I have looked on several different websites, and this seems to be the "range" for my height as far a proper weight. (The range depending on if you have a small, medium, or large frame.) I had originally picked in my head 130 as my goal weight. I am going to my PCP tomorrow, and want to talk with her about what she thinks my goal weight should be. I have not been below 200 pounds since before seventh grade, so many of these numbers I feel I could be comfortable with. I just am scared about being on the "high" end of the range. I know this is a long way off, but I do want to think about it some. I have also heard that your body finds a range on its own, and that is where your goal weight will be.
Monday, July 30, 2007
120-159
I have looked on several different websites, and this seems to be the "range" for my height as far a proper weight. (The range depending on if you have a small, medium, or large frame.) I had originally picked in my head 130 as my goal weight. I am going to my PCP tomorrow, and want to talk with her about what she thinks my goal weight should be. I have not been below 200 pounds since before seventh grade, so many of these numbers I feel I could be comfortable with. I just am scared about being on the "high" end of the range. I know this is a long way off, but I do want to think about it some. I have also heard that your body finds a range on its own, and that is where your goal weight will be.
Sunday, July 29, 2007
Fast Walker
Today, as I was leaving church, I realized how quickly I was walking! Seriously, I could not believe how fast my feet were carrying me. I am amazed...I know it may seem simple to most, but it is a huge deal to me.
New Food
This post will be most helpful to those who have had the DS. I discovered "Jimmy Dean Breakfast Bowls" at Kroger the other day. The have eggs, cheese, sausage (or bacon), and a bit of potatoes. They are PACKED with protein. They have 30 grams of protein! Yummy!
Friday, July 27, 2007
Been Thinking
There has been some serious family drama going on lately. Well, it all involves my sister, but it has really been tough. I have been thinking the past few days how difficult it is to see someone on a downward spiral.....yet not be able to do anything for them. This evening it hit me. It is just like my family seeing ME on a downward spiral with my weight, but not being able to help me. When I really think about it, by the time I went to surgery, I truly felt that there was nothing else within my power that I could do to help myself, other than surgery. I think how it must have grieved my family and friends to see my weight continuing to creep up month after month, year after year. Knowing that my very life was at stake. For the first time in my life I feel a sense of empowerment in my battle to lose weight. As friends from my undergrad in Eastern Kentucky used to say, "It's a long road to hoe," but at least I feel like it is possible to do now.
I am going to really work on keeping my protein above 100 (ideally 140-150 grams a day). I have noticed that Tia and Mary O. (who both have higher BMIs like I do), see more results with the scale the higher their protein numbers are.
I am going to really work on keeping my protein above 100 (ideally 140-150 grams a day). I have noticed that Tia and Mary O. (who both have higher BMIs like I do), see more results with the scale the higher their protein numbers are.
Thursday, July 26, 2007
Four Months Ago Today...
I was getting switched! This morning, I weighed in at 296. I have lost a total of 97.6 pounds in four months! This surgery has been nothing short of AMAZING! If you were to average it out, I have lost .82 of a pound EVERY SINGLE DAY since having my surgery.
Wednesday, July 25, 2007
Feeling Lighter on My Feet
Today as I was going to lunch from a presentation that I was leading, it hit me....I feel lighter on my feet. It took almost 100 pounds to start feeling this, but I really did. It was like I was walking on air. I had a huge grin on my face. It was such a priceless feeling.
Tuesday, July 24, 2007
My Very Necessary Medical ID
I saw this advertised on either Dr. Phil or Oprah. For $40 a year, this medical ID stores all of your medical information. Doctors and hospitals can call the number, enter your code, and get all of your medical history. I think it is well worth the investment.
http://www.vnmedical-idcard.com/
http://www.vnmedical-idcard.com/
I Feel Like a WOMAN!
I can finally cross my legs!!! This is something that I have wanted to be able to do for years, but I could not. While weight loss is slowing in quantity this month, the WOWS are still coming left and right.
I think that my hair loss is starting to slow down as well. It started at the beginning of the third month, and people say it will usually continue through the sixth month. I am just happy that the quantity is decreasing.
I think that my hair loss is starting to slow down as well. It started at the beginning of the third month, and people say it will usually continue through the sixth month. I am just happy that the quantity is decreasing.
Monday, July 23, 2007
New Wows
Tonight I went to the movies with one of my best friends. It was at a theater that I went to before surgery. Every time I would go to this theater, I would "raise the arms" so that I could sit comfortably. I didn't have to raise the arms on the seat. My sides were still touching the arms, but it was not the "cutting of my circulation" type fit I often get.
Another thing that I have been noticing is that I have been getting cold more frequently. I also don't sweat as easily.
The last thing I wanted to share today is about my upcoming entry in the Guinness Book of World Records. They are coming by to take photos tomorrow. I have had a bag of Hershey'd Dark Chocolate kisses in my condo for two months now. The bag is still HALF FULL. This would have never happened as a pre-op. I feel like a "normal" person when I eat candy. Just a few bites, and that is all I want.
Another thing that I have been noticing is that I have been getting cold more frequently. I also don't sweat as easily.
The last thing I wanted to share today is about my upcoming entry in the Guinness Book of World Records. They are coming by to take photos tomorrow. I have had a bag of Hershey'd Dark Chocolate kisses in my condo for two months now. The bag is still HALF FULL. This would have never happened as a pre-op. I feel like a "normal" person when I eat candy. Just a few bites, and that is all I want.
Dem Bones!
One thing I have noticed is that I have a lot less knee fat. My knees used to always look swollen. They are actually becoming defined. I am also starting to be able to feel my hip bones, and when I lay down at night, I can feel my rib cage. I know I am also losing weight in my butt because my tailbone hurts when I sit for long periods of time. I really want to relish in every discovery that I have about my body. I am enjoying the ride with the DS.
Sunday, July 22, 2007
Some Goals I Have...
"Without vision, the people perish." - Proverbs 29:18
You hear so many people talk about not really living their lives prior to weight loss surgery. Being fat hinders you from doing so many things that most people don't give a second thought to. Here are a few particular goals that I have, in no special order. Some are serious, while others are fun. It will be fun to revisit this list, and check off the goals I have accomplished.
1. Be able to cross my legs.
2. Be able to feel my hip bones and rib cage.
3. Be able to comfortably sit in any seat, and also not to have to think that the seat might break.
4. Skydive.
5. Ride in a hot air balloon.
6. Be able to shop from ANY store in the mall.
7. Lose so much weight that people don't recognize me.
8. Be able to fly comfortably.
9. Not be the fattest person in the room.
10. Travel and tour the Holy Lands.
11. Be able to wear heels.
12. Be able to get a pedicure (sitting in the chair that they have is impossible now.)
13. Be able to date.
14. Have increased self-esteem.
15. Be able to move around at a crowded event (like stadium seating, without making everyone stand up to let me through).
