Re: Re: A new postie politician

[Guest guest]

Well, like I said, it's a different way of doing the DS. Congrats on your

weight loss. Whatever surgery anyone has doesn't really matter, as long as

we're healthy, right?

in NJ

[Guest guest]

Not quite, . The " DS , " actually, the Bilio-Pancreatic

Diversion with Duodenal Switch, much like the RNY, has two parts:

restriction (making a smaller stomach to receive the food) and

malabsorption (rearranging the intestinal path so that less food that

exits the restricted stomach is absorbed. Instead of making a pouch

at the top of the stomach, the surgeon cuts vertically and removes

about 80% of the stomach, roughly speaking, changing it from a

football to a banana. The intestinal rearrangement is much like the

distal RNY, except that the alimentary limb is connected to a stub of

the duodenum. That way, the cells that make intrinsic factor at the

base of the stomach, the pyloric valve at the exit from the stomach,

and the first five or six centimeters of the duodenum are all

preserved and functional. Thus, no stoma, and fewer problems with

Vitamin B12 and iron absorption. If anybody wants to read more,

please see http://www.duodenalswitch.com.

Gagner and his associates were among the first to understand that for

super-morbidly-obese patients, it was safer to do the operation in

two parts. First, they did the capacity restriction, that is

resecting most of the stomach (leaving only the " banana " ). That part

is a vertical gastrectomy (VG) or " sleeve " gastrectomy. Then, after

they lose 100 pounds or more, they are in better physical shape for

the malabsorptive second part of the surgery, the " switch. " Many

patients lose considerable weight with the VG alone and elect not to

have the malabsorptive second half of the surgery. There quite a few

in my surgical support group (Dr. Elariny in Northern Virginia) that

have lost well over 100 pounds with the VG alone (one woman in her

late 30's has so far lost 160 pounds with just the VG). The

uncertainty is whether they can keep the weight off without the

malabsorption. Time will tell. But, if they do not, they can always

go back and have the second half. On the other hand, just a few days

ago, one man who started out at over 500 pounds and who lost about

130 pounds with the VG, just had the second half done. (Good thing

for him, too, because Dr. Elariny found a tumor in his intestine,

removed it, and it turned out to be cancerous. But, that is a fluke.)

Just a personal note: I had the full DS in May of '01. I just got

back from meeting my kids and grandkids at a barbecue place. I had

about 3 small ribs, a 4-inch piece of spicy grilled sausage, a small

piece of chicken and a 3-inch piece of corn-on-the cob. I was

stuffed and could not eat more, so I took the remainder of my combo

plate home in a doggie box. So far, I have lost 130 pounds in 18-1/2

months and gone from a BMI of 51 to a BMI of just over 32. I have

about 30 pounds more to lose to get to my goal. At age 62, I am a

slow loser, and have had many plateaus along the way. As much as I'd

like to get to goal weight, if I lose even another 10 pounds and keep

it off, i will be quite satisfied.

Back to Congressman Nadler. From Gagner's description, I think that

Nadler had the full DS, that is, both parts.

Hope this was not too much information to bore you all,

Steve

At 5:11 PM -0500 11/17/02, watnext@... wrote:

>Ah, OK. Thanks for posting the article, I hadn't read it. Yes, it does

>sound like either the DS or sleeve gastrectomy. I think Gagner did that one

>on a member of one of my lists. It's a 2-part surgery, but I don't know the

>details. I think a different way of doing the DS or something.