conceit--update

[conceit]

Hi guys,
I haven't been here in a while. I've been busy working, healing etc. Some of you guys who were familiar with my posts on Proboards may remember that I had done my research and planned everything to the T. It was painful and disappointing, in the sense that I felt guilty for not going through it because life got in the way. I felt like I should've trucked on, but it would've been a poor idea. Some days are harder than others, but I've been making progress, slow and steady.

I just wanted to let the DS/wls family know where I've been and what I've been up to. I hope you guys are doing wonderfully. I wish the newbies the very best with DS recovery and prep, whatever stage you're on.

Given the upheaval of last year, I have reconsidered the DS and have been considering the VSG lately. I haven't decided against the DS, but as a lightweight, if VSG can get my aims met, then I would like to give it due consideration. My main reasons behind getting the DS were pre-D resolution. I've been thinking about the rigorous DS regimen, and I did feel up to it. I am thorough and organized enough, have been on my own for years, have shouldered adult responsibilities from a young age. It may just be the depression making me feel incompetent about handling the DS life. It does affect our self-perception a great deal. For that reason and some financial difficulties I had last year, I've recently thought of the VSG and perhaps the duodenal jejunal-bypass that Baltasar had suggested. This is the surgery that's being performed to reverse diabetes in average weight adults, in Europe. I think that and the VSG or the VSG alone are back in consideration, besides the DS. Excuse me if I sound garbled and disorganized about the different surgeries right now. I am just a bit tired right now, and I have been prioritizing mental health improvements lately, so I am a bit rusty. All of this is partially why I don't want to decide on DS vs VSG right now. It's not the best time to make or reverse decisions.

I am taking it easy for now. Apologies in advance if I bother you guys again with some brainstorming regarding DS and VSG, in the future, as well as my personal thoughts, and request some feedback. I won't do it until I am doing better, however. Please know that I never have and never would take even a moment of your time for granted. I appreciate it all.

Thanks for reading. Oh, a quick shout out to my angel Shellie: Hope you're well Shellie. Sorry, I haven't been in touch. Hope to catch up with you soon.

 

[DianaCox]

Good to see you! All things in good time my dear, and kudos on dealing with your psych/emotional issues first. It's the right thing to do.

 

[JackieOnLine]

glad to hear you are getting the care you need - I would never underestimate depression just because so many of us have it. it's a good sign you are back talking about WLS, I think.

 

[Larra]

You were very wise to postpone your surgery and decision until you were in a better place mentally. When the fog clears you will be able to decide what is best for you at this point in your life. First things first!
And glad you're here with us.

 

[conceit]

Thanks guys for the advice and well wishes. I really appreciate it.
It's good to hear from you too, Diana. Thanks Jackie.

@Larra
You're right; it is best that I wait until things are better. I tell myself that a year's delay won't mean much when I recover well from surgery because I waited until I was ready for it. You're also right about things making more sense once the fog has lifted. Thanks for the reassurance.

 

[SHales]

I agree that you are doing the right thing. We are here for you anytime. I am so glad you posted, it is good to hear from you!

 

[Still Waters]

It is important that you feel comfortable wit the surgery, and the responsibility after DS that is so critical. It is easier as time goes along, and I have been able to adjust my bipolar meds and feel fine. Talk to folks with depression who have made the decision and see how they are doing.I think with time, you will find it is doable, especially with the help from this and many other groups, you are not alone!

 

[conceit]

hi everybody,

quick update: i am not feeling a 100% better, but things have improved. i am slowly getting back into researching things again, so please bear with me heh. i am sticking with the earlier plan of not going for just the VSG. that's out of the way.

now, the choice is between the DS (leaning heavily in this direction) and the VSG + Duodeno-Jejunal Bypass (since I am a light weight and have Pre-D (yearly tests coming up so if it turns out that i am still in this range and still have normal hba1cs despite the elevated fasting glucose...I will do more research on the DJB. If by chance I have blood sugar in the diabetes range this time and/or the hba1cs are getting abnormal...then the DS is final without further question of course). For now, Research on the DJB is in progress. I will come back and share in a bit.

