One Step Closer!

[Up2Me3]

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.

No he never said he "pioneered" the DS but yes he did say that he has shown many doctors how to perform the procedure. In previous posts\threads people were outraged that they were getting the wrong surgery. I'm simply saying he didn't seem to want to hide any information from me. I asked if he was doing this "loop thing" and he said Yes! and then preceeded to tell me the the why's and some pro's that he see's in doing it this way.

I sense that you may have taken offense....I hope that is not the case. While you do seem to have a lot of knowledge please understand that ...to me...you're just some lady on the internet ( I assume you're a lady, and I assume that you're genuine, I assume that you know what the H you're talking about, I assume that you really have had DS surgery)....see where I'm going here? It would be silly of me to just take you at face value at this point in the game as well - for all I know you could possibly be some narcissistic that has an over inflated sense of her worth\knowledge etc etc!

Now. In you're extensive internet experience....what do you think of the video link that my clinic, BMI Utah, posted on the Loop. Also, the New York reference they credit in it?

Elizabeth - I think you're right on the hernia issue. But what about bowel issues - what are the statistics of problems with that? I want to watch a few video's if I can find them (similar to what my clinic posted on the Loop) that are of the straight DS - if would be nice to see this visual of the differences - and even an RNY - so that I can wrap my head around how each works in regards to AMOUNT of weight loss, RETENTION of weight loss and the CONS that are associated with EACH!

Elizabeth

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.

 

[Elizabeth N.]

As I've said a couple times now:

1. There are no stats.
2. I am unaware of any reason to believe that a dual anastomosis procedure bears any higher risk of ANY of the problems you mentioned than would a single anastomosis procedure.

I don't have time to watch those videos. You're asking volunteers (some of whom are post-doc professionals whose time is worth a lot of money; my time is worth less money, but it's still MY TIME) to invest a metric shit ton of time in your questions. So you might want to think a little bit about the demands you're making here.

 

[Up2Me3]

As I've said a couple times now:

1. There are no stats.
2. I am unaware of any reason to believe that a dual anastomosis procedure bears any higher risk of ANY of the problems you mentioned than would a single anastomosis procedure.

I don't have time to watch those videos. You're asking volunteers (some of whom are post-doc professionals whose time is worth a lot of money; my time is worth less money, but it's still MY TIME) to invest a metric shit ton of time in your questions. So you might want to think a little bit about the demands you're making here.

I do appologize. I didn't realize my requests came across as demands. I certainly don't want to waste the time of "post-doc" professionals (smiling here) or any one elses for that matter! Perhaps a few of you on this site could reflect on the fact that you come accross quite caustic at times. In some threads you're ALL over it, jumping down peoples throats!

My request to watch the videos (with a posted link) was directed more towards Diana as she didn't really address my orginal question in regards to the difference in the two variations of the DS. The original question directed to her because of a post she had made "SINGLE ANASTOMOSIS DUODENO-LLEAL BYPASS ("LOOP DS") vs A PROPER DS". I'd like to see the picture or video of what she deems as a "proper DS" in comparison to the pictures she posted of the Loop.

When I first got on this site a week or so ago and posted, return comments made by you "vets" were demeaning in tone telling me to READ the other forums thoughout the site before bothering you. So I did.....and had a follow up question that was sort of side stepped in Diana's rant on the surgeon. Perhaps someone else on this site may benefit from this thread and even from the video's I posted. There is NO HARM in my asking someone to view them and answer in regards to her previous post. If she (or you) does not have the time or frankly the care then don't. But PULEEZ (sarcasm noted I hope!) don't toot your horns, jump upon your soap boxes (as you've chastised others for their non compliance etc) and then whine that you can't be bothered. There is NO harm in my asking!!!

This is a very stressful time for "newbies" and those considering all the many possibilities. If my questions offend you or irritate you.....so be it! But please lighten up a bit with "post-doc" professionals comments and attitudes - because there really isn't a smily icon for EYE ROLLING!! ...Oh wait...yes there is...

