Reversal of DS intestinal switch? Anyone?

[Poodles]

Reasons I want a DS reversal:

Lose weight too fast: 85 cc, lost 18lbs in 2 weeks with flu. Ended up on TPN interveinios nutrition several times.

Constant constipation.

Kidney stones-need low oxalate, low protein diet. Need to take meds.

Malabsorption of vitamins/minerals/medication.Effects on my body.

Vites:

Calcium- bariatric advantage, cinnamon
Multi- Dr Stewart's, dry D3, A, zinc.

Please keep in mind I thought that since my lab levels were with in range that this was sufficient. They never checked for trace minerals other than zinc.

I want a reversal.

So tired of playing this vitamin, drastic weight loss, kidney stone, and now possible neurological issue game. I'm tired. Physically, and emotionally.

I just want to absorb things, but don't want to make things worse. DO YOU KNOW ANYONE THAT REVERSED THE DS? Did it help?

My CBC is awful. My b12 runs high lately, zinc was low so they have me taking extra MWF. (Which lowers copper) Protein is low at 5.5, low in November and low now. Even with increased intake.

This is so bad. Going along thinking everything is fine lab wise. All these other things just plague me. Everything started going wrong after the surgery in 09, and nothing I have tried has fixed it.

I don't know what to do.

The neurologist says to get a good nutritionist, but they don't know about DS issues. The 2 mg recommendation proves that.

What would you do?

 

[Poodles]

I am low on copper. Neurologist says take 2mg twice daily supplement.

Here are my copper results: my #, normal range: 43, 70-175
Seroloplasmin 10, 18-53
Urine low 6, 15-60

 

[Clematis]

Sorry you are going through this

I would see a highly skilled DS surgeon like Dr. K or Dr. Rabin. You may just need your limb lengths adjusted. Or maybe it is something else entirely. I do know that I wouldn't throw in the towel and reverse before making sure I got an opinion from one of the top doctors.

(I don't know what's going on with your vites. Seems like way too little to me, but I am no expert.)

I hope you find answers

 

[DianaCox]

Wait to get input from others here - you are clearly not supplementing correctly, and it is likely affecting your thinking as well, including causing depression.

You need to be supplementing protein - hard - not cutting back! If you aren't eating over 120 g/day then you need to get a high quality protein drink - I personally like the Unjury chicken soup flavor. High protein is not the problem - clearly, your protein ABSORPTION is inadequate, and you need to get more protein that you can absorb.

You need to be taking calcium, zinc, and copper on a proper schedule, keeping the conflicting supplements at least 2 hours apart.

I didn't see iron results there - how are they?

 

[Larra]

Hi and welcome!
The intestinal part of the DS can be reversed. Obviously, the sleeve can't. But is that really necessary? I get that you've tried your best and you're sick of being sick, but it does sound like your supplementation has never been right (not your fault). I agree that consulting with one of the expert DS surgeons is the first step. You lose nothing by doing so, and potentially have a lot to gain.
Regarding your CBC, low copper can cause non-iron deficiency anemia (meaning that this isn't the usual cause of anemia seen in the USA, which is iron deficiency). So if you can get your copper level back up, that should help your CBC as well, and also get you feeling better. My brother had this issue soon after his DS. We never did figure out why. He felt like crap. Once his copper level came back up, so did his CBC and he's felt much better ever since.
Regarding the oxalate and kidney stones, the best person around here to speak to that issue is @Spiky Bugger so hopefully she will see this and have some advice for you.

The bottom line is, don't give up hope. You can be helped. And, if the best people are not able to get you feeling better, THEN you still have the option of reversal, or limb length adjustment.

 

[southernlady]

When were your last labs done and can you post them? Sounds like you weren't on Vitalady's recommended list but that is where I would start.
http://bariatricfacts.org/threads/vitalady-links.11/

I would also email or call Dr. K or Dr. Rabkin in CA.

