SADI-S / Loop - Please share facts about this new procedure here.

[MyNewLife]

How do you make your beef stew? With this cold, that sounds soooo good.

 

[BKLYN07]

The cold weather I love beef stew, chili and chicken vegetable soup. I make the above in the crock pot on low and I let it cook for 8-10 hours.
Beef stew- two/three cans of progresso cream of mushroom soup,, bag of carrots and three onions and two/three packages of stew meat. I love it. My stomach does not tolerate tomato sauce well so the cream of mushroom soup is my substitute and I love it..

 

[Up2Me3]

I had the surgery on 12/3/13 and HW 268 and I range between 111-114. Nutritionist told me to do low fat! I realized this doesn't work for me because it causes constipation. High fiber causes constipation, too. I gave all the low fat products away and bought regular mayo and dressing. I really don't like fried foods but I do enjoy skirt steak, salmon ,broiled filet of sole , lobster and beef stew!!!

This is great to read. I had the SADI on 10/21/2014 and down 62.....I am very impatient and it does seem to be slowing a bit....my lowest week was 2pds. I'm ok with it slowing IF it stays steady. I don't feel like I'm dieting AT ALL .... find it hard to get in even my 80 proteins let alone 100. Congrats on making goal (I assume) I wish you continued success in maintenance!

 

[BKLYN07]

This is great to read. I had the SADI on 10/21/2014 and down 62.....I am very impatient and it does seem to be slowing a bit....my lowest week was 2pds. I'm ok with it slowing IF it stays steady. I don't feel like I'm dieting AT ALL .... find it hard to get in even my 80 proteins let alone 100. Congrats on making goal (I assume) I wish you continued success in maintenance!

Thanks! I am at goal. Trying not to loose anymore weight! i noticed the first two /three months i lost weight but it was 2/3 lbs a week then after 2nd /3rd month i started to eat more and the weight fell off of me!! Best of luck with your amazing journey! !

 

[marissamast]

@Sheanie I'd rather you stay. I hope I'm not making you uncomfortable. I'm just trying to stay neutral and ensure a balanced view. I want to understand why you think it is a really bad thing.

SADI is definitely new and there is limited information and that is a concern, but I personally don't have enough information at this time to gauge whether the SADI procedure itself is equivalent to, better than, or worse than traditional DS for patients. I just want to gather the facts.

To be clear, I think it is horrible when patients aren't properly and fully informed (1) about what procedure they are having and (2) about their surgeon's inexperience with a new procedure. I have a real issue with the reported bait and switch type scenarios which might be happening with some U.S. surgeons, particularly where self-pays are seemingly targeted for experimentation. This is not the case everywhere, though. When patients are informed, know the risks and are willing to be part of a test group for a new procedure and it is performed within the context of a formal study, I think of that as a positive.

Anyway, I hope you will stick around. Your view matters.

Remember....at one time, the DS was this "new and experimental" surgery too....with no knowledge of long term effects, and we need to be thankful to the people who took the chance.

 

[Pacifica]

Remember....at one time, the DS was this "new and experimental" surgery too....with no knowledge of long term effects, and we need to be thankful to the people who took the chance.

Thanks for saying that, marissamast. Your comment has encouraged me to make one of my own:

I've read all of the threads on SIPS - I'm all for balanced views and candor, and I really appreciate folks who do their research on newer procedures. Furthermore, my heart goes out to those on these threads who feel their surgeon didn't given them good info (or worse, misled them) prior to surgery. That is never, EVER ok.

Even so, I have to be honest and say that reading most of these posts regarding SIPS has felt like watching a witch hunt unfold. Now some folks here are pretty open minded, but the venom coming from others feels like a giant "my surgery was the best and only valid surgical choice" popularity contest, all dressed up in misinformation or huge amounts of conjecture about the unknown, which is a contest that a newer procedure could never hope to win.

I gave some thought about whether to even join so I could post this, since the environment for folks who opted for anything other than a traditional DS has seemed such that it doesn't really feel like a place someone like me could come for support. But I thought it was at least worth saying to all the folks on here. Candor and passionate advocacy are great. But so is kindness, support and authenticity. I mean no disrespect to anyone here, I just felt it was an issue worth raising. Thanks for hearing me out, and good luck with all of your journeys!

 

[robs477]

Thanks for saying that, marissamast. Your comment has encouraged me to make one of my own:

I've read all of the threads on SIPS - I'm all for balanced views and candor, and I really appreciate folks who do their research on newer procedures. Furthermore, my heart goes out to those on these threads who feel their surgeon didn't given them good info (or worse, misled them) prior to surgery. That is never, EVER ok.