 

[Up2Me3]

I have been watching my emails all week ... and today a snail-mail letter came from the insurance company. They have approved me for the DS!!!! I am sooooo grateful and happy! I will call the clinic on Monday and hopefully get a surgery date soon!!!

My surgeon had to work with the insurance company directly to advocate for me. The insurance company had old rules that only allowed the DS for a BMI over 50 and mine is 44/45. But I have diabetes. I am very motivated to stop the progression of the diabetes. Also very excited because I have researched a LOT and I didn't want to "settle" for an RNY. I want the DS.

Let me just say here too how grateful I am for this group and all of the good information that you share. This is getting real to me now. I am going to have lots of questions ...

Sophie here is a great link showing the difference between the DS and LOOP. Have you spoke to Dr. Cottam and decided which one you are doing? I'm still debating back and forth - where is our magic 8 ball LOL From what I've been trying to "study" this is what I take from it. The Loop does not malabsorp the carbs like the DS. The loop will still limit the fat and protein absorbtion but not to the degree the DS does. BUT I do like the fact that the bowel is left alone with the Loop (SADI). Short term they are having great results with the Loop...but no long term data to show how much excess weight is usually lost or the retention rates. My inclination is to try the Loop - 1) no bowel cuts 2) there are people who have been successful with just the sleeve only so this is an added step although not as aggressive as the DS 3) there have been revisions from a Loop to a DS (possible if needed I guess)

http://www.dssurgery.com/procedures/compare-weight-loss-surgical-procedures.php

Looking forward to meeting you Tuesday!

EDITED NOTE: Sophie apparently the bowel is worked with so don't listen to me HA ...still trying to figure it out.....

 

[Larra]

A couple corrections to the above -

with a loop DS, the statement "no bowel cuts" is not correct. There is LESS cutting of the small intestine than with the standard DS, and one less anastamosis (surgical connection of one part of intestine to another). But there is still cutting of the small intestine.

Carbs - carbs are well absorbed with the DS and I see no reason they would not be equally well absorbed with a loop DS. The question is how the loop DS would affect the selective fat malabsorption that the DS provides that helps so much with maintenance. I also don't know, and maybe no one does, how well protein would be absorbed with a loop DS. With a standard DS, protein is about 40-60% malabsorbed. This means we need to eat a lot of protein, but again helps with weight loss maintenance.

Not to get picky, well I guess this is picky but it's an important point, your sentence that "The Loop does not malnutrition the carbs like the DS" has one of those things that always bothers me and I'll explalin why. One of the things we see pre-ops worry about a lot with the DS is malnutrition. Malabsorption does NOT equal malnutrition. With the DS, there are things we don't absorb well, but we don't get malnutrition - a clinical condition - as long as we eat plenty of protein, take all our supplements faithfully, and check our labs to make sure our levels are good. And if labs are trending downward, do something about it before they get to deficiency levels.

It sounds like you are leaning towards the loop DS. I think you undertand that this is a newer and less established operation than the standard DS and that longterm results are unknown. It also sounds like you are ok with the idea of having a revision to a standard DS if the loop thing doesn't work out for you. This is a very personal decision. For myself, after struggling with overweight/obesity/morbid obesity progressively since childhood, I wanted the most effective and long lasting solution to a nearly lifelong medical problem that I could get. I did not want to have to think about revision to something more effective which, from what I've seen, takes more courage than having a first time bariatric operation and also means going through yet another failure. If your choice is different from mine, so be it.

 

[jillc]

While you do seem to have a lot of knowledge please understand that ...to me...you're just some lady on the internet ( I assume you're a lady, and I assume that you're genuine, I assume that you know what the H you're talking about, I assume that you really have had DS surgery)....see where I'm going here? It would be silly of me to just take you at face value at this point in the game as well - for all I know you could possibly be some narcissistic that has an over inflated sense of her worth\knowledge etc etc!