 

[Spiky Bugger]

Hi. Sooo, you're a mess. It happens. (And I had to stop typing for a minute because the uro called and wants a scan...go figure.)

If you had bariatric surgery for any reason other than your morbid obesity was killing you, you may have trouble accepting that we sometimes have to jump through hoops to get where we are going. If you had the DS because without it, you were going to die...then reversing it will likely put you back on that path...the path that you KNOW means disability and/or death. You may not want to do that.

That said, I totally get the frustration...I'm supposed to "blend" a low oxalate diet, with a FODMAP diet (and I don't even have IBS), and a gluten-free diet (because I have trouble with wheat flour) and the amazing Interstitial Cystitis diet. I think I'm allowed to eat newspaper.

Well, screw that. I'm human and this surgery was supposed to help me have "a life," not a guarantee of a "perfect life," with no challenges.

Okay...your surgery was almost seven years ago and some of your labs are off and the prescribed diets are mostly impossible and maybe not ncessary, and there is an undefined "neurological problem," but that cannot mean you really want to return to your death march, right?

Pharmacy called. My Uro-Cit K prescription (to supplement citrate) is ready. And the call from the uro was because the ultrasound revealed a small stone. (Probably because I, for some strange reason, stopped taking the Uro-Cit K.). (Duh.)

You need protein. The stones are LIKELY because you are short on citrate. Have you done a 24-hour urine collection? That's how you would know.

You need to address each issue one-on-one before you do something that will make you more miserable.

One-at-a-time...you are trying to eat an elephant, and there is no quick way to do this.

Sue

 

[Marquis Mark]

Reasons I want a DS reversal:

Lose weight too fast: 85 cc, lost 18lbs in 2 weeks with flu. Ended up on TPN interveinios nutrition several times.

Constant constipation.

Kidney stones-need low oxalate, low protein diet. Need to take meds.

Malabsorption of vitamins/minerals/medication.Effects on my body.

Vites:

Calcium- bariatric advantage, cinnamon
Multi- Dr Stewart's, dry D3, A, zinc.

Please keep in mind I thought that since my lab levels were with in range that this was sufficient. They never checked for trace minerals other than zinc.

I want a reversal.

So tired of playing this vitamin, drastic weight loss, kidney stone, and now possible neurological issue game. I'm tired. Physically, and emotionally.

I just want to absorb things, but don't want to make things worse. DO YOU KNOW ANYONE THAT REVERSED THE DS? Did it help?

My CBC is awful. My b12 runs high lately, zinc was low so they have me taking extra MWF. (Which lowers copper) Protein is low at 5.5, low in November and low now. Even with increased intake.

This is so bad. Going along thinking everything is fine lab wise. All these other things just plague me. Everything started going wrong after the surgery in 09, and nothing I have tried has fixed it.

I don't know what to do.

The neurologist says to get a good nutritionist, but they don't know about DS issues. The 2 mg recommendation proves that.

What would you do?

Would definitely talk to Dr. Kesheshian before making any decision. I had a consult/second opinion with him. It's only $112 and he's happy to spend as much time with you as you need. I was with him for well over an hour. If you're not in the LA area, you can do it by Skype. His number is (818) 812-7222. He's very compassionate and "human." I can see you're feeling despondent now, but please remember feelings are transient and it's probably best to let such a consequential decision sit before taking any action - whatever that action may be. Best to you.

 

[bearmom]

I'm not a vitamin guru, but see you need much better supplementation info, and you need better help with preventing kidney stones and have been given information that may make them worse. You have gotten some good advice here, and you almost certainly have low urinary citrate, and high oxalate, which both contribute to kidney stones.

Let me stick this in here - I'm also not a dr, and am just sharing what I've had to learn about kidney stones and am sharing this because I know the majority of kidney stones are calcium and oxalate, and often for the same reasons, but there are other types and causes so you need to have a decent nephrologist or endocrinologist run your labs and a 24 hours urine and help you sort it out.

