Susan in Tennessee
Well-Known Member
I think I should have said Short bowel length SBL rather than total bowel length.
Had an interesting email from Dr. Esquerra's assistant, Nina
- Thread starter Susan in Tennessee
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CarbJunkie73
Active Member
When does the BPL get measured???
CarbJunkie73
Active Member
I think I should have said Short bowel length SBL rather than total bowel length.
No, I mistyped and should have said 'SBL' not Total BL....
www.dshess.com
Susan in Tennessee
Well-Known Member
The process is that the first thing done after they sleeve you is they measure the total small bowel length and then make sure the BPL is 50% and the CC and AL are made to the roughly 10/40% marks, but they vary it based on patient factors. I understand the trepidation but I think Anthone makes a lot of sense and as MM said in your thread, personally I would rather risk a few extra pounds than malnourishment. Obviously I am biased from my experience but I understand your concern as well as Clematis'.
Carbjunkie, above is a cut ad paste of Scott's explanation to me from yesterday in the other thread. It outlines how it's done and in what order.
Carbjunkie, above is a cut ad paste of Scott's explanation to me from yesterday in the other thread. It outlines how it's done and in what order.
CarbJunkie73
Active Member
Munchkin
Full of Fairy Dust
And that's still true!
DSRIGGS
Yes, that is chocolate covered bacon
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Right Susan. The idea behind the Hess DS is that cc + AL = BPL ......that is just a way of saying the absorbing tract length should be roughly the same length as the non absorbing tract. And the 10% cc and 40% al are rough targets. Guys a heck of a lot smarter than me came up with this idea but it makes sense to me, the whole balance thing and I just know that Dr k did a study of over 300 of his patients and using the Hess method none of them required revision due to malnutrition. Now I don't know what % EWL was achieved but they weren't malnourished
CarbJunkie73
Active Member
@Susan in Tennessee
@Clematis
Annnnnnnd, (drumroll please!) here's the response I received from their office this morning....
"In the many years of experience, Dr Ungson concluded that patients with the cc shorter than 100 cm CC were the ones having problems. He started doing the cc as short as 50, 75 etc but the mal nutrition rate for this patients was high, quality of life was not good and these were the patients having the reversals done, which is high risk.
Dr Aceves nor Dr Ungson never went lower than the 100 cm either. We do not consider this a disservice, on the contrary , documented or not this is what the experience taught them and this is the same protocol Dr Esquerra follows. It is not as easy as just taking more vitamins as you may already know.
The Dr may be willing to go a bit shorter like 90 cm which he has done in the past but I am sure he will not go shorter than that. Do not think that because you are not tall that your intestines will automatically be shorter too, you will be surprised at what we find inside. If the sleeve was not enough as a weight loss tool most likely you have longer intestines and this is why you need the DS portion. We can also compensate with a smaller sleeve if needed , sometimes patients with a larger sleeve and a lot of malabsorption have a lot of problems because they can eat too much and live with extreme cases of diarrhea for example. The drs need to balance the weight loss and patient's well being.
We are in an event out of town and Dr Esquerra is not here with us. I will see that you speak with him before you need to fly out here to see if you"
It is, what it is.... I will request the 50/50 split (BPL = AL+CC) and see what he says... Never hurts to ask, right?
@Clematis
Annnnnnnd, (drumroll please!) here's the response I received from their office this morning....
"In the many years of experience, Dr Ungson concluded that patients with the cc shorter than 100 cm CC were the ones having problems. He started doing the cc as short as 50, 75 etc but the mal nutrition rate for this patients was high, quality of life was not good and these were the patients having the reversals done, which is high risk.
Dr Aceves nor Dr Ungson never went lower than the 100 cm either. We do not consider this a disservice, on the contrary , documented or not this is what the experience taught them and this is the same protocol Dr Esquerra follows. It is not as easy as just taking more vitamins as you may already know.
The Dr may be willing to go a bit shorter like 90 cm which he has done in the past but I am sure he will not go shorter than that. Do not think that because you are not tall that your intestines will automatically be shorter too, you will be surprised at what we find inside. If the sleeve was not enough as a weight loss tool most likely you have longer intestines and this is why you need the DS portion. We can also compensate with a smaller sleeve if needed , sometimes patients with a larger sleeve and a lot of malabsorption have a lot of problems because they can eat too much and live with extreme cases of diarrhea for example. The drs need to balance the weight loss and patient's well being.
We are in an event out of town and Dr Esquerra is not here with us. I will see that you speak with him before you need to fly out here to see if you"
It is, what it is.... I will request the 50/50 split (BPL = AL+CC) and see what he says... Never hurts to ask, right?
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Clematis
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Thanks for keeping us updated @CarbJunkie73
I would not ask for a smaller sleeve than the standard 3/4c or 5oz he does routinely. The only part of my DS that gives me trouble is the sleeve.
I would not ask for a smaller sleeve than the standard 3/4c or 5oz he does routinely. The only part of my DS that gives me trouble is the sleeve.
Susan in Tennessee
Well-Known Member
Very interesting, I'm processing this, not sure how I feel yet.
Munchkin
Full of Fairy Dust
I love the diagram!
CarbJunkie73
Active Member
They'll reshape mine once we see what it looks like. I've never had great restriction and I think that's due to how soon I had the sleeve done after I had that dreaded band removed. I did question Nina on getting a refund if they find my sleeve is shaped ok.
@DSRIGGS you just stated the best effect is using the Hess method? Well if her Small bowel is a certain length that would require a 50cc or 75CC and no matter what she is only going to get 100 cc that is not true Hess then how can that not make a difference. If you stand on your statement of as long as Hess is done it will be fine, but should it not be fine if we believe it's the Hess method that makes the difference?
I read through all of this and I have to say while my CC is 100 with a total length of 540, I'm doing just fine in the weight loss department with nearly 70% EWL at 7 months... and I eat probably more carbs than I should, don't particularly exercise (although I'm doing a LOT of walking lately and way more active), and generally go about my business and enjoy life
So you are loosing about 10 pounds a month. My measurements are 50/250. I'm 4'11.5. I lost at
A rate of 10 lbs per month same rate as you. Also Dr. K did tell me that at my height I would loose slower. But my average is about the same as yours even though you have a longer CC.
@Susan in Tennessee Dr. K told me the same thing. I think I would have made it to normal bmi if I hadn't been so sick. October will make 3 years Since surgery. I have gotten to 131 twice but had to go on TPN Twice. My max normal Bmi weight is 128. I still may be able to make it once I get well enough to exercise and get skin removed. Dr. K thinks I have at least 10 to 15 lbs of skin
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