Even so, I have to be honest and say that reading most of these posts regarding SIPS has felt like watching a witch hunt unfold. Now some folks here are pretty open minded, but the venom coming from others feels like a giant "my surgery was the best and only valid surgical choice" popularity contest, all dressed up in misinformation or huge amounts of conjecture about the unknown, which is a contest that a newer procedure could never hope to win.

I gave some thought about whether to even join so I could post this, since the environment for folks who opted for anything other than a traditional DS has seemed such that it doesn't really feel like a place someone like me could come for support. But I thought it was at least worth saying to all the folks on here. Candor and passionate advocacy are great. But so is kindness, support and authenticity. I mean no disrespect to anyone here, I just felt it was an issue worth raising. Thanks for hearing me out, and good luck with all of your journeys!

First off, I would like to say that I offer my you best wishes and best luck too you no matter what you decide. It sounds like you will be making an informed decision and that is by far the most important consideration.

I would now like to address your other comments. I have been coming here for almost a year or so, lurking since last July. And, at first I kind of thought that some of the posters may be "too direct" sometimes also and then realized pretty quickly (within a day or two) that it was just pure passion and knowledge that I was observing and the fact that these folks actually care too much! They are actually TOO kind and are VERY passionate about sharing their knowledge and experience and helping people. I would say at least 95% of the posters are Women and they are NOT the type of Women that play mind games or mince words and do “tit for tat”…or “my surgeries better than your surgery” etc. MANY of these folks are highly educated, and many are professionals, Scientists, Lawyers, Mathematicians etc, and many are just as educated from life’s experiences. I PROMISE you, they have NO SPECIFIC AGENDA or “axes to grind” and are only trying to help people to not make lifelong bad decisions. Plus, they literally have helped hundreds of people over many years and just try to get to the solution as quick as possible. That direct (Not waste precious time), problem solving prowess can also sometimes be miss-perceived or taken the wrong way.

That being said, no doubt, they are VERY PASSIONATE and confident about what they know and in particular are very much an advocate for the DS, just because it’s proven success and track record. As a Scientist, or as an Engineer, you generally go with the tried and proven most successful procedures for anything to give you your highest mathematical probabilities for success. All they are saying is, for something so very important, where you have only ONE chance to get it right, why would you take a chance or opt to have an experimental non-proven procedure?

The point regarding “someone had to be the first DS patient” is not really valid IMHO at all and is NOT comparing “apples to apples” so to speak. Reason being, because there were no mathematically statistically proven successful WL surgeries at that time of the DS inception, there were no comparatives, so essentially, everyone in that era was a lab rat.

So yes, please just be a little patient and understanding and I promise, you will get a lot more out of this than you could ever give back. Go back and read some of the previous threads from folks who said similar stuff and then once they obtained all the info, actually went and had the DS. The most recent being @Denis Korb and all his early posts.

These folks are extremely kind nice people and have become my friends and through their guidance actually helped save my life and MANY others. They selflessly spend a LOT of time trying to help people, and to me, you cannot find a truer kindness than that.

 

[JackieOnLine]

I gave some thought about whether to even join so I could post this, since the environment for folks who opted for anything other than a traditional DS has seemed such that it doesn't really feel like a place someone like me could come for support.

I hope you stick around regardless. this board is only a year old and growing but, yes, we need more people who didn't have the DS.

 

[DianaCox]

"Even so, I have to be honest and say that reading most of these posts regarding SIPS has felt like watching a witch hunt unfold. Now some folks here are pretty open minded, but the venom coming from others feels like a giant "my surgery was the best and only valid surgical choice" popularity contest, all dressed up in misinformation or huge amounts of conjecture about the unknown, which is a contest that a newer procedure could never hope to win."

I submit that you are reading this with a defensive chip on your shoulder - understandable - I've been seeing this for nearly 13 years now, and newbies who are just coming to researching bariatric surgery are often depressed, angry, sad, defensive, frightened, overwhelmed and confused - and thus defensive. Challenging their beliefs tends to be received as challenging their IQ - but we feel it is important to hit quick and hit hard when we see possible confusion or misunderstanding, especially when the person is "bonding" to a particular surgeon/procedure and well on the road to surgery, because the consequences of a wrong decision can be lifelong.

Please do not confuse criticism or even merely questioning of (1) the science behind the new surgery, which is unproven long term, (2) the really egregiously deceptive tactics we have seen from some of the SIPS/SADI/loopDS surgeons which we know the newbies aren't appreciating because they don't know enough to see it (remember, some of these surgeons who are adopting this easier surgery are DECEPTIVE, SLIMEBALL, SURGERY-MILL, USED-CAR-SALESMAN types, and/or their office staff is, who are in it primarily for the benjamins, no matter how slick their advertising is - we have seen it all!), including the truly repugnant sales tactic of describing as "just like the DS, but safer/less malabsorptive/fewer risks/fewer side effects" - because that is just FALSE; or (3) the patient's full knowledge of how the SIPS/SADI/loopDS differs from a proper/real DS, insofar as they are able to give fully informed consent.