16. Be able to look cute in a bathing suit (ok, it most likely will never be a two piece, but I am ok with that.)
17. Start working somewhere where they never knew I was fat.
18. Hike the Grand Canyon and Half Dome.
19. Climb to the top of a lighthouse. (I love lighthouses!)
20. Learn how to ballroom dance.
21. Wear a size without without an (or multiple) "X" in front of it.
22. Be in a single digit clothing size.
23. Maintain my weight loss.
24. Participate in a 5K Run. (Actually RUNNING, not walking....and complete it.)
25. Help others along the way who are trying to lose weight.
26. Swim with dolphins.
27. Be able to relax, take a bubble bath, and actually have room to spare in the tub.
28. Be able to squat.
29. Be able to get up from the ground without having to use a prop to help get me back up.
30. Go White Water Rafting.
31. Be light enough that a man can pick me up, and give me a piggy back ride.
32. Buy cute underwear at Victoria's Secret.
33. Be the same size as my sister.
34. Hike part of the Appalachian Trail.
35. Regularly take the stairs to my 4th flor office - and not be winded.
36. Stay a member of the "not cleaning my plate" club.
37. Go skiing and snowboarding.
38. Become a runner/jogger.
39. Be able to wear cute jewelry.
40. Drink 100+ oz of water per day and get in 140-150 grams of protein per day.
41. Hike through many of the National Parks in the west.
Number Crunching AGAIN
I realized that I only need to lose 34.4 more pounds to have lost 50% of my excess body weight. I know I don't need to be making my own timeline, because my body will go at its own pace, but I would love to lose that in the next two months. That would put me at a 132 pound loss in six months. I thought I was a long way off, but 34.4 pounds seems so obtainable. With any goal, it is good to make several "mini" goals instead of only looking at the big goal ahead. Once I reach the 50%, I will also be 1 point from being out of the Morbidly Obese Category on BMI, and will almost be to the Obese BMI category.
My Feet are Shrinking!
I put on dress shoes that I wore as a pre-op for church this morning. They are BIG. In the back of the shoe, there is a good inch of space between my heel and the end of the shoe. I could also tell that my feet used to get much more swollen than they do now. The shoes were just overall big. I have always worn "wide" shoes, because I have a club foot like my dad. I am going to go have my foot measured, and see how much it has shrunk. I think I have lost an entire size. My mom thinks I'm down a size and a half in shoes. This is so cool.
Eating By The Clock
After reading another blog about never being hungry, I was prompted to write this post. Since surgery, I have NO appetite. Not even a little hint of one. In order to get in the necessary protein, I have become a "clock" eater. There are certain times of the day when I will eat or make myself a protein shake. This helps me to avoid looking at the clock, realizing that half the day is gone, and I need to scramble to get my protein in. Will I always have to be a clock eater? I'm not sure, but for now that is how it needs to be.
The Scale This Morning
I weighed in at 296 pounds! I am 2.4 pounds from becoming a CENTURY CLUB member!!! It is amazing to think that I only had my surgery just shy of four months ago.
Saturday, July 21, 2007
Somtimes You Just Have to Fake It
Today was my sister-in-law's baby shower. My sister and I hosted it. I so did not want to be there. I am trying to keep a healthy perspective, but both of my younger siblings got married before me, and now my brother's wife will be having a baby soon. Maybe I'm not mentally ready to be an aunt. I did the best I could to fake it, and act like I was having a really good time. While I wonder things like, Will I ever get married? Will I have kids of my own one day? I trust God with my whole heart, but I do have moments where I wonder. I know God is big enough for all of my questions. I just don't want to ask so many questions that I drown out His voice.
On an unrelated note, I have a smaller belly. Meaning that this morning as I was weighing myself, I noticed that I don't have to "peer" as far over my belly to actually read the numbers on the scale. Several people at the shower commented on my weight loss. I have always tried to deflect attention from myself.
I have also been reconsidering a desire that I have had for many years. I want to go to the Holy Land. Before WLS, there would be no way this could happen for many reasons. One, I would probably have to get two airplane seats. Two, My overall physical health would prevent me from being able to keep up, let alone enjoy the extensive day tours. This desire is coming back really strong on my heart again.
On an unrelated note, I have a smaller belly. Meaning that this morning as I was weighing myself, I noticed that I don't have to "peer" as far over my belly to actually read the numbers on the scale. Several people at the shower commented on my weight loss. I have always tried to deflect attention from myself.
I have also been reconsidering a desire that I have had for many years. I want to go to the Holy Land. Before WLS, there would be no way this could happen for many reasons. One, I would probably have to get two airplane seats. Two, My overall physical health would prevent me from being able to keep up, let alone enjoy the extensive day tours. This desire is coming back really strong on my heart again.
Friday, July 20, 2007
Class Reunion
Tomorrow night is my ten year high school reunion. I have tossed the idea back and forth several times in my head, but have decided not to go. I'm not exactly sure why, but I just don't have a peace about being there. Perhaps I'll go to the fifteen or twenty year reunion.
It is Good to Remember Where You Came From...
Yesterday I wore a pair of 36W denim capri shorts. They were only able to stay up because the top had a drawstring. Before my surgery, these pants were SKIN TIGHT. Today, I wore a size 28W pants as I was out doing errands. They fit very nicely, not too loose and not too tight. It is amazing to think that I wore one of the largest sizes in women's clothing before surgery. I could only shop out of catalogs for roughly the past two years. I am looking forward to the days ahead when I will be able to buy clothes from almost any store in the mall.
I am a bit nervous about tomorrow. We are having a baby shower for my sister-in-law. There will be lots of relatives there that I have not seen since December. Sometimes even when people are trying to be nice and give you a compliment, they can still come off so RUDE. Also, I am not so sure that I am ready to answer all of their questions yet. The other thing I don't want to deal with is the "FOOD POLICE." The DS is a different kind of eating, and since not many people from this area have had it, it is hard to explain that "high fat" is ok, etc. Luckily, after tomorrow, I will not see most of these people again until December. I will be nine months post-op then.
I am a bit nervous about tomorrow. We are having a baby shower for my sister-in-law. There will be lots of relatives there that I have not seen since December. Sometimes even when people are trying to be nice and give you a compliment, they can still come off so RUDE. Also, I am not so sure that I am ready to answer all of their questions yet. The other thing I don't want to deal with is the "FOOD POLICE." The DS is a different kind of eating, and since not many people from this area have had it, it is hard to explain that "high fat" is ok, etc. Luckily, after tomorrow, I will not see most of these people again until December. I will be nine months post-op then.
How to Make a Yummy Protein Drink
Hood's "Calorie Countdown" Chocoalate Milk, makes for a YUMMY protein drink. I was having a difficult time drinking protein drinks, and this milk made all the difference. Over the past three weeks, I have been drinking at least two shakes a day. This gives me about 30 grams of protein per shake. By drinking more protein, it has enabled me to get my protein levels to over 100 grams a day, and has also allowed me to be able to start eating small amounts of vegetables (which was impossible before because I was so "full" from the protein all the time.) I have found Hood's Calorie Countdown at Kroger and at Super Wal-Mart. (Note: It is now called "Calorie Countdown," not "Carb Countdown" like the picture on the left carton says.)
Number Crunching
I did some calculations this morning.
- I have lost 24% of my overall starting body weight!
- I have lost 36% of the total weight I want to lose. (Typically, by six months, you lose 50% of your excess body weight with the DS.)
- My BMI has been lowered by 14.9 points since the day of surgery!
Books I Recently Finished
Although the majority of this blog will be about my weight loss, I do want to include other aspects of my life. Here are two books that I have recently finished. The first book, "Every Day Deserves a Chance" is by Max Lucado. This is a great book on perspective and how to really live each day to the fullest. The second book "Night" is about Elie Wiesel's experiences during the Holocaust in a concentration camp. The Holocaust has always been of interest to me since I was in fourth grade. This book was amazing, yet so sad. I don't give long reviews of books, but just wanted to give you a quick blurp about what I am reading.
"Teach us how short our lives are so that we may be wise." Psalm 90:12 (NCV)
A New Vegetable I LOVE!
SUGAR SNAP PEAS!
I have always been a vegetable lover. I am just the type of person that gets fixed on a few staples, and rarely branches out. I branched out this weekend and bought some Sugar Snap Peas. They are so yummy! You should try them!
