Pay for the DS... Walk out with something else.

[Munchkin]

@Munchkin I thought you did have the DS....what do you mean you wish you'd had a more drastic DS? Would you mind sharing your numbers....tell me to jump if you'd like....I hold VERY tightly to my number

I have a 3rd follow up with Cottam today and I'm trying desparately to get into Simper for a 2nd and possible surgeon switch. I'll keep you posted. Thanks for all the feedback.

Don't mind discussing it at all. I am a classic superabsorber. Got my first diet when I was 6 weeks old and knew the word obese when I was 2. Most of my life was one starvation diet or another starting with Metrecal back in the 60's. I dieted my way up to about 400lbs. I had to wait 2 years for a surgery date back then and when I found out I was that heavy I got really angry and put myself on @ 500 to 600 calories a day and I was mad enough to stick with it. Maybe that last diet killed what was left of my metabolism? We'll never know.

I had the DS in August of 2003 with Buchwald in Minnesota. I asked for a 50cm CC, he wanted to do 100cm so we compromised on 75cm. I stressed that I wanted the most drastic surgery possible and that I wanted my GB gone for sure. The day I went to surgery my weight was 251 so by DS standards I was a lightweight. My surgery was open and my recovery was perfect. I do have a hernia now that I got from coughing in 2009.

I didn't know back then that Buchwald DSers tended to not lose all the weight. There was something kinder and gentler about his DS surgeries. I know it now. There are quite a few of us who never got down to a normal BMI. I never had any problems and no deficiencies. And if my CC is 75...I probably should have had some! But I wasn't watching during surgery. I do wonder if my CC is really 75. And if I had started out with 20/20 hindsight I would have gone to Baltasar in Spain(could have had the surgery 2 years sooner too). But I picked my surgeon based on the fact he did do the DS and was very experienced, was local to me(70 miles or so), and accepted my insurance.

Lost 53lbs the first 4 months postop and that's it. It just quit. I was doing everything right, carbs under 50, 100gr protein and very little else. After 2 months of nothing I started tweaking things. More fat, less fat, I even tried more carbs. The diet that proved most effective for me was drinking a gallon of plain mint tea every day, 2 weeks on and one week off, less than 10 carbs per day, and one weekend a month was FREE. I could eat anything I wanted. But the weight loss was still dismal. I would read the boards and see all these people posting about needing to gain weight or stop the loss and I got angry again. Those posts drove me crazy. I couldn't imagine wanting to STOP losing weight. But quite a few of those people are now trying to lose again...

One secret weapon left. Exercise. Something I pretty much hated and was saving for last. I wasn't sedentary after surgery and I did become more active as I lost the weight but I wasn't doing anything extra besides walking. So I put the hammer down and started doing 5 miles a day. Then I started doing the same distance and alternating running with walking. Then I started pushing my self to do more running than walking. And in another 6 weeks or so I could run the whole thing. Part of my motivation was that it took to darn long to walk the 5 miles and I resented the time.

Here's what finally got my fat ass down to 170. You read the diet. Plus I was running 40 miles a week. Joined the gym. Did all the machines and played racquetball at least twice a week. But here's the conundrum. It really isn't sustainable to live like this forever. If I wasn't at work I was running or at the gym. I didn't want my whole life and all my free time to revolve around the number on the scale. Plus I was no spring chicken. How long would it be before I had some dire injury from all that high impact exercise? I knew just ageing would make this routine impossible to maintain. Hell, I was lucky to be able to do it well into my 50's. I knew I was pushing my luck.

Today I am almost 60. Officially an old bag soon! I finally had to accept what I can't change. I will always be fat. I did everything I could to change that so no regrets. I don't look like a pig headed to slaughter. I do look like a normal woman my age. And most normal women my age are fat. My weight tends to run from 190 to 200. I look ok in clothes. Naked, I am a trainwreck(picture a six breasted woman). I still diet and in the back of my brain there is still one last plan. Can my malabsorbtion be chemically enhanced? I need to buy a 5lb bag of SF Haribo gummy bears to test this latest hypothesis. And a couple extra cases of TP. Stay tuned!

 

[DianaCox]

That sounds Haribo! Lots of shitting!

