Dr Daniel Cottam, BMI of Utah.

[Lilyofthevalley]

Recently I learned new facts about my Surgeon Dr Daniel Cottam and the Bariatric Medicine Clinic in SLC Utah. In 2014 I had been told by BMI staff members that Dr Cottam was experimenting with his own version of a SIPS surgery. I was also told that he was still performing the Standard BPD-DS as well as the "experimental single loop surgery." That information is no longer accurate. I sincerely apologize for contradicting others erroneously, and continuing to repeat old information.

The current simple facts are:
1. Dr Cottam is indeed doing a surgery which he calls the "Loop DS"
2. He is no longer doing the "old DS" or what you and I call the Standard DS.
3. He no longer offers a standard DS.
4. He has not done a Standard DS in more than 3 months.
5. At least three of his patients who have had surgery with him in the last three months will tell you they had a "DS" if asked what WLS they had.
6. Most of his patients are being given standard diet information irregardless of which WLS surgery they had. General guidelines include 3 meals a day, low carbs, no bread, rice, pasta, fruits, or sweets, and 1000 calories a day for the first year.
7. A BMI Staff Member referred to the standard DS (According to my surgical report) which I had done by Dr Daniel Cottam in September of 2012, as "the old DS."

These facts and information came from a staff member of BMI, Dr Daniel Cottam himself, and information garnered by my attending a BMI support group. Dr Cottam verified that he is no longer offering the standard BPD-DS.

IMO, There does not seem to be a deep understanding among Dr Cottam's patients, of their surgery, anatomical changes, and dietary needs. Believing they have had a surgery only referred to as the DS or Duodenal Switch these patients are seeking information which leads them to sites for the Standard BPD-DS

I believe Dr Cottam is a good surgeon, and that he and his associates have good intentions. I am very concerned that because his patients are telling others they had the "DS," they will assume that their dietary needs are the same as those who have indeed had the Standard Duodenal Switch. If the purpose of the Loop is to decrease malabsorption, then the percentages absorbed for fat and other nutrients will be significantly different than those for the BPD-DS. There are no studies or statistics to point to for guidance at this point.

 

[DianaCox]

That is a shame on MANY levels. Thank you for posting this warning to our membership - and I hope anyone who knows anyone contemplating using Cottam will point people to this post. Patients have the right to give FULLY INFORMED CONSENT - and it sounds to me like Cottam's patients are not being given all the information they need to do so.

 

[JackieOnLine]

wow, thanks for sharing that.

 

[Jo Lynne]

As I saw Dr. Cottam on 3/4/15 I will share my experience. He was up front that he only does the Loop DS now. He asked me if I understood... Because before my initial appointment I was told to watch all the procedures on the BMIUT website and I had. So I already understood this going in. And I have to say I was excited to find there was something which sounded better than the RNY which was all I really knew about from considering WLS about a few years ago. And the Loop DS really addressed some of the concerns I had about the RNY. However I only became aware of the DS after the learning about the Loop DS so I am not as versed as obviously many people here. I just want to say I don't think I have been duped or mislead by the information in anyway. I cannot speak for anyone else.

 

[DianaCox]

Do you understand that there are no long term studies or results for that procedure? Do you understand that the "Loop DS" does not have selective fat malabsorption?

I wouldn't mind if the "Loop DS" replaced the RNY, because I'm SURE it will be better than the RNY, at least in terms of patient comfort (no dumping, no reactive hypoglycemia, more likely to be a higher rate of resolution of diabetes). BUT IT NEEDS IT'S OWN SEPARATE NAME THAT DOES NOT USE "DS" - IT IS NOT A DS!! The hallmark of the DS is selective fat malabsorption, and these single anastomosis variants DO NOT HAVE THIS BENEFIT! And it will be too confusing to people.

People who have this variant surgery should NOT be looking at the DSers for dietary advice - we can and should eat more fat and protein than they can, and far more calories - there simply is no comparison. But I'll bet people with these variant procedures end up with some of the same vitamin and mineral malnutrition issues, because the surgeons and nutritionists DON'T GET IT, and are giving crappy advice to everyone.

 

[Jo Lynne]

I see your point Diane. Being that I am new to both procedures it hasn't been confusing for me. The RNY scared me off. The DS and the lapband scare me too. The idea of having something implanted just grosses me out. And the DS is too much. I am insulin dependent diabetic t2 since my last pregnancy 12 years ago. I am needle squeamish and hope my diabetes might resolve. Already I avoid grains and potatoes and find that easy enough to do but my body seems to like being in the 280s. So I am looking forward to the extra kick that WLS will offer

 

[DianaCox]

"And the DS is too much. I am insulin dependent diabetic t2 since my last pregnancy 12 years ago. I am needle squeamish and hope my diabetes might resolve."

