Will2014
Well-Known Member
- Joined
- Apr 2, 2014
- Messages
- 361
Hello nosnhojm! Just wanted to say I LOVED reading your posts here because they clearly indicate the amount of thought you're putting into this. Good for you!! You should be very cautious and choose wise the procedure and details of said procedure VERY carefully. That being said, it sounds to me like you are a clear candidate for the DS. But remember that the Duodenal switch is actually 2 procedures in one. It's a vertical gastric sleeve (usually left a tad larger than just the sleeve folks-because we have the malabsorptive component as well) and then there's the reworking of the intestines or the "switch" . You have several ways to go if the DS is your choice.Are there any men on these forums that have had issues with osteoporosis and/or anemia? Just curious, since in the general population osteoporosis is more common in women...so does that also skew the DS population?
Also, what are your thoughts on CC length? I think Dr. Ikramuddin does 100 cm, but wondering if anyone on these forums has anything longer (e.g., 125 or 150)...and is there a difference in their labs or supplementation requirements?
And lastly, what should my EWL be for DS? If I'm doing my math correctly, I am currently 390lb @ 6'2" = 51 BMI, and 'normal' would be 195lb (25 BMI). So EWL for DS is (80% * (390-195)) = 156lb lost? That would put me at 236lb, which is really about as low as I would want to be.
I probably should create a new post for these questions, since they don't relate to my original post
1. You could choose to do 1/2 of the procedure now-the modified VSG alone without the switch part. Many Dr.'s try to do this especially for Pt.'s with extremely high BMI's....say 60's and above. This allows for less table/anesthesia time which lowers risk a lot. But for me it also allows you the chance to see if the VSG alone could meet your needs...which in an ideal world would be a very best case scenario. No malabsorption means no life long vitamin/mineral challenges, no bowel issues if eat the wrong foods, etc. The fact is ALL DS patients would rather give up their switch component if we could. It's just that for a LARGE segment of the morbidly obese community, weight regain after 18 months or so with the VSG is a REAL problem. Many lose well...but regain and then have to go to get a revision to the DS. Also, this means you'd be being cut twice...with all the risks associated with major surgery effectively being doubled because it's 2 surgeries. This is a much more viable option for men IMO , because when you read about successful VSG long term for high BMI Pt.'s , it's almost always men. Looking at your BMI and pic, you look like you have a large muscle mass and might be able to pull off the 2 stage approach. If you start to regain at or before 18 months, you could add the switch. But your 51 BMI makes you a member of a rare breed like I was: the Super obese . Which likely means you'd need a stronger surgery than just the sleeve, and that makes one ask a logical question: why get cut twice if? If the odds highly favor a need for the full DS, it just makes sense to do it the 1st time all at once. Now, the next option explores options for the full DS, and do trust me, the devil is in the details!
2. The DS. Please be aware that there are MANY variations on this procedure. Some Dr.'s choose to do a standard length common channel for all Pt.'s or a "cookie cutter" approach. The most common length is 100cm. Better surgeons use the Hess method, which involves measuring the entire small intestine length and certain specific points to determine your absorption potential. This is specific to you. Some CC's are as small as 50 cm, some as large as 190cm. The 3 most commonly used are 75, 100, and 150cm. I am growing to believe that, at least for men, it's better to go with a more conservative approach to the common channel length, which means as long as you can get away with and still have a reasonable shot at hitting your target goal weight. This is NOT an exact science because all of us react differently to our changed bodies. I have a 110cm CC and have lost 223 lbs in 14 months. But now I'm on Creon to try to stop losing, because I'm too thin. Maybe a 150cc would have been better for me? I dunno . And you won't know for sure either. But my hunch tells me for muscular men, a longer CC is best. My computer's acting crazy now...gotta wrap this up by saying this. Only you will have to live with your decisions going forward. The seasoned vets here are in many cases brilliant and accomplished people. They keep coming here to post to help folks like you, even though they had their surgeries 3,7,15 yrs ago. They want to help, as do I. Best of luck in YOUR decision! And welcome to this board!!