More Background On My Life Long Struggle With Weight
I wanted to give a more indepth background about my struggle with weight. I remember weighing 90 pounds in third grade. I was wearing a size 20 in seventh grade. I believe by my freshman year I was wearing a size 24. The only store I could shop in was Lane Bryant. My younger brother and sister have never been overweight. Although my parents are slightly overweight, they are no where near morbidly obese like me. (Actually, at the time of my surgery, I was "SUPER MORBIDLY OBESE.")
The summer before my senior year of high school, I got my parents to take me to a Medical Weight Management place. I was shocked to realize that I weighed 317 pounds. They were giving out Phen-Phen. During the course of my senior year, and the fall of my freshman year of college I lost about 90 pounds. Once I was off Phen-Phen, the weight started piling back on viciously. I remember the summer before I started teaching, I went to Weight Watchers, and my weight was back up to 293. Two different times since I have started teaching I have lost between 30-40 pounds. One time was with medicine, the other was without.
Several people have asked me about what my "goal" weight is. The truth is I have no clue. I have not been below 220 pounds since before seventh grade. I have "ideas" in my head of what I think I would like to weigh, but I am not sure. I just want to be healthier.
I long for the day when I can scan the room, and realize I am not the fattest person in it.
The summer before my senior year of high school, I got my parents to take me to a Medical Weight Management place. I was shocked to realize that I weighed 317 pounds. They were giving out Phen-Phen. During the course of my senior year, and the fall of my freshman year of college I lost about 90 pounds. Once I was off Phen-Phen, the weight started piling back on viciously. I remember the summer before I started teaching, I went to Weight Watchers, and my weight was back up to 293. Two different times since I have started teaching I have lost between 30-40 pounds. One time was with medicine, the other was without.
Several people have asked me about what my "goal" weight is. The truth is I have no clue. I have not been below 220 pounds since before seventh grade. I have "ideas" in my head of what I think I would like to weigh, but I am not sure. I just want to be healthier.
I long for the day when I can scan the room, and realize I am not the fattest person in it.
Twoerville!!!
The scale read 298 this morning!!! That means I am down 95.6 pounds! I am so thrilled!! I have been "hovering" so close to the below 300 mark, but have finally made it under. I love my DS!
Thursday, July 19, 2007
Today at Cracker Barrel
I had lunch with my best friend today. We have so many things in common, except she has always been naturally thin, and I've been fat. She is very healthly, and works out very reguarly. I was amazed because she actually ate more food than I did! It also took me more time to consume the smaller amount of food that I had. For the first time in a long time, I actually felt like I was a normal person eating wise.
I pray that as my weight loss will slow, I will still take time each day to marvel at the "Ordinary Miracles" that are happening right before my eyes. I am posting the lyrics to "Ordinary Miracles" sang by Sarah McLachlan in the Charlotte's Web movie.
Change can come on tiptoe,
Love is where it starts
It resides,
Often hides
Deep within our hearts
And just as pebbles make a mountain,
Raindrops make a sea
One day at a time
Change begins with you and me
Ordinary miracles
Happen all around
Just by giving and receiving
Comes belonging and believing
Ev'ry sun that rises
Never rose before
Each new day
Leads the way
Through a diff'rent door
And we can all be quiet heroes,
Living quiet days
Walking through the world
Changing it in quiet ways
Ordinary miracles
Like candles in the dark
Each and ev'ry one of us lights a spark
And the walls can tumble
And the mountains can move
The winds and the tides can turn
Ordinary miracles,
One for ev'ry star
No lightning bolt or clap of thunder,
Only joy and quiet wonder
Endless possibilities,
Right before our eyes,
See the way a miracle multiplies
Hope can spring eternally,
Plant it and it grows
Love is all that's necessary,
Love in its extraordinary way,
Makes ordinary miracles ev'ery day
I pray that as my weight loss will slow, I will still take time each day to marvel at the "Ordinary Miracles" that are happening right before my eyes. I am posting the lyrics to "Ordinary Miracles" sang by Sarah McLachlan in the Charlotte's Web movie.
Change can come on tiptoe,
Love is where it starts
It resides,
Often hides
Deep within our hearts
And just as pebbles make a mountain,
Raindrops make a sea
One day at a time
Change begins with you and me
Ordinary miracles
Happen all around
Just by giving and receiving
Comes belonging and believing
Ev'ry sun that rises
Never rose before
Each new day
Leads the way
Through a diff'rent door
And we can all be quiet heroes,
Living quiet days
Walking through the world
Changing it in quiet ways
Ordinary miracles
Like candles in the dark
Each and ev'ry one of us lights a spark
And the walls can tumble
And the mountains can move
The winds and the tides can turn
Ordinary miracles,
One for ev'ry star
No lightning bolt or clap of thunder,
Only joy and quiet wonder
Endless possibilities,
Right before our eyes,
See the way a miracle multiplies
Hope can spring eternally,
Plant it and it grows
Love is all that's necessary,
Love in its extraordinary way,
Makes ordinary miracles ev'ery day
A Nice Change
When you are thin, there are so many things you don't have to think about in a given day. One thing that I often think about is "being able to fit" in a BOOTH at a restaurant. At one point, I even got pretty good at always requesting a table. That would usually depend on who I was having a meal with. Over the past two weeks, I have had to eat out many times, and I purposely sat in booths. There were times where I was not sure if I would "fit," but I did!!!
The reason this makes me so excited was thinking back to last September. I was not even at my highest weight (I think I was around 375 then). My family had gone to Texas Roadhouse, and I managed to sit in the booth, but when it came time to get out of the booth, it was an obvious struggle. Most of my family had already started walking, but my eyes met my dads. I knew that he could tell how badly I was hurting - both emotionally and physically.
It is nice being able to comfortably sit in a restaurant booth. Each day keeps on brining new adventures and WOWS!
The reason this makes me so excited was thinking back to last September. I was not even at my highest weight (I think I was around 375 then). My family had gone to Texas Roadhouse, and I managed to sit in the booth, but when it came time to get out of the booth, it was an obvious struggle. Most of my family had already started walking, but my eyes met my dads. I knew that he could tell how badly I was hurting - both emotionally and physically.
It is nice being able to comfortably sit in a restaurant booth. Each day keeps on brining new adventures and WOWS!
It's NOT Ok....
Here are some of the former excuses I used to give when eating.
"It's okay to eat this because... it won't matter."
"It's okay to eat this because... I paid for it."
"It's okay to eat this because... it'll go to waste."
"It's okay to eat this because... I'll disappoint someone if I don't."
"It's okay to eat this because... everyone else is eating it."
"It's okay to eat this because... I'm celebrating."
"It's okay to eat this because... no one will see me eating it."
"It's okay to eat this because... it's free."
"It's okay to eat this because... I really want it."
"It's okay to eat this because... it's a special occassion."
"It's okay to eat this because... I'm upset and I just don't care."
"It's okay to eat this because... I'm craving it and I'll probably just eat it eventually."
These are EXCUSES, nothing less, nothing more. I am worth more than any of these "justifications" for eating things!
"It's okay to eat this because... it won't matter."
"It's okay to eat this because... I paid for it."
"It's okay to eat this because... it'll go to waste."
"It's okay to eat this because... I'll disappoint someone if I don't."
"It's okay to eat this because... everyone else is eating it."
"It's okay to eat this because... I'm celebrating."
"It's okay to eat this because... no one will see me eating it."
"It's okay to eat this because... it's free."
"It's okay to eat this because... I really want it."
"It's okay to eat this because... it's a special occassion."
"It's okay to eat this because... I'm upset and I just don't care."
"It's okay to eat this because... I'm craving it and I'll probably just eat it eventually."
These are EXCUSES, nothing less, nothing more. I am worth more than any of these "justifications" for eating things!
Subtle Differences...
