So New

Discussion in 'Say hello!' started by Rainerific, May 31, 2017.

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    Spiky Bugger

    Spiky Bugger Well-Known Member

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    Aim for two pounds a month, just to shut them up.
     
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    Ever Changing

    Ever Changing Member

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    The True wildberry lemonade packets with stevia are excellent. I'm not a fan of the Mio liquids, but Kool Aid liquids with sucralose are good. I look for stevia first, then sucralose, and try to limit aspartame.
     
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    Rainerific

    Rainerific New Member

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    It's been a little while since I updated. So I'm working on my third month of my insurance's required doctor visits. I've lost 17 pounds since I started the low-carb diet. So I'm slowly loosing, but I'm also not stressing about being perfect. I had Japanese Hibachi (with fried rice!) for my anniversary on the 7th.

    On Monday I'm heading up to Duke for my psychiatric evaluation and to actually meet Dr. Sudan! I'm writing down my questions for him so that I don't forget to ask anything. What all should I ask him?

    I've never seen a psychologist before. I know that I need to be truthful, but I am worried (but I worry about everything...) about how that will go. They said that my visit with him will be 2 hours long!

    Anyway, I'll continue to lurk this website and gleem information. Thank you so for making it so accessible to newbies like myself!
     
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    Caitlunn

    Caitlunn Well-Known Member

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    I had to see the shrink twice before my surgery. Both times, I was extremely nervous. I have dealt with mental illness in the past, so I was worried they were going to tell me I was "too crazy" to be operated on.

    Both times, I was pleasantly pleased with how the visit went, and I left feeling reassured. Remember, these people aren't there to just tell you no! These measures are in place to help you achieve healthy mental habits, along with the physical ones given to you with WLS.

    We all know emotional eating is a real thing. Therapists know that, as well. It's okay to admit your coping mechanisms. If anything, it's helpful. The therapist that I saw right before my surgery gave me ideas on literature to read, and even phone numbers of other patients from the practice that had volunteered to be mentors. Truely, it was very helpful.
     
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    CaitlynR

    CaitlynR Aspiring Wizard

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    Hi! I had surgery with Dr. Guerron from Duke on 9/25/17. I just finished my 2 week pre-op appointments yesterday. Our group all talked about our interactions with our surgeons. I like my surgeon, but from what I heard Dr. Sudan sounds the best of the group in terms of taking time talking to patients, being caring, etc. I felt mine was very willing to talk about more intellectual stuff, which was great for my personality, and a bit uncomfortable with more emotional stuff, which wasn't an issue for me. Everyone was happy with the actual skill and surgical care they received.

    The psychologist visit was not a big deal for me. I do have mental illness (recurrent major depression and generalized anxiety), so she wanted something from my psychiatrist. I am also a psychologist so I knew what to expect from a general evaluation. Just be honest, psychs can often tell when people are trying to look too good. They mostly want to know if you have any past or current mental illness, especially eating disorders, and if you have the ability and motivation to follow medical recommendations. These things take a while as people in general like talking about themselves so don't be intimidated by the time allotment, it may not take that long.

    I have to drive 2 hours each way, and it is worth it as Duke really is a good hospital and the surgeons are top notch. The nutritionists are nice but I find time with them is a bit of a waste of the drive and time, especially if you are reading lots of info and talking to people here.

    They do 200-300 common channel lengths. I talked to my surgeon beforehand, and we agreed to do 100. I recently saw my post op report with all the lengths and they come very close to Hess calculations so I am very happy about that. The only thing I've been unhappy about is that the team had no concern that my iron stores were depleted before surgery despite oral supplements for months. I was able to get an iron infusion a week and a half after surgery but it took a lot of personal legwork to make it happen.

    Feel free to contact me! Ray_of_Fricken_Sunshine also had surgery from Duke a bit over 3 months ago I think.
     
    Last edited: Oct 11, 2017
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    Rainerific

    Rainerific New Member

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    Guys, I have a surgery date! January 16th! I’m wildly excited!
     
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    Munchkin

    Munchkin Full of Fairy Dust

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    CC length??? And congratulations!
     
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    Susan in Tennessee

    Susan in Tennessee Well-Known Member

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    Great news, that's going to be here so quickly!
     
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    Rainerific

    Rainerific New Member

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    100! Dr. Sudan does a cookie cutter DS. Thank you!
     
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    DianaCox

    DianaCox Bad Cop

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    @CaitlynR@CaitlynR - I find this statement odd:

    “They do 200-300 common channel lengths. I talked to my surgeon beforehand, and we agreed to do 100.”

    A traditional 2 anastomoses DS cannot to my knowledge have a 200-300 cm common channel, because the traditional DS has an approximate 250 cm alimentary tract. Conversely, a single anastomosis SADI cannot have a 100 cm common channel, because the whole alimentary tract is common channel.

    It sounds to me like they were planning to give you a SADI, until you insisted on a shorter cc. You may have dodged a bullet. Did you know this?
     
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    CaitlynR

    CaitlynR Aspiring Wizard

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    It was not a SADI. Dr. Guerron shared that he and his team were integrating what the field was learning from surgeries such as the SADI with the traditional DS. He felt that lengthening the CC results in comparable metabolic effects (although lower weight loss) with lower risk of gastrointestinal effects (gas and loose movements).

    Although it is a different office than I went to (which was Duke) nearby is Bariatric Speacilists of North Carolina. Google their site and read the description of the DS. It clearly shows 2 anastomoses and that they use a 300 cm CC. This leads me to think that this idea is common for the region.

    What bothered me he most about this deviation was there was not going to be any informed consent that how they perform the DS is nonstandard. CC length was not listed in any material and no one brought it up until I did, and in fact I wasn’t even going to see the surgeon after the initial consult but I asked to during my pre-op visit. I can respect if they are studying this variation, but I don’t respect that it is not spelled out with written informed consent as an experimental deviation.
     
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    DianaCox

    DianaCox Bad Cop

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    If they made a 300 cm common channel, how long was the entire alimentary limb going to be? My entire alimentary tract is 250 cm, of which 150 cm is alimentary only and 100 is common channel. My biliopancreatic limb is, if I recall correctly, 280 cm (total small bowel length was 630 cm).

    Seems to me that a 300 cm CC would have a ridiculously short section of jejunum between the duodenal anastomosis and the biliopancreatic limb anastomosis. And thus little or no selective fat malabsorption, and thus a pointless second anastomosis. It makes no sense to me.

    The picture on their DS page doesn’t remotely represent a 300 cm CC.
    http://www.surgerync.com/bariatric-procedures/ds.php
     
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    CaitlynR

    CaitlynR Aspiring Wizard

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    Yeah, the picture is consistent with a much shorter CC. I know Dr. Guerron could not provide evidence (published research studies) supporting a 200-300 cm CC length with a two anastomoses DS. I had found one that I mentioned to him that compared 200 with 100 (which found similar metabolic improvement and initial weight loss with much more significant weight regain).

    I agree it doesn’t make a lot of sense. I suspect that since the one anastomosis type is still officially experimental, doing a traditional DS with a long CC allows some of the (purported) benefits of the SIPS/SADI etc such as lower incidence of bowel problems and lower risk of nutritional deficiencies while getting most insurances to pay for it and using the outcomes data obtained from the “classic” DS to advertise to prospective patients (not that I feel at Duke that the DS was particularly encouraged as an option).
     
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    southernlady

    southernlady Administrator Staff Member

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    No, not common for the region just common for THEIR office.
     
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    CaitlynR

    CaitlynR Aspiring Wizard

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    Well, two offices in Durham, NC.
     

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