My Surgeon just debunked everything I have learned on here..

[conceit]

No, I had my surgery 11/14. I am 9 weeks out. Down 48 lbs.

That is awesome! yay!

I just saw your info on the side. It says pre-op. So, I thought you were awaiting surgery. Congrats on the weight loss! You're doing very well.

 

[southernlady]

No, I had my surgery 11/14. I am 9 weeks out. Down 48 lbs.

Fixed it for you. It NOW reads post-op.

 

[marissamast]

Fixed it for you. It NOW reads post-op.

Thank you!

 

[newanatomy]

Dr. Simper is a good surgeon including revisions so, lets not burn him at the stake quite yet even though, I might have lit the match at times. He is like most in his beliefs regarding nutrition. He has done several revisions for members on here and they have done well. Just don't expect hand holding of any kind, good post-op advice or a pain pill supply. He does not do the SADI. He has been on the vetted list of surgeons for years.

 

[conceit]

I hadn't checked prior posts stating his name when I posted first. They were posted while I was responding. It seems like even good surgeons can give really atrocious advice. One just has to not let that overshadow everything that's been learnt here.

 

[Honeybeeblue]

Follow the advice you get here. I have ran in to many minor issues listening to my surgeons office. These veterans have lots of info and advice to offer that helps and works.

 

[star0210]

OR - maybe YOU got a SADI and not a proper DS?

I'm betting she did...I believe I saw on OH some of his patients had the SADI.

EDITED to say: ok I just read everybody's responses so maybe I'm getting him confused with a different surgeon.

@marissamast - do you have a copy of your operative report?

 

[marissamast]

I'm betting she did...I believe I saw on OH some of his patients had the SADI.

EDITED to say: ok I just read everybody's responses so maybe I'm getting him confused with a different surgeon.

@marissamast - do you have a copy of your operative report?

He does not do the SADI

 

[Larra]

When we see people get into nutritional trouble post-op, sometimes it's because they got good advice and didn't follow it, but sadly it's also sometimes because they got bad advice from their surgeon or his staff and DID follow it. Don't let this happen to you.
I've been on this board and others devoted to bariatric surgery and esp the DS for over 9 years. When people take ADEK's because they sound right or because their surgeon told them to, they get into trouble. There just isn't enough of the fat soluble vitamins in them to compensate for our malabsorption. And I can't imagine that the prescription versions of the fat soluble vitamins have been somehow reformulated just for us. There aren't enough of us for this to make financial sense for the companies that manufacture these vitamins.
Diet advice - I guess you could follow the RNY diet, but WHY? I think some doctors, including bariatric surgeons, are so dedicated to the concept of low fat that they can't or won't grasp that for someone with the DS, fat isn't a bad thing. Carbs yes. Fat no.

In spite of all this, I would not tell people not to go to this surgeon. He is just one of many DS surgeons that passes out this advice. If we ruled out every surgeon with this advice there would be almost no DS surgeons left. From everything I've heard about him he's technically a good surgeon and a valuable resource for his part of the country. So please don't ignore the GOOD advice you get here on vitamins and protein, and you should be fine.
And really, I wish doctors, and not just bariatric surgeons, wouldn't sell products. That isn't the function of a doctor and IMHO could potentially bias the advice given to patients. The worst offenders are mostly plastic surgeons and dermatologists, with all sorts of "esthetic" products, but apparently some surgeons also get in on the business. Sad.

 

[newanatomy]

I hadn't checked prior posts stating his name when I posted first. They were posted while I was responding. It seems like even good surgeons can give really atrocious advice. One just has to not let that overshadow everything that's been learnt here.

Exactly!

 

[newanatomy]

I'm betting she did...I believe I saw on OH some of his patients had the SADI.

EDITED to say: ok I just read everybody's responses so maybe I'm getting him confused with a different surgeon.

@marissamast - do you have a copy of your operative report?

He does not do the SADI. I do have a copy of my operative report.

 

[star0210]

He does not do the SADI. I do have a copy of my operative report.

I got him confused with someone else who was deciding between Simper and a different surgeon who does do the SADI. Sorry!

 

[TakeIII]

He does not do the SADI. I do have a copy of my operative report.

Hi Newanatomy,

Did you ask his office for the operative report or did you get it from the hospital?

 

[JackieOnLine]

No, I had my surgery 11/14. I am 9 weeks out. Down 48 lbs.

congratulations, what fun!

 

[DianaCox]

I am in an ASMBS group on LinkedIn - these is a LONG-ASSED thread going on regarding the DS, malabsorption/malnutrition, surgery choices, etc. Most of the comments are by non-DS surgeons.

I posted this:

• All these misinformed comments regarding how difficult it is for DSers to maintain optimal macro- and micronutrient levels need to be taken with a very large amount of salt (and calcium and protein). Out here in the long-term post-op real world, and on the various message boards where DSers congregate (if they are smart enough and lucky enough to find us), it is clear that the vast majority of DSers are getting TERRIBLE and INCORRECT diet and nutritional advice from even the best surgeons. A prime example was the publication of the Norwegian comparative study, where there were multiple objections made to the nutritional advice as between the RNY and DS (essentially the SAME diet and nutritional advice was given for both surgeries, which was wholly inadequate for the DSers).
  
