I think I have come to the realization that I need a revision

Creon is just one option...there is another one can't put my finger on it but I do remember it starts with a V.

List of all options here: http://www.nlm.nih.gov/medlineplus/druginfo/meds/a604035.html

The problem may be that Creon and the others in that class of drugs are an extended release medication and while we all react differently to extended release, it may not have enough time to get released in your shortened intestines and allow full absorption.

Also maybe check for pancreatitis, if that hasn't already been done.
 
The other form is called Viokase. It contains exactly the same digestive enzymes as Creon, though I don't know if they are in the same proportions (probably very similar, if not identical). Both are extended release.
While you can open up the Creon capsule and put it in applesauce or the like, it should not be kept in the mouth as it will cause irritation. This is a nice way of saying that since these are digestive enzymes, they will start digesting the lining of your mouth. Likewise, you want to avoid contact with the skin as well, and not inhale any of the contents. It also should be taken immediately if you do this and not kept for future use.
It would seem to me that dissolving the capsule isn't the reason for using the applesauce method, but rather, as @Will2014 alluded to, some people, esp children or elderly, have trouble swallowing capsules (or refuse, and have to have meds hidden in food). But even with our anatomy, the capsule still has to traverse the entire alimentary limb before it gets to the common channel, which would seem to be enough time to dissolve the capsule. Am I right? Or might it be different for different individuals? I don't think anyone knows the answer to that one. These drugs were designed for people with pancreatic insufficiency, either due to disease (such as cystic fibrosis) or surgery (removal of part or all of the pancreas) and not for people like us. But there is no form designed specifically for people like us, so we have to use what is available.
 
Rob, based on your recommendation, I have purchased the item in question from Amazon. My damn bathrooms are both sooo small that I think it would be a pain to try to permanent install an electric bidet seat. I anxiously await it's arrival! Now, I took the liberty of speaking to Diana regarding this, and she has assured me (grins) that your promotion of this product in this thread constitutes a verbal agreement on your part to fully warranty said item against any and all defects or "unlikeable qualities". Basically, my understanding is that you will need to pay me back for all monetary expenses incurred by me be they real, implied, or delusionally conceived. Furthermore, a standard penalty fee of up to 10x's the purchase price may be indicated for any pain and suffering I may have resulting from said use of this product. Now, while I realize as a layman I may have SLIGHTLY misinterpreted her legal advice, especially since I was all hopped up on cold medicine and porterhouse steaks at the time of our talk, I think it might be best and save time if you would kindly send me a check for $1000.00. I will also accept payment in the form of porterhouse steaks...of course! Thank you for your prompt remittance. - Will

:mess:

Hi Will, well if Diana said it, then it must be true!!! You will love this thing! Hopefully not too much though….lol You can put it wherever you like ;)! If I was of the “Female persuasion” the advertisements for this thing also talk about how you can use it on all those "other" personal parts too, just in case you may be interested:D Ok, never mind…sorry, but my brain is degradating very quickly these days. I think it’s the "not enough fat thingy" for the brain :D.
 
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I just got back from an oncology check-up down in steamy hot New Orleans yesterday. My doctor wanted to put me back on Creon, but because I found it to cause gastrointestinal distress, he is putting me on Zenpep instead. Not sure if it will be any different but it's another option...
 
I'm going to chime in here (or chyme in??):

Larra said: "But even with our anatomy, the capsule still has to traverse the entire alimentary limb before it gets to the common channel, which would seem to be enough time to dissolve the capsule. Am I right? Or might it be different for different individuals? I don't think anyone knows the answer to that one."

I think the answer is somewhere in the middle - I don't know how long it takes for the capsule to dissolve, nor whether it is designed to dissolve right away once it gets wet like a gelatin capsule, or if it is extended release and NOT intended to dissolve in the stomach.

Normal anatomy is on average something 700 cm of small intestine. Most DSers have only the ileum (and teeny smidge of duodenum up top) - about 250 cm - in the alimentary tract, of which about 100 cm is common channel.

