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IMPORTANT! Need anecdotal evidence that vets know more than surgeons

Discussion in 'Duodenal Switch' started by DianaCox, Jan 31, 2015.

  1.  
    DianaCox

    DianaCox Bad Cop

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    As I have posted elsewhere, I MIGHT be invited to speak at Gagner's First International Consensus Conference on the DS. I am trying to convince him that by and large:
    • The advice that most DSers are getting from most of their surgeons is terribly wrong, and worse than worthless, and is contributing to the difficulties with acceptance of the DS in the US in particular
    • That the veterans on SOME message boards (mostly this one!) give advice that is far superior and surgeons need to take note of this fact
    • That our anecdotal experiences and expertise need to be validated with clinical trials
    I would like to assemble an as extensive as possible compendium of first person stories that are structured along the following outline:
    • A description of the (inappropriate) advice that the patient was given by their surgical practice (I would appreciate knowing the name of the surgeon for other purposes, but it will be redacted in what is disseminated)
    • A description of the medical problems that ensued
    • A description of how your doctors were unable to help
    • A description of the advice you were given by other vets that helped
    Please be as thorough and yet as concise as possible - we want the surgeons to READ this.
     
    Last edited: Feb 1, 2015
    Isha, JackieOnLine and conceit like this.
  2.  
    southernlady

    southernlady Administrator Staff Member

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    May I post this in a few FB groups? Like DSP? I KNOW we have members there who used Boyce/Williams and got lousy diet advice. I didn't personally cause I already knew it was lousy advice.
     
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  3.  
    DianaCox

    DianaCox Bad Cop

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    Please do! But since I don't have access to those boards, please ask them to post their responses here.
     
  4.  
    Munchkin

    Munchkin Full of Fairy Dust

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    Well fer cryin in a bucket... Where do I start? I guess I will make multiple posts on this thread over time. Those of us who have been around for a long time are going to have a lot on this.
     
    marissamast, JackieOnLine and conceit like this.
  5.  
    southernlady

    southernlady Administrator Staff Member

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    The ones that don't, I will copy and post here for you.
     
  6.  
    more2adore

    more2adore Well-Known Member

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    One of the biggest myths propagated by weight loss surgeons' offices out there seems to be the low fat diet being necessary after the DS. OMG, the consequences of that I've read on these boards. I bet you can get stories from vets about hair loss, brittle nails, constipation leading to SERIOUS problems, etc. before adding significant fat back into the diet, AND that regain didn't occur even after adding it back in. I think stories like that will be really useful!
     
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    Razbry

    Razbry Well-Known Member

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    You can use my experience as I've posted
     
  8.  
    DianaCox

    DianaCox Bad Cop

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    @southernlady - can you fix the grammatically awkward incomplete sentence in the second bullet point wherever you posted? Add "give advice that" after the parens. My personal editor Spiky pointed it out to me - thanks SB!
     
  9.  
    southernlady

    southernlady Administrator Staff Member

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    Done
     
  10.  
    Munchkin

    Munchkin Full of Fairy Dust

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    Let's start with this...

    Flintstones. More than few docs have told their patients to take these. They are made to fit the needs of a 60lb child eating and absorbing a normal diet. Does this sound like a DSer to you? No? This is not rocket science and no physician should be telling their patients to take these. Plus they are loaded with sugar and that's what we need to avoid. I'm not convinced these are really good for a 60lb child either but you get the point.


    ADEKS. There is not enough of what we need in there. No way, no how. They are very expensive and not adequate for our needs.


    Soft Gels. These are oily fat based gel caps. Get a brain. What do we malabsorb? Fats. Makes no sense to tell patients to take these unless you insist on 5X the normal dose to make up for our malabsorbtion.


    Bariatric Advantage Products. Great. You managed to create another revenue stream for your practice. Too bad the pills you are pushing are not good for us. If you want to supply us with vites, wonderful. And we will buy them. But put a little thought and brainpower behind what you recommend. Too many of us are sheeple and will blindly trust you and follow your advice. Oh, wait, we are supposed to be able to trust you, so maybe you need to recommend an adequate supplement regimen. Take a look at vitalady as a starting point. She has done most of the work for you.


