I have reached a decision

[southernlady]

Okay so it is finalized. Office visit Monday the 17th and surgery on Tuesday the 18th.

Sept?
And do you want it on the calendar?

 

[DSRIGGS]

Sept?
And do you want it on the calendar?

August...we don't flup around!

It is that or go on TPN. I am tired of feeling like garbage and want this over with now, so getting it done quickly.

 

[southernlady]

August...we don't flup around!

It is that or go on TPN. I am tired of feeling like garbage and want this over with now, so getting it done quickly.

OH WOW, you don't.
Now, the calendar??? And do you need someone as an angel?

 

[duh_Mom]

Scott, my thoughts are with you. Glad you are getting it done, we are slowly watching you starve!

 

[DSRIGGS]

Thanks Mom.

Dr k told me something today that I hadn't thought of and now I feel really dumb. I sent him a PDF of cmp and cbc from Friday draw. My Bun/CR ratio was high and he said in the absence of kidney failure that is a sign of dehydration. I told him that drink 60 oz min of water daily plus a few cups of coffee. He told me it doesn't matter how much I drink that it is a matter of surface area in intestine and if there isn't enough to absorb protein you aren't absorbing liquids either. My dumb ass thought we absorbed water in the stomach.. Lol at me

 

[DBmom23]

It's a good reminder to all of us that we need extra fluids because of the reduced surface area to re absorb.

Glad you are getting the surgery you need so quickly. You will have a boatload of good karma and well wishes sent your way over the Internet!

 

[Charris]

I was told he only does revisions open. Idk

 

[DSRIGGS]

I was told he only does revisions open. Idk

My revision isn't a typical/true revision as he is simply going to extend the alimentary limb and possibly extend the common channel as well. This will be a few snips, some measuring and new connections. He will also repair an umbilical hernia that I believe have it really is a hernia and fix any adhesion he might find(don't believe I have any) . He told me he doesn't anticipate a long procedure.

 

[robs477]

Awesome Scott! I know it sucks, but so dang happy you will be in great hands, and I pretty much agree that it looks like this is what you need to do bud.

 

[robs477]

Thanks Rob....see my reply to your questions and comments in bold above.

Thxs for the detailed reply scott! Great info! I wrote some other comments to @Will2014 and you on your other thread regarding what I believe to be more factors on absorption etc and won't duplicate it again here, just referencing that post for ya to see.

 

[Pacifica]

Glad your decision is made and that you are getting the procedure underway so quickly. Best wishes on this - I really hope it resolves your issues!

 

[Munchkin]

Best of luck! I'm sure Dr. K will fix you up.

 

[DSRIGGS]

Best of luck! I'm sure Dr. K will fix you up.

Thanks Munchkin, I have no doubt he will.

That is if he doesn't shoot me before surgery. I ask a lot of questions.

 

[Will2014]

My revision isn't a typical/true revision as he is simply going to extend the alimentary limb and possibly extend the common channel as well. This will be a few snips, some measuring and new connections. He will also repair an umbilical hernia that I believe have it really is a hernia and fix any adhesion he might find(don't believe I have any) . He told me he doesn't anticipate a long procedure.

Scott I was wondering what they've told you to expect as a result of this new surgery. Have they given any indication how much absorption will increase, and exactly what nutrients will be enhanced? Also, when will they tell you EXACTLY what they're planning to do for/to you? It just seems strange to me that it's all a go, but yet it's unclear exactly where you are going to! I'm also interested to know if they gave you any details about options, such as "We can increase your alimentary limb to X, and your common channel to X and this should result in a 20% increase in absorption. OR, we could leave your alimentary limb the same, and increase your CC from 100cm to 165 cm, and this will result in ______." I just know there are literally dozens of possible combinations of approaches you could take, each offering positives and negatives. I sure hope YOU/they explore ALL options before deciding on which would be best for you. I'm pulling for a successful outcome for you....one last surgery and be done with it! You've been through enough and it's time to relax and enjoy the rest of your time on this planet. The whole "measure twice and cut once" doesn't even begin to tell the tale here. It's measure the living hell out of this, and ONLY then after all factors have been considered and weighed carefully, then cut. I've been trying like hell to stop losing, but dropped another lb to 178 now. I watch your situation with baited breath...

