One Step Closer!
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Ok this is for you and for Sopie who is scheduled the day before me. I just spoke with Dr. Cottam. I asked him about the DS versus a "loop DS" he did go into a good explanation that I wouldn't even be able to regurgitate here. I did feel pretty good about what he was saying though. It was a phone conference and I wish so badly to have been sitting next to him with the diagrams that you posted. His take as I understand it....with the Loop you don't split the bowel so there is less chance of problems there. Less Internal hernia issues. Less coooper and zinc deficiencies. Yes I would absorb fat a little easier than a straight DS but this would improve diareha and gas issues. He feels that this still has much better weight loss initially and long term than the gastric bypass (RNY)- perhaps not as impressive as a straight DS but with fewer problems and potential problems??
Here is my question for everyone here.....He said that yes he does a Loop DS........is this the same as the SADI that you all were talking about? I didn't have that as one of my questions for him (dang).
Ok....folks ........dive in, pitch in. I know you have issues with this but I wonder what your feedback is now that I have spoke to him. He was actually 'excited' to have a patient ask or even know\think to ask these questions and didn't seem like he was hiding anything and wasn't irritated that I was questioning him.
He did say he can do a straight DS (he is actually a Dr. that has taught other surgeons this) so he is comfortable with the procedure but he feels that the change in procedure to the Loop DS has benefits that far outweigh not being able to loose quite much\fast. Again its more that gastric RNY results by far.
As far as having dumping...he said that there is a slight potential for dumping even with a straight DS....and that same criteria that would cause that in a straight DS would cause it in the Loop....that it doesn't increase or cause dumping in and of itself.
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Sophie I'm the 21st...the day after you! YIPEE....I think ha ha. Go down and see my reply to Diana about the Straight DS vs the Loop DS. Just got off the phone with Cottam and he does do a Loop and prefers it but will so a straight if we want.
Larra
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For me, the issue wouldn't be how fast the weight loss is, but rather how much weight loss and how good is the maintenance of that weight loss. Dumping is a non-issue, as he said.
Most people don't have big issues with copper or zinc, though there are exceptions. My brother had a DS and did get copper deficiency, which was correctable by, you guessed it, supplementing copper. I'm over 8 years post-op and have never supplemented copper and my levels have always been fine. Go figure. I was taking zinc 4 days a week, just the regular otc zinc from the drug store, and had to cut back to 3 days/wk becaue my level went too high. But of course that is just one person's experience.
If you are ready and willing to supplement as needed and get your labs, I don't see zinc or copper as reasons for one operation over the other. I think it's the extent and sustainabilitiy of the weight loss. For me, given that longterm results of the classic DS are well documented and longterm results of the loop-DS are not, I would go with the classic DS. But I respect Dr. Cottam, esp his willingness to explain the differences and his reasoning, and his willingness and ability to do either operation. Each of you will need to consider his information, consider your own personal needs and what results you want/expect from your surgery, how well you think you will do with maintenance, and decide for yourselves.
Most people don't have big issues with copper or zinc, though there are exceptions. My brother had a DS and did get copper deficiency, which was correctable by, you guessed it, supplementing copper. I'm over 8 years post-op and have never supplemented copper and my levels have always been fine. Go figure. I was taking zinc 4 days a week, just the regular otc zinc from the drug store, and had to cut back to 3 days/wk becaue my level went too high. But of course that is just one person's experience.
If you are ready and willing to supplement as needed and get your labs, I don't see zinc or copper as reasons for one operation over the other. I think it's the extent and sustainabilitiy of the weight loss. For me, given that longterm results of the classic DS are well documented and longterm results of the loop-DS are not, I would go with the classic DS. But I respect Dr. Cottam, esp his willingness to explain the differences and his reasoning, and his willingness and ability to do either operation. Each of you will need to consider his information, consider your own personal needs and what results you want/expect from your surgery, how well you think you will do with maintenance, and decide for yourselves.
I may have miss spoke when I said 'weight wouldn't come off as fast' we talked about the amount of weight and regain issues - not so much how fast it comes. I think the reason he has me leaning to the LoopDS is it is "safer" as far as bowel issues and internal hernias. Hmmm....decisions decisions!