  I submit that the inadequate and just plain WRONG nutritional advice given by DS surgeons to many if not most patients is behind the majority of the problems with maintenance of health post-op (as is the sale of crappy vitamins by surgeons - a pet peeve).
  
  - Water-miscible forms of fat soluble vitamins must be administered individually, as needed. High range values for D3 should be maintained (above 70 ng/mL) because it is very difficult to get D3 into normal range if it slips lower. "ADEKs" are essentially worthless, are not properly balanced, and are ridiculously expensive. As an example, I am 11.5 years out, and have never needed to supplement vitamin A, based on my labs, but I need to take 500,000 IU of D3/week, so if I was taking sufficient ADEKs, I'd probably be broke and toxic in vitamin A.
  
  - IV iron supplementation, at ferritin levels above 30 ng/mL, is critical for many of us, for quality of life - most iron supplements don't work, and really hurt our guts. And if it goes too low, it can be VERY difficult to get into normal range.
  
  - Calcium citrate supplementation is a constant source of confusion for post-ops. Almost everyone needs to be informed BY OTHER PATIENTS that a proper dose is TWO tablets, multiple times per day. Calcium carbonate is insufficient.
  
  - With respect to calcium absorption, vitamin K2 is very important, as is magnesium citrate, but few surgeons teach that.
  
  - With respect to post-op kidney stone formation, many surgeons don't seem to understand that in order to prevent the most frequent type of kidney stones, our diets need to be supplemented by both calcium and citrate , and if stones are forming, dietary calcium needs to be INCREASED to bind to oxalates in the diet in the GUT, so they are never absorbed. And vitamin C is converted to oxalate in the body, so consumption needs to be watched.
  
  - It is stunning how many DS surgeons (or their staff) tell their DS patients to follow a LOW fat diet, which is counterproductive after the first few weeks. Constipation is more of a problem in DSers than diarrhea.
  
  - Failure to inform patients about the benefits of high quality probiotics, taken daily, including S. boulardii to control C. diff, is one of the worst failures. Failing to offer reasonably accessible metronidizole as needed (after ensuring that dietary indiscretions are not the cause) to get relief from imbalances/overgrowth of problem bacteria, followed by intensive repopulation with probiotic organisms is a needless cause of uninformed DSers' discomfort and "complications" of odor and loose stools, which are almost always easily solved by identification and elimination/reduction of problem foods or other ingested substances (wheat, especially resistant starches which have been chilled after rehydration, lactose, sugar alcohols, raffinose, plants in the Solanaceae family [tomatoes, eggplant, peppers], as a few obvious examples).

• In addition to the above, there is a great variability in the construction of the DS between surgeons. Size of sleeve and length of common channel, as well as the length of the alimentary tract (either in absolute lengths or as a percentage of the length of the small bowel, and how THAT is measured), vary all over the place, making comparisons difficult. On the one hand, there's nothing wrong with that in principle - each patient can and SHOULD have their DS personalized to their situation - gender, age, weight, comorbidities, diet history, body habitus (as opposed to BMI per se - what percent is fat vs muscle); on the other hand, giving the same procedure to everyone is just wrong, at least without a good reason such as having given fully informed consent to participation in a clinical trial comparing the effects of these parameters.

• Finally, it IS important to distinguish between patients who would be better off not being given a DS because of inability to comply with the minimal requirements of eating adequate protein, managing moderate carb intake, taking all of the required supplements, getting proper routine lab work, and adjusting diet and supplement intake as required. We have seen people in our community who have refused to care for themselves, who have become substance abusers, who have committed suicide either literally or by abdication of their nutritional responsibilities. It is up to the surgeons and their mental health allies to determine whether a particular patients can manage or be managed adequately - with the understanding that not everyone is capable of handling the gift that the DS can be to someone who is morbidly obese. People die from being unable to manage ANY weight loss surgery - there is a frightening incidence of Wernicke's encephalopathy in the RNY community as a complication of alcohol abuse - but malnutrition (as opposed to desired malabsorption) can happen faster with a DS.

• But shunning the DS - with its superior results in EWL and resolution/cure of comorbidities, durability of both, as well as quality of life - without understanding the responsibility of long term patient monitoring and PROPER nutritional education required to achieve these benefits, is doing a terrible disservice to the morbidly obese patients in your care. It is NOT that hard to manage a DS, but it is critical that it is done properly. That is where the problems come from, not because the DS per se inevitably causes complications.

And then Gagner chimed in

• Well said. At the same time, it is incredible how vitamins/minerals are mismanaged with ROUX-en-Y gastric bypass. I hope participants at the last IFSO got to see one of the top 10 papers, a randomized study looking at supplementation postop (we need more of those for all different types of surgeries, moving from feelings to real science). Dr Aarts from Rijnstate Hospital in Arnhem (Netherlands) presented a double-blind randomized controlled study on the effectiveness of two multivitamin supplemental regimens after weight loss surgery (a standard and a fortified). A fortified multivitamin regimen with vitamin B12 14000 % RDA, iron 500 % RDA, and folic acid 300%RDA was found to decreased substantially deficiencies in mineral and vitamins. The standard regimens are currently insufficient in most bariatric patients, and higher levels are recommended to avoid such micronutrients deficiencies (Iron, Vitamin B 12 and folic acid). This will have an immediate impact on follow-up care of these patients worldwide.