lenghting my common channel

[DSRIGGS]

Yeah I forgot about the revision and I am sure that played into the equation. Regarding what Dr K does foe CC's I didn't think he was doing anything under 100 now for virgin DS....could be wrong.

In any case, I think it is Gary Antone who Dr K told me postulates that the important factor for the DS is that the AL + CC = BPL length.....so he says the relative length of AL to CC is not as important as that combo being 50% of the SBL which I believe you are.

Dr K also said that had I been an original DS patient of his he would have made my channels 275/100 but now do to atrophy of the BPL and Hypertrophy of the CC/AL that calculation changes, so I do agree with your revision that the channel lengths would have been different than a virgin DS. I took another look at my op report and my SBL was 725 CM not 650 CM. My current configuration is effective BPL 275 and CC 200 CM....again only a portion of my CC is absorbing the way it is configured so Dr K estimates that absorption at 125CM (25cm of absorptive cc pick up over my old state).

I understand what you are saying but it isn't cookie cutter. I think that surgeons have found over the last 10 years, through experience and research that the 10% CC number may be a little low and are going more in the 15% range. That is just my hunch.

@Larra and @DianaCox and @southernlady I may be mistaken but I thought one of you made the statement that you didn't think many, if any DS surgeons were doing less than 100 CM CC's for Virgin Ds'rs anymore based on bad outcomes with short CC's in the past. I would also be interested if you had heard anything on what I believe is the Gary Antone (think that is his name) theory of AL + CC = BPL being the most important element of the DS and the AL/CC specific lengths being less important. Maybe that was theory that was just discussed between Antone and Dr K, so I hope I am not sharing or attributing comments to somebody that I shouldn't be.....so anyone reading this thread please note this is my recollection and not directly attributable to either good Dr.

 

[revisionDS]

In a post several months back posted the chart (fit) from a study on this showing the cotrelation between height and total SBL. Taller people in general have longer SBL but their is a variance within similar groups of height . I am 6'2 and my SBL is 650 cm.

Actually no, this is individual, a short person can have a long torso and a normal height person (me) can have a short torso ( I was also measured-military) Torso lenght does not imply intestinal length. Controversy on intestinal length due to most studies done on cadavers, research I have read, I believe intestinal length is primarily affected by height and gender, short women in general have the shortest total length.

Yes as I posted, bowel length is primarily affected by height and to a lesser degree gender, short women, shorter lengths. Yes I know that study well. The original question was torso length, mutually exlusive from bowel length. Torso length is a external physical meaurement, used for bullet proof vest, corsets,etc. for proper fit. And with medicine there are no absolutes, these are generalities.

 

[DSRIGGS]

Yes as I posted, bowel length is primarily affected by height and to a lesser degree gender, short women, shorter lengths. Yes I know that study well. The original question was torso length, mutually exlusive from bowel length. Torso length is a external physical meaurement, used for bullet proof vest, corsets,etc. for proper fit. And with medicine there are no absolutes, these are generalities.

agreed

 

[revisionDS]

@Charris are you sure that Dr K gave you a 50cm CC? 250/50 tells me your SBL is 600 cm and 10% would be 60 cm. CT K told me for CC he rounds up to the 25 cm mark which would be 75 cm, not to mention I didn't think he was doing anything less than 100 cm CC length?

I am going to check my OP report but pretty sure my SBL is 650 (EDIT: I just checked and I am 725 CM total SB). My original DS surgeon said I was 150/100. Dr k actually measured 200/125 (as he said with the elasticity and "squirm" factor trying to measure with instruments during lap surgeruery there can be fair amount of measurement variation) and took my AL to 275 and CC up to 200cm but an effective absorption of 150 due to atrophy from that side of the side by side anastomosis with the BPL (complicated but he has researched atrophy of the BPL and hypotrophy of the CC and AL so I trust him - he used my iv lines to visually show me what he did because it is so confusing).

Anyway I am shocked if your CC really is 50 cm. If it really is an my estimate of your SBL is correct, I hate to say it but that probably is in need of lengthening.

One of the best things about the DS is it's ability to be adjusted for the individual patient. Total lenght is a starting point, but a surgeon should take other factors into consideration, age, virgin ds or revision, 1 revision or multiple revisons, health status of patient, physical activity etc....the list is quite long. Would I be surprised if Dr K today performed a 50 cchannel, no, and I would not be surprised if Charris has a 50 cchannel.

 

[DSRIGGS]

One of the best things about the DS is it's ability to be adjusted for the individual patient. Total lenght is a starting point, but a surgeon should take other factors into consideration, age, virgin ds or revision, 1 revision or multiple revisons, health status of patient, physical activity etc....the list is quite long. Would I be surprised if Dr K today performed a 50 cchannel, no, and I would not be surprised if Charris has a 50 cchannel.

Agreed on flexibility and if you have read any of my posts about my stories you know how adamant I am about the criticality of the need to be flexible with how the DS is performed on each patient. I believe strongly that the cookie cutter DS should be abolished as a standard of care because although it works for many, it is lazy and doesn't provide optimal outcomes when it should. Frankly it can f**K up a person's life like is has done to me over these past two years. I have gone through totally unnecessary rough physical time and multiple surgeries because my original DS surgeon did a "cookie cutter" DS on me.


Regarding Charris and revision patients, I can absolutely see shorter CC's and 100% agree with the qualified DS surgeon making that appropriate choice. For virgin DS'rs, again I believe the research is showing that only in rare instances should a CC of less than 100 CM be done because lesser it simply isn't providing enough nutrition for MOST (not all) patients....so yes, flexibility is key but I do believe that the DS Surgeon Community is finding limits.

