My 2016 DS Journal

[DSRIGGS]

If they think it takes that much longer... ehhh. I don't know that the Hess method tacks on that much more time. You're already positioned to do it (they usually reposition us on the table for measuring bowels) even without using Hess. Heck, they are already measuring... this isn't that much more. I assume Hess can be done laprascopically, but I imagine it requires a bit more skill for that. It may be surgeons don't want to do it because they aren't sure it can be completed without doing it open.

I will ask my surgeon in a few weeks for my revision appointment because I am a nerdy and tactless pain in the ass.

Measuring is not difficult and yes it can be accomplished when doing it laproscopically .
In my opinion yes it is how they trained and in my mind all about money when a surgeon won't measure total sbl. There is nothing new that has happened with DS. Hess is the original DS guy and it has been around for 20 years. I had conversation with somebody today who isn't a Dr but has been around the DS practice for 15 years and that person doesn't know how the standard limb DS got started.

@trace you can't really know what length of a DS is proper if you don't know the total sbl. All I can tell you is that I don't know anyone other than liz who has a 150 cm cc or higher. I believe you said you were not very tall so a best guess for you imo would be a 100 cm cc and 150 AL. Standard limb length in in your case would have a good chance being correct.

I strongly advise against a 34 cm bougie ubless he staples very loosely. A smaller bougie size has shown that it results in no more weight loss than a lager bougie. I believe the two sizes compared in the study were 34 fr and 52 fr. Why go small for sleeve if it greatly increases risk of severe gerd and structure if there is no documented proof of better weight loss?

I am very skeptical that it is a wise plan to give you a 34fr bougie and 150 cm CC without even mentioning the AL or knowing bowel length. Those are warning signs to me but you have to what you think is right, but you MUST ADVOCATE FOR YOURSELF AND WHAT YOU WANT. It doesn't matter if the guy is nice and a good cutter. You have to live with the results of YOUR DS so please tell him you don't want a 150 cm if that is your belief. I personally would still push for a Hess ds and a larger bougie..

I know it is hard to advocate for yourself when tired.. I have had to live with a shitty last 3 years but I advocate very strongly for myself even though i have felt rotten as hell.

 

[Susan in Tennessee]

Scott, I can't begin to say how much I admire you and what a sweet and caring person you are, to take time to write this post (filled with great advice) when you have all that you have going on. I agree totally on sleeve size. I have 36 and sort of wish it was larger. Just so difficult to eat enough protein!

 

[galaxygrrl]

So, tons of disclaimers on this. I have no idea about any of this. And I found it overwhelming and just went with my Drs. recommendation which is close to Hess, but not to a "t"

Anyway, I would have a conversation with Dr. K or Dr Rabkin about this. Pay the couple hundred bucks to talk to them. A second opinion here would be good.

 

[JackieOnLine]

About liver-shrinking diets: Dr. John Rabkin (who is also a liver transplant surgeon) said he didn't need patients to "shrink their liver" pre-op, and something along these lines: "Bariatric surgeons should expect to find an enlarged liver, and should know how to deal with it."

Diana, I have a vague memory of being told that low carb, specifically, makes the liver "less slippery" - anything to that? I don't remember where this came from but I would guess You Know Where.

 

[trace]

Yeah, I've been stewing about all of this. He did tell me AL = 150. I need to call his office and ask to speak to him again.

Meanwhile, I finished my hoop jumping (knock on wood). The final phase of my stress test happened this morning, so I just need to keep my fingers crossed that the results are good.

 

[trace]

By the way, in researching the issue further, I found this information on a NC surgeon's website regarding the DS:

It has the greatest weight loss potential of all the operations available. It works by creating a sleeve gastrectomy for restriction and hunger control. Then after the sleeve the intestines are rerouted similar to a gastric bypass. The principle measured length with a duodenal switch is the common channel. This is the distance from where bile and food meet to the end of the intestines and determines the amount of malabsorption.