I'm going to make up some numbers from whole cloth here - if someone has better numbers based on facts, I invite you to speak up!
  • Assume it normally takes about 12 hours for food to traverse the 700 cm of small intestine
  • Assume it normally takes about 200 cm/4 hours to dissolve the capsule (if it is a timed release) (I HAVE NO IDEA - THIS IS A GUESS!)
  • In that case, the capsule might not be dissolving in a DSer's gut until it's already halfway through the common channel!
  • In any case, if the capsule takes ANY significant amount of time to dissolve, you are missing a significant window of opportunity to get the benefits of the Creon/Viokase.
  • With the very short pancreatic enzyme-free and bile free alimentary tract (150 cm), the opportunity to more completely digest proteins and carbs is extremely limited - I'd want to maximize absorption as MUCH as possible by getting the amylases and proteases in contact with food as soon as possible.
    • By the way, without bile, I don't see that the lipase in the Creon can do jackshit - the fat globules are not accessible to water-soluble lipase until it forms micelles with bile - so DSers who take Creon/Viokase are still only getting fat absorption in the common channel:
      "Bile acts partly as a surfactant which lowers the surface tension between either two liquids or a solid and a liquid and helps to emulsify the fats in the chyme. Food fat is dispersed by the action of bile into smaller units called micelles. The breaking down into micelles creates a much larger surface area for the pancreatic enzyme, lipase to work on. Lipase digests the triglycerides which are broken down into two fatty acids and a monoglyceride. These are then absorbed by villi on the intestinal wall. If fats are not absorbed in this way in the small intestine problems can arise later in the large intestine which is not equipped to absorb fats. Bile also helps in the absorption of vitamin K from the diet."
  • But maybe someone can put a capsule of Creon into a glass of water mixed with some chewed food and see how fast it dissolves.
  • In any case, the purpose of Creon in a DSer is to get digestion of protein and carbs in the alimentary tract - once the food gets to the common channel, there is a more or less normal amount of enzyme and bile
    • Note that this is an assumption - it is possible that the bile mixing with the enzymes in the absence of food and then traveling down the entire 400+ cm of biliopancreatic limb without any food to buffer the denaturing effects of the bile on the digestive enzymes means that DSers have only damaged pancreatic enzymes by the time they hit the common channel.
Does this help?
 
This is a GREAT thread! Lots of good info, good science, suggestions and advice. I learn stuff from you guys every time I come on here.

My 2Cents……I agree with Diana. I think a controlled science experiment is in order. I work in a Lab every day and run tests and experiments 24/7, so, again, here is how I would run this controlled experiment to see just how quickly the capsule dissolves.

1) Spit all the saliva you can in a glass cup for about an hour.

2) Very finely chew up a mouthful of meat (and some fat) and throw in a few carbs such as 1-2 tortilla chips etc. in the mix and make sure it is all blended together with the contents of the “saliva cup” from step # 1. Try to keep the ratio 80% protein/meat/fat and 20% any Carb. I think you need the little bit of carb to provide a sugar, a fermentable to assist in the reaction and better simulate the digestive tract.

3) After its thoroughly mixed together, put a lid on it (can be aluminum foil), and then put it outside for around an hour or so. This time of the year, the outside temperature should be close to 94-98 deg or so, thus simulating your body temp.

4) After this repulsive mix gets to the outside stabilized temperature, put the capsule in the middle of said viscerous gruel, put the lid back on, leave outside and check for the dissolving breakdown of the capsule every ½ hour or so with a wooden popsicle stick, spoon, straw or something similar. (NOTE: do this very gently thus not accelerating the degradation with your own mechanical pressure).

5) When you are assured and confident that the breakdown has occurred, take a spoon and “scoop out” and remove the broken down capsule and its contents and discard.

6) Feed the remaining leftover and yummy "viscerous gruel mix" to your dog or cat as a tasty treat :D.
 
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I just got back from an oncology check-up down in steamy hot New Orleans yesterday. My doctor wanted to put me back on Creon, but because I found it to cause gastrointestinal distress, he is putting me on Zenpep instead. Not sure if it will be any different but it's another option...
@hilary1617

I am sorry you have to go back on Creon and hope that all is well. My best wishes for you.

Dr Marshall gave me zenpep samples. Same stuff as CREON according to the label... The only difference was that the zenpep he gave me was 25,000 IU and CREON was 36000. His thought was that maybe a different manufacturer would make a difference. Honestly I didn't try because I am done with CREON if at all possible so I am seeking a revision.
 
