Reversal of DS intestinal switch? Anyone?

[DSRIGGS]

Do you have a copy of your surgical report? That would be helpful to see if there is by chance a measurement of your other limbs (AL & BPL)

and I missed your comments about how much you have eaten today. A suggestion would be to go to myfitnesspal.com and you can enter what you eat and it will track it for you and save it. That way you can see exactly how many carbs and protein you are eating daily. If you can do that for a few days it would be really helpful. Also if you could detail you vitamin intake....btw, I have to change my vitamin dosing after every lab test based on the results. I still get labs monthly as I am still deficient in some areas but seem to be improving.

hang in there...there is light at the end of your tunnel

 

[DSRIGGS]

and Aayoola has a good reputation....not sure if he has done revisions but fro Virgin DS has good rep from what I understand.

 

[Poodles]

Will try to get exact numbers for you. I can't eat a lot at one time, using the old cottage cheese test, I can eat 12 oz food. Drink 8 oz at a time...wait...then can drink some more. I can drink a 16 oz water bottle in 10 minutes.

Have always had at least one 40gm protein shake a day. Eat mostly meat cheese eggs. But have not tracked it in a long time. Upped the shakes when told to.
Now consuming 120gms in shakes, plus whatever else I can add in.

Spoke with another doctor, he did not give me medical advice but said in the past some patients with severe malnutrition issues need shots. It does not matter how many pills they swallow they need shots. He also said that if he had two patients one with a BMI of 19 and one with a BMI of 27 he would want the one with 19 to be on preop nutrition or TPN to be built up for the surgery. because postop the BMI might go lower. He would also suggest to that person to be on a post op diet (Tpn or tube) to help as the bowel wakes up.

His first question would be to find out if the cc is correct length or not. A full reversal may not be needed, just correction of the measurements. But that is determined by the patient.

I'm the patient, I only have one shot at this IF insurance will pay for it.

1) do I have it revised and risk continued malnutrition issues?
2) do I have it reversed and risk weight gain?

I have been consistently wrong, so I have no idea what to do.

And as I tried to post this my doctors office is called an insurance has paid for the reversal. They want to do it February 8. Wow. My insurance does not like to pay for anything.

 

[DSRIGGS]

120 grams of whey protein daily plus other food protein should be good. That being said, I am of the belief that protein from shakes and protein from drinks are not necessarily equivalent (I have no data to back that up just my opinion). BTW, you don't have to be able to eat a lot at one time. Most of us 6-10 meals/snacks a day. Small meals.

When you say need shots, do you mean for supplements? I had a Vitamin D injection before my revision because Dr K wanted my D levels high. It has worked quite well. I am having trouble getting my Vitamin A up so I am getting an injection of that as soon as my PCP can get it ordered and get me in. I do believe your Dr is absolutely correct about wanting you to get your nutrition up as much as possible before surgery. Dr K was the same way with me. I was lucky in that my weight loss stabilized a bit and my BMI was 22 at time of surgery and labs weren't too bad so Dr K was alright with doing it at that weight.

BTW, either a revision or reversal should be covered because you are having this out of medical necessity to combat malnutrition. Even if you had a revision to increase your absorption and it somehow failed, I am sure insurance would cover the surgery to fix your malnutrition (Full reversal).

Again I would stress not rushing in to this and make sure you are fully informed and comfortable with your decision. Personally I would ask your Dr if he is going to do surgery if he would go in with two scenarios in mind. If he gets inside and measures your channels and finds you are grossly under the length of CC + AL that you need based on the total SBL that he does the revision to get your channel lengths to proper......and if he gets in and finds your channel lengths are long enough under the Hess Method than maybe he goes ahead with full reversal.

In any case I still think you need to get a copy of your original surgical report to see what information you can garner from it, and I would still consult with Dr's Keshishian or Rabkin as well - they are recognized as the two best revision surgeons in the World. You can do that over the phone and or email with Dr K.

and I have to say it again. I know you are stuck on the idea of the CC being the culprit. It very well may be the Alimentary limb this is the culprit. Dr K does 75 CM CC's when that is what the measurements tell him to do so a 85 CM CC might very well be just the proper length. Put it this way. The Hess method says to make the CC roughly 10% of the total small bowel length. If you have an 850 CM small bowel length (highly unlikely it is that long) that would be 10%. If your small bowel length is say 600 CM then an 85 CM CC would be a tad over 14%. Now if your AL is only 150 CM under the same scenarios of 800 and 600 CM range small bowels your AL would be 18.75% and 25%. The Hess method says the AL should be 40% so if you do in fact have a 150cm AL (pretty common from the cookie cutter DS from what I understand...it is what mine was) then you are still grossly too short on the AL under any length SBL in a 400-800 CM range.

