hilary1617
First time at the rodeo.
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Hey! I'm a newbie
- Thread starter cchall
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Larra
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I think @Clematis has said something very important to you, @cchall. Here you are, excited about your upcoming surgery, date set, jumped through all the ridiculous hoops, and then a bunch of strangers come along and tell you something you very much don't want to hear, and something that conflicts with what your surgeon (that you really liked!) has told you. But facts are facts, and all the long term studies about the DS are based on a common channel of 100 cm or thereabouts, and the rate of nutritional problems is remarkably low, and almost always related to noncompliance. There are no studies showing excellent long term results with a common channel of 300 cm. None.
The nutritional deficiencies, or lack thereof, are almost entirely in your hands. It's possible that, in the patient population this surgeon works with, he has a higher than usual percentage of noncompliant patients. And even just a couple of difficult patients can color a doctor's opinion because they do stand out in you mind and you don't forget them. But that's them, not you. You need to do what's best for you, not for someone else.
I hope you'll look at this not as a setback, not as something to be upset about, but as an opportunity to reconsider what's been planned for you and make very, very sure you are doing what's in your best interest, and not settling for something that may be necessary to keep someone less well informed out of trouble. You are smart, you've researched, and you are someone who can keep up with protein and vitamins and labs. This is something you will live with for the rest of your life. Make sure it's something that will serve you well for the rest of your life.
The nutritional deficiencies, or lack thereof, are almost entirely in your hands. It's possible that, in the patient population this surgeon works with, he has a higher than usual percentage of noncompliant patients. And even just a couple of difficult patients can color a doctor's opinion because they do stand out in you mind and you don't forget them. But that's them, not you. You need to do what's best for you, not for someone else.
I hope you'll look at this not as a setback, not as something to be upset about, but as an opportunity to reconsider what's been planned for you and make very, very sure you are doing what's in your best interest, and not settling for something that may be necessary to keep someone less well informed out of trouble. You are smart, you've researched, and you are someone who can keep up with protein and vitamins and labs. This is something you will live with for the rest of your life. Make sure it's something that will serve you well for the rest of your life.
I am getting the DS for sure...
So now I am worried, should I tell my doctor to do the original DS? This is my one shot and I want to get it right!! I don't want to worry about gaining my weight back because the common channel is wrong!!
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Munchkin
Full of Fairy Dust
I would hold out for a shorter CC for sure. Mine is short, 75. And I wish it was shorter!!!!!!! And what Larra said is dead on. There is no peer reviewed, REAL data/study that supports a 300 CC. You want to do the right thing the first time round!
galaxygrrl
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I would check in the price too. I've never heard of a Virgin DS in the United States for less than 22K. That sounds more like a sleeve price, so make sure you knwo what you are getting
Clematis
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Ask to speak to the doctor directly on the phone, not filter this through his staff. Here is what I would say:
"As a scientist, doctor, I know how much importance you must place on peer reviewed research. As you know, there are numerous studies showing the effectiveness and safety of the traditional, 2 anastomoses duodenal switch with limb lengths based on the Hess Method or on a standard 100 cm common channel going back 15-10 years, but I can find no peer reviewed studies showing the effectiveness, much less the long term effectiveness of a DS with a 300 cm common channel. Indeed, most insurance companies define a duodenal switch as a 2 anastomoses procedure with a common channel of 100 cm. I do not want to end up with a procedure with poor initial results and then end up a couple years out having to be on a strict diet the rest of my life desperately trying to fight regain. I understand your concerns about malabsorption, but fat malabsorption is the precise reason why the traditional duodenal switch with a short common channel works. I have the intelligence to monitor semi-annual labs and adjust my vitamins and nutritional intake to counteract any imbalances. I respectfully request that I be given the industry-standard procedure with a common channel based on the Hess Method according to my bowel length or a standard 100 cm common channel."
But what do you do if he refuses? How much money have you paid him? (Again, his price is far too cheap for the US. That is suspicious. Is he doing this and sending you home the same day???) Dr. Esquerra in Mexicali is an excellent option and they can get you in fast. You will appreciate the included four nights in the hospital.
