conceit--update

[conceit]

@Diana Cox

I really appreciate the explanation, and your opinion (very well informed and well considered, I must add) on this procedure. I had been doing my research and trying to understand it, by comparing it to the RNYGB, but it wasn't very clear to me. Thanks once again for your help.

It really doesn't look like a worthwhile procedure to me now that I understand it from reading what you've shared. Goodness, this saved me a lot of unnecessary stress. Thank you x100. *phew*

Diana, is there anything besides the insanely long common channel, which is very discouraging in itself, that makes this a poor choice for diabetes reversal? I wonder if Baltazar meant to say that the "Switch" portion of the DS is what's being done in Europe for 10+ years to reverse diabetes in non-obese diabetics? He mentioned the DJB, though, in this context, which is what confused me.

I just read a post on PB's Diabetes and the DS section where a member had talked about how their non-obese partner had just the "Switch" part of the DS in Europe (Baltazar was the surgeon) to reverse their diabetes.

Do you have any thoughts on how long the common channel is left in this procedure, for non-obese diabetics? *checks* Hmm the member mentioned their partner had a 50 cm common channel, and they were told he'd lose about 30 pounds post surgery, which I believe he was able to regain. This resolved his diabetes, successfully.

It's too bad Dr. B (and please know that I am not trying to disparage him, and I know he is a great surgeon) was trying to convince me to get the DJB, which apparently has a 500 cm common channel (approx) when he himself performs the Switch part of the DS in non-obese diabetics and gives them a 50 cm common channel. I posted about the DJB last year on PB, but I was leaning heavily in the DS direction so I didn't take the time to explore the alternative procedure in more depth. I can glean from my readings that the DJB is an experimental procedure, and it's not the "standard" for diabetes reversal in Europe-- that'd be the switch part of the DS. Well...I wish he had been clearer about this. Anyway, doing my part of the research and asking the experienced members here for their insights..is my job.

Hopefully, this will be useful for any other lightweights who get suggested this procedure because they are not "sick enough" to get the DS.

 

[DianaCox]

If you are going to have a sleeve plus two anastomosis surgery, may as well make it a tailored DS, with a longer than average common channel (maybe 150 - I wouldn't go shorter because I think that makes it more likely the diabetes might recur), maybe a slightly longer alimentary tracts, a generous sleeve, and not suffer or diet so hard?

 

[conceit]

If you are going to have a sleeve plus two anastomosis surgery, may as well make it a tailored DS, with a longer than average common channel (maybe 150 - I wouldn't go shorter because I think that makes it more likely the diabetes might recur), maybe a slightly longer alimentary tracts, a generous sleeve, and not suffer or diet so hard?

Hi Diana

Please read above. I just edited the post heh.

You're right. I am going to consult with Dr. M on getting a slightly longer common channel, and I was thinking more 100-120 cms. My Hba1cs are still, last I checked, in the normal range and my fasting glucose was on the border, so the Pre-D is in effect, I would say. Luckily, since my numbers aren't too bad, a common channel of this length may be sufficient for pre-D reversal and be adequate for weight loss as a lightweight. I will definitely consult further with Dr. M. I am getting my yearly tests soon, so if the numbers have gotten any worse, then of course, I would opt for a 100cm or so common channel, or more like, discuss my concerns with Dr. M. and go with what he decides is best.

Re: diet and suffering, that's a good point too. I was more concerned with the more stringent vitamin and protein requirements. I think it's a good kind of worry. Of course, I will be compliant. I know it's basically a do or die situation, to put it mildly. But, perhaps, a longer common channel, if Dr. M. agrees, may mean a somewhat more comfortable post DS life in terms of diet etc.

 

[DianaCox]

@Munchkin - I'm pretty sure she's talking about Dan.

Talk to a LOT of surgeons. Talk to Keshishian and Rabkin. Talk to Marchesini again. Learn your options.

 

[conceit]

@Munchkin - I'm pretty sure she's talking about Dan.

Talk to a LOT of surgeons. Talk to Keshishian and Rabkin. Talk to Marchesini again. Learn your options.

Yes, I believe their partner's name was Dan. Sorry Munchkin, didn't know it was you who had posted about that.