@Up2Me3 One thing that you don't have to worry about on Bariatric Facts is if someone "seems" to be knowledgeable, they are. Or they'll get stomped on.
@DianaCox is extremely knowledgeable. She volunteers her time helping us with her advice. She's is as brainy as f*ck. On DSFacts.com, she's authored papers that IMO are mandatory reading.

I would suggest you look at this thread about the Loop/SADI vs the DS (http://bariatricfacts.org/threads/sadi-s-loop-please-share-facts-about-this-new-procedure-here.1272/). I would also suggest you study about human anatomy, so you can understand the difference. Getting advice is great, but educating yourself about your body is of the utmost importance as your new anatomy whether it be SADI or DS is going to vastly change.

Perhaps a few of you on this site could reflect on the fact that you come accross quite caustic at times. In some threads you're ALL over it, jumping down peoples throats!

IMO again, caustic shmositic. This board is not about soft voiced ooohs and ahs . It is more like that trust game where you fall off a great height and you trust the group of people below will catch you. The fall may be brutal, but they'll catch you here. Nevermind the bruises that you may get on the landing. @Elizabeth N. @Larra @DianaCox Cox [USER=105]@Spiky Bugger @southernlady @JackieOnLine etc are vets with tons of experience. I personally am grateful to all of them. @Larra told me about this great group.@Elizabeth N. has helped me and volunteered her time and advice, which is invaluable to me. I learn every day from the others, and I enjoy their posts. And the people I've overlooked too (sorry people!)

Welcome and I hope you make the best choice for you.[/USER]

 

[DianaCox]

"The Loop does not malnutrition the carbs like the DS. The loop will still limit the fat and protein absorbtion but not to the degree the DS does. BUT I do like the fact that the bowel is left alone with the Loop (SADI)."

Sorry, you do NOT understand this very well at all - please don't try to explain it to someone else and confuse them even more.

In the DS (assuming the average construction of an approximately 250 cm alimentary tract, comprising 150 cm of ileum proximal to the RNY anastomosis with the biliopancreatic limb and a 100 cm common channel distal to the anastomosis):

• There is a shorter alimentary tract overall of 250 cm
• What happens in the 150 cm is SOME limited protein and complex carbohydrate absorption, because there are enzymes (proteases and amylases) secreted by the ileum that help break down protein and carbs, plus they have been partially digested by stomach acid before they get there - but NO fat absorption, because that requires bile salts and lipases which ONLY are delivered via the bile and pancreatic ducts that are present in the portion of the duodenum that is bypassed. The bile salts and lipases (as well as additional pancreatic proteases and amylases) are only delivered to the food stream for the last 100 cm (common channel).
• These distributions of enzymes and bile result in:
  • Roughly 50% protein and complex carb absorption
  • SELECTIVE fat malabsorption - resulting in only about 20% fat absorption
  • The ability to eat HIGH protein, and HIGH fat

In contrast, with the SADI (assuming a "common channel" of 300 cm anastomosed to the proximal duodenum):

• The there is a 300 cm common channel, resulting in:
  • NO selective fat malaborption - I'm assuming far more than 60% fat is absorbed, because the impact of having three times as long of a common channel will be synergistic - there will be more time to accomplish the two step process of fat solubilization by the bile, which is a the rate-limiting step and the necessary precursor to the action of the lipases to break down the lipids for absorption. So SADI patients will NOT get to eat fat freely, and will be dieting, and will not have the benefit of the satiety that eating high fat provides.
  • There will be significantly more protein and carb absorption as well, because not only is the overall alimentary tract longer, the entire length will be in the presence of the full complement of amylases and proteases. I'd guess there will be 75-85% protein and complex carb absorption. SO - more dieting.

"I do like the fact that the bowel is left alone with the Loop (SADI)." This is BS - the bowel is NOT left alone - do you really not understand that the entire difference between the DS and the SADI is ONE less cut and ONE less anasomosis?