The Urocit-K that Spikey mentioned above, is to help that low urine citrate, and it helps keep minerals from crystallizing in the the kidneys. I take it too. If you've been told to take less calcium by a Dr, get a new one that has read data from this decade. Lowering calcium was how they treated calcium/oxalate kidney stones even 10 or so years ago, and it made things MUCH WORSE. You in fact need more - much much more. I take up to 6000mg of calcium citrate a day, but spread out in doses all with meals. I take calcium every time I eat. The every time I eat part - that is important.

Calcium can bind with the oxalate in the gut, and then just pass it out in the stool - so it never lets that oxalate get into the bloodstream to begin with. Fat in the gut will also bind with the calcium (which is what happens in our fat malabsorbing guts) so you need plenty of calcium EVERY TIME YOU EAT, so there there is enough to go around, and hopefully even get some to your bones after all is said and done.

Another thing I do to try to deal with the excess oxalate is to use a probiotic, which is good for us anyway, but I try to target one that has shown promise metabolizing oxalates. One that has been studied is called Oxalobacter formigenes, and last I checked, we can't yet buy it, but there is a very close strain that is sold in a probiotic called VS#3-DS. I can buy that, so I'm

Dr Keshishian also has some information on kidney stones, and many other things that I highly recommend you go read. It's easily understandable, and is accurate and up to date. It's refreshing for me as someone who has gone to specialists and teaching hospitals to sort out the kidney stone and some iron issues and taken years (my kidney stones pre-dated my DS) to get to the nitty gritty and most currant info, and see that Dr K now has the very latest and accurate info on his site in digestible form for us all to peruse. After having been through so much with it I see it as an absolute gift for his office to have consolidated such useful information and made it available for all of us. In case you don't know, very few of us have had surgeons and nuts that gave good information, let alone accurate.

The only thing on their information I may not agree with is about eating a low oxalate diet. I have yet to see any data that convinces me there is any benefit to eating a low oxalate diet. Not only that, but oxalates are in some of the healthiest foods, and think that avoiding those foods is more detrimental than beneficial, so I make zero effort to eat low oxalate, and do other things to deal with the oxalate absorption issue.

I'm sorry that you have been left to flounder. I can only imagine how discouraging and frustrating that is. All of the things you have going on can be dealt with, if you have a dr with a clue to help guide you. You'd have to take much more in supplements and protein of some sort, and be very aggressive in treating deficiencies, and getting copies of labs yourself (and there are some wise peeps here that can help decipher them) to make sure all things are being adequately addressed. I'm afraid it's not uncommon for us to have to really take the bull by the horns and be adamant and even aggressive with our care. If you just don't have it in you or are just over this DS, then Dr Keshishian is the guy you want to see about revising to a longer cc, or whatever you need. His information is the perfect place to start if you are going to just get your health back and not revise. Either way, that's where I'd start reading tonight, and I think many things will become clearer to you.

 

[DSRIGGS]

Hello - please don't give up. I am a DS patient who was revised by Dr Keshshian (Dr K) in August of 15 due to malnutrition that was caused by my ALIMENTARY LIMB BEING TOO SHORT . Yes I said the AL was to short and this was not allowing for proper nutrition or absorption of vitamins. Many people are under this silly notion that the only thing that matters for absorption with the DS is the CC. THAT COULD NOT BE MORE UNTRUE.