This common channel distance is an important number and has changed significantly over time. Originally this number was 50-100 cm and while it provided excellent weight loss, it left patients with nutritional deficiencies and diarrhea. We currently do a common channel length of 300 cm for most procedures.

http://www.surgerync.com/bariatric-procedures/ds.php

 

[southernlady]

By the way, in researching the issue further, I found this information on a NC surgeon's website regarding the DS:

It has the greatest weight loss potential of all the operations available. It works by creating a sleeve gastrectomy for restriction and hunger control. Then after the sleeve the intestines are rerouted similar to a gastric bypass. The principle measured length with a duodenal switch is the common channel. This is the distance from where bile and food meet to the end of the intestines and determines the amount of malabsorption.

This common channel distance is an important number and has changed significantly over time. Originally this number was 50-100 cm and while it provided excellent weight loss, it left patients with nutritional deficiencies and diarrhea. We currently do a common channel length of 300 cm for most procedures.

http://www.surgerync.com/bariatric-procedures/ds.php

Yeah, BUT as someone who has a common channel of 175, I am SO glad mine is not a smidgen longer. And that surgical office is mixing the common channel of a SADI/LoopDS/SIPS with the 2 anastomosis. According to the CPT code for the DS, the common channel is far shorter than 300. Diana addresses that here: http://bariatricfacts.org/threads/duodenal-switch-report-from-asmbs-nov-2015.3735/

 

[galaxygrrl]

You know, I read about the SADI too and it seems super attractive, but here was my take on it. We don't have long term data on the SADI and it's clear the Sleeve does not work well in the long run and the RNY has issues, so, the SADI is a crap shoot. I was willing to put up with taking vitamins and the runs to be thin. It's not that bad really.

And understand, it's the malabsorption that keeps you thin. Otherwise the sleeve will work. And, I think, though I'm not sure, the SADI has the same malabsorption of the RNY. And the RNY does not work that well over the long run.

Again, I will say, I'm not an expert on this and please don't take these statements as truths. It's just when I looked at it, that was my take on it. I did not get overly focused on how long my DS should be. I just trusted my Dr and the stats. And I was very serious about one and done on the surgery. I don't want another one.

Three weeks ago I was losing slowly and I was thought, crap, I will not get to my goal weight of 135 since I'm short. In the last 2 weeks I've lost 13 pounds - scale owed me some weight - and I now I'm thinking what happens if I can't keep weight on.

So, what this has taught me is make wise decisions and trust your choices, and you will figure it out. Who knows where I will end up. But, what i have learned is I can't overthink this because what will happen will happen.

@southernlady - she is the one who was like, stop over thinking, the surgery works.

Get a second opinion and make a choice you are comfortable living with.

Good luck.

 

[trace]

I got my DS last Thursday!

Srikanth said everything went "great!" I spent one night in the hospital, and I have been home sipping my liquids and napping a lot ever since. I get to start my protein shakes tomorrow, and I am ridiculously excited about that. I'm getting hungry!

Other than remaining soreness around my belly button, I'm doing fine. I started on the Vitalady's regimen, and I'm just adding little by little to it every few days.

Thank you for supporting me so much throughout all of my pre-op angst!

 

[galaxygrrl]

Sweet! Congrats! Keep sipping and make sure to move. I found he first 5 days the hardest.

 

[Kate]

Congrats!!!!

 

[trace]

Sweet! Congrats! Keep sipping and make sure to move. I found he first 5 days the hardest.

I agree. I was having some major buyers remorse the first few days because I honestly didn't except to feel so awful. And so nauseous! That was the worst. Now I'm just ready to eat. Ha!

 

[southernlady]

Welcome to the Dark Side, @trace

 

[galaxygrrl]

I agree. I was having some major buyers remorse the first few days because I honestly didn't except to feel so awful. And so nauseous! That was the worst. Now I'm just ready to eat. Ha!

You'll get over buyers remorse, but it comes back to me once every few weeks, but then, I get a grip and think I'm down 50 pounds and my diabetes is done.

The first week sux. The second week is better. At week 9, I'm still figuring it all out, but it's gets better every day

Welcome to the Dark Side, @trace

Nope, not the dark side. As my best friend said when I woke up from surgery, welcome to the skinny side.

 

[Susan in Tennessee]

Wow, that was fast! Congratulations. Sounds like you're doing really great.