowing the patient to eat normal meals. * There is no dumping syndrome.* If the patient takes vitamins and minerals as instructed, as well as eats sufficient protein as instructed, which is easily accomplished eating normal food and without “protein shakes” or other supplementation, they will have little or no malnutrition issues. * The average lab results on a ten year cohort are all within the normal range.* Long-term studies have shown little or no serious or irremediable nutritional squellae, contrary to frequently expressed – but unsubstantiated – concerns. * It is certainly no longer considered an experimental or investigational procedure, either by the American Society for Bariatric Surgery (ASBS) or by the surgeons who perform it. It is still true that there are not that many surgeons offering the DS as compared with the RNY. It is a more difficult procedure to learn and to perform properly, as the tissue of the duodenum is harder to stitch. You ONLY want an experienced surgeon performing this procedure on you (but that's true for ANY surgery). Many insurance companies are still balking at covering it, but if pressed, they often will cave in, and more of them are now accepting it. But you must ask yourself, which surgery can I live with for the rest of my life -- which will give me the BEST quality of life, as well as ability to maintain my hard-earned weight loss without constant dieting? For me, there was only one answer, and that was the DS. Posted by Diana Cox. Good luck to everyone in making the best and most informed choice you can. A short and easy description of the DS procedure Duodenal Switch This procedure modestly restricts food intake while radically limiting the absorption of calories, especially the obesity causing calories from fat, complex carbohydrates, and starches. Approximately 3/4 of the stomach is removed, but the natural outlet of the stomach, the pylorus, is left in, allowing the stomach pouch to function more naturally. As the stomach pouch stretches out in the first year after surgery, patients are moderately limited in the amount of food they can eat, reduced to about 2/3 of what they could eat before surgery. However, patients are not limited in the types of food they are able to eat, tolerating meats and whole vegetables without difficulty. The food is rerouted through a radically altered intestine, limiting the amount of food that is absorbed, which is what results in weight loss, despite the patient eating freely. The intestine is essentially reduced to less than half of its length and the digestive juices (the biliopancreatic secretions) mix with the food at only the last 10% of the intestine. This arrangement means that not only are the total amount of calories eaten not absorbed, but especially fats, complex carbohydrates, and starches - the things that contribute to obesity. Patients undergoing duodenal switch eat normally and have bowel habit changes characterized by frequent (2-4 per day) soft stools and a propensity for gas. Both of which are generally malodorous unless a stool deodorant (such as Devrom) is taken. 
| A | The stomach is trimmed to a 4-6 ounce volume, preserving its natural inlet and outlet ( the pylorus). Trimming the stomach results in a temporary restrictive effect on eating for several months, which then reverts to normal, and decreases the incidence of ulcer formation as well. |
| B | The small intestine that the stomach normally empties into (the duodenum) is "switched" to the downstream portion of the small intestine (the digestive limb-D). The outflow from the duodenum, carrying the digestive juices and enzymes (but no food) becomes the bilio-pancreatic limb (C) utilizing approximately 60% of the small intestines length. |
| D | The digestive limb takes up approximately 40% of the small bowel length, and most of this length is upstream from where the biliopancreatic limb deposits its juices to allow for the absorption of fats, starches, and complex carbohydrates. |
| E | The common limb, being the portion of intestine where both food and biliopancreatic outflow meet, is made up of the most downstream 100 cm of small intestine and is the only portion where absorption of dietary starches, fats, and complex carbohydrates occurs. The capacity for absorption reaches a maximum within several months after surgery and cannot be over eaten, resulting in long term sustained weight loss.. |
| F | The gallbladder and appendix are removed. |
Both the DS and the RNY have two parts to the surgery - what is done to the stomach (restrictive part) and what is done to the intestines (malabsorptive part). In the RNY, they section off the majority of the stomach which remains in the body, but unused (thus the term gastric bypass). Because this area is 'blind' - not accessible via oral medication or endoscopy, RNY'ers are advised to avoid NSAIDS or non-steroidal anti-imflammatory drugs such as aspirin or ibuprofen due to the potential for ulcers. DS'ers don't have this problem because there is no blind portion - the unused part of the stomach is removed instead, so we can take OTC drugs. For people with *other* problems, such as lupus or migraines or a family history of ulcers, this can be an important factor in their decision. The remaining portion (nicknamed The Pouch) is anywhere from 1-3 oz. (About the size of a large egg). This then feeds directly into a newly restructured part of the intestine with no valve regulating how quickly food moves from the stomach into the intestine. Instead of a valve, there's simply a hole - kind of like a doorway - which leads into the intestines. This is called a stoma. The stoma is not flexible, so it cannot expand if you try to put