"As a scientist, doctor, I know how much importance you must place on peer reviewed research. As you know, there are numerous studies showing the effectiveness and safety of the traditional, 2 anastomoses duodenal switch with limb lengths based on the Hess Method or on a standard 100 cm common channel going back 15-10 years, but I can find no peer reviewed studies showing the effectiveness, much less the long term effectiveness of a DS with a 300 cm common channel. Indeed, most insurance companies define a duodenal switch as a 2 anastomoses procedure with a common channel of 100 cm. I do not want to end up with a procedure with poor initial results and then end up a couple years out having to be on a strict diet the rest of my life desperately trying to fight regain. I understand your concerns about malabsorption, but fat malabsorption is the precise reason why the traditional duodenal switch with a short common channel works. I have the intelligence to monitor semi-annual labs and adjust my vitamins and nutritional intake to counteract any imbalances. I respectfully request that I be given the industry-standard procedure with a common channel based on the Hess Method according to my bowel length or a standard 100 cm common channel."
But what do you do if he refuses? How much money have you paid him? (Again, his price is far too cheap for the US. That is suspicious. Is he doing this and sending you home the same day???) Dr. Esquerra in Mexicali is an excellent option and they can get you in fast. You will appreciate the included four nights in the hospital.
Larra
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I love what @Clematis suggested, but would modify just slightly because people with the excessively long cc may do well initially, given that this is combined with a sleeve. It's what happens after a year or so that becomes problematic. Problem is, most surgeons don't follow their patients long term, because if they did, eventually they wouldn't have time for new patients. And many figure that once they walk out of the OR, they have done their part and the rest is on you. And if you think I'm exaggerating, I actually heard a bariatric surgeon say this (one of the Dr. Davis's, or Davies, from TX, on Tv) as he wrapped up after doing a sleeve.
No wonder his staff is telling you low calorie, low fat, low carb, etc. All you would have is a sleeve with a little malabsorption. The whole reason the DS works so well long term is from the serious malabsorption of fat and calories. Is there a risk of nutritional deficiency? Absolutely! But as long as you take this seriously, eat plenty of protein, follow your labs (don't trust anyone else to do this for you!) and take all your vitamins and minerals as indicated by your labs, you should be fine.
I'm so sorry you're going through this at this late date, but better now than post-op.
No wonder his staff is telling you low calorie, low fat, low carb, etc. All you would have is a sleeve with a little malabsorption. The whole reason the DS works so well long term is from the serious malabsorption of fat and calories. Is there a risk of nutritional deficiency? Absolutely! But as long as you take this seriously, eat plenty of protein, follow your labs (don't trust anyone else to do this for you!) and take all your vitamins and minerals as indicated by your labs, you should be fine.
I'm so sorry you're going through this at this late date, but better now than post-op.
OK ladies, i read up on all the information I could find on the common channel and I decided to tell Dr. Enochs to change it from 300cm to the 100cm and to use the Hemms method. Dr. Enochs reasoning to make it longer is because people are having such a problem with not getting enough vitamins and hair loss, (which I don't want to happen) but I don't want to fight weight gain either!! This is a once in a life time surgery for me and I really want it done right!! Plus I agree that if he does the 300cm its just a fancy VS and that isn't what I want. Thank you for your input because it has helped me so much!! Also, the surgery is being do at Rex Surgical Center in Cary, NC and they keep you for 24 hrs. after surgery, then you go back to the main center to rest and they do the X-rays to make sure there is no leeks. It's normally $32,000, but I am doing a self pay, and going there so that is why its cheaper.
Thanks everyone!
Thanks everyone!
Clematis
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Hair loss??? Hair loss is from WEIGHT LOSS, regardless of how it is lost and/or from the trauma of surgery. I have always lost gobs of hair when I lost weight and the DS is no exception, but it does grow back.