Basically, most of us don't give a rat's patoot what surgery anyone gets - so long as they are able to give fully informed consent to the procedure, including for SADIsts understanding how their diet and nutritional requirements are going to vastly differ from DSers. Our frustration and objections arise from the mischaracterizations or outright lies so many of the SADI patients have been told. WAY too many had no idea they were not being given a proper DS before surgery, and some didn't find out until long afterwards (at least one Mexican surgeon in particular was just lying about it). As well as the fact that some of the surgeons were coding the SADI in ways that very well may not stand up to scrutiny, which could result in procedures not being covered, and (down the road) retroactive repudiation or denials based on the need for further surgeries for complications/failures. These are very REAL, very VALID concerns.

It is my fervent hope that the SADI replaces the RNY, which is sheer butchery in IMNSHO. But the deliberate obfuscation with the DS is deeply troubling to me, from both a patient care and a DS reputation point of view. I truly do not believe the SADI is going to work for a lot of people long term, but it is a metric shit-ton better than an RNY, so I definitely see a place for it in the bariatric repertoire.

The "good" things about the SADI are that (1) it has a sleeve and not a butchered pouch, and (2) it can easily be revised to a proper DS by adding the other anasomosis - the bad thing is that revisions almost never give as good results as the right surgery being done in the first place, because of the damage that every "diet" (any sort of caloric restriction, dietary or surgical) causes to the person's metabolism (lower the basal metabolic rate and increasing efficiency), so revisionistas are almost always at a significant disadvantage (to say nothing of the additional risks, costs, recovery times, etc., of undergoing two or more surgeries instead of one) compared to virgin DSers.

Frankly, I see the SADI (with a view to looking at a proper DS as a fall-back) as the same as cutting off the puppy's tail a little at a time - it is neither a kindness nor a good strategy if the odds are that you are going to need another surgery down the road. And not having the benefit of selective fat malabsorption, one of the very best features of the DS, is something that makes little sense to me.

So at least my personal view is, when I question someone coming to these boards and saying they've already decided on having a SADI/SIPS/loopDS, is that I want to make sure they REALLY understand what they are getting into, that they are not suffering from the delusion of treating their surgeon like he is a god and blindly following his recommendation to do something that is easier for him and lets him slide on responsibility for helping the patient live with more malabsorption (and better effectiveness), that they understand how very differently from DSers they are going to have to eat and supplement, and that they are going into it with the ability to give fully informed consent. I really don't CARE if they don't like my tone - what I DO care about is that they don't get sold a pig in a poke, and live to regret it afterwards.

This is from Dr. Keshishian's paper (attached) in 2004 about DS as a revision procedure - it has colored my attitude since I read it:

The other major consideration in revisional bariatric surgery is patient education. In this study, 96.2 % of the patients claimed that they were unaware of other weight-loss surgical options at the time of their primary operation. One could possibly question the validity of the informed consent at the time of the original operation. Our program incorporates an extensive preoperative education plan geared towards explaining the DS procedure in detail, clarifying the general risks of surgery, the resulting change in anatomy and the long-term follow-up requirements, including supplementation requisites to maintain vitamin, mineral and nutritional levels within normal limits. Patients undergoing DS as their primary operation are in addition required to attend group meetings for all other surgical procedures, in order to assure adequate informed consent. The surgeon has the duty to provide the patient with the information necessary for the patient to make an educated decision as to whether to consent to the recommended operation. For a patient to properly make that decision, all major surgical options, their advantages and disadvantages must be discussed. Patients who are fully aware of all their weight loss surgery options, will better select their primary operation, and will likely decrease their need for future revisional surgery. In our practice, we recommend that our patients not only attend group meetings but also seek a second opinion regarding other bariatric surgical procedures.

If you are fully informed, and go ahead with the SADI anyway, more power to you, and I hope it works for you, and of course you are welcome to post here, so long as you don't follow DS-specific advice - but I STILL want you and the surgeons to stop saying it is "just like a DS" - I want the language that is used to describe it to CLEARLY distinguish it from the DS for all of the above reasons, which could be life-altering if there is confusion.

 

[Pacifica]

I submit that you are reading this with a defensive chip on your shoulder - understandable - I've been seeing this for nearly 13 years now, and newbies who are just coming to researching bariatric surgery are often depressed, angry, sad, defensive, frightened, overwhelmed and confused - and thus defensive. Challenging their beliefs tends to be received as challenging their IQ - but we feel it is important to hit quick and hit hard when we see possible confusion or misunderstanding, especially when the person is "bonding" to a particular surgeon/procedure and well on the road to surgery, because the consequences of a wrong decision can be lifelong.

...