I saw this in my BioSmart newsfeed last week: http://www.bizjournals.com/boston/b...gins-late-stage-study-of-obesity-drug-in.html

The trial, which kicked off today, will test the Boston-based biotech firm’s lead drug, called beloranib. CEO Thomas Hughesexplained recently that the drug works by rebalancing the ways the body packages and uses fat, and in the process slows the mechanism by which a person feels hungry. He plans to first seek approval in people with the generic disease called Prader-Willi, but eventually hopes to seek approval in all people with severe obesity as an alternative to bariatric surgery.

And

Zafgen
Location: Cambridge
Disease: Obesity
Drug name: Beloranib
Possible approval: In two to three years

According to Thomas Hughes, the biggest hurdle in addressing the obesity epidemic is getting people to understand it’s a disease, not a matter of self-control. The CEO of Zafgen, a Cambridge-based biotech firm that went public earlier this year, Hughes hasn’t needed to convince people that it’s widespread, however. According to the Centers for Disease Control, 35 percent of U.S. adults are obese. In medical circles, obesity is defined based on a person’s body mass index, and generally means a person who weighs at least 20 percent more than their ideal weight.

Research in recent years has suggested that changes take place in the body once it becomes obese, said Hughes, making it all but impossible to lose that weight again. In the past nine years since its founding in 2005, Zafgen has been developing a drug called beloranib that’s not your typical amphetamine-based diet pill. Rather, it works by rebalancing the ways the body packages and uses fat. Hughes likens it to filling up a car with gasoline: You could put it all in the tank, or put some in the tank and some in the back seat. “It’s in the car, but your car can’t use it,” he said. Beloranib makes sure all the fuel, or food, goes where the body can use it for energy, and in the process slows the mechanism that causes a person to feel hungry.

Beloranib is first being tested in patients with a rare disease known as Prader-Willi syndrome, which causes constant and intense hunger, as well as those with a damaged or missing hypothalamus. Results are expected next year, and could give a clear indication of whether the drug is effective. But Hughes’ ultimate goal is for the drug to be used to treat severe obesity as an alternative to bariatric surgery. While the size of such a market is difficult to gauge, he said, the $50 billion-a-year global market for type 2 diabetes is a strong indicator.

The drug targets the enzyme MAP2. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3944999/ (full length article)

Diabetes Metab Syndr Obes. 2014; 7: 73–84.
Published online Feb 28, 2014. doi: 10.2147/DMSO.S56924
PMCID: PMC3944999
Inhibition of the methionine aminopeptidase 2 enzyme for the treatment of obesity
Amit A Joharapurkar, Nirav A Dhanesha, and Mukul R Jain
Department of Pharmacology and Toxicology, Zydus Research Centre, Cadila Healthcare Limited, Ahmedabad, India
Correspondence: Amit A Joharapurkar, Department of Pharmacology and Toxicology, Zydus Research Centre, Cadila Healthcare Limited, Sarkhej Bavla NH 8A, Moraiya, Ahmedabad 382210, India, Tel + 91 271 766 5555, Fax + 91 271 766 5155, Email moc.alidacsudyz@rakruparahojtima
Author information ▼ Copyright and License information ►

Abstract
Worldwide prevalence of obesity has nearly doubled since 1980. Obesity is the result of interactions among the environmental factors, genetic predisposition, and human behavior. Even modest weight reduction in obese patients provides beneficial health outcomes. For effective weight reduction, a drug should either increase energy expenditure or decrease energy intake without causing serious adverse effects. To overcome lack of efficacy and central nervous system related side effects, exploitation of the peripheral mechanism of anti-obesity action is needed. Inhibition of pathological angiogenesis in adipose tissue is one such peripheral mechanism that has attracted the attention of researchers in this area. Although originally developed as anti-cancer agents, methionine aminopeptidase (MetAP2) inhibitors induce significant and sustained weight reduction. Here, we review preclinical and clinical pharmacology of MetAP2 inhibitors. Beloranib is a prototype MetAP2 inhibitor, and currently in advanced clinical trials for the treatment of obesity. Clinical data of beloranib indicate that MetAP2 inhibitors could be a future treatment option for weight reduction without serious adverse effects. Further clinical data from Phase III trials will add to our growing knowledge of MetAP2 inhibitor potential for anti-obesity therapy.