I tried to draw this on a piece of scrap paper - my drawing skills and handwriting suck, but I think you can get the gist of it:

ETA: AW CRAP - I got the description of the SADI drawing a little wrong - upstream of the anastomosis with the duodenum is most of (3), and the part DOWNSTREAM (i.e., in the common channel) is the rest of the jejunum. The drawing is correct, but the description that refers to (3) should say "Part but not all of (3)."

 

[Jo777]

Agreeing with Jill above.. I came here after meeting some of the core people elsewhere, then continued interacting with them on another site until this one was a reality. You won't find a better educated, realistic, and sharing group than here. I don't have a DS, but I also learned a hell of a lot about it (frankly, moreso than others who HAVE or are going to GET one in some cases.) I am still around, as this is as good as it comes for reality based caring individuals with the smarts to back up the words, and the ability to get through some thick skulls about things that can be life or death in the worst cases. This isn't a fluffy subject.

 

[Up2Me3]

@Up2Me3 One thing that you don't have to worry about on Bariatric Facts is if someone "seems" to be knowledgeable, they are. Or they'll get stomped on.
@DianaCox is extremely knowledgeable. She volunteers her time helping us with her advice. She's is as brainy as f*ck. On DSFacts.com, she's authored papers that IMO are mandatory reading.

I would suggest you look at this thread about the Loop/SADI vs the DS (http://bariatricfacts.org/threads/sadi-s-loop-please-share-facts-about-this-new-procedure-here.1272/). I would also suggest you study about human anatomy, so you can understand the difference. Getting advice is great, but educating yourself about your body is of the utmost importance as your new anatomy whether it be SADI or DS is going to vastly change.


IMO again, caustic shmositic. This board is not about soft voiced ooohs and ahs . It is more like that trust game where you fall off a great height and you trust the group of people below will catch you. The fall may be brutal, but they'll catch you here. Nevermind the bruises that you may get on the landing. @Elizabeth N. @Larra @DianaCox Cox [USER=105]@Spiky Bugger @southernlady @JackieOnLine etc are vets with tons of experience. I personally am grateful to all of them. @Larra told me about this great group.@Elizabeth N. has helped me and volunteered her time and advice, which is invaluable to me. I learn every day from the others, and I enjoy their posts. And the people I've overlooked too (sorry people!)

Welcome and I hope you make the best choice for you.][/USER]

[QUOTE="DianaCox, post: 27596, member: 3"]"The Loop does not malnutrition the carbs like the DS. The loop will still limit the fat and protein absorbtion but not to the degree the DS does. BUT I do like the fact that the bowel is left alone with the Loop (SADI)."

Sorry, you do NOT understand this very well at all - please don't try to explain it to someone else and confuse them even more.

In the DS (assuming the average construction of an approximately 250 cm alimentary tract, comprising 150 cm of ileum proximal to the RNY anastomosis with the biliopancreatic limb and a 100 cm common channel distal to the anastomosis):
[LIST]
[*]There is a shorter alimentary tract overall of 250 cm
[*]What happens in the 150 cm is SOME limited protein and complex carbohydrate absorption, because there are enzymes (proteases and amylases) secreted by the ileum that help break down protein and carbs, plus they have been partially digested by stomach acid before they get there - but NO fat absorption, because that requires bile salts and lipases which ONLY are delivered via the bile and pancreatic ducts that are present in the portion of the duodenum that is bypassed. The bile salts and lipases (as well as additional pancreatic proteases and amylases) are only delivered to the food stream for the last 100 cm (common channel).
[*]These distributions of enzymes and bile result in:
[LIST]
[*]Roughly 50% protein and complex carb absorption
[*]SELECTIVE fat malabsorption - resulting in only about 20% fat absorption
[*]The ability to eat HIGH protein, and HIGH fat
[/LIST]
[/LIST]
In contrast, with the SADI (assuming a "common channel" of 300 cm anastomosed to the proximal duodenum):
[LIST]
[*]The there is a 300 cm common channel, resulting in:
[LIST]
[*]NO selective fat malaborption - I'm assuming far more than 60% fat is absorbed, because the impact of having three times as long of a common channel will be synergistic - there will be more time to accomplish the two step process of fat solubilization by the bile, which is a the rate-limiting step and the necessary precursor to the action of the lipases to break down the lipids for absorption. So SADI patients will NOT get to eat fat freely, and will be dieting, and will not have the benefit of the satiety that eating high fat provides.
[*]There will be significantly more protein and carb absorption as well, because not only is the overall alimentary tract longer, the entire length will be in the presence of the full complement of amylases and proteases. I'd guess there will be 75-85% protein and complex carb absorption. SO - more dieting.
[/LIST]
[/LIST]
"I do like the fact that the bowel is left alone with the Loop (SADI)." This is BS - the bowel is NOT left alone - do you really not understand that the entire difference between the DS and the SADI is ONE less cut and ONE less anasomosis?