In the end weight is not the ultimate end all, be all outcome of the DS. That target outcome is optimal health. Although a person may want to reach 125 - 130 pounds it may end up that 140 - 145 pounds is the optimal healthy weight range and the DS should be designed around that target (personally I think it is better to error to the slightly high side than the too low side - the low side has serious health effects that can wreak havoc on one's life).

 

[southernlady]

@Larra and @DianaCox and @southernlady I may be mistaken but I thought one of you made the statement that you didn't think many, if any DS surgeons were doing less than 100 CM CC's for Virgin Ds'rs anymore based on bad outcomes with short CC's in the past.

Wasn't me...

I do know that Dr. Boyce and his partner, Dr. Williams are doing larger sleeves on DS'ers now. (Larger as in more like a 50% reduction than an 80% reduction. That might be helping in avoiding GERD.

 

[DSRIGGS]

Wasn't me...

I do know that Dr. Boyce and his partner, Dr. Williams are doing larger sleeves on DS'ers now. (Larger as in more like a 50% reduction than an 80% reduction. That might be helping in avoiding GERD.

Thanks...and I had a fairly large Sleeve as well. More in the 5 oz range with 56 fr bougie, than the tight sleeves. As you know from my past comments at crazyville, I am all for this. I think too small a sleeve is cruel, of no medical benefit to DS patients and as you point out with GERD can have negative consequences in that regard....

...BTW, my GERD is back with a vengeance even though I am on Omeprazole 40 Mg 2/day and tagamet at night was just added. I am not trusting that Upper GI and tending to believe the EGD may have some merit, as something has definitely happened to cause my GERD to come back. I may need to switch to Protonix or Dexilant to see if changing up PPI's helps.

 

[aaa]

My zinc is up near at 80 now and was 47 when I was severely malnourished before started creon. It was hard as hell to get that level up. I take 300 mg a day of zinc......

so I am sure I was shitting it all out back then

I'm down to 350 mg. per day as my zinc levels got a bit too high. I assume you're also taking a good amount of copper to balance things out.

 

[aaa]

@aaa my CC is 50. I'm 250/50. I heard that a lot of Dr. K's patients have the same numbers. Which really doesn't mean much since he uses the Hess method.

That is short. I don't know that I've ever heard of anyone with a cc shorter than 75. But I'd never argue with Dr. K.

 

[Charris]

When I started looking to the surgery the only options I ever heard of were 50, 75, and 100. When I posted my opinion report on the other board someone commented and said there quite a few of Dr. K patients with the 50/250. Plus I'm sure he took into consideration all the things that I have against me like: height, sex, ethnicity, the fact I was a distal rny and so on.

 

[southernlady]

BTW, my GERD is back with a vengeance even though I am on Omeprazole 40 Mg 2/day and tagamet at night was just added. I am not trusting that Upper GI and tending to believe the EGD may have some merit, as something has definitely happened to cause my GERD to come back. I may need to switch to Protonix or Dexilant to see if changing up PPI's helps.

Omeprazole aka Prilosec NEVER worked for me...before or after my DS.

Back when they first diagnosed me with GERD, the PCP put me on prilosec (this was before it went OTC). After a month, he increased the dose, at 2 months we tried a new one but we had a fight on our hands to get the insurance company to agree.

I use the Prevacid generic that can be found at Costco. Two a day (30 mgs total) keeps me under control but I can tell when I forget.

 

[Charris]

@southernlady never worked for me either. I tried Rantidine and failed it. Then primos economy and failed then finally insurance paid for Protonix but I had to fail 2 lower priced ones first when protonix just came out my copay was $70 for a 3 month supply. Now it cost me like 10 bucks for the same

 

[DSRIGGS]

Omeprazole aka Prilosec NEVER worked for me...before or after my DS.

Back when they first diagnosed me with GERD, the PCP put me on prilosec (this was before it went OTC). After a month, he increased the dose, at 2 months we tried a new one but we had a fight on our hands to get the insurance company to agree.

I use the Prevacid generic that can be found at Costco. Two a day (30 mgs total) keeps me under control but I can tell when I forget.

Omeprazole has worked well for me for a good 5-7 years and just now I am having issues.

 

[revisionDS]

I understand what you are saying but it isn't cookie cutter. I think that surgeons have found over the last 10 years, through experience and research that the 10% CC number may be a little low and are going more in the 15% range. That is just my hunch.

@Larra and @DianaCox and @southernlady I may be mistaken but I thought one of you made the statement that you didn't think many, if any DS surgeons were doing less than 100 CM CC's for Virgin Ds'rs anymore based on bad outcomes with short CC's in the past. I would also be interested if you had heard anything on what I believe is the Gary Antone (think that is his name) theory of AL + CC = BPL being the most important element of the DS and the AL/CC specific lengths being less important. Maybe that was theory that was just discussed between Antone and Dr K, so I hope I am not sharing or attributing comments to somebody that I shouldn't be.....so anyone reading this thread please note this is my recollection and not directly attributable to either good Dr.

while it was not me who made the comment, this has been stated by at DS revision surgeon (obviously not Dr K) who will not do any DS virgin or revision less than 100 cchannel, also the Hess method is not used.

 

[revisionDS]

But I'd never argue with Dr. K.

hahaha, he actually likes to debate, and he is funny as all hell.