Clinical studies on MetAP2 modulators
Beloranib (CKD-732, ZGN-440, or ZGN-433) is an investigational drug candidate for the treatment of obesity. It was discovered by Chong Kun Dang Pharmaceutical Corp. (Seoul, South Korea) and is currently being developed by Zafgen Inc. Beloranib, an analog of the natural chemical compound fumagillin, is an inhibitor of the enzyme MetAP2.73 It was originally designed as an angiogenesis inhibitor for the treatment of cancer.73 However, once the potential anti-obesity effects of MetAP2 inhibition became apparent, the clinical development began to focus on these effects and beloranib has shown positive results in preliminary clinical trials for this indication.

The first Phase I study showed that beloranib (ZGN-433) at a dose of 0.9 mg/m2 was well tolerated and reduced body weight by a median value of 1 kg per week and 3.1% over 26 days relative to placebo in severely obese subjects.76 The results of the study also demonstrated a decline in hunger as well as meaningful changes in lipid parameters following treatment at 0.9 mg/m2. These changes included a 38% reduction in triglyceride levels and a 23% reduction in low-density lipoprotein (LDL) cholesterol levels. Additionally, beta-hydroxybutyrate, an indicator of fat oxidation, increased to levels seen with very low-energy diets. No treatment-related serious adverse events were observed.76

The second Phase I trial was a randomized, double-blind, placebo controlled study to evaluate the safety, tolerability, and efficacy of twice-weekly intravenously administered beloranib in severely obese women with a BMI of 39.1±3.7 kg/m2.76 Individuals received 0.9 mg/m2, 3 mg/m2, or 6 mg/m2 beloranib (n=17) or placebo (n=11) twice weekly over a 25-day period (seven doses). Patients were allowed to eat normally and were not advised to change their exercise habits. The trial enrolled 34 subjects of whom 28 completed the study.76

Beloranib treatment for 25 days resulted in significantly more weight reduction versus the placebo-controlled group (4.3±0.4 kg versus –0.6±0.5 kg in placebo). Additionally, subjects treated with beloranib showed improvements in cardiometabolic risk factors, including reduced triglycerides, LDL cholesterol, waist circumference, diastolic blood pressure, and C-reactive protein, whereas there was no change with placebo.76 There was a trend for beloranib to be associated with a reduction in the percentage of subjects with metabolic syndrome that did not reach statistical significance. The most common adverse events were nausea, infusion site injury, and headache. Most events were of mild/moderate intensity and tended to be self-limiting.76

The third Phase I trial was a randomized, double-blind, placebo-controlled study to evaluate the safety, tolerability, and efficacy of intravenously administered ZGN-433 in severely obese women with a BMI of 37.8±0.6 kg/m2.76 Individuals received ZGN-433 at 0.1 mg/m2, 0.3 mg/m2, or 0.9 mg/m2 or placebo twice weekly by intravenous administration over a 4-week period. Patients were allowed to eat normally and were not counseled to change their exercise habits. The trial enrolled 31 subjects and 26 people completed the study.76

After 26 days of treatment, subjects had decreased LDL cholesterol levels by 22% in the group that received 0.9 mg/m2 of ZGN-433 versus a 2% increase in the placebo group. Consistent with results seen in obese mouse models, treatment with ZGN-433 at a dose of 0.9 mg/m2 increased beta-hydroxybutyrate, an indicator of fat oxidation, increased plasma adiponectin concentrations, and increased the ratio of adiponectin/leptin.76

On November 15, 2013, Zafgen Inc., announced final body weight loss and cardiometabolic data from a Phase II study of beloranib for obesity. The 12-week study results showed significant weight loss and improvements in cardiometabolic risk markers in 147 obese individuals over 12 weeks of treatment, the largest and longest trial to date for the beloranib program.76

In this double blind, placebo-controlled study, Zafgen Inc., investigated the safety, tolerability, pharmacokinetics, and metabolic effects of beloranib in obese men and women. The trial enrolled 147 patients, of whom 122 completed the study. Subjects were mostly obese women with a mean age of 48.4 years, mean body weight of 100.9 kg, and a mean BMI of 37.6 kg/m2, who were enrolled into one of the four arms of the trial: n=37 for 0.6 mg; 37 for 1.2 mg; 35 for 2.4 mg; and n=38 in the placebo arm. Patients were allowed to eat normally and were not counseled to change their diet or exercise habits.76

