Had an interesting email from Dr. Esquerra's assistant, Nina

[Susan in Tennessee]

I had been asking her if Dr. Esquerra did indeed use the Hess method of calculating limb lengths and finally received an answer, after my second request. It was: "yes, Dr. Esquerra uses the Hess method. We do not do the common channel shorter than 100 cm though, this is the shortest he will go for the patients own long term safety."

This really has thrown me. I haven't replied yet to try to argue the point. I am thinking of asking if he would be able to call me so I could talk to him about it. From what I've read and learned from everyone here about the Hess method, if done correctly it keeps a person from suffering malnourishment and ALSO makes sure shorties like myself (5'1") who are also more likely to have a shorter common channel get a length correct to help them lose as they should.

In my opinion the hardest part of going the Mexico route is not being able to sit face to face with your surgeon during the decision making process and have questions answered without going through emails via his personal assistant. I can't help but have a doubt in the back of my mind as to whether Dr. Esquerra ever gets the questions we ask or does Nina answer them all on her own.

Opinions and suggestions on how to argue for traditional Hess calculations appreciated and also feelings on whether he is right to limit the length this way. Good or bad?

Oh, I had my regular lab work done last week like always and my vitamin D has come up from 40 to 92!! That made me happy.

 

[Marquis Mark]

100 is not so short that you won't get good weight loss. Sounds like he's just trying to ensure you don't get malnourished. In my case, the doctor said most of his DSs end up at around 75 cm. I asked for a bit longer to help ensure I wouldn't be malnourished or get diarrhea. So mine is about 85-90. It's fine.

Please remember we're literally only taking a few inches on a small intestine that can be 20 feet long.

In my case, I said I'd rather have a few extra pounds (if any) than deal with excess malnutrition, etc. As it is, I'm already mildly anemic, low in cooper and my PTH is up thanks to the DS.

Up to you, but what he's saying doesn't seem unreasonable to me.

 

[DSRIGGS]

See my response to Clematis in the thread from Carbjunkie, that way I don't have to write it all out again.. Truth is that just because you are short, there could still be a large variance in SBL for that given size. You could have a longer SBL and be say 600 CM.

Just my opinion, but I think people in general put too much emphasis on CC length rather than focusing on the total absorbing path length (CC + AL) being roughly equal to BPL Length.

I think you are very wise to ask these questions and I think you are going to be in good shape. Hopefully he will call or correspond with you over email at a minimum.

 

[DSRIGGS]

100 is not so short that you won't get good weight loss. Sounds like he's just trying to ensure you don't get malnourished. In my case, the doctor said most of his DSs end up at around 75 cm. I asked for a bit longer to help ensure I wouldn't be malnourished or get diarrhea. So mine is about 85-90. It's fine.

Please remember we're literally only taking a few inches on a small intestine that can be 20 feet long.

In my case, I said I'd rather have a few extra pounds (if any) than deal with excess malnutrition, etc.

Up to you, but what he's saying doesn't seem unreasonable to me.

What I wouldn't give to have had that scenario. Again I tend to think Dr Anthone's hypothesis that AL + CC = BPL is the most important factor in DS success (nutrition vs weight loss balance...it is a balance) and that the make up of the individual CC and AL isn't as important...just that they roughly equal the BPL.

JMO

 

[Susan in Tennessee]

I had been asking her if Dr. Esquerra did indeed use the Hess method of calculating limb lengths and finally received an answer, after my second request. It was: "yes, Dr. Esquerra uses the Hess method. We do not do the common channel shorter than 100 cm though, this is the shortest he will go for the patients own long term safety."

This really has thrown me. I haven't replied yet to try to argue the point. I am thinking of asking if he would be able to call me so I could talk to him about it. From what I've read and learned from everyone here about the Hess method, if done correctly it keeps a person from suffering malnourishment and ALSO makes sure shorties like myself (5'1") who are also more likely to have a shorter common channel get a length correct to help them lose as they should.

In my opinion the hardest part of going the Mexico route is not being able to sit face to face with your surgeon during the decision making process and have questions answered without going through emails via his personal assistant. I can't help but have a doubt in the back of my mind as to whether Dr. Esquerra ever gets the questions we ask or does Nina answer them all on her own.

Opinions and suggestions on how to argue for traditional Hess calculations appreciated and also feelings on whether he is right to limit the length this way. Good or bad?

Oh, I had my regular lab work done last week like always and my vitamin D has come up from 40 to 92!! That made me happy.

I just reread what I wrote above and noticed I got mixed up and when I said "shorties like myself (5"1") who are also more likely to have a shorter common channel I meant to say total bowel length! sorry.

 

[DSRIGGS]

LOL no problem....I knew what you meant. As and told teacher said me when he called me my brother's name, it is what I mean not what I say! OMG is that so true now for me!

 

[Susan in Tennessee]

LOL no problem....I knew what you meant. As and told teacher said me when he called me my brother's name, it is what I mean not what I say! OMG is that so true now for me!

I hear you, my husband have lengthy conversations that way and filled with "old what's his name, "that thing" etc, and we understand each other!

 

[DSRIGGS]

I hear you, my husband have lengthy conversations that way and filled with "old what's his name, "that thing" etc, and we understand each other!

haha. I am going to be a complete blithering idiot in 10 years. Right now I am just partially there.

 

[jim1969]

All this talk about limb lengths I had to pull out my surgery notes. My AL is 150,
BPL 250, and CC is 100.
So I guess he did it right on me.

 

[Clematis]

Your total bowel length was only 500 @jim1969 ? That's short for a man.

 

[jim1969]

What should it be?

 

[CarbJunkie73]

Welp, I just emailed the office and requested a chat with the doc using some of the comments in this post to explain my 'cause for concern' with a semi-Hess method with cookie cutter 100cm CC length on us shorter folks. I even copy/pasted the dshess.com 'Parameters' section and highlighted the important parts! They'll probably fire me as a patient and tell me to take my crazy ass somewhere else for the DS and resleeve but it'll be worth it if it raises his/their awareness that we're paying for services and expect to get what we pay for! The true Hess Method DS!

My brain hurts now.... it's time for bed!

 

[DSRIGGS]

What should it be?

How tall are you? It isn't male vs female that shows SBL correlation it is height

http://meetings.ssat.com/abstracts/2014/Mo2053.cgi

 

[Susan in Tennessee]

Welp, I just emailed the office and requested a chat with the doc using some of the comments in this post to explain my 'cause for concern' with a semi-Hess method with cookie cutter 100cm CC length on us shorter folks. I even copy/pasted the dshess.com 'Parameters' section and highlighted the important parts! They'll probably fire me as a patient and tell me to take my crazy ass somewhere else for the DS and resleeve but it'll be worth it if it raises his/their awareness that we're paying for services and expect to get what we pay for! The true Hess Method DS!

My brain hurts now.... it's time for bed!

Please let me know what kind of response you get!

 

[DSRIGGS]

Welp, I just emailed the office and requested a chat with the doc using some of the comments in this post to explain my 'cause for concern' with a semi-Hess method with cookie cutter 100cm CC length on us shorter folks. I even copy/pasted the dshess.com 'Parameters' section and highlighted the important parts! They'll probably fire me as a patient and tell me to take my crazy ass somewhere else for the DS and resleeve but it'll be worth it if it raises his/their awareness that we're paying for services and expect to get what we pay for! The true Hess Method DS!

My brain hurts now.... it's time for bed!

I bet you get s good response. Many of these docs are reasonable if you show them that you know what you are talking about and are reasonable with your advocacy for yourself.