My quick story (yes you will see some similarities). I had a DS with Dr Stephen Marshall in Peoria, IL in September of 2013. At the time I did not know that there were two ASMBS standards of care for the DS Surgery. The first being what I call the standard or cookie cutter DS where the Surgeon gives the patient a predetermined CC & AL length without measuring the total small bowel and with no regard to patient height or other medical history. The second being the Hess Method where the total small bowel length is measured and then the patient is given roughly a 10% of the total SBL CC & then and AL of roughly 40% of total SBL. I was given the former with a CC of 100 CM & AL of 150 CM. My total SBL was not measured. A year after surgery I had an emergency intestinal hernia repair as it was causing a blockage. Roughly a month later I ended up back in the hospital for a week as my BP was 70/40, Heart Rate was down in the low 30's and I kept passing out. I was given a full cardiac work up short of stress test. Everything was perfectly fine. When they looked at labs they finally saw that my Total Protein was 4.5, Albumin 2.5, Zinc very low, Copper very low, A, D, E & K were now low and I was very anemic but my Iron and Ferritin were well in range. I was extremely malhourished due to lack of absorption (and later I found out it was due to the AL not the CC). I went on 400,000 IU's of Creon daily (that is what we refer to as a metric shit ton). This brought my numbers back up in to range and I was advised to stay on this until the 2 year post surgical mark as my absorption should have picked up by then.

I started consulting with Dr in April of that year as my oldest son had severe gastroparesis and Dr K eventually did surgery on him and pretty much eliminated the problem. We started talking about my and he agreed that I should try to hold out to the 2 year mark before we did anything. Well in July of last year I dropped about 20 pounds in two weeks (sound familiar) and Dr Marshall told me, well your labs are great (they weren't great and I was on 400K freaking IU's of CREON so guess what they would have bee without it) so let's wait another 30 days. I called Dr K that night (we talked and traded email all the time) and he told me I either needed to have Dr Marshall put me on TPN or get out to him ASAP to get revised to lengthen my common channel. So my wife and I hopped on a plan a week later and were in Glenadale in Dr K's office.

So we talked and Dr K explained several things to me about what he was going to do. The first was that he needed to measure my total SBL to determine what length my CC & AL should have been and then he would do what is called a side by side anastomosis taking some of my BPL (Bilopancreatic Limb) and putting it into the "absorbing part of the DS". It ended up that my total SBL was 725cm, so with a 100cm CM CC and 150cm AL I only had 250cm of 725cm absorbing. That was only 34% of my small bowel absorbing nutrients when it should have been 50% of my SBL absorbing nutrients.....so Dr K added to my channels and got me closer in balance to where I should have been.

What have the results been? I went off the CREON immediately and my numbers didn't drop. Had I done that previously I would have been in the hospital. I am not perfect yet and it has been a slow journey but I have gained roughly ten pounds from 170 pounds at Surgery to 180 pounds now. I am 6'2 so at 170 I am a freaking bone back and I am an ex Offensive lineman in football. My labs are not perfect but much better. Dr K and I decided that my goal weight should be 200-205 lbs and he told me it would take time to get there and I am confident that I will.

Okay now that you have my background and see similarities (BTW I had a stone 3 weeks after my original DS but none since) to your situation we need to get some understanding of your:

• Daily protein intake
• Daily supplementation schedule
• Copy of latest labs
• What are your CC, AL & BPL lengths if known and do you know if you had the Hess Method DS or the standard?

So let me tell you how much protein I eat daily and my supplementation schedule

Daily Protein Intake (all from food) 200-250 grams minimum
Vitamin Regimen -

Vitamin A 200,000 IU (divided up in two doses throughout day)
Vitamin D 200,000 IU (divided up in two doses throughout day)
Vitamin E 800 mg (divided up in two doses throughout day)
Vitamin K 4,000 mcg (divided up in two doses throughout day)
Zinc 300 mg (divided up in two doses throughout day)
Copper 2 mg
Cal Citrate 2,000 (divided up in two doses throughout day)
Multi 2/day
Folic Acid Once Daily (have to check dose)
Vit C Once Daily 500 mg
Probiotic Primal Ultra Defense 1/Day
Protonix 40 mg 2/day
B12 None as my numbers were very high to begin with
Iron None as I am well within range (I am still iron deficient anemic)​

So as you can see I eat a ton of protein and I take a ton of vitamins. We need to see how your numbers compare but I have a feeling you are probably nowhere near these levels.