If you are fully informed, and go ahead with the SADI anyway, more power to you, and I hope it works for you, and of course you are welcome to post here, so long as you don't follow DS-specific advice - but I STILL want you and the surgeons to stop saying it is "just like a DS" - I want the language that is used to describe it to CLEARLY distinguish it from the DS for all of the above reasons, which could be life-altering if there is confusion.

Thanks for responding. Look, I'm sure you are somewhat weary of repeating yourself to every newbie who comes by fresh-faced and perhaps a little naive. And, after having read several of your posts in other threads, I've seen you put a great deal of time and effort into trying to guide folks who appear to be on the wrong track, or don't even fully understand what track they are on. Bad cop has a role, I get it.

But I really don't think my comment was based on a chip on my shoulder. I hadn't even made a final decision about my surgery type, nor did I ever claim that SIPS/SADI was "just like the DS". Or even close to the DS. There aren't enough longitudinal studies to make many reliable long-term predictive claims about SIPS/SADI - positive or negative. You know that, and I know that. And I specifically agreed that surgeons should be informing and not misleading patients, and that to hear otherwise was really disturbing news. Conflate me with other posters if you need to, but I don't think you need to.

You are right about one thing. Finding yourself at the point of considering these surgeries is an overwhelming time in a person's life. And while I by no means meant to limit anyone's speech (nannies aren't wanted and I wouldn't welcome that either), it just seemed like a bullhorn was being used on folks who were already shellshocked. That being said, I still appreciate all the effort and info you give, regardless of where you think I am coming from.

 

[DianaCox]

I'm not conflating you with others - you said "reading most of these posts regarding SIPS has felt like watching a witch hunt unfold" which sounds to me like a bit of a chip on your shoulder. And keep in mind that I write my posts somewhat generically - this was intended not just for you, but for those who will come here afterwards and read this thread.

As for your further "chippish" comment that "it just seemed like a bullhorn was being used on folks who were already shellshocked" - trust me when I say that was purely intentional. I feel it is CRITICAL to reach people who are on a speeding train path to making a wrong or at least not fully-informed decision. It is MEANT to shock and disturb, and make them question their decision-making process. It is NOT intended to be a rainbows-and-unicorns-and-puppies pat on the head - it is a wake-up call, served up as a smack in the face, before a bad decision is made. It is the only way many people can be reached through the fog on the primrose path their surgeons are leading them down.

 

[JackieOnLine]

I like Pacifica's post

 

[DianaCox]

One final comment - once someone has had their surgery (with or without a fully informed decision having been made), there is no point in hammering on them further - support is unconditional after that. If the person runs into trouble afterwards with what I would consider an ineffective or inferior surgery, yes they will likely be steered towards the DS again, especially if they are thinking about trying a waste-of-time-and-money half-assed revision.

We are trying to help people make the best decision for them, by advocating for the one we know has the best statistics, bar none. The SIPS/SADI/loopDS is likely to be a vast improvement over the RNY, but I doubt very much that the long term results are going to match the DS. And that's important for people to know before they commit to ANY surgery.

 

[JenKapNC]

I will add that had it not been for this board and Dr. Ara Keshishian's great website explanations/graphics, I would not have known about the DS. My options were band (which Dr said he didn't endorse anymore), sleeve (which was highly touted), RNY bypass and SIPS which was strongly recommended over RNY if a malabsorptive procedure was desired. I'm sure it's just a surgeon sales tactic. Don't inform about procedures you don't do. Misleading? No, not IMO. But, it would be helpful if every Doc out there informed their patients of every option available. That puts the onus on the patient to do the research. I understand both of your points of view and we are all here to learn and share the knowledge and experience we have. I can appreciate that regardless of the delivery. Looking forward to more info on this "new" procedure. I hope it has positive results so that it can at least replace the RNY as others have mentioned before.

 

[DianaCox]

"Don't inform about procedures you don't do. Misleading? No, not IMO. But, it would be helpful if every Doc out there informed their patients of every option available. That puts the onus on the patient to do the research."


Um, not only is it misleading, it has been determined by at least two courts to be unethical: http://www.amednews.com/article/20090824/profession/308249981/2/

Separate high court rulings in Maryland and Wisconsin may impose greater liability risks on physicians who fail to tell patients about treatment options.

Doctors must inform patients of all relevant treatment alternatives and the risks, according to unanimous decisions issued separately July 24 by the Maryland Court of Appeals and the Wisconsin Supreme Court. The two courts also clarified that proof of medical negligence is not required for plaintiffs to bring an informed-consent claim.

"The gravamen of an informed consent claim ... is a health care provider's duty to communicate information to enable a patient to make an intelligent and informed choice," the Maryland court said. "The law does not allow a physician to substitute his judgment for that of the patient," judges said, citing a court precedent.