Your diabetes may NOT resolve if you have been insulin dependent that long. If it were ME in that situation, I would be wanting the biggest metabolic bang for the buck, which would be the DS.

What do you mean "the DS is too much?" Too much what? I would argue the "loopDS"/SADI is not enough for someone like you. Ask Cottam the HARD questions - what evidence does he have that LDS will be ENOUGH for someone with your severe metabolic issues, especially long term evidence, and (since I don't believe he has ANY evidence) why does he think it WILL be enough without such evidence?

There is a clear correlation between the length of time someone is insulin dependent diabetic and whether the DS can resolve their diabetes:
http://www.ncbi.nlm.nih.gov/pubmed/23011463

Preoperative predictors for nonremission of T2DM were a higher BMI, insulin usage, and lowinsulin C-peptide ...
The duration of T2DM and age of the patient are the most important preoperative predictors for the remission of T2DM and hypertension, respectively.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3065014/pdf/JOBES2011-860169.pdf

Finally, to further evaluate whether the remission of T2DM depends on the duration and severity of diabetes, 74 patients were divided into 4 groups according to their need for insulin: we could see that even patients with a long history of insulin-dependent T2DM have a good chance for remission. However, in the group with a usage of insulin >10 years the chance of remission is significantly lower and a small percentage of patients will not be completely free of insulin—probably due to secondary beta-cell failure.

Personally, I would want the BEST chance for cure of my diabetes NOW, while there was still a chance of remission - and not try to half-ass it when you are already in deep doo-doo based on how long you have already been insulin dependent. If the LDS doesn't do the job, the odds are going to be much worse 3 or 4 years from now, when you have been insulin dependent 15-16 years, that a proper DS will be able to help.

Cottam has decided to commit himself to ONLY doing LDS, in part because he's doing STUDIES with Roslin: http://www.medpagetoday.com/Endocrinology/Obesity/48868

SIPS is a modified duodenal switch, which was given its name by myself and Dr. Daniel Cottam in Utah. It involves the formation of a sleeve gastrectomy that is slightly larger than our usual sleeve, with an attachment placed beneath the pyloric valve, which controls emptying of the stomach into the mid gut, located three meters from the terminal ileum.

Dr. Cottam and I decided to standardize our approach, and now more surgeons are becoming very interested. In Spain, a similar procedure has been done by Juan Antonio Torres and Anders Sanchez. Their sleeve is larger and they bypass more intestine.

It is MY opinion (and not only mine) that they are trying to make names for themselves, even coming up with a new name ("SIPS") for "their" very slight variation on the SADI, and that bugs me, a lot.

My point is, Cottam has decided to throw out the power screwdriver (the DS) in favor of the hammer, and now EVERYONE looks like a nail to him. That is not good medicine, IMNSHO - the SIPS procedure is not a one-size-fits-all, UNLESS you are doing experiments to try to figure out (retrospectively) who should have gotten a different procedure. I would NOT want to join his experiment if I were in your shoes.

I don't want a standardized procedure - I want one that is TAILORED to my needs. The DS can be tailored, and Cottam is doing the same procedure on EVERYONE. Because he's experimenting.

 

[Jo Lynne]

The DS is a bigger operation (3-4 hrs vs less than one hour) -it scares me. If you understand my fear factor and how I quit last time you might appreciate why this works better for me. Surgery scares me... Not the healing or modified diet part but the operation. I am a baby with a flebotonist. That is all. Yes I know my T2D may not resolve with any WLS at this time because of how long I have been diabetic. It might have had a chance about 5-6 years ago when I was getting qualified for an RNY only to chicken out. I can get my head around this operation and feel it is better than my current path of fighting my diabetes. It should reset my resistance level. My doctor referred me to this surgeon agreeing weight loss surgery was a good choice for me and after discussing my fears.

 

[DianaCox]

"The DS is a bigger operation (3-4 hrs vs less than one hour)"

That's a ridiculous statement. The sole difference (cutting-wise) between a proper DS and the LDS/SIPS is ONE cut, and ONE anastomosis.

There is NO WAY the SIPS takes under an hour. He has to do a PROPER sleeve - exact same operation between the DS and SIPS. He has to cut the duodenum just above the biliary and pancreatic ducts, sew up the distal end of the duodenum, and measure and anastomose the proximal portion of the ileum to the proximal duodenal stump. The only thing that's missing is the second cut at the proximal ileum and anastomosis to the distal portion of the ileum - I'll bet that part of the procedure takes a skilled surgeon under 30 minutes.

Where you probably ARE going to be cheated is that he is not planning on either removing your appendix or gallbladder, which I believe should be done with all bariatric procedures. Ask around about what people think about THAT shortcut.

