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Hi, I have a consult with Dr. Inabnet on May 7, and am sure I want

the DS. The thing is I found this webpage with a long list of

potential complications with wls. I am not one to panic, but went

through the list one-by-one and tried to put each comment into

perspective. I am still sure I want the surgery, but I would like some

people to go through the list, and my comments, and put in their

opinions. Not just on the list, but if my comments are incomplete, or

incorrect, I'd like to know. I want to be sure I have all the facts in

before having the surgery. I will also take this list with me to the

consult. The URL for the unedited page is

http://members.home.net/gswidemark/readplace.htm Scroll down and click

on " Read this if you are considering Weight Loss Surgery! "

Here is the edited version with my comments.

My responses are indented below each paragraph.

Things to think about when you are considering Weight Loss Surgery

by Sue Widemark

1.A Gastric Bypass is not only a 'stomach stapling' as the media is

fond of calling it. It's also an intestinal bypass. In a proximal

bypass (like Carnie had), only about 20 inches of small

intestine is bypassed but that includes the Duodenum in which most of

the absorption of

vitamins and minerals takes place. This means that even with a

small amount of intestine bypassed, the post op might develop vitamin

and mineral deficiencies.

Yes you need to take vitamins, but the DS does

not bypass the pyloric valve.

2.The only place the body can take in calcium is in the duodenum

part of the small intestine - this is bypassed in all gastric bypasses

except the 'duodenal switch'.

Which means that no matter how much calcium supplements you take,

your body will not be able to access it. And this means, you will

within six to seven

years, get osteoporosis.

The DS does allow more absorption of calcium

than other wls

3.You might have to go back to the hospital for repeat surgeries

for hernias, bowel obstruction (this is very painful until you have

the

surgery done) and scopes (tubes down your throat to see if all if

ok). Most WLS post ops also have a lot of plastic surgery because the

original surgery does

not give them the svelte figure they imagined it would.

There is less of a risk of hernias (very low)

with the removal of the stomach as in the DS

than with the sectioning of the stomach as in

others, I don't know about bowel obstructions.

4.Many WLS patients have plastic surgery to their faces because

those around them complain that they look sick with sunken cheeks and

bags under the eyes.

Although the plastic surgery can cover this up, a 'sick look'

usually means that the person IS not well and possibly should not be

ignored. Prolonged

starvation as WLS causes can not be healthy for anyone!

I would assume this is true if you do not eat

enough protein and take your vitamins. We all

know this is crucial.

5.Several post ops of longer term have complained of bloating from

gas pains. Some say this goes away after a session of anti-biotics but

returns as soon as the

anti-biotics are stopped. This tends to suggest that the

bacterial state of the intestines may be unhealthy - and these

deleterious bacteria can easily get into the

bodily systems since there is virtually no stomach acid to kill

germs, undigested food is fermenting and absorption takes place in the

small intestine. The

bacteria entering the system is the cause of many serious side

effects and actually often caused death in those with the older

intestinal bypass surgery.

I don't know about this, but would assume it to

be less of a risk with the DS since the stomach

is left larger and eventually stretches to an

almost normal size.

6.Many post ops who are four and five years out from surgery, do

stay fairly thin but only because they have a lot of physical

problems. Be careful that you

aren't exchanging one set of problems for another. Cancer will

make you thin also but that doesn't mean it's something a person would

want to have.

?

7.Weight Loss Surgery will not fix depression. As a matter of fact,

prolonged starvation (which you will experience, eating 500-1000

calories a day and not

absorbing much in the way of nutriants) has been observed to

cause depression.

No, if you have a true depression caused by

chemical imbalances, weight loss alone will not

help. But, if you are just down because you are

hiding because you don't want to be seen at

your current weight, I believe it could make a

huge difference. Also, I am not physically able

to do a lot of things I wou ld like to do, and

that does depress me in a different way than

someone with chemical imbalances.

8.The reason you start to gain weight after a year or so, is

because your body has set your metabolism way down due to the

prolonged starvation for the first

year. Your body does this by cannibalizing it's own muscles and

even parts of organs. There is a growing body of evidence that

starvation can cause brain

damage and a lessening of mental abilities as well. This would

make sense as the brain is not necessary to maintain life.

First, they say a couple paragraphs up

(#6) that most post-ops remain thin

because they have so many physical problems.

Now you gain the weight back after a year.

Also, form what I have read, most post-ops

stay a little heavy, in the high range of

their ideal weight, or more than likely a

little above it. How can they be " starving " if

they are still overweight and taking the

proper vitamins and protein? You long term

post-ops out there: do you feel your brain

cells are dying? I have heard all this with

people bashing low carb diets, and I do not

believe that the human body is so inefficient

that given it has plenty of fat to chew on, it

eats your muscles and organs instead.

9.According to what statistics are known (the gastric bypass is a

pretty new procedure), about 1 out of every 200 who has the

surgery, dies from complications.