Your surgical report that your office should be able to get to you, should have the CC and AL lengths on it. This would tell Dr Ayoola a good bit of information about what likely needs to be done.

 

[DianaCox]

I didn't see anyone mention trying Creon for a while.

 

[DSRIGGS]

I didn't see anyone mention trying Creon for a while.

Good point. Since she has been on TPN I guess I didn't even think about the suggestion. It certainly could't hurt.

I still think the op report and her CC & AL lengths will tell a lot. If she has a 300cm AL that is one thing but it if it is in the 150 CM range that paints a different picture to me of the direction to choose. In the meantime I think you are correct that CREON should be tried.

 

[bearmom]

Frankly, if something like the burn from urocit-K is a deal breaker for avoiding the pain of kidney stones (not like moist wipes can't fix that), then I'm not sure you're really up to tackling the myriad of nutrition stuff you would have to tackle to stay on top of the DS nutrition if you don't have a revision. Lets face it - following labs, and nutritional info and having a go at some drs like a pitbull in order to get what we need is not everyone's cup of tea, but is what's required of many DSers.

I also know you liked your surgeon and trusted that he referred you to Ayoola when he retired, but many of us had great surgeons, and think the world of them and their cutting ability, but would be dead with their nutrition info. I'm one. We can't trust they are having adequate labs drawn - we need to know what THOROUGH labs are, and ensure those are what is actually drawn, and then have to watch for things in them that aren't mentioned by Dr because they only follow up on what is flagged as being out of range by the lab. By the time some things are out of range, we can be in trouble.

I know you trust your surgeon, but if YOU feel its too hard to stay on top of all of the nutrition stuff and don't just want a revision but a reversal, it's you that has to live with it. Pick your battles for what is easiest and possible for you.

 

[k9ophile]

Piggy-backing on Bearmom's post: My PCP is one of those rare doctors who knows not only about nutrition for *normal* people, he researched DS information and even talked to a DS surgeon to understand my new anatomy. When I shared my lab results (as he ordered) my surgeon was in awe. Not only of my numbers, but that my PCP ordered more tests than he did. He then stated that he wished more patients had a PCP like mine. Nice, but he never upped his game. He's still ordering the same inadequate number of labs. He also quit doing the DS because (he said) of dismal outcomes. Great cutter; lousy follow-up. And he takes no responsibility for his inadequate post-op nutrition program.

Of course I realize how blessed I am. Then again, so is anyone who finds this forum. WLS patients have to take responsibility for their health and this is the best place to get to get the straight dope. It may not always be delivered in a sweet and unicorn farts kind of manner, but what matters is the content; not the delivery style.

 

[Marquis Mark]

Piggy-backing on Bearmom's post: My PCP is one of those rare doctors who knows not only about nutrition for *normal* people, he researched DS information and even talked to a DS surgeon to understand my new anatomy. When I shared my lab results (as he ordered) my surgeon was in awe. Not only of my numbers, but that my PCP ordered more tests than he did. He then stated that he wished more patients had a PCP like mine. Nice, but he never upped his game. He's still ordering the same inadequate number of labs. He also quit doing the DS because (he said) of dismal outcomes. Great cutter; lousy follow-up. And he takes no responsibility for his inadequate post-op nutrition program.

Of course I realize how blessed I am. Then again, so is anyone who finds this forum. WLS patients have to take responsibility for their health and this is the best place to get to get the straight dope. It may not always be delivered in a sweet and unicorn farts kind of manner, but what matters is the content; not the delivery style.

Not trying to start a fight, but just out of curiosity, do you doubt your doctor's sincerity when he said he stopped doing the DS because of dismal outcomes? I think most of us are fans of the DS, but there ARE bad outcomes and it's important to acknowledge them, too, no?

 

[k9ophile]

I don't see you picking a fight. (This isn't Facebook ) He did a DS on a patient that had to fight tooth and nail to get it. He wanted to do the sleeve and IF that wasn't successful, he'd do the switch part. Follows is a post by her on this forum: Are you putting (name deleted by me, not the patient, to avoid looking like a witch) on the list?? Please don't. He's vetted but is not worthy to be on any list for surgery of any kind. His skills aren't the issue....HE'S the issue! I finally decided to listen to the advice of others and fire his ass! He really crossed the line at my 6 month post op appt. I'm in process of transferring my care to Dr. X. Waiting for him to review my records and make a decision.

She had mentioned that she'd had a few rough days and doubts after the DS, and he said something to the effect of, "So what? I got paid." He also supposedly used the F-word in regards to concerns. I wasn't there, yet I'm not surprised. I have gotten to know this patient and I don't think she would lie or exaggerate. I went to an information seminar as a former patient and I think ten whole words were spoken about the DS. I agree with her in that he is a great cutter. I retired from health care and he really is a typical surgeon when it comes to bedside manner. I'm used to arrogant doctors and I don't really care about the ego if they are good cutters. I'm not going to them for touchy-feely; that's what I had a psychotherapist for.

