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

[DSRIGGS]

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 too am not an advocate of tiny sleeves as the data doesn't show that it adds benefit over a larger sleeve. My sleeve caused me issues early on like you have had (not as bad you have experienced though). It was probably around 6 months for me when that got a great deal better.

 

[DSRIGGS]

@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?

C, the 10% and 40% are guidelines, not something etched in stone. I would venture to say that most people given the hess have more than a 10% cc. Again the Hess is about basing limb lengths as a proportion of the total small bowel length and limb length is customized to the patient based on surgeon's judgement of the patients history . That doesn't mean that the hess method has not been used if it isn't exactly a 10 / 40 split.

I keep harping on balance and firmly believe that too shortof a cc can cause nutritional issues. There is a happy balance between all three limbs and Clematis has a right to be upset that Esqerra gave her 60% of absorbing intestine when it should have been much closer to 50%. Personally I think Esqerra should have given her the proportions he gave Jim. I have no idea why he gave her such a long AL as compared to Jim when they both had same sbl.

Again, my cc was 125cm or roughly 17%. It would have been 72.5 cm had it been 10%. No way in the world would I have wanted that. In actuality it the equivalent of 150 cm after my revision and I still dint absorb fat very well at all. If I eat too much fat I get bad oil slicks,

I have asked somebody we both know and respect greatly, about data of individual component limb length percentages. He was going to take a look and see what the data shows. My guMysays that the 10/40 guide is actually closer to 15/35. My guess is that you will see a blog on this overall debate in the near future.

I think this is a great debate and carbjunkie has advocated very well for herself and that she will get a well balanced DS that works well for her.

 

[Charris]

C, the 10% and 40% are guidelines, not something etched in stone. I would venture to say that most people given the hess have more than a 10% cc. Again the Hess is about basing limb lengths as a proportion of the total small bowel length and limb length is customized to the patient based on surgeon's judgement of the patients history . That doesn't mean that the hess method has not been used if it isn't exactly a 10 / 40 split.

I keep harping on balance and firmly believe that too shortof a cc can cause nutritional issues. There is a happy balance between all three limbs and Clematis has a right to be upset that Esqerra gave her 60% of absorbing intestine when it should have been much closer to 50%. Personally I think Esqerra should have given her the proportions he gave Jim. I have no idea why he gave her such a long AL as compared to Jim when they both had same sbl.

Again, my cc was 125cm or roughly 17%. It would have been 72.5 cm had it been 10%. No way in the world would I have wanted that.

I have asked somebody we both know and respect greatly, about data of individual component limb length percentages. He was going to take a look and see what the data shows.onLy gut days that the 10/40 guide is actually closer to 15/35 My guess is that you Wii see a blog on this overall debate in the near future.

I think this is a great debate and carbjunkie has advocated very well for herself and that she will get a well balanced DS that works well for her.

I just know I'm like Carb junkie and Susan I'm a shorty at 4'11.5. Plus having a revision and the long list of other marks I have against me when it comes to loosing weight I WANTED ALL THE HELP I COULD GET. But you know I have also had malnourishment issue almost unto death. We only can go by what our surgeon tells us they did. Plus as Southern Lady brought up how the bowel was measured was it streched? So what one calculated at 10% another may measure and come up with very different measurements. At least Dr. E is letting clients know in advance the smallest they will get for cc is 100 so they can weigh their options and not come out of surgery surprised.

 

[DSRIGGS]

I understand what you are sayihe, that being said the purpose of the Hess is to render height -(really bowel length) irrelevant. I mean that is exactly why it is done rather than the cookie cutter. It is a recognition that we have different bowel lengths and it compensates for that different height... so theoretically a 6'2 person should have the same outcome as a 4'11 person.

I think Esqerra is being very upfront and he either brain cramped or made a surgical report typo for Clematis. He screwed up IMO. If he intentionally gave her a 60% absorbing length ratio I am sure clematis would like to know why.

 

[Munchkin]

I just know I'm like Carb junkie and Susan I'm a shorty at 4'11.5. Plus having a revision and the long list of other marks I have against me when it comes to loosing weight I WANTED ALL THE HELP I COULD GET. But you know I have also had malnourishment issue almost unto death. We only can go by what our surgeon tells us they did. Plus as Southern Lady brought up how the bowel was measured was it streched? So what one calculated at 10% another may measure and come up with very different measurements. At least Dr. E is letting clients know in advance the smallest they will get for cc is 100 so they can weigh their options and not come out of surgery surprised.