I know you all may think I am crazy, but I have a difference that I have noticed since starting to lose weight. Men are actually HOLDING DOOORS OPEN for me. This rarely happened before, and now it is starting to happen all the time. This really does make me smile. I thought it was a lost courtesy, but now I believe the more attractive you are, the more likely men will do little things like this for you. Who knows! All I know for certain is that I am enjoying it.
Wednesday, July 18, 2007
More Information about the DS
Here is some more information on the DS. Regardless of being self-pay or covered by insurance...be proactive for the surgery that will BEST benefit you.
PLEASE READ THIS BEFORE MAKING YOUR DECISION ON WHICH SURGERY TO GET!
It is a sad truth that there is a lot of misinformation being circulated about the duodenal switch (DS) procedure. Even more sadly, much of it comes from RNY surgeons and their patients, who have various degrees of vested interest in promoting their surgery (or in certain cases, dissing WLS altogether). I would hope that each and every potential WLS patient who is researching what to do about treating his or her morbid obesity has access to the FACTS before making the decision about which surgery to have.
For a number of years, insurance approval has been the vehicle by which access to the DS procedure has been limited -- most of the largest insurers, including Blue Cross, Blue Shield, Aetna and Cigna, have cited misleading information and each others' policies to claim that the DS is "experimenal," "investigational" or "unsafe and inadequately studied." However, the papers cited by these insurance companies to support this allegation are often not even related to the correct procedure.
When the DS was introduced, it was an improvement over the Biliopancreatic Diversion procedure, or BPD -- unfortunately, this led to the procedure being called the BPD/DS, which is a misnomer. While the intestinal part of the BPD is essentially the same as the DS, the stomach part is VERY different. The problems with the BPD are much more like a distal RNY than the currently practiced DS, as the BPD involves removing much of the lower part of the stomach, including the parts that absorb vitamin B12 and iron, and the pyloric valve, and BPD issues include potentially serious malnutrition issues. What insurance companies often do is to cite papers discussing the very real problems with the BPD (which is rarely performed anymore) against the DS, which is quite inappropriate. In addition, they completely ignore the growing body of scientific evidence that is approaching 20 years of study on the DS and the wonderful results that have been established.
Over the past several years, and due in no small part to the steady pressure exerted by patients demanding the DS procedure, there have been numerous inroads made into educating both the insurance companies and the external reviewers who end up ruling on the appeals of die-hard DS wannabees. The tide appears to finally be turning, as one after another insurance company is beginning to acknowledge the beneficial effects and safety of the DS. Blue Cross of California has recently changed their official policy to permit the DS, and it seems from recent legal challenges that Blue Shield will not be far behind. The national Blue Cross/Blue Shield Technology Evaluation Center assessment of the DS is currently being reviewed as well, and there is a good possibility that they will reclassify the status of the DS. The most recent CPT Code book for 2005 has given the DS a new, Category I, code number, indicating that it is now a generally recognized procedure and not still being evaluated for safety and efficacy.
In addition to the many published articles that have come out recently praising the DS procedure (available on request), there is now an almost astonishing new source of analysis and validation of the procedure -- the external reviewers of the Center for Health Dispute Resolution of Maximus. This organization has been contracted to perform external reviews for 25 states, Federal government employees and Medicare/Medicaid appeals. They now appear to be taking the position that essentially ANY patient (including those with a BMI under 50) should qualify for the DS, and that insurers are improperly refusing to acknowledge this. One of the most available sources of information about this sea change is the published decisions of the California Department of Managed Health Care, which is the agency to whom California HMO participants appeal denials of coverage.
Needless to say, organizations such as CHDR are inclined to be very conservative, since they are hired by politically influenced state agencies -- as you can imagine, it is likely that the insurance companies will have SOME input to how such state reviews are conducted. In addition, these organizations are also performing PRIVATE external medical reviews for insurance companies which are able to chose who will perform the external reviews of their own decisions. So it is in my opinion a significant fact that CHDR is now supporting the DS and overturning almost every denial that comes their way, at least in California (which is the only source of published opinions I have found -- I will be happy to provide the link to it on request, because putting it here will make this posting difficult to read, since it will stretch out the entire posting and all posts in response sideways to accommodate the entire link). (*Leslie's Edit: This is the link: http://tinyurl.com/9ufl3 )
Here are some quoted comments on the DS in these published decisions by CHDR, which has NO vested interest whatsoever in seeing this procedure being more commonly performed, other than their own intellectual honesty:
* Techniques in duodenal switch have been available since the 1980s. There is now sufficient data to show that duodenal switch has a superior long-term outcome when compared to gastric bypass.* In the Roux-en-Y procedure dumping syndrome, stomal ulcers, and vitamin deficiency are commonly seen. * Long-term studies of the duodenal switch procedure demonstrate equal effectiveness with less need for a highly restrictive diet than with gastric bypass.* There is a significant risk of marginal ulceration with the standard gastric bypass that does not appear to be present in the duodenal switch procedure. * The data strongly supports the high failure rate of Roux-en-y gastric bypass in patients who are super morbidly obese.* Review of the medical literature indicates revisional weight loss surgeries have a high complication rate. A patient who has failed a restrictive operation (Lap-Band) is more likely to fail another restrictive operation longer-term unless a malabsorptive element is added. The study cited above reported high incidence of protein and nutritional deficiency after revision of gastric bypass to distal gastric bypass. Furthermore, a patient with a BMI of 48 may have a high failure rate after a restrictive procedure. A more suitable option may be a hybrid procedure such as duodenal switch.* The duodenal switch procedure has a track record greater than 15 years. The anticipated complications associated with other malabsorptive procedures (i.e., distal gastric bypass, jejunoileal bypass) has not been encountered with the duodenal switch.* At the 2003 American Society of Bariatric Surgeons meeting held in Boston, Massachusetts, scientific papers were presented, which indicated there is growing evidence that protein malnutrition is a much larger problem post gastric bypass than was initially suspected.* Techniques in duodenal switch have been available since the 1980s. With duodenal switch, patients lose weight in the range of 69% to 80%.* Complications have been reported to be comparable to other operations. Multiple vitamin deficiencies, mineral deficiencies, bacterial overgrowth issues seem all to be comparable and less than other alternative surgeries. Hundreds of duodenal switch operations have been performed on patients in California and they appear to have a good track record of positive results.
In addition to this clarifying information about the safety and efficacy, I also want to make people understand that the "socially unacceptable" side effects of the DS surgery are often exaggerated in the extreme by those who don't have actual information from real patients to be making such statements. Again, sometimes this is confabulation of the problems associated with the BPD to apply to the DS, which is inappropriate. Sometimes, it is purely to steer patients from a surgery the surgeon doesn't perform (the DS) to one they do (the RNY or LapBand). Here is my experience, which I have substantially in common with most DSers:
* I have a bowel movement every morning as soon as I wake up. Sometimes, I have another one after breakfast, IF I am still at home. Sometimes, I have another one shortly before bedtime. I NEVER have to go poop outside my house (except when I'm traveling, of course, and then only at the hotel). I do not have diarrhea, uncontrollable need to poop, or anything like that. In fact, my post-op issues with IBS have significantly improved, and my bathroom habits are BETTER than they were pre-op. It smells somewhat worse then it did pre-op, but not that much worse, and a quick spray of Ozium takes care of any lingering smell.* I fart, and it stinks, IF AND ONLY IF I have eaten some of the foods that disagree with me, such as white bread, most pasta, onions, beans and broccoli. This will happen 4-6 hours after eating such foods, so I can still eat them if I know I will not be around people (other than my family) when it kicks in. I can also take Gas-X and smell-reducing agents such as Beano, Devrom or Innermint with the meal to ameliorate the gas. It is entirely dealable with, and not really worse than it was pre-op with my IBS issues. The gas WAS more of a problem in the first 2-3 months after surgery, but it has gotten a LOT better since then, both because I have learned how to manage my diet and because my body has accommodated. Plus, I take a probiotic every day to help maintain my internal flora.* I take the following vitamins at 15 months out, and my one year labs were perfect: One prenatal vitamin, and 4 calcium citrate pills. That's it. No malnutrition or protein or vitamin deficiencies. I don't even need to supplement the fat soluble vitamins A, D, E or K.* I don't diet anymore. I eat what I want, starting with protein. I can eat about 2/3 of what I used to eat and I feel full -- comfortably -- when I'm done.* I don't barf, ever, even if I overeat (which I'm less inclined to do, though sometimes I eat reflexively while watching TV). At worst, I get a little uncomfortable, and I immediately stop. No nausea, ever, either.
