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

[Susan in Tennessee]

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.

I appreciate your thoughts on this Mark and see what you're saying. You did mean 100 is not so long that you won't get good weight loss (right).

 

[CarbJunkie73]

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

@Susan in Tennessee I'm 5'3", 200ish

...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.)

I actually did make that statement in my email.... "a recent patient of Dr. Esquerra's who has a 500 total bowl received the 100cm CC and her weightloss has been extremely slow due to the length. The Hess Method would have given her the correct length and she wouldn't be struggling....."

And I haven't heard anything back from them today and I'm supposed to wire the rest of the money tomorrow.

 

[CarbJunkie73]

Quite honestly, my reason for being so adamant on the method and lengths is due to this being my 3rd WLS and God-willing, my last. I'm already facing the facts that my 70# to lose will undoubtedly come off slow as molasses and I don't need anything else working against me. I'm paying cash money and I expect the surgery to be what I was told it will be, Mexico or not. And I was and have been very up front and direct with Nina/Karla in my emails. It might not change anything, but at least I can say I told them my expectations for what I'm paying for.

 

[southernlady]

Quite honestly, my reason for being so adamant on the method and lengths is due to this being my 3rd WLS and God-willing, my last. I'm already facing the facts that my 70# to lose will undoubtedly come off slow as molasses and I don't need anything else working against me. I'm paying cash money and I expect the surgery to be what I was told it will be, Mexico or not. And I was and have been very up front and direct with Nina/Karla in my emails. It might not change anything, but at least I can say I told them my expectations for what I'm paying for.

If I was on my third, I would be just as adamant. Hell, I would be like that if I got to a second one.

 

[Clematis]

Quite honestly, my reason for being so adamant on the method and lengths is due to this being my 3rd WLS and God-willing, my last. I'm already facing the facts that my 70# to lose will undoubtedly come off slow as molasses and I don't need anything else working against me. I'm paying cash money and I expect the surgery to be what I was told it will be, Mexico or not. And I was and have been very up front and direct with Nina/Karla in my emails. It might not change anything, but at least I can say I told them my expectations for what I'm paying for.

Oh yeah you BETTER get what you want!!

If Esquerra could cite the study that says that 100cc minimum is "safer" I'd say OK... but there isn't one. His mentor Ungson didn;t restrict cc to no less than 100. Esquerra is like 12 yrs old, he doesn;t follow up with his patients so he simply has no PROOF.

 

[Susan in Tennessee]

@Susan in Tennessee I'm 5'3", 200ish


I actually did make that statement in my email.... "a recent patient of Dr. Esquerra's who has a 500 total bowl received the 100cm CC and her weightloss has been extremely slow due to the length. The Hess Method would have given her the correct length and she wouldn't be struggling....."

And I haven't heard anything back from them today and I'm supposed to wire the rest of the money tomorrow.

I'm going to work on composing my email tonight. I do my best work after hubby and the furkids go to bed!

 

[Clematis]

Tagging @Svetlana Leigh who is going to Esquerra on May 27. You should be asking Nina these questions as well.

 

[Will2014]

Remember that the difference between a 100cm CC and a 125cm one is 9.8 inches. The effect on absorption probably isn't that much really. While I completely understand your desire to achieve your weight loss goals, I don't think it's as huge a deal as you might think. I absolutely agree that Nina should provide ALL details before you provide final payment and I'm quite sure she will. I also want to encourage you to speak with the doctor directly...they WILL do that and provide a translator if needed. Please keep us posted!

 

[DSRIGGS]

Quite honestly, my reason for being so adamant on the method and lengths is due to this being my 3rd WLS and God-willing, my last. I'm already facing the facts that my 70# to lose will undoubtedly come off slow as molasses and I don't need anything else working against me. I'm paying cash money and I expect the surgery to be what I was told it will be, Mexico or not. And I was and have been very up front and direct with Nina/Karla in my emails. It might not change anything, but at least I can say I told them my expectations for what I'm paying for.

as well you should have high expectations.

That being said, please don't get too hung up on the CC length. It is only part of the equation and the most important thing is that Hess is followed. BTW, rarely is the CC 10% of SBL. I am not sure why that number hasn't been revised to what it actually seems to be, more like 15% or more. I know I am beating a dead horse, but the Hess is about the balance of the absorbing and non absorbing intestinal tract NOT THE INDIVIDUAL component length.

Finally, remember that they can't tell you what your CC & AL are going to be until they get inside you and measure your small bowel.

 

[CaraOC]

Holy Crap!! I've missed a lot!! What's all this? Esquerra fucked up somewhere? I'm trying to speed read here.

 

[CaraOC]

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.

I pulled out my surgical report and now I'm scared I might have issues too. My total SBL was 470cm!! So my CC per Hess would be 47cm? My report states I have a CC of 100cm too??? My AL is 150cm and my BPL 220cm.

 

[CaraOC]

I remember post op although stoned on milk of the poppy that Dr Esquerra told me I had a short small bowel!!! I'm screwed ain't I?

 

[DSRIGGS]

I remember post op although stoned on milk of the poppy that Dr Esquerra told me I had a short small bowel!!! I'm screwed ain't I?

No. Why do you think you are screwed?

So your absorbing path to non absorbing path ratio is 53/47. That is within a safe margin of error to the 50/50 perfect Hess DS. You aren't going to be malnourished and your weight loss should do fine in my opininion.

 

[CaraOC]

No. Why do you think you are screwed?

So your absorbing path to non absorbing path ratio is 53/47. That is within a safe margin of error to the 50/50 perfect Hess DS. You aren't going to be malnourished and your weight loss should do fine in my opininion.

I was trying to catch up and power read on what Clamatis thing was. My small bowel length was 470 cm so per Hess I thought the CC should be 10% of this? So what doesn't add up with her numbers???

 

[DSRIGGS]

Please read my comments in response to clematis concerns. The Hess method 0f 10/40/50 is target and the key is balance of the al÷cc =bpl. The individual lengths are not as important according to Dr anthone as that overall balance. It is just my opininion but people are way too hung up on the CC length. It is not the only absorbing limb. My cc was roughly 15% and I became malnourished. Why? Because the other key absorbing limb was way too short.