Results indicate that after 12 weeks of treatment, subjects on 0.6 mg, 1.2 mg, or 2.4 mg of beloranib lost an average (± standard error of the mean) of 5.5±0.5 kg, 6.9±0.6 kg, and 10.9±1.1 kg, respectively, versus losses of 0.4±0.4 kg for those on placebo (all P<0.0001 versus placebo). The results have also demonstrated that weight loss with beloranib was progressive and continuing at week 12, and included a reduced sense of hunger, improved cardiometabolic risk markers, and was generally well tolerated. As observed in previous trials, this study also showed improvements in LDL-cholesterol, high density lipoprotein-cholesterol, triglycerides, and reduction in blood pressure. The most common adverse events with a higher incidence rate in those taking beloranib were nausea, diarrhea, headache, injection site bruising, and insomnia.76

Go to:
Conclusion and place in therapy
Although MetAP2 inhibitors were originally developed as anticancer therapies, research has demonstrated their efficacy for effective and sustained weight reduction along with increased energy expenditure and reduced calorie consumption. Inhibition of MetAP2, and hence angiogenesis, is a novel mechanism for the treatment of obesity and related complications. MetAP2 inhibitors target angiogenic vessels to arrest their growth, which would prevent further development of adipose tissue and thus obesity. As opposed to anti-angiogenic therapy for cancer, MetAP2 inhibition for obesity treatment might not lead to drug resistance because of the genomic stability of adipocytes and endothelial cells.77 Nevertheless, long-term activation of different signaling pathways may result in reciprocal switching of angiogenic responses. Additional advantages of such treatments is that the timescale is not designed for a lifetime; when target body weight is achieved, the treatment can be stopped.77 Although no meaningful adverse effects are noted in clinical trials of beloranib, theoretically, patients who are obese and have already developed cardiometabolic complications, such as hypertension, might not be appropriate for this type of therapy. Another possible adverse effect can include delayed wound healing in obese subjects and patients with type 2 diabetes.77

Robust clinical data of beloranib indicate that it has very good potential for weight reduction in moderate to severe obese patients without serious adverse effects. The reduction in cardiometabolic risk factors is an added advantage of such treatment. The absolute weight loss achieved by the beloranib treatment is similar or greater than approved anti-obesity therapies. For example, absolute weight loss achieved by the highest dose of orlistat, lorcaserin, or phen-termine/topiramate combination is 3.0, 4.8, and 12.2 kg, respectively versus 10.5 kg for beloranib treatment.76,78 Further clinical data from Phase III trials will add to our growing knowledge of MetAP2 inhibitor potential for anti-obesity therapy.

Has to be administered IV - that's a big limitation. But I'd try it.

 

[Munchkin]

That sounds Haribo! Lots of shitting!

I saw this in my BioSmart newsfeed last week: http://www.bizjournals.com/boston/b...gins-late-stage-study-of-obesity-drug-in.html

And

The drug targets the enzyme MAP2. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3944999/ (full length article)




Has to be administered IV - that's a big limitation. But I'd try it.

I'd sign up too!

 

[Up2Me3]

@Munchkin - Thanks for sharing. I hear you on wanting it ALL off.....I have these day dreams of me being thin and toned and yada yada. But really if I were to get below 200# I would be happy. Even if my BMI stilled showed overweight - I look at it this way - I am FAR FAR better off at 190 than I am right now. Frankly- that at almost 60 you're running 5 miles is AWESOME! I agree with you .... at what freaking point can we stop obsessing about it.

I'm still keeping my second opinion open next week BUT I did have a 3rd follow up with my doc and I actually feel pretty good about it. He does a tight\small sleeve. He has been doing the alimentary limb at 300 as Sanchez reports revisions from too much weight loss at 250. But he would consider doing the 250 for me. The way he explained the bile reflux issue or non issue in his opinion, does make sense to me. I didn't think the new connection which carries bile was any closer to my pyloric valve than in my normal anatomy. He says that it is a little closer and with his fingers showed maybe 1\2 inch or smidge more. Both he, Roslin and Sanchez in Spain have not thought this was a potential problem. My doc has done over 100 of the Loops and has not had any evidence or complaint of it. He does have 40% follow up and increased that for the paper he is submitting to 65% with personal phone calls. I've been studying bile reflux without any relation to bariatric surgery (so people with normal anatomy can have this) it can be treated the same as acid reflux medication. Very rare to have bigger issues than that.