There's more, but you get the picture? The so-called "socially unacceptable problems" that you probably have heard about the DS are for the most part, scare tactics, a myth and I daresay a LIE.
Other facts that should be understood (from a preprint of an ongoing study by Hess et al.):
* The DS is a CURE for type II diabetes. In Europe, the intestinal part of the DS is being performed on people who are not obese to cure type II diabetes. There is data going out over 10 years now demonstrating the cure rate is 98%.* The average excess weight loss at ten years is 76%. * 94% of 10 year out patients are in the satisfactory category (50% or more excess weight loss). * There are no foreign materials used. * The pylorus is retained and controls the stomach emptying. * There is no small stoma that could dilate causing failure, allowing the patient to eat normal meals. * There is no dumping syndrome.* If the patient takes vitamins and minerals as instructed, as well as eats sufficient protein as instructed, which is easily accomplished eating normal food and without “protein shakes” or other supplementation, they will have little or no malnutrition issues. * The average lab results on a ten year cohort are all within the normal range.* Long-term studies have shown little or no serious or irremediable nutritional squellae, contrary to frequently expressed – but unsubstantiated – concerns. * It is certainly no longer considered an experimental or investigational procedure, either by the American Society for Bariatric Surgery (ASBS) or by the surgeons who perform it.
It is still true that there are not that many surgeons offering the DS as compared with the RNY. It is a more difficult procedure to learn and to perform properly, as the tissue of the duodenum is harder to stitch. You ONLY want an experienced surgeon performing this procedure on you (but that's true for ANY surgery). Many insurance companies are still balking at covering it, but if pressed, they often will cave in, and more of them are now accepting it. But you must ask yourself, which surgery can I live with for the rest of my life -- which will give me the BEST quality of life, as well as ability to maintain my hard-earned weight loss without constant dieting? For me, there was only one answer, and that was the DS. (Written by and posted with permission by Diana Cox)
Good luck to everyone in making the best and most informed choice you can.
A short and easy description of the DS procedure
Duodenal Switch
This procedure modestly restricts food intake while radically limiting the absorption of calories, especially the obesity causing calories from fat, complex carbohydrates, and starches. Approximately 3/4 of the stomach is removed, but the natural outlet of the stomach, the pylorus, is left in, allowing the stomach pouch to function more naturally. As the stomach pouch stretches out in the first year after surgery, patients are moderately limited in the amount of food they can eat, reduced to about 2/3 of what they could eat before surgery. However, patients are not limited in the types of food they are able to eat, tolerating meats and whole vegetables without difficulty.
The food is rerouted through a radically altered intestine, limiting the amount of food that is absorbed, which is what results in weight loss, despite the patient eating freely. The intestine is essentially reduced to less than half of its length and the digestive juices (the biliopancreatic secretions) mix with the food at only the last 10% of the intestine.
Patients undergoing duodenal switch eat normally and have bowel habit changes characterized by frequent (2-4 per day) soft stools and a propensity for gas. Both of which are generally malodorous unless a stool deodorant (such as Devrom) is taken.
A
The stomach is trimmed to a 4-6 ounce volume, preserving its natural inlet and outlet ( the pylorus). Trimming the stomach results in a temporary restrictive effect on eating for several months, which then reverts to normal, and decreases the incidence of ulcer formation as well.
B
The small intestine that the stomach normally empties into (the duodenum) is "switched" to the downstream portion of the small intestine (the digestive limb-D). The outflow from the duodenum, carrying the digestive juices and enzymes (but no food) becomes the bilio-pancreatic limb (C) utilizing approximately 60% of the small intestines length.
D
The digestive limb takes up approximately 40% of the small bowel length, and most of this length is upstream from where the biliopancreatic limb deposits its juices to allow for the absorption of fats, starches, and complex carbohydrates.
E
The common limb, being the portion of intestine where both food and biliopancreatic outflow meet, is made up of the most downstream 100 cm of small intestine and is the only portion where absorption of dietary starches, fats, and complex carbohydrates occurs. The capacity for absorption reaches a maximum within several months after surgery and cannot be over eaten, resulting in long term sustained weight loss..
F
The gallbladder and appendix are removed.__________________________________________________________________________
Swiped from BT, just too good not to add here....
Both the DS and the RNY have two parts to the surgery - what is done to the stomach (restrictive part) and what is done to the intestines (malabsorptive part). In the RNY, they section off the majority of the stomach which remains in the body, but unused (thus the term gastric bypass). Because this area is 'blind' - not accessible via oral medication or endoscopy, RNY'ers are advised to avoid NSAIDS or non-steroidal anti-imflammatory drugs such as aspirin or ibuprofen due to the potential for ulcers. DS'ers don't have this problem because there is no blind portion - the unused part of the stomach is removed instead, so we can take OTC drugs. For people with *other* problems, such as lupus or migraines or a family history of ulcers, this can be an important factor in their decision. The remaining portion (nicknamed The Pouch) is anywhere from 1-3 oz. (About the size of a large egg). This then feeds directly into a newly restructured part of the intestine with no valve regulating how quickly food moves from the stomach into the intestine. Instead of a valve, there's simply a hole - kind of like a doorway - which leads into the intestines. This is called a stoma. The stoma is not flexible, so it cannot expand if you try to put something through it that is too big. This is why RNY'ers are told to chew their food VERY well, and are advised AGAINST having fluid with meals, because just like a sink drain, solid stuff will go down easier if you 'flush' it down with water. Because there is no regulation there, three-fourths of all RNY patients suffer a syndrome called Dumping. For some people, dumping just makes them feel a little bad. Others vomit. Still others have a more severe reaction that feels more like a bad case of the flu, and a rare but potentially dangerous reaction can be like a diabetic attack. Dumping Syndrome can be both a positive and a negative factor - if you immediately suffer a REALLY bad reaction to eating sweets, you're going to learn (the hard way) to avoid foods that aren't good for you. It's called Aversion Therapy, and if you learn better from the stick than you do from the carrot, this will keep you on the straight and narrow. In the DS, they literally do a gastrectomy, removing the outer curvature of the stomach (making it physically smaller), but leaving the actual functionality of the stomach intact as it was before surgery. The remaining portion of the stomach is kind of "banana" shaped, and you start with about 3-5oz stomach - a little larger than the RNY, but still MUCH smaller than it is now. You have multiple places in your body where you have a sphincter type muscle - the one everyone is familiar with is your anus, at the 'bottom' (pun intended) of your intestines. Well, you have a similar 'ring of muscle' at the pit of your stomach called the pyloric valve. Because this valve remains in use, DS patients do not have any dumping because the pyloric valve is still regulating how often food moves into the intestines as it does for you right now. In both surgeries, the stomach/pouch will expand over time to about twice it's post-surgery size. This leaves long-term RNY'ers with about 3-5oz and long-term DS'ers with about 10-12oz. Then we move into the lower portion of the surgery, which is essentially the same for both with a few small, but significant differences. The small intestine has three sections/phases - called the jujuneum, the illeum and the duodenum. (Forgive my spelling if it's wrong - it *is* 4:30 in the morning)Right now, it is one continuous line. What they do is cut it in two and reattach them in a Y formation. One branch of the Y comes down from the liver with the digestive juices. The other portion comes down from the stomach (DS) or the pouch (RNY) with food. The two them come together into what is called the common channel which then has both digestive juices and food. It is in the common channel that most digestion takes place. (Some digestion takes place all throughout the whole digestive system, starting from saliva in the mouth, all the way to the colon)The primary differences between the two in the lower part are this:1) In the RNY, the common channel is generally longer - perhaps 275cm. In the DS, it's generally shorter - about 100cm. Everyone absorbs carbs like a non-WLS patient, but we malabsorb for protein, fat and calories - DS more than RNY, again due to the shorter common channel. The 'big' problem this causes the DS'ers is too much fat can cause bad-smelling gas and/or diarrhea - and it's the one thing everyone who has every heard of the DS has heard of. However, for MOST people, this isn't a huge problem, is easily controlled with products like Beano, and watching what they eat. 2) The Duodenum is bypassed in the RNY, and it is functional in the DS. What makes that important is that this is where protein, calcium, iron and vitamin B12 are absorbed. So even though the DS has a greater malabsorptive factor (the shorter common channel), it actually has more normal nutritional absorption than the RNY because the duodenum is still involved in the digestive process.Now - BOTH types have to watch what they eat, and be aware that they are susceptible to nutritional deficiencies. For the most part, these can be controlled with diet, but if your diet is out of control, you can do *severe* damage to your health if you ignore this. DS patients specifically need to make sure they take calcium & protein, and the fat soluable vitamins. RNY patients need to make sure they get protein, calcium, iron & B12. (Some need B12 shots, but not all). A person who has never had surgery needs about 60g of protein a day. RNY need about 80g. I've seen recommendations for DS patients of 90-120g. Everyone should take a multi-vitamin, and get exercise, with or without WLS surgery. A low-carb, high protein diet is recommended to make sure you get in your protein, and you'll find LOTS of suggestions on what to eat on every board - both food, protein shake and supplement-wise.
