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It's becoming real...

Discussion in 'Say hello!' started by CaitlynR, Aug 27, 2017.

  1.  
    CaitlynR

    CaitlynR Aspiring Wizard

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    I've been here a few months and posted a few times, but now that I have an actual surgery date I feel it's time to more directly introduce myself.

    So...hello, happy and scared to be here. I write in essays so this'll probably be long.

    I am scheduled for September 25th with Dr. Guerron from Duke in Durham, NC. I live about an hour and 40 minutes away, and didn't like the local bariatric surgeons (who were really pushing the RnY). I am getting the DS (two anastomoses) and will need to discuss CC length with my surgeon in the next pre-op visit as others have said he may do non traditional (200-300) length. After much deliberation I will ask to go no longer than 150 as there is at least one study conducted comparing 100 to 200 showing roughly equal weight loss but more significant regain with the 200 CC length. I know that CC length is not the full picture, and I would much prefer to individualize it based on the Hess method, but it's not like I can insist on that.

    I originally was going for the sleeve, but after learning about the DS and delving into the outcomes data I feel the DS is the way to go. Adding to my anxieties is that I had an older brother who died a couple of years after getting the RnY. The death was not directly attributable to the surgery but he had too much malnutrition so had a surgery to reverse as much as they can, and something happened in that second surgery which led him to become very medically fragile, never walk again and have organ damage so that he died a while later. My parents are terrified of me getting bariatric surgery, I didn't tell them anything until recently but they made it clear they don't want me to have it but want to be kept in the loop. They don't want to lose their only other child. I don't think my brother's experience means I am going to have bad outcomes but it does make surgery scarier and it worries my parents.

    Prior to getting the date I kind of felt that something would get in the way but it looks like it is going to happen. I know it's not the best plan but I've been eating some of my favorite foods while I can. I like sweets, bakery type things and fruits, which of course are what to avoid the most, so there will be some adjustment.

    I am 5'6' 275lbs with a BMI of about 44. I am 36 years old, married, with a 8 yr old son. I have high blood pressure, on 3 bp meds. My blood sugar is not great and in the pre-diabetes range. I am doing this for my health. I have been obese all my adult life so really am not sure how it would feel like otherwise. In a way the weight loss itself is going to feel uncomfortable as I've always avoided focusing too much on the scale and as I am uncomfortable with people commenting on noticing when I lose weight, but will have to deal with that.

    I am a clinical psychologist, mostly doing indv psychotherapy part of an organization, and am very passionate about my work. I love what I do but the organizational/administrative stuff has been really getting to me. I have been burning out a bit so in a way looking forward to surgery in order to have a good amount of time away from work (taking 4 weeks and possibly half time for two more weeks if I need it).

    So...thanks for being here. I don't have a local support group so I am very happy to find this group online.
     
  2.  
    KathrynK

    KathrynK Well-Known Member

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    Welcome, Caitlyn! I am impressed with how you are approaching this. It has been said that DS should be reserved for those with a high IQ, since they need to be smart about all aspects of DS life and to be able to research and understand the surgery, nutrition, and vitamin and protein maintenance after DS. Please keep posting your updates! Most of us don't have local groups, so this is a resource for DS specific information even for those who have been living with DS for more than a decade. Glad you are here!
     
  3.  
    Rainerific

    Rainerific New Member

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    I wanted to chime in and say that I think that you are awfully brave to go forward with bariatric surgery. Many of the things that you wrote are also true of me. My brother also had RnY, he didn't pass away but came close. He spent 6 months in the hospital and had many close calls. It wasn't because of his surgery, but rather because of the hernia that was repaired at the same time. He's nearly two years out and is still considered disabled. I'm also going to Duke, but decided to have Dr. Sudan do my surgery. Not DS related, but I also have an 8-year-old son.

    Have you joined any of the DS facebook groups? They are also a great source of information!
     
    CaitlynR likes this.
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    Larra

    Larra Well-Known Member

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    Hi and welcome!
    I'm so sorry about your brother. We hear so much about the potential nutritional deficiencies of the DS, but in reality people with any bariatric surgery can run into nutritional problems.
    Go for the shortest cc you can get your surgeon to make (within reason, of course! You wouldn't want less than 75 cm, and 100 cm is a very reasonable length for most people). As you have already figured out, you can still lose with a longer cc but will have to work harder to avoid regain. Stick to your guns, remember, you are the one who will live with the results, not the surgeon.
     
    CaitlynR likes this.
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    hilary1617

    hilary1617 First time at the rodeo.

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    Hi and welcome @CaitlynR! Surgery is a difficult decision for most, but wow - it must have been especially tough in your case. Health is the absolutely right reason to pursue surgery and you have a clear understanding the risks and benefits of remaining morbidly obese versus the risks of surgery. I'm sorry to hear of the loss of your brother and wish you a happy, healthy future ahead. All the best!
     
    CaitlynR likes this.
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    southernlady

    southernlady Administrator Staff Member

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    Good for you for being so well informed. And good luck.
     
