VSG vs DS for me?

I'm so frustrated, I had to get on here to vent. I called Dr. Srikanth's office yesterday morning to check on the status of my insurance verification. Left a message with reception. Called back in the afternoon and left a message directly on the "onboarding" person's voicemail asking her to call me as quickly as possible. Nothing. It's now almost 10:00 am my time, and I am no further along than I was 24 hours ago.

Now, I realize this sounds insanely impatient to everyone, but every. single. day. that goes by with nothing accomplished is another day that I am hobbling around with pain. Unable to live the life I want to live.

Meanwhile, the original weight-loss surgeon's office has me setup for eleventy billion appointments because I don't know whether I should halt the process with them??? I am supposed to see the NP on Friday, and get my endoscopy next week. Do I cancel those???

Oh! And I have been diligently adhering to a keto diet, and (surprise!), I'm not losing any weight. So seeing the scale this morning just added to my cranky mood.

I swear, I'm not usually this big of a whiner, but you all have become my sounding board. (Lucky you!) ;-)
 
Probably not the news you want to hear but I will be honest with you, these things take a long time to make happen. I decided I wanted to go forward with the DS in August of 2012 after having several conversations with a coworker who had the procedure. It was September of 20th of 2013 before I was finally able to have surgery. I thought I was going to be able to have it done over Holiday Break at work where we has Christmas Eve through New years day off and with a few days of vacation you could easily turn it into 2-3 full weeks. I was so wrong.

Once the office got me in for a visit, then I went through classes, had to see my PCP to go though an insurance mandated 6 month diet that I believe end in July, they finally submitted for approval....of course that sat a week because the only freaking lady in the huge office (15 surgeons doing numerous different areas of specialty) who could submit. It took her several days to get off her lazy ass to do her job and then it was another week or so to get approval. They won't submit for approval until you have met all conditions. Then they were out almost 7 weeks on the surgeons schedule. I was infuriated but it was what it was.

This is one of the reasons many people have self paid and gone to Mexicali to have the DS because you can get in within a month or two from what i understand if you are committed to doing it.

I know it is frustrating but all you can do is push. What approval is it that you are waiting for? I kind of looked back in this long thread but I didn't see what it was. Are you just wanting to see if you in general qualify for the DS with your insurance plan?

Hang in there and keep pushing and if you are determined to have the DS with this office then make sure you get going on their program ASAP as it takes time.

If you are interested in Esquerra in Mexicali several of the ladies on the board can give you cost and contact information if they haven't. They had great success there and say the facility and people are first class so no worries about going out of the country. It is just on the border.
 
@DSRIGGS The surgeon's office who does VSG called me yesterday and told me our insurance company approved the surgery, and I can go ahead and schedule it. I don't have to jump through all of the 6-months of hoops. I could get the VSG done as soon as 10/25.

However, since starting with them, I discovered this forum, and I am convinced I should get the DS instead. So, when it takes more than 1 week to even hear back from the DS surgeon's office (different surgeon altogether) about insurance verification, let alone scheduling the consultation itself, that upsets me. I just called the main line again, and it sounds like there may be some *issues* with the onboarding person. I left a message for the office manager.
 
Okay got it. My mind is fuzzy but I remember now. Yeah, I feel you but as many have advised others. You only want to do this once and you want to do it to work. If the keto diet isn't doing anything for you the VSG is probably not going to do much for you either. I am not sure if there are other from the DS office with whom you can talk to get an idea of program requirements for the DS as to how long it took them but I think you know from discussions here and research that the DS is the best procedure that will work for you and if you go the VSG route you will likely not lose as much as you want or maintain and be back in two years for the second part of the DS.

Best of luck. Believe me I understand your frustrations.
 
Okay, next up, a call to my PCP. Apparently Dr. Srikanth's office is in a "transition." Nobody called to tell us that -- my husband called on my behalf, since he is the carrier of our insurance. I'm not sure anything is going to help at this point, though. It sounds like everyone there is MIA. Super disappointing.
 
I'm sorry if you've answered this, but there are 6 pages to go through so I may have missed it, but did you verify Srikanth will do a real DS, and not something "close enough" like the SIPS, SADI, LOOP, or whatever?

I'm in WA so I try to follow who we have available here for DS, and last I heard Srikanth was shifting from real DS to the experimental ones, which I personally wouldn't want.
 
My goodness. I took everyone to the pool this afternoon, and all the s**t hit the fan. In a good way. :)

@bearmom My husband finally got through to someone today, who is the "CEO/office manager," and she did mention the SADI to him. I know I need to stick with the DS. (Although, can anyone here give me the cliff notes on why?)