To clarify: It is not the Hess method AND 100cm. It's one or the other. The Hess method is based on bowel length but can be tricky as bowels are stretchy. One doc may measure taut, another loose. Many docs do a cookie cutter length common channel of 100cm. This works as well as one-size-fits-all in anything. Those of moderate height (bowel length is sometimes but not always based on height) do well, but 100cm can cause reduced weight loss in the short and dangerous malnutrition in the tall (esp men).
I have a friend who has 125cm not based on Hess, just because thats what the doc wanted to give her, and she is rail thin. I was disappointed to get 100cm because according to Hess method I should have received a 75cm. (He decided to make it longer because of my age.) So don't get too hung up on the number as long as it is reasonable. And 300 isn't reasonable!!
To clarify: It is not the Hess method AND 100cm. It's one or the other. The Hess method is based on bowel length but can be tricky as bowels are stretchy. One doc may measure taut, another loose. Many docs do a cookie cutter length common channel of 100cm. This works as well as one-size-fits-all in anything. Those of moderate height (bowel length is sometimes but not always based on height) do well, but 100cm can cause reduced weight loss in the short and dangerous malnutrition in the tall (esp men).
I have a friend who has 125cm not based on Hess, just because thats what the doc wanted to give her, and she is rail thin. I was disappointed to get 100cm because according to Hess method I should have received a 75cm. (He decided to make it longer because of my age.) So don't get too hung up on the number as long as it is reasonable. And 300 isn't reasonable!!
Clematis
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Esquerra $11k plus air fare to San Diego where they pick you up. Included is transportation to and from San Diego airport, one night in hotel and four nights in hospital. Even if you lose, say, $1k deposit with current surgeon, you'd come out ahead!! (PS I recommend first class airfare back home as you'll appreciate the more comfortable seat post-op.)
galaxygrrl
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So, on the hair loss thing, some people lose hair and some people don't. I have never lost hair when I lose weight and I did not with the DS either. I did take Biotin because my Dr said it works and I read on FB it works. Other people have said it does not. I have no idea but for $10 for 2 months, I was like what the heck. And I did not lose my hair. It did thin a little though but the only who noticed was me and it was not bad and now it's growing back. Really no one noticed but me becasue it was not a lot of hair. I just noticed more hair in my hairbrush for a couple months.
Even if you do loose hair, it will grow back.
It's better to loose a little hair then have a common channel that is too long.
Even if you do loose hair, it will grow back.
It's better to loose a little hair then have a common channel that is too long.
Larra
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Hair loss - I did lose some hair with the DS, but it came back. As others have said, it's from weight loss, not from how the weight is lost. I guess with the 300 cm cc, you don't lose as much weight, so less problems with hair loss - but more problems with your weight. I don't know about you, but I had struggled with my weight for so many years, that the risk of losing too much weight, or having to deal with some vitamin deficiency or other, was nothing compared with the risk of having an operation that wouldn't give me adequate weight loss, or would lead to weight regain after a couple years.
Have a Plan B ready just in case your surgeon refuses to reconsider on the cc length. I don't know him at all, so I have no idea how he'll react. For the record, I'm one of the people with a cookie cutter DS (my surgeon later adopted the Hess method) and I did just fine with it. It may not be perfect for everyone, but for sure it's better than such an excessively long cc.
And if he does agree to the shorter cc, put it on your consent form - DS with either Hess method or 100 cm common channel, whichever he agrees to. So he can't tell you later that well, he found some reason that he just couldn't do what he agreed to do. Put in in writing. Make sure he knows it's there. You can't be too careful.
Have a Plan B ready just in case your surgeon refuses to reconsider on the cc length. I don't know him at all, so I have no idea how he'll react. For the record, I'm one of the people with a cookie cutter DS (my surgeon later adopted the Hess method) and I did just fine with it. It may not be perfect for everyone, but for sure it's better than such an excessively long cc.
And if he does agree to the shorter cc, put it on your consent form - DS with either Hess method or 100 cm common channel, whichever he agrees to. So he can't tell you later that well, he found some reason that he just couldn't do what he agreed to do. Put in in writing. Make sure he knows it's there. You can't be too careful.