Keep the feedback coming. Perhaps on these 3 points: 1) SADI vs Loop DS (I'm not sure I understand this) 2) Bowel safety \ hernia issues between Straight and Loop 3) Amount of excess weight loss AND maintenance compared to gastric (we already know Loop won't be as much as Straight)
Thanks!
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Elizabeth N.
Herder of cats
I, too, am very pleased to hear that Dr. Cottam gives a cogent explanation of what he's doing. If I were in your shoes, I would insist about the "real" or "traditional" DS and explicitly, in writing, refuse a SADI/LOOP procedure. I am NOT comfortable with the idea of being a guinea pig.
In a few years, where there's real long term data on it, I would probably feel better about it.
That being said, Dr. Hess and a few other pioneering, thinking, very skilled surgeons were doing "guinea pig" procedures in the early years of the DS. Some brave people trusted them and now we have the platinum standard of WLS. SADI procedures are being studied in controlled environments in a couple of places. If you really, really, REALLY want a single anastomosis, and you REALLY are cool being one of the few people on the planet with guts designed that way, then I will look forward to following your progress and cheer you on.
The main issues are IMO:
If we keep screaming RUN LIKE HELL and whatnot, then we're doing to people interested in SADI exactly what RNYers did to DSers for a hell of a long time when it was a new procedure.....And look how that turned out. They were wrong and "we" were right
.
In a few years, where there's real long term data on it, I would probably feel better about it.
That being said, Dr. Hess and a few other pioneering, thinking, very skilled surgeons were doing "guinea pig" procedures in the early years of the DS. Some brave people trusted them and now we have the platinum standard of WLS. SADI procedures are being studied in controlled environments in a couple of places. If you really, really, REALLY want a single anastomosis, and you REALLY are cool being one of the few people on the planet with guts designed that way, then I will look forward to following your progress and cheer you on.
The main issues are IMO:
- Informed consent. None of this "guess what I did to you" bullshit.
- Clarity with insurance. For some insurance plans, calling a SADI a DS would be seen as fraud. I am confident that Tricare would see it that way. (Which is a moot point because Tricare still doesn't cover the DS.)
- Commitment to follow-up. When you have super special designer guts and only a couple surgeons on the planet know the drill, this could get problematic. Of course any good GI surgeon could sort it out, but you need to understand that you are a very rare bird.
If we keep screaming RUN LIKE HELL and whatnot, then we're doing to people interested in SADI exactly what RNYers did to DSers for a hell of a long time when it was a new procedure.....And look how that turned out. They were wrong and "we" were right
.
Elizabeth N.
Herder of cats
1. SADI=LOOP
2. No data available yet
3. No data available yet. Oh, and "gastric" means nothing in DS. When WLS people talk about "the gastric," they generally mean RNY gastric bypass. Gastric is a synonym for stomach.
I, too, am very pleased to hear that Dr. Cottam gives a cogent explanation of what he's doing. If I were in your shoes, I would insist about the "real" or "traditional" DS and explicitly, in writing, refuse a SADI/LOOP procedure. I am NOT comfortable with the idea of being a guinea pig.
In a few years, where there's real long term data on it, I would probably feel better about it.
That being said, Dr. Hess and a few other pioneering, thinking, very skilled surgeons were doing "guinea pig" procedures in the early years of the DS. Some brave people trusted them and now we have the platinum standard of WLS. SADI procedures are being studied in controlled environments in a couple of places. If you really, really, REALLY want a single anastomosis, and you REALLY are cool being one of the few people on the planet with guts designed that way, then I will look forward to following your progress and cheer you on.
The main issues are IMO:
I would like to see folks here stop demonizing the SADI type procedures as a matter of course. If these issues are very, VERY clearly handled, then MAYBE moving in this direction is a viable option for some people.
- Informed consent. None of this "guess what I did to you" bullshit.
- Clarity with insurance. For some insurance plans, calling a SADI a DS would be seen as fraud. I am confident that Tricare would see it that way. (Which is a moot point because Tricare still doesn't cover the DS.)
- Commitment to follow-up. When you have super special designer guts and only a couple surgeons on the planet know the drill, this could get problematic. Of course any good GI surgeon could sort it out, but you need to understand that you are a very rare bird.
If we keep screaming RUN LIKE HELL and whatnot, then we're doing to people interested in SADI exactly what RNYers did to DSers for a hell of a long time when it was a new procedure.....And look how that turned out. They were wrong and "we" were right
Thanks Elizabeth - I am actually self pay so insurances be damned!