 

[DSRIGGS]

Will

The starting point for my lengths will be a result of determining the total length of my small bowel. Without having that baseline it is like shooting in the dark and the primary reason I am going to Dr K is because he measures and bases lengths off of the total SB length. I posted his study in either this thread or another one showing protein nutrition (albumin and tot protein) results of 370 patients with the 10%/40% limb to small bowel ratios. That study clearly shows that the Hess method works for protein absorption.

All that being said, Dr K suspects my AL is too short but without knowing the total length of my small bowel he says that doing anything could over correct or under correct. I will ask questions similar to yours when I get to sit down with Dr K next Monday in my pre op consult. He won't be able to tell me that adding X cm's to the AL will = X% increased absorption (unfortunately medicine is just not precise in this case) but he will give me his educated opinion from doing over 2,000 DS procedures and 500 of those being RnY to DS revisions as to what he believe the best adjustments will be based on the small bowel measurement.

I am expecting my SB to be in the 800-900 CM range (could be wrong but that is my gut based on studies I have seen) so the science would say to do the following based on this range of Total SB length:


Two Key Points:

1. Dr K will apply his best judgement and may or may not increase my CC length. The key is that happy medium between not enough protein and overall absorption, and too much overall absorption. That is where the "art" part of this scientific craft comes in. Dr K stated several time to me when I was out for Cameron's surgery and discussed my case, "that is what the science tells us to do". Dr Marshall said to me on my last visit where I was told to come back in a month and we would talk (SMH), well if we extend your CC (he doesn't believe in Hess method and gave me that "you're freaking nuts" look when I mentioned extending the AL) we aren't engineers so we can't say take 100 CM * X to get Y so we just don't know what Y will be....to which I said to myself bull fooking shit you just made my decision and I will be going to Dr K because he absolutely knows there is science that tells us exactly what to do in my case.
2. If you look at my current food absorption path I only have 250 CM of possible absorption, so even though a great portion of absorption (esepecially protein) happens in the CC we still absorb carbs AND protein in the AL. As the GI who put me on CREON explained, if the body isn't absorbing enough carbs it also doesn't allow for enough protein absorption. I know this sounds odd, but the root of my problem is likely that I am not absorbing enough carbs so it is preventing proper protein absorption as well. Increase carb absorption and protein should follow. That to me is why the Hess method arrived at those percentages.

I will ask Dr K numerous questions and believe me, I will share my results as the journey continues after my revision.

Question for you. I know you are very worried about your weight but:

1. What are your lab values for H & H, Albumin & Total Protein (those are the key indicators of malnutrition and anemia which you will become in malnourished)? I am currently anemic an before CREON my Alb & TP were half minimum range..currently I am a little anemic (11 on hg on min 13'sh scale) Alb dropped from mid range to almost min & the TP dropped to exactly minimum....trending the wrong way.
2. How do you feel? I feel weak and fatigued all the time and my guts and butt are mess bathroom wise.
3. What dosage of CREON are you on? I take two 36K capsules with a meal and 1 with snacks so I am in the 320K'sh daily range.

Again, I will share my results as I know you view me as a bit of a proxy for your future protein absorption. I also want to educate the board about people in my situation and the possible impacts - I never even thought of the AL and was under the impression that the Common Channel was all that really mattered for absorption....I found out I was dead wrong in that regard. I will see how this goes, but if it goes as I suspect I want to push as much as I can and be a case study for getting DS surgeons around the world to follow the Hess Method or some close variation and outlaw the cookie cutter, one size fits all DS.