@Larra you crack me up....Thanks for the support and thanks for the visual on the loose skin. I do think the only skin I'd really worry about would be my stomach. My thighs have always been ...well...not model type ha ha.

Considering I went into the process a couple months ago in hopes of getting the RNY that several of my friends have had (yes they have all gained a little bit back but still 100# lighter) and now coming out of it.....a HELL of a lot more informed than I was. I think the Loop is sounding like a good comfy 'safe' spot for me. As I vasillate back and forth - even at one point thinking I'd do just the sleeve - I'm thinking the Loop - while not as aggressive as the DS -does offer me more than the RNY I initially started out to get?!?!

 

[hilary1617]

@Up2Me3 Glad you have made a decision that is right for you!

I'm also particularly happy to read that the Loop surgeons with whom you've been in contact don't seem to think bile reflux will prove to be an issue. I understood the theoretical bile reflux risk to stem from bile flow direction in addition to increased proximity. In uncut anatomy, the bile is introduced past the pylorus and in a downward flow directed away from the pylorus, whereas in the Loop, it appears the bile is introduced in such a way that it would flow upward towards a "fork in the road" near to and leading the pylorus, which would increase the potential risk of bile crossing into the stomach through the pyloric valve (which I think is the reason that the surgery would not be recommended if there is pyloric insufficiency) or possibly irritating the valve itself over the long term if there is a lot of exposure. It's a theoretical risk, so glad to hear this does not appear to be an issue in practice. Again, I'm not a medical professional, I've just been studying the mechanics and whatever info I can find, so my understanding could be off.

I'm definitely grateful to the people who, like you, took a leap of faith and went for a surgery without long term info way back when the DS was introduced.

You definitely are conducting thorough due diligence and have as much info as is possible at this point, so I'm really comfortable that you are making an informed decision. It's also great for you that Cottam has done 100 Loops - you're not facing being his first by any means. He must be doing surgery really frequently to have gotten to that number in such a short while, which to me is a sign that this will be very routine for him.

Please keep us posted on how everything goes!
Hilary


ETA the following info from Larra
@@hilary1617 , the is no way bile can get into the intestinal system upstream from the pylorus with either DS or SADI no matter what that diagram looks like. Bile enters the duodenum via the common bile duct. That doesn't change with either operation. I think what Dr. Roslin and others are saying is that with the SADI the location where the bile duct connects with the duodenum becomes a little closer to the pylorus than with normal anatomy, but it remains downstream no matter what.
I really don't see the bile reflux business as a major issue unless there is something amiss with the pylorus. My concerns are around the lack of known longterm results and the potentially less malabsorption, particularly less fat malabsorption, with the SADI. I believe these attributes of the DS are part of what make it both more effective longterm than any other bariatric operation as well as easier to live with and easier to comply with from the patient's point of view.

 

[sophiehatter]

@Up2Me3 - A huge, huge THANK YOU to you for all of this information. I knew that Dr. Cottam was doing something that wasn't the traditional DS, and I was okay with how he explained it to me too. I asked for more details, first because of this board and all the great information here, then from your detailed questions too. But your research definitely outclassed mine! And I have been the benefactor and again I thank you.

I feel comfortable going forward with the Loop DS and I hope all goes well with your surgery! I think I am 10/20 and you are 10/21, right? PM me and I can keep in touch! And I will send a quick update to this board as well.

 

[DianaCox]

BTW, that chick SweetMel7 on OH doesn't know WTF she's talking about - she supposedly has a SADI from Roslin and says:

SWEETMEL7
on 10/9/14 5:49 pm - NY
I believe my common channel is either 125 or 150 and he removed 85 percent of my stomach....

There is no common channel in a SADI - there is only the length of the alimentary tract and it is somewhere between 250-350 cm. NOT 125. Sad ignorant people - she's almost a year out.

 

[Munchkin]

The very very most important thing is you went into this with your eyes open and completely informed. At that point it doesn't matter what surgery you get. We have to assume you know you better than we do and are doing the best thing for you. And that's exactly how I want it to turn out.