What makes you think you are going to have FEWER needs for phlebotomy with a SIPS vs a DS? I get blood drawn once a year. It is likely you are STILL going to have to check your glucose and take insulin. Even if you have less need for insulin, you are going to have to test.

On the other hand, if you are the sort of person who lets short term issues dictate your life long term, by all means, get a surgery that doesn't work as well, but is something that is less likely to punish you as severely for not taking care of it properly. Boggles my mind that someone would do that, but it's your life. Just so long as you understand the TRUE facts before you get talked into doing an experimental procedure, and being part of the experiment.

 

[Larra]

@Jo Lynne I think your fear is misplaced, in that in terms of how much is being done on the inside, there isn't that much difference between the loop DS and the real DS, but there may be a huge difference in results, not just for weight loss but also for resolution of metabolic comorbidities like your type 2 diabetes. Surgically the loop DS is just one less anastomosis (reconnection) of the small intestine. The time difference between the 2 operations isn't, or shouldn't be, hours in length. Both require general anesthesia. Both can be done either lap or open. Both have similar recovery. But even the surgeons who are promoting this new operation can't tell you what the long term results with the loop DS are because NO ONE KNOWS. On the other hand, the long term results of the DS are well documented in large numbers of patients, and it has been a standard of care bariatric surgery for years now.
Based on what you have said so far, my impression is that you are letting your fear of a couple extra hours AT MOST during surgery dictate what long term results you will live with for years, and lowering your chances for resolution of a serious disease. and your doctor who referred your for bariatric surgery, I'm assuming you mean your pcp, probably has no idea that there are so many different operations being done these days and may not have even heard of all the different options, let alone be familiar with how new and unproven the loop DS is. He just thought you were a good candidate for bariatric surgery and referred you to a reputable bariatric surgeon in your area. That's it.
I would recommend at a minimum that you get a second opinion with a bariatric surgeon who does the DS. As far as RNY goes, I completely understand your decision not to have it as I felt exactly the same way. It was just not something I could live with. But I think you are being sucked in to something that speaks to, if I may say so without being judgmental, a somewhat irrational fear of surgery/needles/whatever that is preventing you from considering the operation most likely to help you.

 

[Jo Lynne]

I was using phlebotomy as an example of my stupid irrational fear its not about getting away with less blood draws just more how I skip them all together... I have to sit in the chair and try not to jerk my arm or hyperventilate. Obviously the same things that would bother you don't scare me.

My gall bladder is already removed.

What I find an interesting relationship is you called it an LDS. Here in Utah LDS is the Latter Day Saints Church aka the Mormons. I wonder if that might be an advantage in this market?

 

[DianaCox]

I thought about that too, Jo-Lynne!

But the puzzling thing is, Roslin made a big deal of the new name (SIPS) and Cottam isn't using it. I think it should be called a SADI - and it should not use the DS in any way.

 

[more2adore]

I'm glad you haven't run off after the tough love above, Jo Lynne - but Diana and Larra are, as always, spot on. The DS has THE best resolution statistics of ANY bariatric surgery out there. If I were tired of dealing with it (which I would be, in your shoes!) I would be after the surgery with the BEST proven results of resolving my diabetes. Did you know that in some countries they perform the switch part of the DS alone for normal-sized people, simply to resolve their diabetes? The results are so well known that it's used for that. I know it's easy to get sucked into what you're told about SADI/SIPS, but give it some serious thought. You want to make sure you're getting the surgery with the best documented chance of actually helping you. My two cents.

 

[Lilyofthevalley]

Jo Lynne, to answer your question to me, I had the standard BPD-DS performed by Dr Cottam in September of 2012. He had only been with BMI about a year then, and had been performing the DS since the Spring of that year. He had previously performed the standard DS on patients in another state for several years.

I have lost over 260 pounds and I am no longer being treated for Diabetes, Lymphedema, Leg Ulcers, Gerd, and a dozen other serious morbidities. I would like to make clear the fact that I am happy with MY surgery and pleased and grateful with how I personally have been treated by Dr Cottam for a complication that arose last year. My concerns are for others who will be confused by the terms and names being used. As Diana states there are no statistics on the SIPS and you really have no way of knowing what you are getting long term, and how much malabsorption you will have.

I believe Dr Cottam is a very good surgeon. However, it is important that each patient know and understand exactly what they are getting. That is impossible for the SIPS as even the Sugeons can not know since the procedure is in infancy. Please, before you make a final decision call Dr Simpers office and make an appointment. He can point out the advantages of the standard DS. That way you can make a more informed decision about the surgery, and surgeon you want to go with.

 

[DianaCox]

What ALSO concerns me is the misinformation you are being given by Cottam's office (by Cottam himself?). This statement is so clearly untrue, it boggles the mind: "The DS is a bigger operation (3-4 hrs vs less than one hour)" - that makes me wonder what else are you being told that isn't true?