Please provide the information I requested and as the ladies have already stated , WE CAN AND WILL HELP. Before talking to Dr K you really need to get this information documented as he will want to know, and yes you should absolutely talk to Dr K. He is the best Dr of any sort I have ever met as he is incredibly curious and incredibly compassionate wanting nothing but the best for anybody, HIS PATIENT OR NOT. I hesitate to say this at times because I feel like I burden the man, but the first time I emailed him to talk to him about my son's case was on a Saturday morning around 7 AM central. I went from my office to get a cup of coffee and by time I was back I had missed a call from California. Yep, Dr K replied to my email with a phone call within 5 minutes. I can't tell you how many emails we have traded since then but it isn't double digits it is in the hundreds. I tell you this to let you know that he is incredibly responsive and wants to help. Get the information for us and then reach out to Dr K. You can find his direct email on dssurgery.com. You can call or email his staff, who are great, but you can also email him directly describing your situation and that you are looking for some help in solving your problems.

Finally, I know you are tired and frustrated. Believe me I know how tiring and frustrating it is to feel weak and hurting all the time due to malnutrition. That being said, PLEASE DO NOT JUMP INTO ANYTHING. You might respond to simple changes in diet (Upped protein - do that immediately) an increased supplementation, or you could end up like me needing a revision to get your channel lengths the proper dimensions so they are optimally absorbing., or it is possible you need a complete reversal but I think it is very possible that you don't need that.

Sorry for the book, but welcome and please get us the protein and supplementation schedule/dosing immediately. We can help. Some of these ladies are more than 10 years out and doing very well. I would have been lost without this place because most DS Surgeons offices absolutely suck at nutrition and supplementation guidance....this site is fantastic about that because we live with it, those Nutritionists don't live with the DS and most don't understand it. Hang in there!!

 

[DSRIGGS]

Quick note: I just saw your copper numbers. Take the 2mg copper pill twice a day and see what that does. Also, make sure you are not taking the zinc and copper at the same time as you know they fight one another. So take the first dose of copper, or even double it up (I think you can without any absorption issues - ladies can comment) first thing in the AM and then your zinc at least two hours later. I divide my zinc up in two doses daily.

One other comment. You probably know this but your vitamins need to be water miscible (dry) especially A, D, E & K. If they aren't you are just passing them through you system.

I buy Biotech A, D & K and the E comes from Now Foods.....I get all of it through Amazon which you can link to through this site.

 

[Munchkin]

Looks like you are in trouble because you listened to your docs office about nutrition. This can be fixed but it will take time. Surgeons are cutters and it is a rare doc or nut that actually understands postop nutrition and supplement needs. Bariatric Advantage products are an extra income stream for your doc but they are no good for us. Better than nothing but not much.

You said nothing about your weight. If you were doing so badly you were on TPN your BMI must be under 20? How long ago was your surgery? What's your CC? Generally speaking the fast weight loss phase doesn't last more than 2 years. Are you close to that point? Many people experience about a 10% bounceback gain around this time.

To answer your question, the switch part of the DS is reversible.

 

[newanatomy]

I'm not a vitamin guru, but see you need much better supplementation info, and you need better help with preventing kidney stones and have been given information that may make them worse. You have gotten some good advice here, and you almost certainly have low urinary citrate, and high oxalate, which both contribute to kidney stones.

Let me stick this in here - I'm also not a dr, and am just sharing what I've had to learn about kidney stones and am sharing this because I know the majority of kidney stones are calcium and oxalate, and often for the same reasons, but there are other types and causes so you need to have a decent nephrologist or endocrinologist run your labs and a 24 hours urine and help you sort it out.