    The Low Fat Diet. It wasn't me who said "Fat is your friend." It was Dr. Hess. And he was right. You are wrong. Eating a high fat diet is very normal for the average DSer. Because we can! This is due to the fact that we have extensive malabsorbtion and the fats we eat do not affect us. Those of you who specify low fat are doing your DSers a disservice. Eating a diet high in fat allows us to be satisfied and stick to the low carbs we need to lose and maintain. One size never fits all and postop diet recommendations need to be tailored to the patient's surgery.

    RNY and sleeve patients most likely need to be very aware of fats and calories but DSers do not. All we need to remember is the only good carb is the one we don't eat. It's not a disaster for us to eat steak for breakfast. It's protein, not carbs. The disaster for us is eating all those low fat products that add in extra carbs and salt to make the food palatable. Don't believe me, go to the store and read some labels for yourself.


    Pill crushing. Why? You did absolutely nothing to my esophagus to change or limit my ability to swallow. I can swallow anything post-op that I could pre-op.


    Inadequate post-op pain meds. Stop this! The DS is major surgery and it is not acceptable for you to deny patients reasonable pain relief. At least 10 to 20 day's worth for a normal recovery. Your patients will be able to move more and have fewer complications if they are not in pain. Pain is debilitating, slows your recovery, and makes it more difficult to do the things we need to do to recover. 2 or 3 days worth of pain meds is not enough.


    Where did you get your NUT? Did you save boxtops?

    Our usual advice to the pre-ops is smile and nod. Be agreeable and keep your mouth shut.

    There is no excuse for your NUTs not understanding the procedures you do. It is at least partly your responsibility to educate them. NUTs are responsible for a lot of the misinformation out there, including poor diet recommendations. And most know nothing about supplementation requirements. Low fat and high carbs is inculcated into their being from the day they enter school. Working with DSers requires a change in mindset. And acquiring a lot of new knowledge.

    Do you give all patients the same post-op advice? If you do please work with your NUT and come up with something better.

    These people represent you and your practice when they speak to your patients. Do you even know what they tell your patients?


    The Draconian Pre-op Fast. The ASMBS says not necessary. So why is this requirement getting worse instead of improving things for the patients? Seriously, why the restrictions 4, 5, 6 weeks before surgery? I get it that empty bowels and a glycogen deprived liver make surgery easier and better for the surgeon and the patient. Anything more than 1 week max is excessive. And many of the diets you prescribe lead the patient into surgery in a state of nutritional deprivation not conducive to proper healing.


    For you, all of this is just another day at the office. For your patients this is a life changing event. Why not try to give them the best possible experience and outcome? The ASMBS says obesity is a disease. Not a character flaw. Please try really hard to believe this. We have already suffered enough. We don't need to suffer more to be deserving of losing weight. Promise.

    The end of chapter one.
     
  11.  
    newanatomy

    newanatomy Well-Known Member

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  12.  
    brooklyngirl

    brooklyngirl Yankee gone south

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    Me too! The only thing I would disagree with is the pill crushing. Took me a while to be able to take big enough gulps to swallow pills, but I think that's because I've always had trouble choking down large ones and needed to chug fluid to do it. Wasn't enough tummy space at first!
     
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    southernlady

    southernlady Administrator Staff Member

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    Yes, BUT that should be up to the patient, NOT the NUT. I agree not everyone can swallow pills...but most of them know that ahead of the surgery.
     
    Jbandmmomma likes this.
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    brooklyngirl

    brooklyngirl Yankee gone south

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    True, just maybe a "hey, if you gag on a multivitamin, you might wanna get a pill crusher for after surgery" type heads up, but not making it a necessity.
     
    marissamast likes this.
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    JackieOnLine

    JackieOnLine Moderator Staff Member

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