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I can tell you this.. When I got on the proper dose of CREON my albumin and total protein levels nearly doubled so obviously the lipase dissolved.

Now why it has stopped working I have no idea, but I gurantee you it isn't anything as silly as not eating fast enough.
 
Scott, I bought and installed a really cool handheld bidet and it rocks. It can be fairly high pressure depending how far you depress the pressure sensitive trigger and it is temperature controlled warm water. I can knock those “Kling-ons” of quicker than the starship enterprise! It cleans really well and you can leave it there for as long as you want and get the job done thoroughly. I hate not having one at work etc and have gotten really used using it and to the extra cleanliness it provides, and then a good dry wipe of course.


if you dont mind sharing, I would love to know where you purchased yours and the approx price...im not a DSer, but I love the idea of a Bidet in my bathroom....lovely.
 
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Some very thoughtful and scientifically based reponses here. We're all just guessing about so much, because the information simply doesn't exist ANYWHERE that I know of. Robs great scientific experiment is almost air tight, except that it doesn't include 2 things which should speed up the dissolving of the Creon capsule: hydrochloric acid from the stomach and the effect of stomach churn to assist in the breakdown process. I can only assume the capsule degradation would be faster than in the study experiment because of these 2 factors. Diana as, always, provides an excellent analysis and yes it's VERY helpful, for someone with an ear to hear. The REAL problem as I see it is timing the food and Creon intake so that they are present in the stomach together where mixing can take place. If one were to take Creon and eat immediately afterwards, allowing the food AND Creon to be in the stomach at the same time, stomach churn (such as it is with our greatly reduced stomachs) can mix the 2 together and allow for efficient breakdown and absorption. If the Creon follows or lags the food intake at all, so that the 2 are allowed to be separate, I don't see how the enzymes can work. There is no systemic effect from the medication, the only action occurs when the enzyme is present with it's opposing substrate (Lactase vs. lactose for instance). I've been taking my Creon in an attempt to stop losing and maybe even gain a few. I thought it was working, and hold out hope it still may, but I lost my recent gains and am back into the 170's at 179. I'm emaciated, and I'm hoping to find answers to this riddle for Scott's sake and my own as well. Trial and error, thinking outside the box, and being open to ideas originating from someone other than ourselves is the key I think. I don't know how to do it, but I'd be willing to provide pics of my death camp physique on an individual basis to you seasoned vets and leaders here on this site. I don't feel comfortable posting them for all, but think for the sake of science and to help others here, it's important for the leadership team to see what I'm talking about. Rob-this includes you and the other guys here as I'm growing to suspect it's more a guy thing as far as being unable to turn the weight loss switch off. Scott is in a similiar place I assume, which is why even when he gets snippy towards me I've tried to offer ideas to help. He's in trouble, and is under enormous pressure I realize because of his sons and his own medical issues. Maybe his answer will be a revision of some form, I dunno. But I know I'm hoping that I don't have to go under the knife again. I'm eating well....but it just seems to pass right through me. Frustrating! But I have no doubt it will all work out one way or another. I'll keep you posted, and if anyone wants me to send a private pic or 2 shirtless, let me know. The battle goes on and, as always, I like my chances!
 
