Today I Advocated for Myself!!!

[Ray_Of_Fricken_Sunshine]

I tried to post this earlier, and for some reason, I can't find it anywhere...

So, I know that advocating for myself doesn't seem like a big deal, but y'all, it really, really is for me. I've always been the person that will fiercely defend anyone else, but will crawl under a rock when it comes to defending myself. I had my Pre-Op with my surgeon today, and we got into a discussion about Common Channels.
My Dr. said that as a group, the Duke bariatric surgeons do the same length common channel on everyone-250cm. I told him that I was very uncomfortable with that, and that the longest common channel I'm willing to have is 100cm. He began arguing that the length of the common channel does not negatively affect how much weight I will lose, and that he does a very tight sleeve to guarantee my weight loss success. He also told me that the malabsortion rate with a 100cc is too high, and that the diarrhea would be too much to live with. He promised me that I will shit myself. Regularly.
I reminded him that he told me to become an expert in this surgery, and that I have been obsessively researching since. I explained that what I learned that was while the shorter cc may not affect my initial weightloss, the malabsortion is what helps us maintain our weightloss over time; and I don't wan to spend the rest of my life battling regain or perpetually "dieting". I told him that I understand a lot of his patients are stuck in their ways, and don't supplement like they should. I told him that this is my one shot, and I want to do it the right way, and be aggressive; and that if he would not consider doing a shorter CC, I would seriously reconsider having the surgery.
He listened to what I had to say, and when I was done, he said that I was one of the most educated patients he has had(HAHAHA... He would be blown away and not know what to do with y'all!!!), and that if I feel that passionately about it, he would agree to the 100cc.
I even asked him to put it in writing, and he said that he would include it in the surgery notes that it is to be done.
Again, I know that it doesn't seem like a big deal, but for me, it's something really big. Granted, I disclaimered the entire time.. "Please don't think that I think I know more than you..." "I know that you're the surgeon who has been practicing for years, and I just recently started learning..." "Please don't think that I'm being disrespectful..."
Now, the majority of my knowledge comes from y'all, and I can't thank y'all enough for everything you have all done for me so far!! Now, Please be right!!
@Larra , @Clematis , @Munchkin , @cchall , Y'all helped me so much with this thread:http://bariatricfacts.org/threads/hey-im-a-newbie.5397/page-3#post-81312
Thanks so much!!

 

[DianaCox]

Good for you!!

I have to say, one of the most useful things for me in day-to-day life about having a PhD and law degree is having the ability to wave them in the faces of my doctors to get them to speak to me as if I were a knowledgeable "colleague" in another specialty. In fact, that's what I tell them - "just talk to me like I am an ophthalmologist or something so narrowly focused that you have to explain things, but at a high level. I'll stop you if I need more of an explanation."

Most - but not all - of the time, they don't treat me like an older housewife. When they do, I move on.

 

[Ray_Of_Fricken_Sunshine]

LMAO, Miss @DianaCox I wanna be you when I grow up!!! Unfortunately, doctors don't hold a culinary degree in the highest regard.

 

[Munchkin]

Congratulations to you! And this is just the beginning. Yes, it's WLS but for a whole lot of people it is also assertiveness training. And it will serve you well in all areas of your life.

Here's a secret. Every time you stand up for yourself, it becomes little easier the next time. It changes the color of your world when you know you can do this. Tomorrow you will be walking a little taller!

So you stated and defended your position and you won.

And yes, we are right. My CC is supposedly 75 and I wish it was shorter!

 

[Ray_Of_Fricken_Sunshine]

But for real, y'all, is the diarrhea going to be like that? Am I going to shit myself? Because he made it seem like that was such a common thing; and I'm just not at the point in my life that I've accepted soiling my damn self a common thing.