If you hang out on these boards long enough you will understand this completely but I will put you ahead of the curve. I think this applies to almost all surgeries but fat people more than most because we are used to being ignored or reviled by the medical community for our lack of discipline and inability to follow their sage advice. When we finally meet a surgeon that is going to 'fix' us, we fall in love. Surgeon worship! Not a good place to be. Add that to the fact we are brought up since birth to believe docs always know what's best and have our best interests at heart. Surgeons are not Gods...they are cutters. Surgeons are human beings and many of them are motivated by money and they want yours. So they will sell a 500lb person a lapband knowing full well there is a 95% probability it won't work. And when it fails it is always the patients fault. Pretty good deal for the surgeon, huh? Toyota would be in high cotton if they could blame the buyer for their defective car!

We, the patients, have to be critical thinkers and self advocates to be successful. If you are suffering from Surgeon Worship you can't be objective and make the best decision. You will blindly do whatever this God tells you to do. It makes not one whit of difference that there is all sorts of evidence out there to the contrary. You believe your doctor just like you believe your lover. You are desperate to lose weight and that makes you vulnerable. You want to believe there is hope!

^^^^^This is one of the reasons we exist!

 

[Up2Me3]

BTW, that chick SweetMel7 on OH doesn't know WTF she's talking about - she supposedly has a SADI from Roslin and says:


There is no common channel in a SADI - there is only the length of the alimentary tract and it is somewhere between 250-350 cm. NOT 125. Sad ignorant people - she's almost a year out.

HA HA @DianaCox I actually asked her to check that again as well. She is confusing numbers of the DS with Loop. Dr. Roslin called me back and while he doesn't obviously know this person he says she doesn't know what she is saying. Those numbers are a DS and if she had the Loop with him then he does a 300 alimentary track. @hilary1617 I asked Roslin about your thoughts on the direction of bile - and again just on phone so I read your thoughts and then told of the picture on Central Valley's website. He does not know what that picture looked like but he does not believe the direction of bile flow has changed - just slightly closer to pylorus valve. I will ask this of my Doc, Sanchez and my 2nd opinion Doc. as well though.

@Up2Me3 - A huge, huge THANK YOU to you for all of this information. I knew that he was doing something that wasn't the traditional DS, and I was okay with how he explained it to me too. I asked for more details, first because of this board and all the great information here, then from your detailed questions too. But your research definitely outclassed mine! And I have been the benefactor and again I thank you.

I feel comfortable going forward with the Loop DS and I hope all goes well with your surgery! I think I am 10/20 and you are 10/21, right? PM me and I can keep in touch! And I will send a quick update to this board as well.

@sophiehatter yes I'm the day after you but I think we're at 2 different hospitals. My day he's in SL Regional. Good Luck and yes let's keep in touch.

 

[Up2Me3]

The very very most important thing is you went into this with your eyes open and completely informed. At that point it doesn't matter what surgery you get. We have to assume you know you better than we do and are doing the best thing for you. And that's exactly how I want it to turn out.

If you hang out on these boards long enough you will understand this completely but I will put you ahead of the curve. I think this applies to almost all surgeries but fat people more than most because we are used to being ignored or reviled by the medical community for our lack of discipline and inability to follow their sage advice. When we finally meet a surgeon that is going to 'fix' us, we fall in love. Surgeon worship! Not a good place to be. Add that to the fact we are brought up since birth to believe docs always know what's best and have our best interests at heart. Surgeons are not Gods...they are cutters. Surgeons are human beings and many of them are motivated by money and they want yours. So they will sell a 500lb person a lapband knowing full well there is a 95% probability it won't work. And when it fails it is always the patients fault. Pretty good deal for the surgeon, huh? Toyota would be in high cotton if they could blame the buyer for their defective car!

We, the patients, have to be critical thinkers and self advocates to be successful. If you are suffering from Surgeon Worship you can't be objective and make the best decision. You will blindly do whatever this God tells you to do. It makes not one whit of difference that there is all sorts of evidence out there to the contrary. You believe your doctor just like you believe your lover. You are desperate to lose weight and that makes you vulnerable. You want to believe there is hope!

^^^^^This is one of the reasons we exist!