Some very thoughtful and scientifically based reponses here. We're all just guessing about so much, because the information simply doesn't exist ANYWHERE that I know of. Robs great scientific experiment is almost air tight, except that it doesn't include 2 things which should speed up the dissolving of the Creon capsule: hydrochloric acid from the stomach and the effect of stomach churn to assist in the breakdown process. I can only assume the capsule degradation would be faster than in the study experiment because of these 2 factors. Diana as, always, provides an excellent analysis and yes it's VERY helpful, for someone with an ear to hear. The REAL problem as I see it is timing the food and Creon intake so that they are present in the stomach together where mixing can take place. If one were to take Creon and eat immediately afterwards, allowing the food AND Creon to be in the stomach at the same time, stomach churn (such as it is with our greatly reduced stomachs) can mix the 2 together and allow for efficient breakdown and absorption. If the Creon follows or lags the food intake at all, so that the 2 are allowed to be separate, I don't see how the enzymes can work. There is no systemic effect from the medication, the only action occurs when the enzyme is present with it's opposing substrate (Lactase vs. lactose for instance). I've been taking my Creon in an attempt to stop losing and maybe even gain a few. I thought it was working, and hold out hope it still may, but I lost my recent gains and am back into the 170's at 179. I'm emaciated, and I'm hoping to find answers to this riddle for Scott's sake and my own as well. Trial and error, thinking outside the box, and being open to ideas originating from someone other than ourselves is the key I think. I don't know how to do it, but I'd be willing to provide pics of my death camp physique on an individual basis to you seasoned vets and leaders here on this site. I don't feel comfortable posting them for all, but think for the sake of science and to help others here, it's important for the leadership team to see what I'm talking about. Rob-this includes you and the other guys here as I'm growing to suspect it's more a guy thing as far as being unable to turn the weight loss switch off. Scott is in a similiar place I assume, which is why even when he gets snippy towards me I've tried to offer ideas to help. He's in trouble, and is under enormous pressure I realize because of his sons and his own medical issues. Maybe his answer will be a revision of some form, I dunno. But I know I'm hoping that I don't have to go under the knife again. I'm eating well....but it just seems to pass right through me. Frustrating! But I have no doubt it will all work out one way or another. I'll keep you posted, and if anyone wants me to send a private pic or 2 shirtless, let me know. The battle goes on and, as always, I like my chances!

Hi Will, actually, wouldn’t my experiment scenario be opposite of what you said, i.e. it would present the worst case scenario or slowest dissolvent because of no mechanical churning and also the hydrochloric stomach acids? Which of course is a great point, but could never accurately duplicate.

Regarding the larger scope of this……Will, I’m going to shoot straight here and speak very honestly. I am worried about you guys, BOTH. I never really wanted to broach this subject with you because you was still losing and still hopeful it would plateau or stop. Also, I would be lying my ass off if I said it wasn’t a growing concern regarding myself as well. I have lost 3.8 lbs per week for over 6 months and I currently weigh around 243, around 113 lbs or so lost including 13 pre-op.

At this rate of deflation, I should be joining our new “Guys Only Charter Membership Stick Club” just in time to play “Skeletor” this Halloween :ROFLMAO:.

I know I’m not there yet, but, looking at the members and the trending, I am starting to get a little worried.

I also dis-agree slightly with Scott’s assessment (gonna update your thread on that one also Scott), that this whole “absorbent thingy” is all just pure math and is determined solely based on the CC length and alim limb ratio etc. There are some other VERY significant factors involved in this equation yet to be determined or discovered or found.
IMHO…It is NOT just the length of the CC length and alim limb ratio…that’s just way too simple. I think it depends a LOT on the density and the absorption ability of the “villi and the microvilli” that is inside the small intestines which is there to increase the total amount of the surface area available for the absorption of nutrients etc.

I also believe that this “villi–microvilli” density varies significantly from person to person and also believe it to be more densely abundant in individuals whom may have been on “starvation style” yo-yo dieting for years such as myself. I think our bodies adapted to the SUSTAINED decreased food intake, thus growing more “villi–microvilli” for more surface area absorption, thus my self-imposed diagnosis and title “Super Absorber”. That’s the main reason I asked Scott in the other thread what his pre-op eating styles were like.

I also believe that the “villi–microvilli”, (and the CC length and alim limb ratio of course), are only two components of many, the others being a host of other metabolic and hormone triggers not even identified or known of yet that probably increase blood flow and or initiate some chemical triggers that tells the “villi–microvilli” to either absorb or In your case and in Scott’s (maybe mine to come too), NOT ABSORB.

These triggers have somehow been turned off and or are dormant and that is the main part I don’t understand because it is 180 deg opposite of what having the Super Absorption was???

All I can tell you for sure is that there are some very significant and MAJOR chemical induced triggers in to play here. If you go back over some of my previous posts, you can see where I felt them 3 days after surgery. My metabolism changed INSTANTLY. This is also I believe to be of the same component that cures the diabetes that “they” don’t understand. My cells are communicating for the first time in over 35 yrs, insulin is being absorbed instead of just remaining static in my body, glycogen and glucagon synthesis and conversions were working.

I am saying, SOMETHING is staying turned on that is still telling all these complex systems that you are still in that starvation mode and you/we need to burn/convert from our muscle and fat stores still instead of burning what you eat real time.
Very convoluted and very mid-boggling actually! Its turning my brain in to goo and gristle :confused::confused::confused:.

