Back home, kissing x revision.

[Poodles]

Going to the doctor tomorrow. I have been taking my vitamins, have been eating what I can, and have been drinking protein shakes.

I can tell that I am absorbing a little more because of my medication. Took a pain pill one time and nothing. The next time it knocked me on my bottom. (Not literally).

The DS forum, Dr K, has recommended a lot of great articles about neurological issues post bariatric surgery. Most due to vitamins and minerals that are not on my doctors regular lab list.

I have been forwarding these to my surgeon and would like to be tested for these.

If the 2 week labs will not be accurate should I ask for them to be tested anyway? Then compare to later labs?

 

[JackieOnLine]

no idea about the labs but contrats on your revision and I am glad you are feeling so well.

 

[Poodles]

What am I?

Surgeon has ordered DS labs for me, plus copper, selenium, and thiamin.

I have gained 5 pounds, and my BMI is right at 23.

Surgeon says I need to supplement as if I were a sleeve patient. I AM going to wait for the labs first, but I bought the bariatric advantage multi for sleeve patients, per his advice.

Since I know the vets here are more experienced, and I do listen (hence the kissing X instead of a reversal), what would you guys consider a revised DS?

Would you consider yourself a sleeve patient with their rules?

OBVIOUSLY, I need to rely on the lab results and adjust vitamins accordingly. And my diet needs to change, but I am just wondering if I am just a sleeve now.

Weird question, I know. To me, I'm a revised DS and need to supplement as such until lab levels say otherwise.

 

[southernlady]

OBVIOUSLY, I need to rely on the lab results and adjust vitamins accordingly. And my diet needs to change, but I am just wondering if I am just a sleeve now.

NO, you are not a sleeve. You are still a DS'er.

What was your original common channel and did your surgeon tell you about how much he added thru the revision into that length?
I am a virgin DS'er with a 175 common channel and while I don't supplement as many vitamins, I still watch ALL of mine like a hawk cause deficiencies are hell to dig out of.

 

[Jo777]

I would def say NO to treating yourself like a sleever.. I treat myself as a normie as a sleever, which means intermittent vites. Once a year or less I get a full vite panel and nothing has been low- save D, when I don't supplement, which I try to since it's a good thing to have in a good range.. I eat plenty with zero malabsorption so imo, and per my labs- I'm doing a-ok. You will need more than a couple Centrum a week.

 

[DianaCox]

Kissing X revision - the distal portion of your duodenum and much of your jejunum is still not touching food, and the admixing of pancreatic enzymes with food is not the same as it was. You are probably just as prone to certain micronutrient issues (iron, zinc, copper) as you were before - just more absorption of fat, carbs and protein.

 

[Poodles]

Per the operative report:

Procedure: laparoscopic enteroenterostomy

Findings: The anastomosis at about 20cm down the ambulatory limb and biliopancreatic limb.

Detail (I shortened it a little):

Sleeve gastrectomy was identified, followed down to the duodenal ileal anastomsis and identifying the ambulatory limb. Marched down about 20cm and placed grasper here. Identified the ligament of Treitz and measured out about 20 cm. Placed stay sutures of O Surgidac between ambulatory limb and biliopancreatic limb and created enterotomies. Fired white load of the Endo-GIA stapler to create a side to side staple anastomsis and closed the common enterotomy with a 2-O V-Loc in a running fashion. Once accomplished, a crotch stitch was placed at the crotch of staple line to reinforce it.
------------------

Dr Stewart originally gave me a 85 cc.

 

[Poodles]

As for deficiencies being hell to get out of, I agree.

I am in hell.

Diana, I am hoping that the procedure will help absorption of more than just fat and carbs. Have been low on protein before as well. Really hoping this will help my malnutrition issues. If not, all of this would have been in vain. I'm tired. Broken down. (Poor me). Trying to make the right move.

A true revision is not an option anymore, hoping I made the right choice.

 

[DSRIGGS]

As for deficiencies being hell to get out of, I agree.

I am in hell.

Diana, I am hoping that the procedure will help absorption of more than just fat and carbs. Have been low on protein before as well. Really hoping this will help my malnutrition issues. If not, all of this would have been in vain. I'm tired. Broken down. (Poor me). Trying to make the right move.

A true revision is not an option anymore, hoping I made the right choice.

What do you mean a true revision is no longer an option? Your surgeon simply gave you a side to side anastomosis with your BPL 20cm from your duodenal anastomosis. In other words you only have 20cm of small bowel path where the food isn't mixed with digestive enzymes.

A couple points, assuming I read the surgical report correctly:
First, if you had a BMI of 23 it sounds to me like your issue was plain and simple improper supplementing.. Secondly, you still have the dudenum bypassed so you are not going to absorb enough nutrients and minerals not to supplementing your DS malabsorbing vitamins and minerals. So now you need to take the proper amounts of A, D, E, K, iron, copper, zinc and calcium citrate. Labs will tell you how much to take and that is still going to be a lot more than what you were taking.