The Urocit-K that Spikey mentioned above, is to help that low urine citrate, and it helps keep minerals from crystallizing in the the kidneys. I take it too. If you've been told to take less calcium by a Dr, get a new one that has read data from this decade. Lowering calcium was how they treated calcium/oxalate kidney stones even 10 or so years ago, and it made things MUCH WORSE. You in fact need more - much much more. I take up to 6000mg of calcium citrate a day, but spread out in doses all with meals. I take calcium every time I eat. The every time I eat part - that is important.

Calcium can bind with the oxalate in the gut, and then just pass it out in the stool - so it never lets that oxalate get into the bloodstream to begin with. Fat in the gut will also bind with the calcium (which is what happens in our fat malabsorbing guts) so you need plenty of calcium EVERY TIME YOU EAT, so there there is enough to go around, and hopefully even get some to your bones after all is said and done.

Another thing I do to try to deal with the excess oxalate is to use a probiotic, which is good for us anyway, but I try to target one that has shown promise metabolizing oxalates. One that has been studied is called Oxalobacter formigenes, and last I checked, we can't yet buy it, but there is a very close strain that is sold in a probiotic called VS#3-DS. I can buy that, so I'm

Dr Keshishian also has some information on kidney stones, and many other things that I highly recommend you go read. It's easily understandable, and is accurate and up to date. It's refreshing for me as someone who has gone to specialists and teaching hospitals to sort out the kidney stone and some iron issues and taken years (my kidney stones pre-dated my DS) to get to the nitty gritty and most currant info, and see that Dr K now has the very latest and accurate info on his site in digestible form for us all to peruse. After having been through so much with it I see it as an absolute gift for his office to have consolidated such useful information and made it available for all of us. In case you don't know, very few of us have had surgeons and nuts that gave good information, let alone accurate.

The only thing on their information I may not agree with is about eating a low oxalate diet. I have yet to see any data that convinces me there is any benefit to eating a low oxalate diet. Not only that, but oxalates are in some of the healthiest foods, and think that avoiding those foods is more detrimental than beneficial, so I make zero effort to eat low oxalate, and do other things to deal with the oxalate absorption issue.

I'm sorry that you have been left to flounder. I can only imagine how discouraging and frustrating that is. All of the things you have going on can be dealt with, if you have a dr with a clue to help guide you. You'd have to take much more in supplements and protein of some sort, and be very aggressive in treating deficiencies, and getting copies of labs yourself (and there are some wise peeps here that can help decipher them) to make sure all things are being adequately addressed. I'm afraid it's not uncommon for us to have to really take the bull by the horns and be adamant and even aggressive with our care. If you just don't have it in you or are just over this DS, then Dr Keshishian is the guy you want to see about revising to a longer cc, or whatever you need. His information is the perfect place to start if you are going to just get your health back and not revise. Either way, that's where I'd start reading tonight, and I think many things will become clearer to you.

Thanks for all of this well presented information! Mwah!

 

[Poodles]

Went to the surgeons office yesterday. At seven years out I have lost 23 pounds in 25 days. I weigh 126 pounds and have a bmi of 19. I am 5'7" tall. All bones. Do not know how they figured my cc.

I do take the biotech dry form of a and D. I take these twice daily along with zinc and Dr. Stewart's multivitamin. My vitamins change often depending on lab levels. I do listen to the directions and follow them.

Unfortunately Dr. Stewart passed away and his partner has taken over my care. His name is Ayoola and he is very knowledgeable and teaches classes regarding the DS. He listens and wants to follow every patient.

Dr Stewart was top in the field, so I trust his choice in a business partner. I believe Dr Stewart knew Dr K.

My intestines can not handle the urocit-k. I have horrible acidic, burning bowel movements. That leads to other anal issues.

I have upped my Isopure shakes to 3 a day. Mixing with cream, cream cheese, avocado, banana, anything to get calories and protein. Tried weight gainer powder and DONT recommend it. Horrible gas pain.

Upped my multi to 3 day.

Ct scan on Sunday showed multiple kidney stones ranging from 1-5. From past history, They are calcium oxalate stones.