I tried to draw this on a piece of scrap paper - my drawing skills and handwriting suck, but I think you can get the gist of it:
[IMG]http://i6.photobucket.com/albums/y217/DianaCox/IMG_10961_zps5db1ba91.jpg[/IMG][/QUOTE]

No I don't understand it completely Diana. While I am an educated individual - I am not an attorney with debating skills nor a medically trained person to fully grasp the inner workings of my guts. I'm doing my best, so do try to be patient!! I do understand the difference between malnutrition and malabsoption - I miss spoke - I appologize! Also, I wasn't trying to explain\educate OR CONFUSE Sophie in the slightest - I was simply trying to work through my own thoughts in telling her what I thought I was understanding up to this point!!


Thanks Jill - I did check out that thread and it was very helpful. I'm not needing soft voiced oooohs and ahs. But people process and work through and problem solve differently. I go back and forth with pros and cons which obviously its annoying ha ha. But the way I try to learn and retain is to reprocess it -to my husband, to my doctor but apparently I shouldn't do it here until I have it down pat!!!!

I'm sorry if I seem a little touchy (ok a lot) but I wonder how many patients have these surgeries and really truly know what the freak they are doing to their bodies? Did all of you know it inside and out BEFORE surgery? Hell....maybe it's just best to close my eyes and jump AHAHAHAHAHAHAHAHHAAH

 

[Larra]

Closing your eyes and jumping is the last thing anyone should do!!

Unfortunately, the vast majority of people who have bariatric surgery do exactly that. They get the operation they have heard of, or that some pseudo-celebrity got, or someone from the PTA or church or who knows where. They see ads on TV or billboards. They get whatever the clinic closest to home is selling. They don't even realize that other, better options exist. And let's be real, the people we can reach here and on other websites comprise a tiny fraction of the 200,000 people in the USA alone who have bariatric surgery every year.

You have the great good fortune to have found a well informed group, AND to haave a surgeon who actually made the effort to explain the difference between two complex operations to you and to give you a choice. Take advantage of both these resources. Learn as much as you can, then make your decision. But do know that we really are bariatric surgery veterans, we really are as well informed as we claim to be, and as Jill pointed out, when a troll shows up, which does happen from time to time, he or she will be thoroughly stomped on. Check out "daphne"'s recent thread if you don't believe me.

 

[Jo777]

Yes, actually I did know inside and out, both my anatomy- what it does, and how surgery was going to change it, for both surgeries I was considering (and also for those that I ruled out) before I chose. I willingly hopped up on the table, hell yes I knew. I have to live with it- and need to make sure what I was risking, financially and physically was a good fit. I DO agree, many walk in- get sold at a seminar with just the basic dumbed down info (many times with much omitted/wrong).. and walk out nearly clueless and unable to explain exactly what they allowed someone else to do to them. That freaks me out.