something through it that is too big. This is why RNY'ers are told to chew their food VERY well, and are advised AGAINST having fluid with meals, because just like a sink drain, solid stuff will go down easier if you 'flush' it down with water. Because there is no regulation there, three-fourths of all RNY patients suffer a syndrome called Dumping. For some people, dumping just makes them feel a little bad. Others vomit. Still others have a more severe reaction that feels more like a bad case of the flu, and a rare but potentially dangerous reaction can be like a diabetic attack. Dumping Syndrome can be both a positive and a negative factor - if you immediately suffer a REALLY bad reaction to eating sweets, you're going to learn (the hard way) to avoid foods that aren't good for you. It's called Aversion Therapy, and if you learn better from the stick than you do from the carrot, this will keep you on the straight and narrow. In the DS, they literally do a gastrectomy, removing the outer curvature of the stomach (making it physically smaller), but leaving the actual functionality of the stomach intact as it was before surgery. The remaining portion of the stomach is kind of "banana" shaped, and you start with about 3-5oz stomach - a little larger than the RNY, but still MUCH smaller than it is now. You have multiple places in your body where you have a sphincter type muscle - the one everyone is familiar with is your anus, at the 'bottom' (pun intended) of your intestines. Well, you have a similar 'ring of muscle' at the pit of your stomach called the pyloric valve. Because this valve remains in use, DS patients do not have any dumping because the pyloric valve is still regulating how often food moves into the intestines as it does for you right now. In both surgeries, the stomach/pouch will expand over time to about twice it's post-surgery size. This leaves long-term RNY'ers with about 3-5oz and long-term DS'ers with about 10-12oz. Then we move into the lower portion of the surgery, which is essentially the same for both with a few small, but significant differences. The small intestine has three sections/phases - called the jujuneum, the illeum and the duodenum. (Forgive my spelling if it's wrong - it *is* 4:30 in the morning)Right now, it is one continuous line. What they do is cut it in two and reattach them in a Y formation. One branch of the Y comes down from the liver with the digestive juices. The other portion comes down from the stomach (DS) or the pouch (RNY) with food. The two them come together into what is called the common channel which then has both digestive juices and food. It is in the common channel that most digestion takes place. (Some digestion takes place all throughout the whole digestive system, starting from saliva in the mouth, all the way to the colon)The primary differen ces between the two in the lower part are this:1) In the RNY, the common channel is generally longer - perhaps 275cm. In the DS, it's generally shorter - about 100cm. Everyone absorbs carbs like a non-WLS patient, but we malabsorb for protein, fat and calories - DS more than RNY, again due to the shorter common channel. The 'big' problem this causes the DS'ers is too much fat can cause bad-smelling gas and/or diarrhea - and it's the one thing everyone who has every heard of the DS has heard of. However, for MOST people, this isn't a huge problem, is easily controlled with products like Beano, and watching what they eat. 2) The Duodenum is bypassed in the RNY, and it is functional in the DS. What makes that important is that this is where protein, calcium, iron and vitamin B12 are absorbed. So even though the DS has a greater malabsorptive factor (the shorter common channel), it actually has more normal nutritional absorption than the RNY because the duodenum is still involved in the digestive process.Now - BOTH types have to watch what they eat, and be aware that they are susceptible to nutritional deficiencies. For the most part, these can be controlled with diet, but if your diet is out of control, you can do *severe* damage to your health if you ignore this. DS patients specifically need to make sure they take calcium & protein, and the fat soluable vitamins. RNY patients need to make sure they get protein, calcium, iron & B12. (Some need B12 shots, but not all). A person who has never had surgery needs about 60g of protein a day. RNY need about 80g. I've seen recommendations for DS patients of 90-120g. Everyone should take a multi-vitamin, and get exercise, with or without WLS surgery. A low-carb, high protein diet is recommended to make sure you get in your protein, and you'll find LOTS of suggestions on what to eat on every board - both food, protein shake and supplement-wise.
------------------------------------------------------------------------------------------------------------ Great links from Anne S's profile....
Dr. Hess (suggestion: select PowerPoint presentation)
http://www.dshess.com
Dr. Husted (animated DS)
(look for animation link - scroll down)
http://johnhustedmd.com/switch.htm Dr. Ungson (animated DS)
http://www.drungson.com/eng/obe/swi.htm
Dr. Smith (streaming video image)
http://tinyurl.com/y6ey9y
Dr. John Rabkin (gives an excellent speech with PowerPoint presentation on his website, and he explains the pros and cons of the Lap Band, RNY (gastric bypass), vertical sleeve gastrectomy, and the Duodenal Switch.)
http://www.paclap.com Dr. Buchwald (text description)
http://www.university.fairview.org/Clinical_Services/Weight/c_126333.asp
Cornell University in NYC (text description)
http://tinyurl.com/2odovv
Dr. Kesheshian (click "procedure image")
http://tinyurl.com/y7w3ab Dr. Cirangle (description)
http:
