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

[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!

How short are you, Wonder Woman? I'm 5'1" @ 235ish

 

[jim1969]

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

5' 10

 

[southernlady]

Susan, the common channel is just ONE piece of the puzzle. Many have a 100 common channel and do very well. Mine is 175 and I've done fine. As long as he does the Hess method to measure all pieces, don't fret.

 

[DSRIGGS]

5' 10

Interesting. This shows how much variation of SBL there can be at a given height. My understanding is that your SBL is at the low side for your height. Which shows exactly why it is so important to measure and then follow the Hess method.

 

[Charris]

@Susan in Tennessee I being 4'11, black, revision, female understand how important it is to us to get a true Hess method DS. I've been malnourished 2 times due to some h pylori stuff going on. It depends on what you are willing to to accept and how strongly your willing to fight or change doctors. I would hate to be in your situation to have it at the tip of your fingers but not the way you feel you need it.

Edit auto correct

 

[Susan in Tennessee]

Interesting. This shows how much variation of SBL there can be at a given height. My understanding is that your SBL is at the low side for your height. Which shows exactly why it is so important to measure and then follow the Hess method.

Our point exactly!

 

[Susan in Tennessee]

Susan, the common channel is just ONE piece of the puzzle. Many have a 100 common channel and do very well. Mine is 175 and I've done fine. As long as he does the Hess method to measure all pieces, don't fret.

Yes, I do realize that, I see lots of living proof. What are your other measurements, Liz? Does Boyce consider that too? The point you and Scott make of it being the measurements all combined to consider rather than whether cc was made 10% does make sense, but for Esquerra to lead people to believe he does Hess method without qualifying his personal parameters as happened with Clemantis and not having the math add up any way you look at it stinks. Granted, I have been warned so I would be in a different position.

 

[DSRIGGS]

Our point exactly!

I understand but as I have been trying to explain, don't get overly hung up on the CC length. It is the overall balance we discussed yesterday that really matters....so as long as you are accurately measured and given that rough 50/50 absorbing limbs (AL + CC) to Nonabsorbing (BPL) ratio it doesn't really matter what the exact individual component length is as long as it is in a reasonable range.

We also know from me that you can have a CC that is longer than 10% and and AL that is much shorter than 40% of total SBL and have severe nutritional issue. That is exactly what happened to me. My original CC length as measured by Dr K* when he did my revision showed that my CC was actually 17% of total SBL and my AL was only 27%. Clearly it was my short AL that caused my issues NOT MY CC Length. That is why I preach to people to not be so hung up on CC length as it IS ONLY ONE PART OF THE EQUATION AND NO MORE IMPORTANT THAN ANY OTHER PART.

As long as you have that 50/50 balance you are going to be be in good shape and have a high probability of success which I define as optimal balance of weight loss and nutritional health. They are not independent of one another. Somebody may want to weigh 120 pounds for appearance but in reality they will be nutritionally deficient and not healthy so instead their balance might be say 145 pounds, which is higher than they want to weigh for their mind's appearance but the healthiest weight they can be at.

* Dr K measured my CC at 125 cm and AL at 200 when Marshall said he made them at 100 and 150 respectively - according to Dr K that is just measuring technique difference - how much tension is put on the intestine to "straighten out" for measuring.

 

[DSRIGGS]

Yes, I do realize that, I see lots of living proof. What are your other measurements, Liz? Does Boyce consider that too? The point you and Scott make of it being the measurements all combined to consider rather than whether cc was made 10% does make sense, but for Esquerra to lead people to believe he does Hess method without qualifying his personal parameters as happened with Clemantis and not having the math add up any way you look at it stinks. Granted, I have been warned so I would be in a different position.

Yes, what he did for Clematis was not in balance. Hopefully she will be fine.

 

[Clematis]

Yes, what he did for Clematis was not in balance. Hopefully she will be fine.

...or as fine as I get.


@Susan in Tennessee I think you should reiterate your concerns now with Nina. She is sure to pay attention when carbjunkie has contacted her with the same issue. The point to make is that Esquerra can have no data to support a minimum 100cc when all the data points to the HESS METHOD. You can also say someone is complaining that she was given a cc twice as long as her small bowel would have dictated and that she is losing weight exceptionally slowly.

I want you and carbjunkie to get the DS I should have had.

(And your bowel may very well be 600 so 100cc would be the correct length.)

 

[Susan in Tennessee]

...or as fine as I get.


@Susan in Tennessee I think you should reiterate your concerns now with Nina. She is sure to pay attention when carbjunkie has contacted her with the same issue. The point to make is that Esquerra can have no data to support a minimum 100cc when all the data points to the HESS METHOD. You can also say someone is complaining that she was given a cc twice as long as her small bowel would have dictated and that she is losing weight exceptionally slowly.