24 hr urine has been done before, and will get results of recent one on Monday when I see my specialist.

Dr Ayoola asked me if I want a partial reversal or full. I want a full. He says the reversals he has done have been successful. Malnutrition issues go away almost immediately. He cautioned about weight gain, and stressed diet change. Vitamins are still needed, because I still have the sleeve. He also stressed that he wants to follow me. No one can learn from DS experience unless the DSers tell the doctors the good news as well as the bad.

Hoping my nutrition will help depression, pain, kidney stones, neurological issues, memory loss, ability to ABSORB medications (instead of needing iv antibiotics) and other maladies. If it would help ANYTHING, I need it. I'm on the brink of a Tpn line, but he says my Ama is in range, and protein is close, so he would do the surgery. No Tpn unless I get worse.

Already on disability because of pre neuro illnesses. Had the surgery because my lapband eroded, I was pre-diabetic, back problems, high blood pressure. I don't want to go back to prediabetic and high blood pressure. The back pain will always be there. Know I must rely totally on my sleeve.

At 350 pounds a shorter channel seemed fine with me. Now I think it is too drastic, Ayoola says that 120 to 150 is common practice now. That is why he put the revision on the table. I will still have "minimal" malabsorption, due to how they have to put me back together. But not enough to really matter.

There is no guarantee that insurance will pay for the surgery, so I don't know if I'm even going to be able to have it.

There is no guarantee it will help any of my post op issues.

I don't want another surgery. But,
I have tried, I have modified, I have been tested and retested and sent up the ladder to specialists, changed back and forth from Vitaladies system to Dr Stewart's, and do not know what else to do.

Yes, I switch vitamin systems depending on budget. My numbers were good on each system. It's when they started checking for things not on the routine list, that the world of trace elements kicked my ass.

I have taken my vitamins, drank 2 40 gm shakes, ate a banana, a chicken salad with all kinds of crap in it (mayo, cheese,eggs),Three tbs peanut butter on 1/2 bread. It is 12:30pm here, and I will keep eating all I can. Throughout the day. I can't get worse.

I will keep asking questions, see if insurance will cover the surgery, modify my vites again, and try to gain weight. Never in my wildest dreams did I ever think I would want to gain weight.

It is literally hard to lift my head up. Something is wrong.

 

[DSRIGGS]

Honey, we really need to know exactly how much protein you are eating daily and how much of each vitamin you are taking daily or we can't tell if you are eating or supplementing properly. If you aren't eating at least 150 grams of protein a day you aren't eating enough protein.

and frankly the statement "At 350 pounds a shorter channel seemed fine with me. Now I think it is too drastic, Ayoola says that 120 to 150 is common practice now" is not completely true. As I tried to explain in my long first post. The common channel is ONLY ONE PART OF THE EQUAION. You are completely ignoring the Alimentary Limb which does absorb protein and supplements as well, as well as its length and the Bilo Pancreatic Limb length. Those things are crucial and if you need a revision these need to be part of the equation. It is exactly why I went to Dr K for my revision. My orginal surgeon just want to add, and he didn't have any idea how much and was going to be guessing, to my common channel. The common channel wasn't why I was malnourished it WAS MY ALIMENTARY LIMB BEING TOO SHORT>>>>>>HALF OF WHAT IT SHOULD HAVE BEEN. Dr K lengthened the AL and I was better almost immediately and well on my way back to goal weight.

Please give us your exact protein, water and daily vitamin intake so we can help you. No two people have the same supplementation requirements because we are all different, but we can look at your lab values and your daily intake and give very good advice how you need to adjust. These long term vets who have done very well, know their stuff in that regard and THEY WILL HELP.

Please don't make any rash decisions. I know you are hurting and I empathize but please make sure you make a 100% fully informed decicision that you won't later regret. The right decision might very well be a full reversal, but it also might be to get a revision.