(LONG) Surgery for SteveG

[Guest guest]

Dear Friends,

Please pardon this impersonal mailing, but there are quite a few

of you that I want to reach and little time in which to do it.

This Wednesday, May 2, I will undergo weight loss surgery at

Inova Fairfax Hospital in Falls Church, VA () at about

8:45 AM. The surgery may take from four to eight hours. If

things go well for me, I should be home by the weekend.

I don't mean to impose on your time, but several friends have

asked me about the surgery, and I offer some information below.

You may have heard a lot about weight loss surgery lately because

of the publicity generated by singer Carnie and MSNBC's show

" Last Chance, " both of which feature a somewhat different

surgical approach than the one I will be having. Both approaches

effect weight loss by two mechanisms: (1) reducing the amount of food

intake by surgically restricting the stomach volume, and (2) reducing

the absorption of food by surgically re-arranging the small intestine

to present a shorter path for the partially digested food passing from

the stomach.

The more popular surgery that you hear about in the headlines is

called Roux en Y (RNY, after the French physician Roux), and the

surgery that I will have is the Bilio-Pancreatic Diversion with

Duodenal Switch (BPD/DS or " DS " for short). They

differ mainly in the way that the stomach restriction is

accomplished. The RNY staples off an egg-sized stomach pouch at

the base of the esophagus and connects the shortened intestinal limb

through a slit made in the pouch. The DS actually partitions off

a long sleeve of stomach (by stapling) and removes the remaining

(major) portion of the stomach. The shortened intestinal limb is

connected just beyond the normal outflow of the remaining stomach at

the duodenum.

There are pluses and minuses to each technique, the RNY and

the DS, and people debate them endlessly and, I think, with futility.

I chose to have the DS mainly because, by keeping a normal, albeit

much smaller, stomach arrangement, it imposes fewer constraints on

food intake (types, chunkiness, crispiness) in the long term. I

expect to lead a fairly normal life as regards when, what and how I

can eat, save for significantly reduced capacity and the need to take

daily supplements of mal-absorbed essential nutrients (mainly calcium

and water-soluble preparations of vitamins A,D, E and K) for the rest

of my life.

For general information about the DS, please visit

http://www.duodenalswitch.com.

If you want to see an animated line-drawing overview of the

surgery, please look (requires Flash plug-in) at:

http://www.med.nyu.edu/bariatric/operations/BPDflash.html

For a thorough discussion, complete with color anatomical

drawings, Dr. Baltasar's exposition is very informative, although it

probably has much more information than most of you would want to take

in:

http://www.drbaltasar.com/Cruce_duodenal_Ing.html

And, for those of you who might delight in cinema

verité, you can view a film of the first laparoscopic DS/BPD

being performed by Dr. Gagner at Mt. Sinai Hospital in NYC

(requires RealPlayer) at:

http://www.SAGES.org/media/duodenallow.ram

<=Telephone Dialup Connection

http://www.SAGES.org/media/duodenalhigh.ram

<=LAN/DSL /Cable Connection

If you read Dr. Baltasar's article, you will quickly understand

that this is major surgery. Complications can be severe.

My surgeon will be Dr. Hazem Elariny (http://www.alagsa.com/prod01.htm

), a superbly accomplished, talented and meticulous physician who

specializes in the less invasive laparoscopic techniques that are

believed to minimize surgical trauma. He has an excellent track

record in weight loss surgery, including the laparoscopic DS.

Patients come to him from great distances, including two women from

Texas as of late. I have great confidence in him, and, indeed, I shall

be placing my life in his very capable hands.

I owe great thanks to my primary care physician, Dr. R.

Fender ( http://www.gimg.com ) who, over the years was

persistent in making me aware of the dangers of the excess weight that

I was carrying and who finally guided me toward " stomach

stapling " as my only chance for overcoming the problems.

Dr. Fender also referred me to an extraordinarily caring cardiologist,

Dr. Goldman (http://www.cardiovascular-care.com/). Even

though my weight seemed to rule out the most common diagnostic tests,

Dr. Fender kept after both me and Dr. Goldman to do sufficient testing

to make sure that my shortness of breath did not preclude

surgery. Happily, led me through a cardiac

catheterization in February with flying colors (no blockages in heart

arteries, and good pumping action).

I hope to be home from the hospital by the weekend. A

recovery period of at least four weeks is normal. Some patients

feel miserable (weakness, nausea, bowel problems) for four weeks,

plus-or-minus, and others seem to sail through with but minor

discomfort. I certainly hope to be in the latter group, but I

know that there are no guarantees. I plan to return to work

sometime in June, but I also plan to work part-time from home in May

once I regain my strength and ability to concentrate (after the

prolonged effects of the anesthesia wear off).

I want to thank my family as well as my friends and colleagues

who have supported me in my decision to pursue the surgery, despite

its risks. I am also very grateful to scores of correspondents,

most of whom are personally unknown to me, on the

Duodenal_Switch support group mail list. I have

drawn immense support, courage and essential knowledge from the good

folks on that list. I look forward to a long, long continuation

of my mutual history with all of you.

--Steve

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