I had last consulted Dr. Aceves (, Dr. Ungson, Dr. b and Dr. m. This was last year. I didn't discuss the customization of the DS itself in detail and was going to do it as the conversation progressed, as I was initially more concerned if they would even take me with my lower BMI. I, then, had to delay the surgery for personal reasons. I am Canadian and self-pay.

It would be a good idea to get an opinion from Dr. Keshishian and Dr. Rabkin, as well. I'll do my best to learn my options moving ahead.

 

[Munchkin]

No worries! If I was in your shoes I would stick with the DS and a CC of 100 or so.

 

[conceit]

No worries! If I was in your shoes I would stick with the DS and a CC of 100 or so.

I am considering that too . I was curious about the cost of just the Switch portion. Do you mind if I asked? If you like, you could Pm me. Also, do you know of any reputable doctors in North America or elsewhere (Brazil/Europe etc.) who perform the switch portion on non-obese diabetics?

 

[newanatomy]

I am considering that too . I was curious about the cost of just the Switch portion. Do you mind if I asked? If you like, you could Pm me. Also, do you know of any reputable doctors in North America or elsewhere (Brazil/Europe etc.) who perform the switch portion on non-obese diabetics?

Just being a bit of a stickler, you are a non-obese, non-diabetic. You have "pre-diabetes", correct? That may make somewhat of a difference.

 

[star0210]

Dr. Ungson charges $9k for just the switch part. That's all I would have paid if my sleeve didn't need to be redone.
That brought the total to $14,500.

 

[DianaCox]

Just being a bit of a stickler, you are a non-obese, non-diabetic. You have "pre-diabetes", correct? That may make somewhat of a difference.

She's a lightweight (needs to lose 90 lbs) but most definitely severely - if not technically morbidly - obese.

 

[newanatomy]

She's a lightweight (needs to lose 90 lbs) but most definitely severely - if not technically morbidly - obese.

Thank you, I misunderstood the situation.

 

[conceit]

Just being a bit of a stickler, you are a non-obese, non-diabetic. You have "pre-diabetes", correct? That may make somewhat of a difference.

edit: just saw that diana already addressed the query.
i wasn't saying that i was not obese. i wouldn't be on a wls board had i thought so lol. i was just curious what the cost was for the surgery (just the switch portion) on non-obese diabetics, for comparison sakes vs. the full DS performed on obese patients.

@star0210

thanks a ton! that helps a great deal.

 

[Munchkin]

edit: just saw that diana already addressed the query.
i wasn't saying that i was not obese. i wouldn't be on a wls board had i thought so lol. i was just curious what the cost was for the surgery (just the switch portion) on non-obese diabetics, for comparison sakes vs. the full DS performed on obese patients.

@star0210

thanks a ton! that helps a great deal.

Dan's surgery was about 14K back in 2004. I think you would get a better deal with Ungson.

When we met with Dr. Baltasar, he wanted to do the switch only because his BMI was 27 and Dan was 6'2". I know another diabetic patient who also ended up having surgery. She was pretty short and needed to lose just under 100lbs to reach a normal BMI. Dr. B said because she was short, female, and very close to morbid obesity, he preferred to do the whole DS. She did great and had no problems. She controlled the diabetes with oral meds only before surgery and Dan was the same, only metformin/glucophage.

 

[conceit]

Hi friends,

I am sorry I haven't checked in here for so long. When I logged in today, I was astounded to noticed how much time had passed. It feels a bit surreal that I joined the community all those years back, ready and prepared for the DS, then had second thoughts about which surgery would be better (as seen in this thread). Life has taken me in some interesting unexpected directions since. I ended up having to cancel surgery due to extenuating circumstances. Given the upheavals of the past couple of years, that was for the best.