 

[Charris]

But for real, y'all, is the diarrhea going to be like that? Am I going to shit myself? Because he made it seem like that was such a common thing; and I'm just not at the point in my life that I've accepted soiling my damn self a common thing.

my common channel is 50. i don't s*** myself although when I have been sick and thought it was gas 2 times it wasn't. not bad in 4 years

 

[harrietvane]

Mine is 100cm, and I don't shit myself either. I have had one slight accident, but that was food poisoning, not DS. With the proper calcium supplementation, you're more like to have 'stop' problems rather than 'go' problems.

 

[Clematis]

You've got the power, Ray!

Your next step is to tell your surgeon you do not want "a very tight sleeve". You will be miserable. The doctor is applying VSG (wiggly) science to a DS: your VSG and the time to adjust to it is what will slow you down int he beginning and it's the switch that will keep the weight off as you go forward. Im not saying that the sleeve isn't important in the long run as the synergism of both components are magical, just that you don't need to be as girdled as someone who is only relying on a VSG.

I have a loosely stapled 37 bougie. If you are unfamiliar with that term, the bougie (BOO-zhee, "g" is pronounced like the "z" in ZaZa) is a banana shaped tool that is slid into your stomach and used as a size guide, the stomach stapled around it, then the bougie is removed. Just as a surgeon can measure out your common channel with the intestines pulled taut or loose, the surgeon can staple tightly or loosely to the bougie so it is not a perfect science. What you want is a sleeve size of about 5 ounces or 3/4 cup. If it were me, that's what I'd tell the surgeon.

I was TERRIFIED of the poop and gas issues people report. I have NONE of that, thank god. I poop once a day when I get up as I have done my entire life. The first few months I did need to get up quickly to poop but that soon settled down. There was 2 times while I was out on my 4 mile power walk that I suddenly had to poop like NOW and made it back to a library near the trail the first time. The second time I had to drive home making deals with the almighty to get me home and in the door. But was that DS or just random loose poopies from another cause? Who knows. As for gas, it took me 9 months to realize that my gas (which was never bad, BTW) was after I had milk and I must have developed lactose intolerance after the surgery, a common occurrence. (Only with milk, not yogurt, cheese, ice cream or protein drinks.) My problem has been more with constipation from the calcium supplements and I have had two horrifying episodes where I thought I was going to die, the last ended me in the ER just a month ago after having a lower body lift and being on Percocet for 4 days. But again, DS or Percocet? All that said, yes, there are a few people who have loose poopies after the first few months but I'll bet this is due to eating too much fat. I do not, in fact I have to track my fat to make sure I get enough so I can poop!

I'd wish you good luck but you don't need luck when you have the power of FACTS!!!

 

[Clematis]

Oh, one more thing. People who are having problems seek out online forums to check if their issue is normal and/or how to remedy it. Therefore some of the reports (i.e. pooping oneself) can make it seem like most people have problems when in fact those who have no problems never bothered to join online forums in the first place. The same may apply to surgeons -- all they hear from are the squeaky wheels. Those without issues have their surgery and fade away in bliss.

 

[Ray_Of_Fricken_Sunshine]

@Charris No judgement, Girl. Who among us hasn't taken a gamble and lost in that department?!
@harrietvane Food Poisoning is no joke!! BTW, every time I see your posts, I always think that you have the best superhero name! Random, but true!

@Clematis You always know what to say!! My surgeon did mention the bougie(I'm so glad you told me the correct pronunciation! I before E, I can work around... But G sounding like Z? The English language is just bazzar!) but he mentioned it briefly, and seemed to get sidetracked, tapering off mid sentence to get back to his original point. I want to say that he mentioned a bougie range of 37-48. To be honest, I was so focused on not getting distracted from the CC conversation, I let that go.
I have read so many different posts about bathroom behavior, and based on veterans responses, I just assumed that I'd have to take it slow with reintroducing things back into my diet, and stay away from carbs. When he was so adamant, however, it shook me a little! The perspective that you offered makes complete sense, though. It's a perfect explanation. Thank You!

 

[southernlady]

Good for you.