I do believe my surgeon does have decent human values beneath all that arrogance. I think he has some legitimate concern about outcomes. I know a few of his patients that did not do well and that may have had an influence on his decision to slow down on the DS. I also think there is some greed and fear of malpractice behind his decision to cut back on the DS. I certainly didn't mean to paint him solely as an ogre. All things said and done I would recommend him as a surgeon with the proviso that the person come here for nutrition information. Or at a minimum, not rely on him for nutrition and complete labs. The program, to the best of my knowledge, is still using the RNY based information that I got in 2008.

 

[bearmom]

Not trying to start a fight, but just out of curiosity, do you doubt your doctor's sincerity when he said he stopped doing the DS because of dismal outcomes? I think most of us are fans of the DS, but there ARE bad outcomes and it's important to acknowledge them, too, no?

Meh, that's not my idea of starting a fight. I come here in hopes of getting or sharing info, that's hopefully as accurate as possible, and may agree, disagree or clarify.

I wouldn't doubt a drs sincerity saying why they stopped doing the DS, but I don't think it's reasonable to expect consistently good outcomes when so many give deplorable nutrition advice.

Too many of us do well DESPITE our surgeons follow up and nutrition info, not BECAUSE of it.

 

[southernlady]

Not trying to start a fight, but just out of curiosity, do you doubt your doctor's sincerity when he said he stopped doing the DS because of dismal outcomes? I think most of us are fans of the DS, but there ARE bad outcomes and it's important to acknowledge them, too, no?

It's a publicly available post that @k9ophile posted...but it's on further on in the thread that we get the full story.
http://bariatricfacts.org/threads/list-of-ds-surgeons.1766/page-2#post-28804

 

[k9ophile]

Thank you, @southernlady for pointing out the thread so that people can read everything and come to their own conclusions. I can get verbose and in an effort to achieve brevity I may have been misleading.

I stand behind my assertion that he is a great cutter with an abrasive personality. I do not trust his office for follow-up. In that regard, he is no different from many, many WLS surgeons.

 

[DSRIGGS]

Meh, that's not my idea of starting a fight. I come here in hopes of getting or sharing info, that's hopefully as accurate as possible, and may agree, disagree or clarify.

I wouldn't doubt a drs sincerity saying why they stopped doing the DS, but I don't think it's reasonable to expect consistently good outcomes when so many give deplorable nutrition advice.

Too many of us do well DESPITE our surgeons follow up and nutrition info, not BECAUSE of it.

Exactly. The DS done properly is an excellent surgery with the best outcomes of any bariatric procedure.....we all know that. When a patient doesn't do well after the DS it is for 3 possible reasons, really 2 but the second has two causes:

1. The DS was done improperly providing too little or too much absorption.
2. Poor nutrition and supplementation
   1. Due to improper guidance from the surgeon's office
   2. Noncompliance to proper eating and supplementation guidelines on the patient end of the stick.

This board is here because of 2-1

 

[Marquis Mark]

Thank you, @southernlady for pointing out the thread so that people can read everything and come to their own conclusions. I can get verbose and in an effort to achieve brevity I may have been misleading.

I stand behind my assertion that he is a great cutter with an abrasive personality. I do not trust his office for follow-up. In that regard, he is no different from many, many WLS surgeons.

Absolutely fine. Your opinion is totally valid and obviously more informed than mine when it comes to your surgeon.

I didn't read all the other stuff first. I think I was responding to a place in me that wants to ensure we always stay real and honest about the DS. Once you make a "big purchase" like the DS, it's easy to grow rose colored glasses and put aside negatives because it is in our nature not to want to be wrong and to be validated.

From my own research I don't doubt that if you're a heavyweight, DS is the way to go. As for myself, I am a lightweight and even though I went through with the DS and have been fine so far (save for one unrelated anal fissure), there's still a voice in the back of my head which wonders if I've done the right thing.

My main concern is still with longevity/lifespan after the DS. Obviously if you're 400 pounds, you're likely better off losing the weight with the DS and taking any consequences which may come, but if you're a lightweight? I haven't been able to find anyone more than 15 years out or older than 68. Also, the first man to have the DS in Ohio in 1988: last I heard anything about him was in 2004. Sure would be curious to find out how he's doing.

If anyone has any info on an "old timer" or studies on life expectancy I sure would be curious...

Thanks.

 

[Clematis]

This is an article about a study showing life expectancy does not increase after WLS. http://www.reuters.com/article/us-surgery-weightloss-idUSTRE7855YR20110906

The study was done my a doc named Livingston who is anti-DS.