i am fully aware of why WLS circles have the think twice, cut once adage going. My main concern with the DS, following a financial setback last year, is a fear of being unemployed and somehow rendered poor (these fears are deep rooted and have to do with life experience, and i am working on this in therapy) to the point where I can't afford the DS regimen and the dietary requirements. I am sure quite a few of us have thought of this, and for some this is more of a possibility than it would be for others. My fear with the DS is signing up for a massive life time commitment that's both high risk and high reward, but somehow failing due to extenuating circumstances or my own ineptness (this is more depression related...worthlessness fears...again something i am working on). I know full well, at least intellectually, that I am smart and organized. Many members complimented me on my preparedness last year. I get it, but the depressed mind isn't always the most rational assessor of ones capabilities. The third issue is having the DS in my late 20s (a couple of people got it even younger, I know), and having this long medicalized life ahead of me. If I can do with a less malabsorptive procedure like the VSG+DJB, and reap the metabolic and Pre-D reversing benefits, perhaps it might be the right choice for me. My mental back up is that if I end up developing diabetes despite the DJB...I could get a revision. Then, you would be right to ask..well get the fucking DS, and get it over with. To that, my poverty fearing and ineptness and medicalization fearing mind would just start going in loops. This is just where I am right now, and I am sure when I get unstuck...I will get past it.

(excuse the ramble..just wanted to provide a glimpse into my thought process. and fwiw, i think it's important to consider these things...not get wound up like i have but still think about whether or not a surgery is a best fit)

In the meantime, if anyone has any thoughts/impressions about the DJB and VSG combination or just the DJB by itself, feel free to share. thanks in advance for any thoughts/comments you may have.

 

[robs477]

Ma’am, Of course I don’t know you, but regarding your original post, I just wanted to tell you that it takes a VERY brave Woman, or person to be that honest with oneself and share it with others like you did. If you can do that, you can do anything!

Regarding your “poverty fearing and ineptness and medicalization fearing mind”, I think those concerns are absolutely rational and certainly warranted. I even took that thought process one step further on another post asking what we would do in an economic or some sort of apocalyptic collapse and the consensus from everyone was very realistic. To sum it up, everyone said, NO, it is not irrational to “What if” and try to think ahead, plan for the worst, hope for the best, but the primary overriding consensus was: "It would all be a mute point, because If I didn’t get the DS (or loose the weight), I wouldn’t be around to have to worry about it anyway". I NEVER cease to be amazed at how practical and forward thinking these Ladies (and 1 or 2 of us guys) are on this site. I think it would be very careless to not think about potential contingency planning. And yes, your young age is definitely a factor in the equation, but those concerns are over my "pay grade" and I will defer to our experts on that one! My best wishes though for you whatever you decide!

 

[SHales]

I am afraid I don't know what VSG + Duodeno-Jejunal Bypass is exactly. Do you have a description of this surgery?

 

[DianaCox]

I think it is another name for the SADI/SIPS - NOT a DS.

 

[Munchkin]

SADI. Hi there! I just thought you might want to know there are patches we can do daily now. Check out patchmd. But don't buy anything till you find a promo code!

 

[conceit]

I am aware it's not the DS. The DJB in combination with the VSG is what Dr. Baltazar had suggested to me last year. The DJB is being done in Europe to reverse diabetes in non-obese diabetics. I was informed that it's the standard procedure for diabetes reversal in non-obese diabetics, in Europe. Like I said, my own research is in progress.

@SHales -

INTRODUCTION : Bariatric surgeries are now redefined as metabolic surgeries given the excellent resolution of metabolic derangements accompanying obesity. Duodenojejunal bypass (DJB) is a novel metabolic surgery based on foregut hypothesis. Duodenojejunal bypass as a standalone procedure has been reported for treating diabetes in non-obese subjects. Sleeve gastrectomy is combined for obese subjects.
DJB with sleeve gastrectomy is proposed as an ideal alternative to RYBG with the stated advantages -
1.Presence of difficult to access gastric remnant in RYGB is at risk of cancer development in high endemic regions. Endoscopic surveillance is easy in sleeve gastrectomy.
2.Preservation of pyloric mechanism prevents dumping syndrome.
3.Reduced alimentary limb tension.

http://www.sages.org/meetings/annua...s-with-sleeve-gastrectomy-for-morbid-obesity/

The attached file (about 4 pages0 explains the procedure in more detail. I'll share a brief excerpt.

DJB was added with 50–100 cm of biliopancreatic tract and
150–200 cm of alimentally tract. DJB consisted of a jejunoje-
junostomy created by a linear stapler and hand sewing closure
and duodenojujunostomy by hand sewing with two layers.