A few things have changed since then. Good news first, my financial situation is much better. I am in school. I had a disconcerting panic attack (involving facial numbness and difficulty swallowing) some time back, which resulted in a lot of tests and scans, all of which came back normal. My heart is fine. Brain is fine. Cholesterol is fine. Blood vessels are doing fine (carotid ultrasound was normal). I have an MRA left, which is going to be fine too I think.

last time I had blood tests was two years back, the blood sugar was in the 'pre' D range. I had lost 20 pounds, was still a fatty but an active fatty and was eating about 50-60 gms of carbs/day. I was working out 5 days a week and enjoying it, doing it more for the sake of strength and cardiovascular fitness goals than weight loss per se (which often ended up being demoralizing). In this time, I kept considering the VSG and thinking of possibly revising to DS later if the blood sugar didn't normalize, because that seemed to have become the biggest deal to me, more so than the countless indignities of fatphobia. I think I was not fully ready for such a major lifetime commitment in my late 20s, with a lower BMI, an active life, more active than I'd been in years and overall good health. I was also trying not to romanticize the DS and trying to remain aware of its gifts as well as challenges. I was also concerned about some of the long term risks with malabsorption, since I wasn't yet 30.

Lately, I discussed WLS with my partner since my intuition was screaming at me all month that something was off with my blood sugar. I just had a very very bad feeling about it. At first, I thought it could be because I've been getting all these tests and scans done all month. When I saw the neuro, I asked her to show me the blood work from my hospital visit (when i had the numbness, difficulty swallowing, arm weakness) which was less than a month back. Nothing was marked as abnormal, but I looked at my blood sugar and it was 6.8. It wasn't flagged because the test was apparently a random one. But I knew that I hadn't eaten a thing for at least 12 hours when my blood was drawn. I immediately booked an appointment with my GP. Even though it was only a matter of time, given the 'pre'-D, I discovered today that my FBS was 8 and the A1C was 6.9.

With that, 95 % of my hesitation about the DS has gone out of the window. What's the 5% nonsense about, you may ask? It's an irrational hope that the VSG might put the recently diagnosed Diabetes into remission, so I won't have to worry about vitamins and protein supplementation, but more so long term impact of malabsorption. From the copious amount of research I have done, I know the DS has the best chance of sending the diabetes into remission, hopefully forever, given my recent diagnosis. So I know it's my best and only bet.

Forgive me for the unnecessary self pity here, but I felt such deep resentment today about the diabetes. I felt like ..damn I am moving and challenging this fat body, doing well with getting physical activity for the sheer joy of it and its positive impact on depression and anxiety, gotten used to keeping carbs at/below 60, gotten to accept and respect my fatness, love my body, perceived imperfections and all. And then comes diabetes, of which I had no family history even, messing it all up. You know I knew it'd happen eventually, I just didn't think it'd happen in a period where I had made tremendous strides in taking care of my health. This wretched disease..like if I have developed it at 30..after being more active than a lot of thin people, watching what I eat most of the time, then what hope do I have of not needing insulin in 10-15 years? not having extensive damage to my organs in 15-20 years? Sure my BP, cholesterol are normal. Kidneys and liver are fine. But I am only 30. The disease will take its toll, and I know there's a genetic component to it that only the DS can reverse. And I also know with diabetes will come hyperlipidemia (of which there is a family history), increased risk of stroke and heart disease and a whole bunch of other complications.

I can trade that for vitamins and 120 grams of protein/day. And cross my fingers and pray the diabetes will stay in remission post DS.

I apologize for having been gone for so long, for having cold feet about the surgery, despite your generous feedback. And thank you for reading this and for building the kind of community we can return to. If you don't mind me, I'll be starting another thread with a few questions about lab work etc. for Canadian DS'ers.

Thank you so much

 

[Munchkin]

Glad to see you and sorry about the diabetes.
Here's what I think is the straight scoop. If you got down to a normal weight tomorrow, your diabetes would be history most likely. But it's not cured. The weightloss fixed it temporarily. It will always be right there on the horizon because there was no metabolic change.

The DS forces a real metabolic change. And over 95% of the time it reverses type 2. Right away as in immediately postop. Weightloss has nothing to do with it. People have had other procedures and resolved their diabetes with weight loss. But gain a few pounds and it comes right back. The only procedure that offers hope to never see diabetes again is the DS. Nothing else you can do works as well as the DS. The DS ends the hyperlipidemia too. You won't need statins. You won't have neuropathy and retinopathy in your future.

I encourage you to do the the surgery ASAP. Before all these issues even start. I agree with you that diabetes is a terrible disease. The only thing that causes more amputations and blindness than diabetes is accidents. You are right to take it seriously.

http://bariatricfacts.org/threads/ds-for-diabetes-dans-story.355/