@Munchkin point taken. But I don't have love or worship for my doc. I've questioned him left and right. I worked in an OR for 10 years prior and it kinda became my thought that - "the bigger the ass the better the surgeon"!! He would fit in right there. One thing I do believe about him is that he is a skilled laporscopic surgeon. So now it's just been deciding the procedure itself. He knows and freely admits this is fairly new when you consider the DS is out 20+ years. But, he also can give me explanations as to why he prefers this and those reasons sound\sit\feel well with me (I think ha ha). Here's hoping that I don't have any regrets 10\20 years out!!

 

[robs477]

The very very most important thing is you went into this with your eyes open and completely informed. At that point it doesn't matter what surgery you get. We have to assume you know you better than we do and are doing the best thing for you. And that's exactly how I want it to turn out.

If you hang out on these boards long enough you will understand this completely but I will put you ahead of the curve. I think this applies to almost all surgeries but fat people more than most because we are used to being ignored or reviled by the medical community for our lack of discipline and inability to follow their sage advice. When we finally meet a surgeon that is going to 'fix' us, we fall in love. Surgeon worship! Not a good place to be. Add that to the fact we are brought up since birth to believe docs always know what's best and have our best interests at heart. Surgeons are not Gods...they are cutters. Surgeons are human beings and many of them are motivated by money and they want yours. So they will sell a 500lb person a lapband knowing full well there is a 95% probability it won't work. And when it fails it is always the patients fault. Pretty good deal for the surgeon, huh? Toyota would be in high cotton if they could blame the buyer for their defective car!

We, the patients, have to be critical thinkers and self advocates to be successful. If you are suffering from Surgeon Worship you can't be objective and make the best decision. You will blindly do whatever this God tells you to do. It makes not one whit of difference that there is all sorts of evidence out there to the contrary. You believe your doctor just like you believe your lover. You are desperate to lose weight and that makes you vulnerable. You want to believe there is hope!

^^^^^This is one of the reasons we exist!

Speaking in general terms, (not particularly this thread) because what you said can be applied across the board, that was one of the best writings, analysis, descriptions, expletives, (not exactly sure how to define it) that I have read! Love the Toyota analogy...so true, well said.

 

[hilary1617]

@Up2Me3 , just to clarify on the theoretical bile-related risk, direction change of the bile may not be the most accurate wording. It is more the relative location of the pylorus to the bile entry point. In normal uncut anatomy, the bile flow enters the intestines downstream of the pylorus, where in the Loop/SADI, it appears to enter the intestines upstream of the pylorus. That's what the diagram seems to show. Hope that makes more sense? Anyway, again, it purely a theoretical risk - only experience would show whether it is realized or not.

ETA the following information from Larra:
@@hilary1617 , the is no way bile can get into the intestinal system upstream from the pylorus with either DS or SADI no matter what that diagram looks like. Bile enters the duodenum via the common bile duct. That doesn't change with either operation. I think what Dr. Roslin and others are saying is that with the SADI the location where the bile duct connects with the duodenum becomes a little closer to the pylorus than with normal anatomy, but it remains downstream no matter what.
I really don't see the bile reflux business as a major issue unless there is something amiss with the pylorus. My concerns are around the lack of known longterm results and the potentially less malabsorption, particularly less fat malabsorption, with the SADI. I believe these attributes of the DS are part of what make it both more effective longterm than any other bariatric operation as well as easier to live with and easier to comply with from the patient's point of view.

 

[Munchkin]

@Up2Me3 Actually the point of my post was to congratulate you! No matter what you pick, your eyes are open!

 

[Larra]

@hilary1617 , the is no way bile can get into the intestinal system upstream from the pylorus with either DS or SADI no matter what that diagram looks like. Bile enters the duodenum via the common bile duct. That doesn't change with either operation. I think what Dr. Roslin and others are saying is that with the SADI the location where the bile duct connects with the duodenum becomes a little closer to the pylorus than with normal anatomy, but it remains downstream no matter what.
I really don't see the bile reflux business as a major issue unless there is something amiss with the pylorus. My concerns are around the lack of known longterm results and the potentially less malabsorption, particularly less fat malabsorption, with the SADI. I believe these attributes of the DS are part of what make it both more effective longterm than any other bariatric operation as well as easier to live with and easier to comply with from the patient's point of view.

 

[hilary1617]

@Larra thanks so much. This is very helpful clarification. I have edited the earlier posts to add this info.