Thanks for bringing this up! The 'stretched' thing is very valid. Intestines are motile, like earthworms. It you lay them out, you can watch them move. A 100cm CC would be shorter if stretched out. I have always said we could put the 10 best DS surgeons in the world in an OR with one patient. Have them each measure out a 100cm CC and each and every measurement would be different.

 

[BebeZed]

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.

Thanks @Charris - that's good to know! It's encouraging for sure.

 

[Susan in Tennessee]

Thanks for bringing this up! The 'stretched' thing is very valid. Intestines are motile, like earthworms. It you lay them out, you can watch them move. A 100cm CC would be shorter if stretched out. I have always said we could put the 10 best DS surgeons in the world in an OR with one patient. Have them each measure out a 100cm CC and each and every measurement would be different.

Hopefully each surgeon had their set way and they use same basic tension or lack thereof while measuring entire procedures (all limbs) so the ratios would be good, did that make any sense at all??

 

[DSRIGGS]

Thanks for bringing this up! The 'stretched' thing is very valid. Intestines are motile, like earthworms. It you lay them out, you can watch them move. A 100cm CC would be shorter if stretched out. I have always said we could put the 10 best DS surgeons in the world in an OR with one patient. Have them each measure out a 100cm CC and each and every measurement would be different.

Yep I am a prime example as Marshall measured my cc and AL at 100 and 150 while Dr k measured 125 and 200.

 

[DSRIGGS]

Hopefully each surgeon had their set way and they use same basic tension or lack thereof while measuring entire procedures (all limbs) so the ratios would be good, did that make any sense at all??

Agreed

 

[thamilt]

This is JoJo's mom. Just a word about whether Nina answers for the doctors in her replies to questions. I was in the cafeteria here at Almater Hospital yesterday. Across from me sat Nina and Dr. Campos, having chips . Nina had her computer and they were answering questions on line. Sounded to me that Dr. Campos was telling her what to reply, so she wasn't just making up answers.

 

[Susan in Tennessee]

This is JoJo's mom. Just a word about whether Nina answers for the doctors in her replies to questions. I was in the cafeteria here at Almater Hospital yesterday. Across from me sat Nina and Dr. Campos, having chips . Nina had her computer and they were answering questions on line. Sounded to me that Dr. Campos was telling her what to reply, so she wasn't just making up answers.

You met Nina? She was at Almater? Only people I met were Carla and Yolanda. Carla is the one who greeted you and takes you around to have your pre-op tests then Yolanda (older woman than Carla) talks to the patient and gives out the two pills to take the night before surgery. When I asked Ernesto about Nina, he told me that she is located in an entirely different location/town. I've never emailed Dr. Campos. I know he lives there in Mexicali, or again, was told this by Ernesto, the knower of all things! LOL He told me where Esquerra lives and I think it was Hermosilla, but I'm not feeling 100% certain on that.

 

[Clematis]

Glad to know Nina's answers are driven by the physicians.

Nina does not work out of the hospital but is in Mexicali. She came into the hospital room with Esquerra after my surgery when I was zoned out on morphine. Others who went to Esquerra last fall have said they too met Nina when she came in with Esquerra. So if she is in another town, she wasn't then. Her sister Karla (most of the time when one emails Nina it is Karla who answers) never comes in to the hospital -- not to be confused with nurse Carla. Yolanda (mother of Nina and Karla) is there as well.

 

[thamilt]

Glad to know Nina's answers are driven by the physicians.

Nina does not work out of the hospital but is in Mexicali. She came into the hospital room with Esquerra after my surgery when I was zoned out on morphine. Others who went to Esquerra last fall have said they too met Nina when she came in with Esquerra. So if she is in another town, she wasn't then. Her sister Karla (most of the time when one emails Nina it is Karla who answers) never comes in to the hospital -- not to be confused with nurse Carla. Yolanda (mother of Nina and Karla) is there as well.

Yes, Nina came in and introduced herself. JoJo's "coordinator " is Yolanda. So Nina is the daughter of and boss of Yolanda.

 

[thamilt]

Not sure how my reply got put on Clematis' post.

 

[southernlady]

Not sure how my reply got put on Clematis' post.

Fixed it for you.