@SHales and @Diana Cox. I am in the process of researching it myself. I am going to look into the SADI and the DJB, to understand the differences between the two. I am not really considering the SADI though, so I only really have to research the DJB and see if it would be a fit for me. If I am going to go for the malabsorptive component, I would stick with with the DS over the SADI since the diabetes reversal (pre-d in my case) stats of the DS are well established, and if I am going to go for a DS-like vitamin and protein regimen anyway, I might as well get the DS. However, if the DJB has been successful in the reversal of diabetes in non-obese diabetics, then perhaps it may, in combination with a VSG, be a good fit for my weight loss (I have less than 100 pounds to lose-90 or so) owing to the VSG and the (pre)D reversing benefits of the DJB. Long term follow up studies are needed, though re: DJB. The main benefit, besides Pre-D getting reversed, is that it, in my current understanding, would not require the supplementation and protein requirements equivalent to the SADI and obviously not the DS.

Again, this is just a cursory update. I am not totally caught up with research myself, and I am not expecting you guys to do it for my or anything. I will share more as I understand the procedure and outcomes better. In the meantime, I certainly welcome any critiques of the procedures from interested members or those familiar with the DJB.

I have attached a file that provides more details about the procedure, for those interested.

Here's a study that I just found, and this one doesn't quote a very encouraging result.
http://www.ncbi.nlm.nih.gov/pubmed/19288284

Interesting..considering more than one surgeon (Baltazar being one of them; the other is a South Asian surgeon I met on my travels) has suggested the DJB to me as being the standard procedure for reversing diabetes in non-obese diabetics. One study obviously isn't conclusive, and if this procedure has been the standard in Europe for at least 10 years, then one would hope there'd be more information on the specifics and the effectiveness of the surgery.

 

[SHales]

Ahhh. Thank you. The name was unfamiliar. Personally, I would want the DS.

Here is what I do about vites and supplements: I usually purchase 3 to 6 months at a time but I did land in a spot where I was having trouble paying for them so now I also put $$ in a separate account for this specifically. My goal is to have enough for 2 years worth. I am retired now and living on a fixed retirement income so this is important to me. I figure 2 years is enough time to get back on my feet even if I had to go back to work part-time.

I also keep copies of lab work and required supplements in paper form, listing things that need to be done and when.

It's a difficult decision and in the end you need to go with what you feel will be best for you.

I have my daughter living with me now until we can get her meds back on track. She is a dual Dx with PTSD and either Bipolar or Schizophrenia. Different Doctors gave different Dx. SMDH. Anyway, she is overweight and needs surgery but the only thing I would help her get is the VSG. She starts feeling better and then decides she can live without her meds and so begins another cycle. I think the DS would kill her eventually if she can't stay on track.

I wish you the best. Stay in touch here.

 

[DianaCox]

I know I answered this post a couple of days ago - but I don't know where the post went!

The VSG-DJB is MUCH closer to an RNY (with a sleeve instead of a pouch) in having minimal macronutrient (fat, carb and protein) malabsorption, which will dissipate over time, as the intestine adapts. Thus, according to what you posted, the procedure has the following minimal intestinal bypass:

• 50–100 cm of biliopancreatic tract
• 150–200 cm of alimentally [alimentary] tract (ithe the part of the intestine above the RNY anastomosis, not the total portion of the intestine that the food passes through)
• Assuming a 750 cm small intestine, that means the common channel is between 450-550 cm

By comparison, the DS properly constructed in a 750 cm small intestine according to the Hess formula of 10% in the common channel, 40% overall in the alimentary tract (meaning the part above the RNY anastomosis) and the rest in the bilipancreatic limb (http://www.dshess.com/, parameters tab):

• 450 cm biliopancreatic limb (50% of the total length)
• 300 cm alimentary limb = 40%
• Common channel 75 cm (10%)

Many DS surgeons are making the common channel significantly longer, but still leaving about 50% in the biliopancreatic limb, and out of the total portion (alimentary + common channel) through which food passes.

I don't believe the long term results for either weight loss or resolution of diabetes are going to be very good, in particular the weight loss aspect. ~500 cm common channel?? That is basically the same as having a modest bowel resection, form which people metabolically recover nearly normal function.

I'm not a surgeon, but as a scientist, this looks like a BAD idea.