Just to let you and Scott know, for whatever is worth, I am right here with you guys and pulling for you and wishing you the best. If you want or need to PM me, please feel free to do that also. Unfortunately, there’s not a lot of us guys around here to get a large enough sampling pool to analyze from, but this anomaly, most definitely appears to be a “male component” that is factoring in here.
 
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Rob - on my phone so I just skimmed but will read more closely. I don't disagree that villi can differ by individuals. You mentioned CC length numerous times but not the alimentary limb. Dr k has a study on his site where he compared ...well here, read it
Percentage based bypass of the Small intestine results in exceptionally low protein malnutrition Ara Keshishian MD FACS, Karim Zahriya MD FACS, Teny Haroutunian MD, Dawn Keshishian BSN, CCRN, Michelle Wiggins Background: Critics of The Duodenal Switch operation frequently cite high incidence of Protein malnutrition as complication of the operation. Our experience differs significantly with both anecdotal and published data. Method: Retrospective Chart review Results: Between November 99, and November of 2002, 373 patient underwent the DS operation in DRMC. Our peri-operative mortality rate was zero. Our major complication rate was <10%. The mean age was 42.4 (16-68). The mean pre-op BMI was 50.3 (35.9-80.9). The female to male ratio was 5:1. The mean one-year post op BMI was 30.6 (19.0-55.6). Two years out, the mean BMI was 27.6 (20.4-35.4). The length of the common and the alimentary channels were based on a percentage of the total small bowel length. The mean length of our patients’ small bowel length was 682.1cm (450-925). Most often, for patients between pre operative BMI of 40-55 common channels were approximated to 10% of the total length, and the alimentary limb was approximated to 40% of the total length. The preoperative Albumin and total Protein was 4.3 and 7.2. One year post op they were 3.9 and 6.8. The two-year post op values were 4.0 and 6.9. No patients required hyperalimentation. Seven patients were placed on short term Pancreatic enzyme supplementation to stabilize their weight, albumin, and total protein levels. Conclusion: We have documented that percentage base bypass of the small bowel in the duodenal switch operation will results in a very low incidence of protein malnutrition. This is contrary to previous reports.

373 DS patients where the 10% common channel and 40% AL (that is key with me, not my CC...we absorb much more through the AL than I had originally believe, according to Dr K and he has done over 2,000, yes 2,000 DS procedures) demonstrate a " very low incidence of protein malnutrition".

I get the villi argument but it my assumption that this 10%/40% length was what they standardized to when doing this procedure as it caught the full normal distribution of folks and their specific villi absorption ability...so the low absorbers were still "protected by these lengths" and the high absorbers lost enough weight with these lengths..if that makes any sense.

So when I say it is math, I am saying your villi argument was compensated for in this algorithm. That is my somewhat educated opinion.

Regarding your situation, all I can say is that if you are worried you are losing too much then get a CBC and CMP monthly or every other month and watch your Albumin and Total Protein closely. I would say if those numbers are in range and show a positive (not declining) trend then you are in good shape. I can tell you my numbers lagged my initial weight loss by about 3 weeks. I had full draw 3 weeks ago and then CBC & CMP on Friday....the Tot Protein and albumin are heading the wrong direction again as I suspected. To me this has always been more about the lab values and how I feel (weak as shit) and weight was secondary...sure weight is an indicator but the lab values and how you feel are the true metrics that need to be followed....JMO
 
Regarding your situation, all I can say is that if you are worried you are losing too much then get a CBC and CMP monthly or every other month and watch your Albumin and Total Protein closely. I would say if those numbers are in range and show a positive (not declining) trend then you are in good shape. I can tell you my numbers lagged my initial weight loss by about 3 weeks. I had full draw 3 weeks ago and then CBC & CMP on Friday....the Tot Protein and albumin are heading the wrong direction again as I suspected. To me this has always been more about the lab values and how I feel (weak as shit) and weight was secondary...sure weight is an indicator but the lab values and how you feel are the true metrics that need to be followed....JMO
Right here seems to be the KEY!!! Lab values...cause it means while you may be eating correctly, something isn't working right.
 

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