 

[DSRIGGS]

You've got the power, Ray!

Your next step is to tell your surgeon you do not want "a very tight sleeve". You will be miserable. The doctor is applying VSG (wiggly) science to a DS: your VSG and the time to adjust to it is what will slow you down int he beginning and it's the switch that will keep the weight off as you go forward. Im not saying that the sleeve isn't important in the long run as the synergism of both components are magical, just that you don't need to be as girdled as someone who is only relying on a VSG.

I have a loosely stapled 37 bougie. If you are unfamiliar with that term, the bougie (BOO-zhee, "g" is pronounced like the "z" in ZaZa) is a banana shaped tool that is slid into your stomach and used as a size guide, the stomach stapled around it, then the bougie is removed. Just as a surgeon can measure out your common channel with the intestines pulled taut or loose, the surgeon can staple tightly or loosely to the bougie so it is not a perfect science. What you want is a sleeve size of about 5 ounces or 3/4 cup. If it were me, that's what I'd tell the surgeon.

I was TERRIFIED of the poop and gas issues people report. I have NONE of that, thank god. I poop once a day when I get up as I have done my entire life. The first few months I did need to get up quickly to poop but that soon settled down. There was 2 times while I was out on my 4 mile power walk that I suddenly had to poop like NOW and made it back to a library near the trail the first time. The second time I had to drive home making deals with the almighty to get me home and in the door. But was that DS or just random loose poopies from another cause? Who knows. As for gas, it took me 9 months to realize that my gas (which was never bad, BTW) was after I had milk and I must have developed lactose intolerance after the surgery, a common occurrence. (Only with milk, not yogurt, cheese, ice cream or protein drinks.) My problem has been more with constipation from the calcium supplements and I have had two horrifying episodes where I thought I was going to die, the last ended me in the ER just a month ago after having a lower body lift and being on Percocet for 4 days. But again, DS or Percocet? All that said, yes, there are a few people who have loose poopies after the first few months but I'll bet this is due to eating too much fat. I do not, in fact I have to track my fat to make sure I get enough so I can poop!

I'd wish you good luck but you don't need luck when you have the power of FACTS!!!

I am so glad you posted this @Clematis .

Ray DITTO, DITTO, DITTO to what Clematis said about the dangers of a tight sleeve. There are too many dumbass surgeons out there (yes I said it) doing tight sleeves who FUCK PEOPLE UP (yes I said that too). I believe it was Dr K who did the study but there is ZERO CORRELAION between long term weight loss and sleeve size. I think a 36 fr bougie compared to a a 56 fr bougie.. (tube they use to shape the sleeve...they staple against it and the larger the number the larger the diameter of the tube...and should be a larger sleeve...however some surgeons staple very tightly agains the bougie and some more loosely so a 36 fr bougie does not necessarily mean two sleeves formed using it will be the same size). There was no difference in long term weight loss.

Remember, as you have said, the sleeve gets the weight off initially but if you have been around for a while and done your research you know it doesn't keep the weight off. Because so many VSG patients get revised to DS a few years later. Dr K even has patients who he can't convince to do a DS and opt for just VSG, sign a "I told you this wasn't going to work but you did it anyway" document for when he says they inevitably come back 2-3 years later having regained all or most of their weight.

A tight sleeve can cause serious and irreversible GERD that can lead to Barrett's esophagus and potentially esophageal cancer. It can cause a stricture. There is simply no advantage to a tight sleeve so get that guy to do as big as sleeve as you can get him to do. My sleeve was done at roughly 5 oz and I am a bean pole now.

BTW, I have to disagree vehemently with the common channel focus. The common channel is simply one part of the digestive track and the Alimentary Limb still absorbs nutrients even though there is not digestive juices. I became malnourished, not because I had a 100 CM CC (it was actually 125 when Dr K measured at my revision) as according to the Hess Method it should have been shorter, but because my Alimentary limb at 150 cm was too short. My point is that without measuring your total small bowel length the Dr is FUCKING GUESSING and putting you AT UNNECESSARY RISK of losing too much or not enough weight. The CC AND THE AL (people forget about this equally important limb as if it doesn't matter...that is pure boooool sheet) need to be determined based off of science, not just guessing. CC length alone will not determine your weight loss.