PLEASE READ THIS BEFORE MAKING YOUR DECISION ON WHICH SURGERY TO GET!
It is a sad truth that there is a lot of misinformation being circulated about the duodenal switch (DS) procedure. Even more sadly, much of it comes from RNY surgeons and their patients, who have various degrees of vested interest in promoting their surgery (or in certain cases, dissing WLS altogether). I would hope that each and every potential WLS patient who is researching what to do about treating his or her morbid obesity has access to the FACTS before making the decision about which surgery to have.
For a number of years, insurance approval has been the vehicle by which access to the DS procedure has been limited -- most of the largest insurers, including Blue Cross, Blue Shield, Aetna and Cigna, have cited misleading information and each others' policies to claim that the DS is "experimenal," "investigational" or "unsafe and inadequately studied." However, the papers cited by these insurance companies to support this allegation are often not even related to the correct procedure.
When the DS was introduced, it was an improvement over the Biliopancreatic Diversion procedure, or BPD -- unfortunately, this led to the procedure being called the BPD/DS, which is a misnomer. While the intestinal part of the BPD is essentially the same as the DS, the stomach part is VERY different. The problems with the BPD are much more like a distal RNY than the currently practiced DS, as the BPD involves removing much of the lower part of the stomach, including the parts that absorb vitamin B12 and iron, and the pyloric valve, and BPD issues include potentially serious malnutrition issues. What insurance companies often do is to cite papers discussing the very real problems with the BPD (which is rarely performed anymore) against the DS, which is quite inappropriate. In addition, they completely ignore the growing body of scientific evidence that is approaching 20 years of study on the DS and the wonderful results that have been established.
Over the past several years, and due in no small part to the steady pressure exerted by patients demanding the DS procedure, there have been numerous inroads made into educating both the insurance companies and the external reviewers who end up ruling on the appeals of die-hard DS wannabees. The tide appears to finally be turning, as one after another insurance company is beginning to acknowledge the beneficial effects and safety of the DS. Blue Cross of California has recently changed their official policy to permit the DS, and it seems from recent legal challenges that Blue Shield will not be far behind. The national Blue Cross/Blue Shield Technology Evaluation Center assessment of the DS is currently being reviewed as well, and there is a good possibility that they will reclassify the status of the DS. The most recent CPT Code book for 2005 has given the DS a new, Category I, code number, indicating that it is now a generally recognized procedure and not still being evaluated for safety and efficacy.
In addition to the many published articles that have come out recently praising the DS procedure (available on request), there is now an almost astonishing new source of analysis and validation of the procedure -- the external reviewers of the Center for Health Dispute Resolution of Maximus. This organization has been contracted to perform external reviews for 25 states, Federal government employees and Medicare/Medicaid appeals. They now appear to be taking the position that essentially ANY patient (including those with a BMI under 50) should qualify for the DS, and that insurers are improperly refusing to acknowledge this. One of the most available sources of information about this sea change is the published decisions of the California Department of Managed Health Care, which is the agency to whom California HMO participants appeal denials of coverage.
Needless to say, organizations such as CHDR are inclined to be very conservative, since they are hired by politically influenced state agencies -- as you can imagine, it is likely that the insurance companies will have SOME input to how such state reviews are conducted. In addition, these organizations are also performing PRIVATE external medical reviews for insurance companies which are able to chose who will perform the external reviews of their own decisions. So it is in my opinion a significant fact that CHDR is now supporting the DS and overturning almost every denial that comes their way, at least in California (which is the only source of published opinions I have found -- I will be happy to provide the link to it on request, because putting it here will make this posting difficult to read, since it will stretch out the entire posting and all posts in response sideways to accommodate the entire link). (*Leslie's Edit: This is the link: http://tinyurl.com/9ufl3 )
Here are some quoted comments on the DS in these published decisions by CHDR, which has NO vested interest whatsoever in seeing this procedure being more commonly performed, other than their own intellectual honesty:
* Techniques in duodenal switch have been available since the 1980s. There is now sufficient data to show that duodenal switch has a superior long-term outcome when compared to gastric bypass.* In the Roux-en-Y procedure dumping syndrome, stomal ulcers, and vitamin deficiency are commonly seen. * Long-term studies of the duodenal switch procedure demonstrate equal effectiveness with less need for a highly restrictive diet than with gastric bypass.* There is a significant risk of marginal ulceration with the standard gastric bypass that does not appear to be present in the duodenal switch procedure. * The data strongly supports the high failure rate of Roux-en-y gastric bypass in patients who are super morbidly obese.* Review of the medical literature indicates revisional weight loss surgeries have a high complication rate. A patient who has failed a restrictive operation (Lap-Band) is more likely to fail another restrictive operation longer-term unless a malabsorptive element is added. The study cited above reported high incidence of protein and nutritional deficiency after revision of gastric bypass to distal gastric bypass. Furthermore, a patient with a BMI of 48 may have a high failure rate after a restrictive procedure. A more suitable option may be a hybrid procedure such as duodenal switch.* The duodenal switch procedure has a track record greater than 15 years. The anticipated complications associated with other malabsorptive procedures (i.e., distal gastric bypass, jejunoileal bypass) has not been encountered with the duodenal switch.* At the 2003 American Society of Bariatric Surgeons meeting held in Boston, Massachusetts, scientific papers were presented, which indicated there is growing evidence that protein malnutrition is a much larger problem post gastric bypass than was initially suspected.* Techniques in duodenal switch have been available since the 1980s. With duodenal switch, patients lose weight in the range of 69% to 80%.* Complications have been reported to be comparable to other operations. Multiple vitamin deficiencies, mineral deficiencies, bacterial overgrowth issues seem all to be comparable and less than other alternative surgeries. Hundreds of duodenal switch operations have been performed on patients in California and they appear to have a good track record of positive results.