Yes, you had a true revision to add absorbing small bowel. No you didn't haveca full reversal.

How much of the vitamins I listed were you taking daily? Did your surgeon give an injection of vitamin A, D or an iron infusion. If you were low prerevision and he didn't, well that would be negligent.

It is up to you to supplement properly or you will not see any significant improvement of your lab values. FYI a 23 BMI is healthy IF you are getting enough vitamins and minerals and eating enough protein.

 

[Poodles]

I was at 18 bmi. Have been on Tpn line several times over the years.

Was diagnosed with primary lateral Sclorosis and went to the top person in tx for it. She ran a test for copper and I was severely low. Her diagnosis is that my neurological issues are "probably" due to the malabsorption.

My lab tests have been occasionally low on zinc, protein, d,a. I have been getting D shots. Increased my protein, taken dry AD, etc.

I have my labs tested annually, if something was low, every 6 months.

According to research upping my zinc probably lowered my copper. This is the first time anyone has tested for copper.

Have been taking Dr Stewart's DS vitamins, dry D, A, and zinc. Upped protein shakes, and still had problems.

If I get sick, I drop weight quickly. Last time was 20 lbs in 2 weeks, which landed me in the upper teens of bmi.

Another surgery is out of my price range, which is why I say it is not an option.

I wanted a reversal to try and fix my malabsorption issues. According to the diagram, I chose wrong. Now, I will need to change my diet, and still have malnutrition issues because I did not revise totally.

Supplements are not the issue. I have been taking them and modifying them according to lab work, but I never had anyone put the neurological issues together with my wLS before.

The pls diagnosis/issues may not be related, but I wanted to absorb things "normally" to find out.

This is so messed up. I had surgery for nothing.

 

[DSRIGGS]

Please list how much of each vitamin you take daily. If you are in a DS office recommended vitamin list I doubt you are taking anywhere close to enough. For example they would like recommend maybe 50.000 IU of d. I need 200k daily, dame with A.. DS surgeons in general guve terrible nutritional and supplementing advice so please list how much of each supplement, total for each day and frequency as well as last level for each.

We can help you if you share that info

 

[southernlady]

Have been taking Dr Stewart's DS vitamins, dry D, A, and zinc. Upped protein shakes, and still had problems.

No disrespect to Dr. Stewart but what DS vitamins?

 

[Larra]

@Poodles don't panic! You had a near total reversal of the "switch" part of your DS. The new anastomosis of the alimentary (not ambulatory, sorry to correct you but I just couldn't stand it!) and BP limbs is just 20 cm past the old anastomosis. 20 cm is about 8 inches, roughly. So now, almost all your small intestine is back in the game. Yes, you will still have a little malabsorption, but you should now have much greater absorption of fat and protein, and of the fat soluble vitamins as well. You will probably still need to supplement iron and calcium and maybe some others, but really, this is how a "reversal" of a DS is usually done and it should make a big difference for you.
Is it a true, complete reversal? No, that would involve taking the switch completely apart and would be a much larger and more risky operation. What you had has been done before and works well without subjecting the patient to unnecessary risk.
So just focus on your recovery, and let us know how things go. I'm very hopeful that this will help you greatly.

 

[Tblues]

Glad you were not reversed and hope you feel better soon. . Since you still have a DS, taking vitamins as required is still crucial because your doudenam is still bypaased and that is where much absorbing of many vitamins happens. You will also still need to focus in protein first eating. Additionally you may need to take Creon for awhile until back on solid ground as surgery knocks us for a loop even when going in healthy..... So your body needs nutrition...

Since your stomach wasn't touched you should be able to eat regular food as well. With my channel lengthening revision I was able to eat regular food immediately . You need the nutrition so I would advise you get to real food as soon as you can tolerate it..150 grams of protein daily should be your goal and of course 64 oz water at minimum.

I’m new here and I realize that this is a very old posting. My question is I recently was revised to two connections since my initial surgery was SADI. My surgeon did not touch the sleeve. It’s so strange because I feel so hungry. I’ve been doing the liquid portion two weeks before and now 5 days po. Is this normal?

 

[southernlady]

I’m new here and I realize that this is a very old posting. My question is I recently was revised to two connections since my initial surgery was SADI. My surgeon did not touch the sleeve. It’s so strange because I feel so hungry. I’ve been doing the liquid portion two weeks before and now 5 days po. Is this normal?

Yes, is normal. You need the new connection to heal. And to heal means just liquids for a while. And since your sleeve wasn’t touched, of course you’re hungry. Feed it all the liquids you can for now focusing on protein.