1) So SADI and Loop are synonymous. Good to know on the INFORMED CONSENT not an open ended consent.
2) I realize that there isn't any data yet on the bowel \ hernia safety but what is the opinion of the Vets out here....as you seem to know the workings of your new guts. Dr. Cottam thought it better - less complication risk - but is there something I'm not knowing to ask him. When you say very few people would know how my system works.....how or why would this be important because frankly...my intern Doc knows NOTHING about DS and even very little on the RNY (thanks for clarifying that...when I've said gastric I mean RNY)
Is there anyone specific on these boards - here or any site - that HAVE HAD the Loop that I could talk with?
I have never heard this terminology before.....is this the DS
http://www.youtube.com/watch?v=JNJonJEtuhM
Here is the BMI clinic that I'm going through explanation of the Loop
http://www.youtube.com/watch?v=JauC_zV1n9M
http://www.youtube.com/watch?v=JNJonJEtuhM
Here is the BMI clinic that I'm going through explanation of the Loop
http://www.youtube.com/watch?v=JauC_zV1n9M
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Well....No....he has doctors that come from other states to him as well....! Unless of course your suggesting that he may be lying straight face to me? He said that he has taught and was one of the first to do a DS years ago. And that this Loop is fairly new but that he has had around 40 surgeons that he has now shown this to.
Where do you get your information? It would be helpful if you could list that so that we too may verify for ourselves and frankly if your site or info IS correct then he will hear from me I assure you!
Please see the video attachments I posted in this thread and give me your feedback...maybe go to BMI Utah and Dr. Cottam on youtube......
Oh puleeze. I've been involved in the DS online world since 2002, I've been helping people with their DS insurance appeals since 2003, and I've been involved with providing input on "vetted" surgeons for almost all of that time. I only HEARD of Cottam as a DS surgeon in the last 3 years or so (and then, primarily because of the SADI issues). Your posts suggests he pioneered the DS, which is crap. The DS has been around since 1988, and while he may have been doing some DSs before I heard of him, I would be EXTREMELY surprised to hear that he is the go-to guy in the US, much less the world, for training new DS surgeons. And even if he was, it hasn't been for long.
I get my information based on my wide-ranging conversations with DSers who are on the internet, as well as discussions with much better known DS surgeons.
Oh wait - WTF? He really said this?? "He said that he has taught and was one of the first to do a DS years ago." He was one of the first to do a DS? Really?
Then don't you think he would have boasted about that HERE?: http://doctorsofweightloss.com/the-doctors/dr-daniel-cottam-md
And HERE?: http://www.bmiut.com/daniel-cottam-md-bariatric-surgeon/
According to this: http://www.intelius.com/results.php...&qf=daniel&qmi=&qn=cottam&qcs=ut&focusfirst=1
he is 46 years old. The DS was "invented" in 1988 by Dr. Hess, 26 years ago. Your Dr. Cottam was 20 years old in 1988.
I get my information based on my wide-ranging conversations with DSers who are on the internet, as well as discussions with much better known DS surgeons.
Oh wait - WTF? He really said this?? "He said that he has taught and was one of the first to do a DS years ago." He was one of the first to do a DS? Really?
Then don't you think he would have boasted about that HERE?: http://doctorsofweightloss.com/the-doctors/dr-daniel-cottam-md
And HERE?: http://www.bmiut.com/daniel-cottam-md-bariatric-surgeon/
According to this: http://www.intelius.com/results.php...&qf=daniel&qmi=&qn=cottam&qcs=ut&focusfirst=1
he is 46 years old. The DS was "invented" in 1988 by Dr. Hess, 26 years ago. Your Dr. Cottam was 20 years old in 1988.
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Elizabeth N.
Herder of cats
He might have been the first in SLC/regionally to do a DS, but unless he was doing them in the late 80's/early 90's, he's not one of the pioneers of the procedure.
My thoughts on the obstruction-hernia type worries: The incidence of these kinds of problems is overall quite low with the DS. MAYBE the SADI will turn out to have better stats, but only time will tell.
My thoughts on the obstruction-hernia type worries: The incidence of these kinds of problems is overall quite low with the DS. MAYBE the SADI will turn out to have better stats, but only time will tell.