I want you and carbjunkie to get the DS I should have had.

(And your bowel may very well be 600 so 100cc would be the correct length.)[/QUOT
Yes, I am going to email them. Clematis ,have you emailed and asked about your measurements, or rather, complained about their measurements? Do you think I should wait a day or so and let Carbjunkie hit them with her email first or go for it right now?

 

[Clematis]

The first operative report I was given was only a single paragraph and only said CC and AL lengths -- not total bowel or BPL. 2-3 months later when I came out of my fog and realized this operative report was lacking -- there wasn't even mention of my gall bladder being removed -- I pitched a fit and was told that wasn;t my operative report "That's not how we do things" and was sent an in-depth report which was a) really my report or b) they pulled it out of their ass. In it was the wacky limb lengths. No I didn't contact them again after that. I was pretty devastated and knew there wasn;t anything they could do about it short of more surgery. But I thought it was just me. Coincidentally, every one else who went to Esquerra had a bowel length of at least 600 so 100cc was correct. Now that I know he gives a too-long cc for anyone with a total bowel under 600, I think I will make my displeasure known.

I think you should hit Nina now and get the answer IN WRITING. If this is a deal breaker for you, why bother going through the pre-diet if you are going to have to wait and go to someone else.

Again, you may very well have a 600 total bowel length so this won;t be an issue for you.

 

[DSRIGGS]

Clematis I know you are frustrated with your pace of loss and your Op report, but if you look at your BMI numbers you have dropped from nearly 40 to almost 25 in 6 months. That is a 33% BMI reduction in 6 months or another way of looking at it, 71% of your goal BMI achieved. I think you have lost a significant amount and are maybe comparing yourself to the loss of others and letting that bother you.

BTW, it all personal preference and how you feel but Dr K told me that there is a balance between good health and where we want our ideal weight to be, because as he says it isn't possible to have both. At a 21 BMI which you show as your goal I would weigh 163.5 lbs (a fucking bone bag). I am currently 185 as of yesterday and a BMI of 23.8 which still leaves me with some low lab levels and feeling shitty. Dr K and I both agreed that my optimal weight to health balance will be achieved at somewhere between 195-205 lbs. That would be a BMI range of 25 - 26.3. So interestingly enough that high end GW number for me is right where you are at now.

Please understand that I am not trying to tell you that you shouldn't be concerned or where you should want your BMI/Weight to end, but I did want to share that observation.

Now you can tell me to shut up or blow it out my ass if you want.

 

[southernlady]

Yes, I do realize that, I see lots of living proof. What are your other measurements, Liz? Does Boyce consider that too? The point you and Scott make of it being the measurements all combined to consider rather than whether cc was made 10% does make sense, but for Esquerra to lead people to believe he does Hess method without qualifying his personal parameters as happened with Clemantis and not having the math add up any way you look at it stinks. Granted, I have been warned so I would be in a different position.

Boyce does a standard common channel of 100 unless there is reason for longer. He said for me 175 to 200. I got him to agree to 175. Mine is 175 but then I was right at the line of not being MO at all. I am 5'4", and while I am a couple of lbs over normal BMI now, I am still at a good weight. I honestly do not remember what the other measurements were except for my sleeve size. He gave me a very tiny sleeve.

I do know that that office has adjusted that, they are doing a bigger sleeve...about 50% reduction not the usual 75-80% reduction. And the 100 common channel. His office says it's due to problems with nutrition but if he and his office did a proper DS nutrition and didn't rely on HIS own line of piss poor vitamins, his office would have less issues with that.

I saw a local bariatric surgeon in Feb (long story about getting labs here) who does understand the DS but chooses to not perform it. His comment about my labs and my husband's was that they were the best he had seen in ages.

 

[Susan in Tennessee]

Boyce does a standard common channel of 100 unless there is reason for longer. He siad for me 175 to 200. I got him to agree to 175. Mine is 175 but then I was right at the line of not being MO at all. I am 5'4", and while I am a couple of lbs over normal BMI now, I am still at a good weight. I honestly do not remember what the other measurements were except for my sleeve size. He gave me a very tiny sleeve.

I do know that that office has adjusted that, they are doing a bigger sleeve...about 50% reduction not the usual 75-80% reduction. And the 100 common channel. His office says it's due to problems with nutrition but if he and his office did a proper DS nutrition and didn't rely on HIS own line of piss poor vitamins, his office would have less issues with that.

I saw a local bariatric surgeon in Feb (long story about getting labs here) who does understand the DS but chooses to not perform it. His comment about my labs and my husband's was that they were the best he had seen in ages.

More proof you're doing things right and I appreciate you sharing your knowledge with me and everyone else!