    CaitlynR likes this.
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    galaxygrrl

    galaxygrrl Well-Known Member

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    Good luck! Health is the right reason to get WLS.
     
    CaitlynR likes this.
  8.  
    CaitlynR

    CaitlynR Aspiring Wizard

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    Thanks, everyone! It is reassuring to hear that experienced folks feel I am on a good path from how I am thinking about things. And also thank you for the condolences about my brother. I think once I am past the 3 or 6 month mark or so and am hopefully absorbing enough nutrition to be healthy some of my worry (and my parents') will get better.

    Rainerific, is there any FB group you recommend? I did join a couple but am not of FB too often lately. I know one of the groups wasn't my thing mostly because there were so many posts about members having (not particularly DS related) health problems which was hard to read.
     
    hilary1617 likes this.
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    harrietvane

    harrietvane Well-Known Member

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    I'm a snob, but I prefer this board to almost all FB groups or other WLS communities I've found over the years. The average IQ is waaaay higher here.
     
  10.  
    Rainerific

    Rainerific New Member

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    @CaitlynR, Duodenal Switch Patients is the primary one. Be forewarned they aren't the kindest group of people out there. They don't like people asking questions and seem to enjoy being rude, but there is a ton of information if you search the group.

    @harrietvane, I like this forum better as well. Everyone does seem more intelligent. Kinder too. That said, I triple check my posts before publishing simply because everyone seems so smart. It is kinda intimidating.
     
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    Caitlunn

    Caitlunn Member

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    My thoughts exactly. It is a good resource, don't get me wrong. But seeing grown adults bicker about "post nannying" and other BS like that is something else. Sometimes, it gives me a good laugh. I find the people here to be much more supportive.
     
  12.  
    CaitlynR

    CaitlynR Aspiring Wizard

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    Update:
    I had me pre-op visits earlier this week. The nutritionist, as predicted, wasn't helpful. Smile and nod. On that note, does anyone know if a week of low calorie low fat low carb to shrink liver is actually necessary?

    I'm frustrated that Duke is going opioid-free. There are several pain meds they give you but all are non opioids. I get the impression only if you loudly complain for hours will they give you even a small amount and they said it would be oral. This is during your inpatient time. I've only had opioids twice in my life, once after I broke a leg and once after gall bladder surgery. My interest in opioids is only out of concern of the effectiveness of non opioid medications in the 24 hours post surgery. I know fear of ineffective pain relief if increasing my anxiety.

    The surgeon pre-op appointment was interesting. First I met with a PA and apparently I wasn't even going to meet with the surgeon unless I specifically requested to do so, which for sure I did. This is Guerron in Durham NC. I wanted to know if he used the Hess method of measuring bowel lengths (even though I knew from here he does not) and discuss CC lengths. He shared they do a 200-300 cc length. I hope I didn't come across too strong or like I thought I new better than him. I shared most of the studies I could find compared much shorter lengths (50 vs 75 vs 100, for example) and that 200-300 does not seem congruent with standard practice.

    (Will continue in second post as in the past I lost a long post for taking too long I think)
     
  13.  
    CaitlynR

    CaitlynR Aspiring Wizard

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    He explained he and his team feel
    that the longer CC shows the same benefit with less incidence of excessive bowel movements (6+) per day and bowel accidents. I shared if he is concerned I would not follow the vitamin regimen, that if anything I am obsessive about informing myself and living evidence based so I will keep on top of that. He said no he is not seeing malnutrition just bowel accidents and frequency. I asked if that resolves over time and he said yes after around 6 months.

    I shared the only study I could find that compared longer Cc lengths compared 100 and 200 and showed more regain with the 200. I acknowledged he may have access to additional sources. He said he is only concerned about metabolic improvements and not specifically about weight loss (which is, honestly, a fair point). However, I say, if I am going to have this life changing thing I want to go all in, with a surgery that has several years of data.

    (Continued once more)
     
  14.  
    CaitlynR

    CaitlynR Aspiring Wizard

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    He shares they decided on the 200-300 from surgeries which are modifications of the DS, which he confirmed were the SIPS and SADI when I asked. I shared concern that these are considered experimental and even more so to take one aspect (long CC lengh) and apply it to the DS. I said there doesn't appear to be good data on outcomes of this longer CC with an otherwise traditional DS. I shared I chose this surgery based on the evidence so was uncomfortable with basically an experimental protocol. He shared his team is collecting data (err...without telling people it is an experimental change unless they specifically ask??) but it was still early yet and he couldn't give me what they have so far.

    So...in the end he says he does at times perform a traditional 100 CC DS and as he knows my wishes and to remind day of surgery that is what he will do. I was a nervous wreck that I came across as some know it all. Though he did say all patients should be like this and have these kind of debates as I understand the variables and risks and benefits of the tool.
     
  15.  
    LynneV

    LynneV Member

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    I have a CC of 100 and I have 1 BM a day and always have since surgery.
     
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