In addition to this clarifying information about the safety and efficacy, I also want to make people understand that the "socially unacceptable" side effects of the DS surgery are often exaggerated in the extreme by those who don't have actual information from real patients to be making such statements. Again, sometimes this is confabulation of the problems associated with the BPD to apply to the DS, which is inappropriate. Sometimes, it is purely to steer patients from a surgery the surgeon doesn't perform (the DS) to one they do (the RNY or LapBand). Here is my experience, which I have substantially in common with most DSers:
* I have a bowel movement every morning as soon as I wake up. Sometimes, I have another one after breakfast, IF I am still at home. Sometimes, I have another one shortly before bedtime. I NEVER have to go poop outside my house (except when I'm traveling, of course, and then only at the hotel). I do not have diarrhea, uncontrollable need to poop, or anything like that. In fact, my post-op issues with IBS have significantly improved, and my bathroom habits are BETTER than they were pre-op. It smells somewhat worse then it did pre-op, but not that much worse, and a quick spray of Ozium takes care of any lingering smell.* I fart, and it stinks, IF AND ONLY IF I have eaten some of the foods that disagree with me, such as white bread, most pasta, onions, beans and broccoli. This will happen 4-6 hours after eating such foods, so I can still eat them if I know I will not be around people (other than my family) when it kicks in. I can also take Gas-X and smell-reducing agents such as Beano, Devrom or Innermint with the meal to ameliorate the gas. It is entirely dealable with, and not really worse than it was pre-op with my IBS issues. The gas WAS more of a problem in the first 2-3 months after surgery, but it has gotten a LOT better since then, both because I have learned how to manage my diet and because my body has accommodated. Plus, I take a probiotic every day to help maintain my internal flora.* I take the following vitamins at 15 months out, and my one year labs were perfect: One prenatal vitamin, and 4 calcium citrate pills. That's it. No malnutrition or protein or vitamin deficiencies. I don't even need to supplement the fat soluble vitamins A, D, E or K.* I don't diet anymore. I eat what I want, starting with protein. I can eat about 2/3 of what I used to eat and I feel full -- comfortably -- when I'm done.* I don't barf, ever, even if I overeat (which I'm less inclined to do, though sometimes I eat reflexively while watching TV). At worst, I get a little uncomfortable, and I immediately stop. No nausea, ever, either.
There's more, but you get the picture? The so-called "socially unacceptable problems" that you probably have heard about the DS are for the most part, scare tactics, a myth and I daresay a LIE.
Other facts that should be understood (from a preprint of an ongoing study by Hess et al.):
* The DS is a CURE for type II diabetes. In Europe, the intestinal part of the DS is being performed on people who are not obese to cure type II diabetes. There is data going out over 10 years now demonstrating the cure rate is 98%.* The average excess weight loss at ten years is 76%. * 94% of 10 year out patients are in the satisfactory category (50% or more excess weight loss). * There are no foreign materials used. * The pylorus is retained and controls the stomach emptying. * There is no small stoma that could dilate causing failure, allowing the patient to eat normal meals. * There is no dumping syndrome.* If the patient takes vitamins and minerals as instructed, as well as eats sufficient protein as instructed, which is easily accomplished eating normal food and without “protein shakes” or other supplementation, they will have little or no malnutrition issues. * The average lab results on a ten year cohort are all within the normal range.* Long-term studies have shown little or no serious or irremediable nutritional squellae, contrary to frequently expressed – but unsubstantiated – concerns. * It is certainly no longer considered an experimental or investigational procedure, either by the American Society for Bariatric Surgery (ASBS) or by the surgeons who perform it.
It is still true that there are not that many surgeons offering the DS as compared with the RNY. It is a more difficult procedure to learn and to perform properly, as the tissue of the duodenum is harder to stitch. You ONLY want an experienced surgeon performing this procedure on you (but that's true for ANY surgery). Many insurance companies are still balking at covering it, but if pressed, they often will cave in, and more of them are now accepting it. But you must ask yourself, which surgery can I live with for the rest of my life -- which will give me the BEST quality of life, as well as ability to maintain my hard-earned weight loss without constant dieting? For me, there was only one answer, and that was the DS. (Written by and posted with permission by Diana Cox)
Good luck to everyone in making the best and most informed choice you can.
A short and easy description of the DS procedure
Duodenal Switch
This procedure modestly restricts food intake while radically limiting the absorption of calories, especially the obesity causing calories from fat, complex carbohydrates, and starches. Approximately 3/4 of the stomach is removed, but the natural outlet of the stomach, the pylorus, is left in, allowing the stomach pouch to function more naturally. As the stomach pouch stretches out in the first year after surgery, patients are moderately limited in the amount of food they can eat, reduced to about 2/3 of what they could eat before surgery. However, patients are not limited in the types of food they are able to eat, tolerating meats and whole vegetables without difficulty.
The food is rerouted through a radically altered intestine, limiting the amount of food that is absorbed, which is what results in weight loss, despite the patient eating freely. The intestine is essentially reduced to less than half of its length and the digestive juices (the biliopancreatic secretions) mix with the food at only the last 10% of the intestine.
Patients undergoing duodenal switch eat normally and have bowel habit changes characterized by frequent (2-4 per day) soft stools and a propensity for gas. Both of which are generally malodorous unless a stool deodorant (such as Devrom) is taken.
A
The stomach is trimmed to a 4-6 ounce volume, preserving its natural inlet and outlet ( the pylorus). Trimming the stomach results in a temporary restrictive effect on eating for several months, which then reverts to normal, and decreases the incidence of ulcer formation as well.
B
The small intestine that the stomach normally empties into (the duodenum) is "switched" to the downstream portion of the small intestine (the digestive limb-D). The outflow from the duodenum, carrying the digestive juices and enzymes (but no food) becomes the bilio-pancreatic limb (C) utilizing approximately 60% of the small intestines length.
D
The digestive limb takes up approximately 40% of the small bowel length, and most of this length is upstream from where the biliopancreatic limb deposits its juices to allow for the absorption of fats, starches, and complex carbohydrates.
E
The common limb, being the portion of intestine where both food and biliopancreatic outflow meet, is made up of the most downstream 100 cm of small intestine and is the only portion where absorption of dietary starches, fats, and complex carbohydrates occurs. The capacity for absorption reaches a maximum within several months after surgery and cannot be over eaten, resulting in long term sustained weight loss..
F
The gallbladder and appendix are removed.__________________________________________________________________________
Swiped from BT, just too good not to add here....
