Will
The starting point for my lengths will be a result of determining the total length of my small bowel. Without having that baseline it is like shooting in the dark and the primary reason I am going to Dr K is because he measures and bases lengths off of the total SB length. I posted his study in either this thread or another one showing protein nutrition (albumin and tot protein) results of 370 patients with the 10%/40% limb to small bowel ratios. That study clearly shows that the Hess method works for protein absorption.
All that being said, Dr K suspects my AL is too short but without knowing the total length of my small bowel he says that doing anything could over correct or under correct. I will ask questions similar to yours when I get to sit down with Dr K next Monday in my pre op consult. He won't be able to tell me that adding X cm's to the AL will = X% increased absorption (unfortunately medicine is just not precise in this case) but he will give me his educated opinion from doing over 2,000 DS procedures and 500 of those being RnY to DS revisions as to what he believe the best adjustments will be based on the small bowel measurement.
I am expecting my SB to be in the 800-900 CM range (could be wrong but that is my gut based on studies I have seen) so the science would say to do the following based on this range of Total SB length:
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Two Key Points:
- Dr K will apply his best judgement and may or may not increase my CC length. The key is that happy medium between not enough protein and overall absorption, and too much overall absorption. That is where the "art" part of this scientific craft comes in. Dr K stated several time to me when I was out for Cameron's surgery and discussed my case, "that is what the science tells us to do". Dr Marshall said to me on my last visit where I was told to come back in a month and we would talk (SMH), well if we extend your CC (he doesn't believe in Hess method and gave me that "you're freaking nuts" look when I mentioned extending the AL) we aren't engineers so we can't say take 100 CM * X to get Y so we just don't know what Y will be....to which I said to myself bull fooking shit you just made my decision and I will be going to Dr K because he absolutely knows there is science that tells us exactly what to do in my case.
- If you look at my current food absorption path I only have 250 CM of possible absorption, so even though a great portion of absorption (esepecially protein) happens in the CC we still absorb carbs AND protein in the AL. As the GI who put me on CREON explained, if the body isn't absorbing enough carbs it also doesn't allow for enough protein absorption. I know this sounds odd, but the root of my problem is likely that I am not absorbing enough carbs so it is preventing proper protein absorption as well. Increase carb absorption and protein should follow. That to me is why the Hess method arrived at those percentages.
I will ask Dr K numerous questions and believe me, I will share my results as the journey continues after my revision.
Question for you. I know you are very worried about your weight but:
- What are your lab values for H & H, Albumin & Total Protein (those are the key indicators of malnutrition and anemia which you will become in malnourished)? I am currently anemic an before CREON my Alb & TP were half minimum range..currently I am a little anemic (11 on hg on min 13'sh scale) Alb dropped from mid range to almost min & the TP dropped to exactly minimum....trending the wrong way.
- How do you feel? I feel weak and fatigued all the time and my guts and butt are mess bathroom wise.
- What dosage of CREON are you on? I take two 36K capsules with a meal and 1 with snacks so I am in the 320K'sh daily range.
Again, I will share my results as I know you view me as a bit of a proxy for your future protein absorption. I also want to educate the board about people in my situation and the possible impacts - I never even thought of the AL and was under the impression that the Common Channel was all that really mattered for absorption....I found out I was dead wrong in that regard. I will see how this goes, but if it goes as I suspect I want to push as much as I can and be a case study for getting DS surgeons around the world to follow the Hess Method or some close variation and outlaw the cookie cutter, one size fits all DS.