The basic prcedure has been around for quite a

while, I think I read that the first one was

done in the 1940's, not sure though. The

mortality rate is about right from what I have

read, and is the same as for many other

procedures. I have heard the risk compared to

a histerectomy. How many women have been sent

by their doctors for histerectomies that were

not even needed? I don't know the figures,

just that there were a lot of them. Doctors

made millions.

10.Many post ops four and five years out have arthritis or lupus.

Some percentage of patients get a creeping paralysis of the legs and

arms ( " peripheral

neuropathy " ). This is a somewhat crippling condition and is not

curable at present.

IF this is true, which I don't know, I would

assume it to be less likely with the DS since

there is better absorption of calcium. Also,

if you take your vitamins.

11.The gastric/intestinal bypass is, for all practical purposes, not

reversible. So be very sure of what you are doing before you make this

decision. (Note:

The Mini-gastric bypass done by Dr Rutledge of N.C. is easily

reversible unlike the RNY)

Is this an advertisement?

12.Some have the surgery because they feel it's the only way to lose

weight and that they will not be successful in any other way but the

truth is that many

thousands of people are successful in losing weight through a

healthy program of exercise and a low fat diet. Remember, you will

have to exercise after surgery

also or you might gain the weight back.

Are they? Most of us serious about having

surgery have started listing (or at least

thinking about) all our previous diet faiures.

Usually we lose some weight initially, then

the weightloss slows down (stops?) that there

is no reward for our efforts and we give up.

Then we gain it back along with a bonus. Our

metabolisms slow down to a crawl and every

time we try to diet we lose even less than the

last time, and gain back even more. If diets

did work, we wouldn't be here.

13.If you have a proximal gastric bypass, you will probably begin

gaining weight after 12 to 18 months. For this reason, many patients

have distal bypasses and

BPD (bileopancratic diversions). In this type of bypass, MOST of

the small intestine is bypassed, just like the old (and dangerous)

intestinal

bypass! This means you will probably develop severe nutritional

deficiencies due to lack of absorption. Many surgeons will not do

distal bypasses and BPDs

for this reason. Although they've refined the operation somewhat

by closing off the bypassed intestine, it still has pretty much the

same side effects as the older

intestinal bypass!

Refer to paragraph 1,2,4,6 & 8... take your

vitamins! Is this the reason only a few surgeons do

the DS, or are they just not trained in it yet? Or

that the other surgeries are less complicated than

the DS and faster to do, even though they are less

expensive, if they can get more done and faster, they

can make just as much with less work.

14.According to the ASBS website: " Any procedure involving

malabsorption must be considered at risk to develop at least some of

the malabsorptive complications exemplified by JIB (jejuno-ileal

bypass). " All gastric bypasses work through malabsorption so the

following complications would (according to the ASBS) be seen

with the modern gastric bypass:

Yes, some of these are seen with DS, many are

temporary. Most can be avoided with proper

supplementation.

Listing of jejuno-ileal bypass complications:

Mineral and Electrolyte Imbalance:

Decreased serum sodium, potassium, magnesium and

bicarbonate.

Osteoporosis and osteomalacia secondary to protein

depletion, calcium and vitamin D loss, and

acidosis,

Protein Calorie Malnutrition:

Hair loss, anemia, edema, and vitamin depletion

Cholelithiasis:

Enteric Complications:

Abdominal distension, irregular diarrhea, increased

flatus, pneumatosis intestinalis, colonic

pseudo-obstruction, bypass enteropathy, volvulus with

mechanical small bowel obstruction.

Extra-intestinal Manifestations:

Arthritis

Acute liver failure may occur in the postoperative

period, and may lead to death acutely following

surgery.

Liver disease, occurs in at least 30%

Steatosis, " alcoholic " type hepatitis, cirrhosis,

occurs in 5%, progresses to cirrhosis and death

in 1-2%

Erythema Nodosum, non-specific pustular dermatosis

Weber-Christian Syndrome

Renal Disease: (in other words, kidney disease and kidney

failure)

Hyperoxaluria, with oxalate stones or interstitial

oxalate deposits, immune complex nephritis,

" functional " renal failure.

Miscellaneous:

Peripheral neuropathy, pericarditis. pleuritis,

hemolytic anemia, neutropenia, and

thrombocytopenia.

If you join one of the post operative support groups, you will

indeed see several people with the above complications. The longer ago

they had the

surgery, the more complications seen. You will also see some of

those people say that their complications are not because of the

Weight Loss Surgery,

even though what they are describing is listed as one of the side

effects of WLS. Some people are in denial about the cause of their

physical problems,

perhaps because it would be too painful to realize that they

might have made a bad decision to have the surgery.

As with all things, if in doubt, don't. You can always have the

surgery at a later date when you have a greater comfort level about

it.

Absolutely ! If your not sure to a comfortable

degree, don't do it!