Both the DS and the RNY have two parts to the surgery - what is done to the stomach (restrictive part) and what is done to the intestines (malabsorptive part). In the RNY, they section off the majority of the stomach which remains in the body, but unused (thus the term gastric bypass). Because this area is 'blind' - not accessible via oral medication or endoscopy, RNY'ers are advised to avoid NSAIDS or non-steroidal anti-imflammatory drugs such as aspirin or ibuprofen due to the potential for ulcers. DS'ers don't have this problem because there is no blind portion - the unused part of the stomach is removed instead, so we can take OTC drugs. For people with *other* problems, such as lupus or migraines or a family history of ulcers, this can be an important factor in their decision. The remaining portion (nicknamed The Pouch) is anywhere from 1-3 oz. (About the size of a large egg). This then feeds directly into a newly restructured part of the intestine with no valve regulating how quickly food moves from the stomach into the intestine. Instead of a valve, there's simply a hole - kind of like a doorway - which leads into the intestines. This is called a stoma. The stoma is not flexible, so it cannot expand if you try to put something through it that is too big. This is why RNY'ers are told to chew their food VERY well, and are advised AGAINST having fluid with meals, because just like a sink drain, solid stuff will go down easier if you 'flush' it down with water. Because there is no regulation there, three-fourths of all RNY patients suffer a syndrome called Dumping. For some people, dumping just makes them feel a little bad. Others vomit. Still others have a more severe reaction that feels more like a bad case of the flu, and a rare but potentially dangerous reaction can be like a diabetic attack. Dumping Syndrome can be both a positive and a negative factor - if you immediately suffer a REALLY bad reaction to eating sweets, you're going to learn (the hard way) to avoid foods that aren't good for you. It's called Aversion Therapy, and if you learn better from the stick than you do from the carrot, this will keep you on the straight and narrow. In the DS, they literally do a gastrectomy, removing the outer curvature of the stomach (making it physically smaller), but leaving the actual functionality of the stomach intact as it was before surgery. The remaining portion of the stomach is kind of "banana" shaped, and you start with about 3-5oz stomach - a little larger than the RNY, but still MUCH smaller than it is now. You have multiple places in your body where you have a sphincter type muscle - the one everyone is familiar with is your anus, at the 'bottom' (pun intended) of your intestines. Well, you have a similar 'ring of muscle' at the pit of your stomach called the pyloric valve. Because this valve remains in use, DS patients do not have any dumping because the pyloric valve is still regulating how often food moves into the intestines as it does for you right now. In both surgeries, the stomach/pouch will expand over time to about twice it's post-surgery size. This leaves long-term RNY'ers with about 3-5oz and long-term DS'ers with about 10-12oz. Then we move into the lower portion of the surgery, which is essentially the same for both with a few small, but significant differences. The small intestine has three sections/phases - called the jujuneum, the illeum and the duodenum. (Forgive my spelling if it's wrong - it *is* 4:30 in the morning)Right now, it is one continuous line. What they do is cut it in two and reattach them in a Y formation. One branch of the Y comes down from the liver with the digestive juices. The other portion comes down from the stomach (DS) or the pouch (RNY) with food. The two them come together into what is called the common channel which then has both digestive juices and food. It is in the common channel that most digestion takes place. (Some digestion takes place all throughout the whole digestive system, starting from saliva in the mouth, all the way to the colon)The primary differences between the two in the lower part are this:1) In the RNY, the common channel is generally longer - perhaps 275cm. In the DS, it's generally shorter - about 100cm. Everyone absorbs carbs like a non-WLS patient, but we malabsorb for protein, fat and calories - DS more than RNY, again due to the shorter common channel. The 'big' problem this causes the DS'ers is too much fat can cause bad-smelling gas and/or diarrhea - and it's the one thing everyone who has every heard of the DS has heard of. However, for MOST people, this isn't a huge problem, is easily controlled with products like Beano, and watching what they eat. 2) The Duodenum is bypassed in the RNY, and it is functional in the DS. What makes that important is that this is where protein, calcium, iron and vitamin B12 are absorbed. So even though the DS has a greater malabsorptive factor (the shorter common channel), it actually has more normal nutritional absorption than the RNY because the duodenum is still involved in the digestive process.Now - BOTH types have to watch what they eat, and be aware that they are susceptible to nutritional deficiencies. For the most part, these can be controlled with diet, but if your diet is out of control, you can do *severe* damage to your health if you ignore this. DS patients specifically need to make sure they take calcium & protein, and the fat soluable vitamins. RNY patients need to make sure they get protein, calcium, iron & B12. (Some need B12 shots, but not all). A person who has never had surgery needs about 60g of protein a day. RNY need about 80g. I've seen recommendations for DS patients of 90-120g. Everyone should take a multi-vitamin, and get exercise, with or without WLS surgery. A low-carb, high protein diet is recommended to make sure you get in your protein, and you'll find LOTS of suggestions on what to eat on every board - both food, protein shake and supplement-wise.
So Close...and Yet So Far Away...
The scale keeps on hovering anywhere from 301 to 305. I want to be in TWOERVILLE!!! I am so ready to see 299 on the scale! My biggest problem is weighing everyday, and to top it off, weighing MULTIPLE times a day. I did this even Pre-DS. I wish I could put the scale away, and only weigh once a month or so. This is so difficult for me. The DS is not like being on a typical diet. I tend to lose several pounds over the course of a week or two, then I "hover" within a 3-5 pound range. The scale is NOT creeping up. Praise God for that. I have come such a long way, in such a short period of time. I often wonder what my thoughts will be re reading some of these posts a year and a half from now.
Monday, July 16, 2007
Good Intentions
I had all intentions to start a blog as soon as I got back from surgery. I am a few months behind, but after reading many other blogs that have been so helpful to me, I am starting my own. I hope it will be a source of information about the Duodenal Switch journey.
I started researching Weight Loss Surgery in 2006. In August, I formally sought to get Gastric Bypass through my insurance company. I was denied three times, even through an independent appeal process. I hired an attorney, but the policy was iron clad, and I was NOT going to be covered. In the end, it was a huge blessing. Since I was going to self pay, I was not "desperate" to have "any" surgery covered. I became a consumer, and started researching the BEST surgery for me. The Duodenal Switch was the answer.
Why did I choose this surgery? In short, it has the highest success rate for people who are extremely obese (with a BMI of over 50), and patients have been able to keep the highest percentage of their excess weight off with this surgery. Many people who had the RNY surgery, and are not successful, usually have revisions to the Duodenal Switch.
I decided to have my surgery done out of the country in Mexico. I had my surgery March 26, 2007 with Dr. Daniel Huacuz. I received more personal attention and care there than I have ever received in any American hospital. Dr. Huacuz was very patient with me, and talked to me in detail many times on the phone. (When I was considering RNY, I got to meet the doctor for THREE minutes, and would not see him again until he performed surgery on me.)
I took four weeks off of work. I stayed at my parents house for two weeks. My mom was a godsend, and helped me with everything.
I entered surgery weighing 393.6 pounds. Here is a look at my weight loss to date:
First Month: 35 pounds
Second Month: 22 pounds
Third Month: 26.6 pounds
I started researching Weight Loss Surgery in 2006. In August, I formally sought to get Gastric Bypass through my insurance company. I was denied three times, even through an independent appeal process. I hired an attorney, but the policy was iron clad, and I was NOT going to be covered. In the end, it was a huge blessing. Since I was going to self pay, I was not "desperate" to have "any" surgery covered. I became a consumer, and started researching the BEST surgery for me. The Duodenal Switch was the answer.
Why did I choose this surgery? In short, it has the highest success rate for people who are extremely obese (with a BMI of over 50), and patients have been able to keep the highest percentage of their excess weight off with this surgery. Many people who had the RNY surgery, and are not successful, usually have revisions to the Duodenal Switch.
I decided to have my surgery done out of the country in Mexico. I had my surgery March 26, 2007 with Dr. Daniel Huacuz. I received more personal attention and care there than I have ever received in any American hospital. Dr. Huacuz was very patient with me, and talked to me in detail many times on the phone. (When I was considering RNY, I got to meet the doctor for THREE minutes, and would not see him again until he performed surgery on me.)
I took four weeks off of work. I stayed at my parents house for two weeks. My mom was a godsend, and helped me with everything.
I entered surgery weighing 393.6 pounds. Here is a look at my weight loss to date:
First Month: 35 pounds
Second Month: 22 pounds
Third Month: 26.6 pounds
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