Diet Advancement for Duodenal Switch

[OldBroad]

I've attached the document I got from Dr. Elariny's office. Do you folks have any comments on this protocol?

 

[southernlady]

You need to find out if he uses a ValTrac ring...if he does, follow it to the letter.

 

[OldBroad]

Ack! Before I go down a rabbit hole of medical literature, please elaborate what the ValTrac ring is and what it has to do with my post-surgical diet.

 

[southernlady]

It's a dissoluble ring added to help the anastomosis created (you will have two anastomosis created).

Not all surgeons use them but if they do you can seriously hurt yourself but not following your surgeon's suggested eating plan for at least 2 months. @DianaCox can explain it better and she might know if he does or not.

I happen to know my surgeon does not use them. But I don't know if Dr. Elariny does.

 

[DianaCox]

1) Valtrac ring (http://products.covidien.com/pages.aspx?page=ProductDetail&id=13606&cat=Devices&cat2=Model) -

• It is a hard ring made of material that dissolves after a few weeks (3-4) that helps position the tissue-papery ends of the intestines that are being anastomosed, supporting the edges until they heal.
• It precludes eating anything that might not be 100% chewed to paste from being eaten until it is dissolved, to prevent a chunk of food from getting caught in the ring before it dissolves.
• But you many not need to worry about it - just ask Elariny if he uses them.

2) Things I disagree with on his plan (and you don't have to TELL him you plan to not listen)

• Drinking protein shakes - FEH! - if you can get them down, great; if you can't, don't sweat it. HYDRATION is important in the first few weeks, not protein.
• Ditto the vitamins - if you can get them down, great; if not, don't worry about it and don't make yourself ill trying - at least not in the first few weeks.
• Crispy not allowed for first six weeks - if you are nauseated, especially first thing in the morning, I would recommend eating Saltines - let them melt in your mouth first, until they start to get sweet from the action of amylase in your spit on the starch.
• I don't know about the crunchy rules - I wasn't given those rules by Rabkin, and that section keeps using the word "POUCH" - you won't have a pouch - that's RNY - you have a fully functioning (if smaller and temporarily more tender) stomach. I think they erroneously carried that over from their RNY rules.

3) If you are already on a PPI other than Prevacid, I'd stick with that. I had to switch back to Aciphex after the prescribed med didn't work.

4) Tell him you want to get rid of your gall bladder, as previously recommended.

 

[OldBroad]

Spoke with Elariny this afternoon. He said he'll remove the gallbladder since that's what I want. He said he doesn't use the ValTrac. He explained that the instructions were conservative. He said his patients did well following the protocol. He was calling on a weak signal (I think he may be on vacation) so I didn't get into a discussion on his reasoning for the protocol.

I think this may be a matter of inertia. I got the impression that he's used this protocol for years and hasn't had any reason to rethink it.

 

[DianaCox]

Inertia is likely. His answer was measured - validated your concerns without admitting his rules were not necessarily supported by facts.

Main thing, though, is that he knows you are an informed patient, and was willing to discuss your options and preferences. Make sure the cholecystectomy is coded as being in response to symptoms, to make sure that part of your surgery is covered as medically necessary.

Have you made sure the anesthesiologist is in network?

 

[Spiky Bugger]

Inertia is likely. His answer was measured - validated your concerns without admitting his rules were not necessarily supported by facts.

Main thing, though, is that he knows you are an informed patient, and was willing to discuss your options and preferences. Make sure the cholecystectomy is coded as being in response to symptoms, to make sure that part of your surgery is covered as medically necessary.

Have you made sure the anesthesiologist is in network?

My recent experiences with the "anesthesiologist in network" issue proved that it didn't much matter. We are at the mercy of the surgeons and hospitals...and lately, my insurances haven't bothered with the in-network issue FOR THAT SPECIALTY.