Meanwhile, I also just got this jaw-dropping text from a friend of mine, who is married to a doc and is therefore friends with a lot of docs. She said:

"Big news out of the American Academy of Orthopedics. My friend just called me to tell me that he was asked to sit on a panel of thought leaders to discuss cases like yours and they are now saying that high BMI candidates are not at any greater risk. He’s going to recommend someone in Seattle that is a thought leader that you may want to see. He also said that he would talk to you if you wanted to ask him any questions. I can’t talk now because we are at drum lessons but I wanted you to know that you have hope!!!!!"

That puts a whole new spin on things.
 
My husband finally got through to someone today, who is the "CEO/office manager," and she did mention the SADI to him. I know I need to stick with the DS. (Although, can anyone here give me the cliff notes on why?)
Because the SADI is STILL considered experimental. No long term data out there.

And insurance companies do not cover it. If it's submitted as a DS but is a SADI, and you signed your consent form FOR THE DS, it's considered assault and battery on your person. But also if insurance paid for it, they could come back and make you pay for the entire surgery at full cost.

Yes, at some point, the DS was experimental but the bottom line is it IS a standard of care operation as defined by ASMBS, the insurance industry, and Medicare.
 
Really helpful, @southernlady. I remember reading somewhere that you should make sure you get it in writing that you are receiving the DS. But how in the heck would I know when it's all said and done?
 
You will never see your own guts. All you can do is make sure the doc knows you want a traditional 2 anastomosis surgery. You tell them you do not want SADI/SIPS/Loop DS. And you want to discuss the length of your CC. I would go for as short as they are willing to go.
 
Really helpful, @southernlady. I remember reading somewhere that you should make sure you get it in writing that you are receiving the DS. But how in the heck would I know when it's all said and done?
First, read your consent form...and if necessary, add an addendum stating a traditional TWO anastomosis Duodenal Switch ON the consent form and have it witnessed by the person who handed it to you to sign as well as a support person YOU bring or your spouse.

When all is said and done, GET a copy of your operative report and read it. IF they told you a DS and your operative report has the SADI et al on it as in just the one anastomosis and a longer than normal common channel (over 200 cause even standard DS'ers can be up to about 200, mine is 175). THEN you will know and have grounds to sue your surgeon for assault and battery.
 
With all due respect to Munchkin who's opinion I very much value, I would ask that you please not just tell the surgeon that you want as short a CC as they will give a patient. They need to understand your full picture before determining limb lengths. The CC is only one element of the DS and alone the CC length doesn't guarantee success or failure. I know people in the DS community have been conditioned to believe the CC is the end all be all for DS success, but it is just one equally important element of limb length and ultimate DS success. I had severe malnutrition with what actually ended up being a 125 CM CC BECAUSE MY ALIMENTARY LIMB WAS EXCESSIVELY SHORT giving me only about 35% absorbing intestinal path (CC + AL) and 65% non absosbing path (Bilo Pancreatic Limb). So I had what is considered a very long CC which to common DS patient community believe should have meant that I would not lose enough weight....the opposite happened.....so the CC was not the determining factor of my DS success.

Please ask you Dr to do a HESS DS or something similar where at a minimum he measure your total small bowel length and then give you CC and AL lenghts based on the length of the Small Bowel. Hess says CC she be approximately 10% of that length and the AL 40% of that Length. Dr Gary Anthone has a little different spin and says the exact length of each limb isn't as important as it is to make sure the AL + CC together equal 50% of the total Small Bowel Lenght. That is the same ending percentage as the Hess Method.

BTW, Hess was doing CC's basically at 75, 100, 125 cm I believe and letting the Alimentary limb make up the rest of the 50% of small bowel length. Dr K does similar and rounds up to the next 25 CM increment so for me with a 725 CM total SBL as a virgin DS'r he probable would have given me a 75 CM CC and a 290 CM AL limb ...that would have left a 362.5 cm BPL. Instead my virgin DS surgeon gave me what he said was * 100 cm CC, 150 cm AL and didn't know what BPL was because he didn't measure total small bowel. That was way too little absorbing path for me and why I have struggled so mightily to be healthy.

I do agree with Munckin in that CC length is an important part of the DS. I just know that the other two limbs are equally as important so please tell your Dr you want a customized DS where he measures your small bowel length in total and customizes you channels based off of that number.

* Note: Dr K actually measured by CC and AL as 125 and 175'sh respectively as opposed to 100 and 150 CM stated by the original DS surgeon who messed me up. There is measurement variation from surgeon to surgeon due to technique.
 
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and absolutely agree with the ladies on DS not a SADI. Get the procedure that we know for sure works and is covered by insurance.
 
* Note: Dr K actually measured by CC and AL as 125 and 175'sh respectively as opposed to 100 and 150 CM stated by the original DS surgeon who messed me up. There is measurement variation from surgeon to surgeon due to technique.
And THAT depends on if they stretch it at all or how much they stretch to measure.
 

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