 

[Up2Me3]

Yes, actually I did know inside and out, both my anatomy- what it does, and how surgery was going to change it, for both surgeries I was considering (and also for those that I ruled out) before I chose. I willingly hopped up on the table, hell yes I knew. I have to live with it- and need to make sure what I was risking, financially and physically was a good fit. I DO agree, many walk in- get sold at a seminar with just the basic dumbed down info (many times with much omitted/wrong).. and walk out nearly clueless and unable to explain exactly what they allowed someone else to do to them. That freaks me out.

Jo - That's sure what I'm trying to do! I really think nerves are a big part of it. I'm ok with the things I would have to deal with after a DS - the vitamin and protein regimens - that part. It's the whole potential bowel problems and death that kinda have me freaking out.....mostly at night because everything is scarier at night right!

Do you mind me asking you why you did the sleeve only? If you researched them all inside and out...what made you hold back for the DS part of the surgery? The sleeve only doesn't really scare me at all....but I have nearly 200# to get to my goal and I don't know if I can do it with just the sleeve?!?

 

[Jo777]

I just knew me.. I had only about 100-110 to lose.. I had no issues losing, and lost at the same exact speed post op from 264 to 155 as I did some 10-15yrs earlier when I lost from 300 to 155. My issue was really poor eating choices and quantities, and never been satisfied with "enough."

I knew with the way I am, as much as I am intelligent, I did not want the greater responsibility in upkeep, nor do I believe I need the malabs. aspect to stay in a healthy weight range. I needed a reset button.

A couple years prior to surgery I had made some changes to my eating, leveled off my decade long slog back to MO.. and I wanted a lot of assistance to get back to a normal weight, with a little assistance in the future to maintain it.

I also have a very long family history of gut issues, which to this point, save for some nasty IBS flares, I have avoided.. but both my sisters have had resections, and my father has no large intestine and a portion of his small gone due to it.. so that also factored in, but not as much as the points above.

So far, the sleeve has worked well. So long as I eat a nice varied diet- heavy on veg/protein/fat (I eat relatively high fat- 50-60% cals are fat most of the time) I lose or maintain. If I get stupid and binge on donuts and beer, I gain (duh.) It's freed me from counting cals and dieting (save for the first year or two post-op, where I did.. and learned well from it.)

 

[DianaCox]

We absolutely DO NOT advocate "closing your eyes and jumping" - you may just find you're jumping into the pits of Hell.

I am copying a post I made elsewhere:

From what I have heard recently (though I haven't confirmed), Cottam's practice seems to be better than that of several other surgeons who are doing the SADI (aka, SADIsts).

My biggest issues with the SADIsts are (1) whether there is full and complete disclosure of what they are doing, including how they describe it as a "loop-DS" or "just like a DS only safer" - which are pretty close to lies in my view; (2) ethical concerns about pushing an experimental procedure on self-pays, who are already highly vulnerable to pressure to pick a "cheaper" option; and (3) whether or not the SADI is being offered by the surgeon as a "cowboy' one-off procedure for their own convenience or curiosity, or whether they are performing it as a part of a controlled, scientifically supervised, experimental protocol in a proper clinical trial, with all patient protections in place.

There are some surgeons who DON'T do the DS at all, and are not telling their patients that the SADI is experimental, who are not disclosing how VERY different it is from a proper DS, or even WORSE - are just DOING the SADI without getting fully informed consent at all.

 

[Elizabeth N.]

I'm sorry if I seem a little touchy (ok a lot) but I wonder how many patients have these surgeries and really truly know what the freak they are doing to their bodies? Did all of you know it inside and out BEFORE surgery? Hell....maybe it's just best to close my eyes and jump AHAHAHAHAHAHAHAHHAAH

Um, as well as a person with no medical training can know, YOU'RE DAMNED FUCKING SKIPPY I knew it inside and out before I had my DS. And had the DS had as little data behind it as the SADI/LOOP procedures do now, hell would have frozen over before I'd have had it done.