BTW, I do agree that a 250 CM CC is WAY TOO LONG.....that, I think, can be safely said without measuring. Sure there will be no malnutrition but there will likely not be much weight loss long term either.

Again as a disclaimer. The standard limb DS works well for many patients, but I think that depends on height and SBL. Shorter people in general have shorter SBL's than taller people, so the shorter subset have much better luck with the Standard Limb than taller people. That being said, some people who are shorter may be given TOO LONG OF AN ABSORBING PATH (the opposite of me) and they DON"T LOSE ENOUGH WEIGHT. I don't think it is a CC issue it is a TOTAL AL ISSUE (CC + AL btw I hate that they call the combo the AL and just the AL the AL...not too confusing is it...LOL).

Anyway, please tell the guy no on tight sleeve and tell him to take and extra 15 minutes to measure your SBL and give you a proportional limb length DS (HESS).

 

[DSRIGGS]

and I forgot to say, yes, Great job advocating for yourself. It is sad because we are taught to trust our Dr's but if you don't advocate for yourself in our system you are at risk of bad outcomes. You know your body.

One final comment on diarrhea. You will hear many DS'rs tell you that you need to chug fat. I am not a fan of that advice because it can cause diarrhea and the dreaded oil slicks. Some people need more fat in their diet than others because we all have different DS's....some absorb more or less fat relative to others. You will find a balance and your bowels will tell you based on what you are eating. Too much fat will cause diarrhea. Too little can result in constipation but there are other things that can cause that (too little water, calcium citrate can be binding so I use Jarrow Bone UP instead for my calcium...I don't need iron but I know for others it can be binding) ....so I am just saying. No diarrhea isn't a given for the DS .....as Clematis said, on message boards and groups we hear the horror stories but there are so many out there having no problems.....so you will learn with the help of this place and some other FB groups, to adjust your diet for good bowel health.


Best wishes

 

[aaa]

@Ray_Of_Fricken_Sunshine I'm a 100 cc and have had a few accidents. They've been at home & when I've eaten junk. At night. I do go to the bathroom 4-5x/day but those are definitely not accidents. Plus, I rarely have to run. I can generally hold it for a time.

Congrats on advocating for yourself. I did it, too, when one surgeon wanted me to get a RNY and I had done the research like you & said no. I went elsewhere. The next set of doctors were so impressed with my accordion folder of information they said they knew I'd be a diligent patient, lol.

BTW, Diana is right. Waiving the JD does help. They seem to take me more seriously.

 

[Larra]

Great job, Ray, both for becoming so well informed and then for using your knowledge to advocate for yourself successfully.
@DSRIGGS is right that there is more to the story than just cc length, but if that's done wrong, the others will be wrong as well because all the limbs come from the same source, i.e. your small intestine. So even if you can't get the surgeon to measure and use the Hess method, having an appropriate cc is going to help make the other limbs reasonable lengths as well.
And everyone is also right about a tight sleeve not being a good thing. I think what has happened, for some surgeons or groups, is that they have a few patients who don't follow the nutrition rules and get into trouble, and these people can be very sick and very difficult to get back to good health. Doctors are human and these experiences affect their subsequent approach. But with the DS, there is no advantage to you in having an excessively tight sleeve, and some potential disadvantages.
I would recommend that, on your consent form, you write in something about a cc of 100 cm or Hess method, and no tight sleeve. If you have email access to your surgeon, I would also recommend you send a very polite, appreciative email today thanking him for listening to your concerns and for agreeing to make your cc 100 cm and not too tight sleeve. Document everything. You can't be too careful.