Re: Is the Dueodenal Switch experimental? (long)

[Guest guest]

Gobo,

The only info I have on this guy is as follows:

" Walter J. Pories, MD Professor of Surgery and Biochemistry, Brody

School of Medicine, East Carolina University, and Staff Physician,

University Health Center of Eastern North Carolina, Greenville, North

Carolina. " .

The original link is:

http://www.medscape.com/Medscape/features/ResourceCenter/obesity/AskEx

perts/2001/03/obesity-ae07.html

If you want to go to this link you will have to setup an account (but

it is free and painless to do).

I don't know what makes him an expert, but I am sure that this is all

the insurance guys need to make their case. Lets look point by point:

Point #1:

" The biliopancreatic diversion with duodenal switch is a relatively

new procedure that has yet to be shown as safe and effective in long-

term studies.[1] ... My major concern is that the experience with

this procedure is limited to the short term "

The procedure is now 12 years old. I think the RNY is more like 20

years old. However, the BPD (without DS) is 24 years old and the

Scopinaro paper cover a 21 year period - very long term it seems to

me. So he is just plain wrong on tis one. He certainly

mischaracterizes the Hess paper.

Point #2:

" However, anemia, hypocalcemia, and hypoalbuminemia have been

reported in patients undergoing this procedure.[3] Furthermore,

diarrhea and halitosis are common side effects. "

We need to find reference [3] to verify this. There might be some

validity in this. Certainly halitosis is common, but is the claim of

diarrhea being common true?

Point #3:

" I am also concerned about the long-term effects of

this " malabsorptive operation, " especially in regard to deficiencies

of B12, B6, iron, and folic acid. "

This one is true enough. Here are Dr. Anthone's comments on the

subject:

link:

http://www.spotlighthealth.com/morbid_obesity/chats/mo_chat_trans_14.h

tml

DR. ANTHONE

" Regarding the increased demands on the liver—I don't think there's

an issue there. I think what you need to understand when you have a

more malabsorptive procedure like the DS, is that you run the risk of

having a fat-soluble vitamin deficiency. The most important one being

Vitamin D, and if you don't take your calcium and Vitamin D

supplements that can lead to osteoporosis. That's what I'm concerned

about with the DS. I know patients initially always say they're going

to get followed up, but it doesn't happen all the time and so they

have to make that commitment. You have to see a doctor at least once

a year for the rest of your life. Carnie gets her labs done every

three months, which is something you should do for the first year

after surgery. "

Point #4: (The death blow as far as insurance companies are

concerned):

" At the present time, however, I and many other bariatric surgeons

consider the procedure experimental "

I would like to know the names of the other bariatric surgeons!

ONE OTHER ISSUE IS THIS OFTEN REPEATED QUOTE:

Following is what the American Society of Bariatric Surgery says

about the Biliopancreatic Diversion, including the Duodenal switch:

" Extensive gastric bypass (biliopancreatic diversion). In this more

complicated gastric bypass operation (figure 5), portions of the

stomach are removed. The small pouch that remains is connected

directly to the final segment of the small intestine, thus completely

bypassing both the duodenum and jejunum. Although this procedure

successfully promotes weight loss, it is not widely used because of

the high risk for nutritional deficiencies. BPD and its variants are

the most major procedures performed for obesity and it follows that

prospective patients who wish to consider BPD should seek out

experienced surgeons with life-long follow up programs. "

This doesn't exactly damn the procedure and the final phrase is good

advice.

Hull

> > Dear Ds'ers,

> >

> > After much seraching, I have finally found what I think is the

> source

> > of the insurance companies claim that DS is experimental.

> Please

> > read the section that follows.

> >

> > Now we need to attack this point by point.

> >

> > Hull

> >

> >

> >

> > Ask the Experts on . . .

> > Biliopancreatic Diversion With a Duodenal Switch

> >

> > ------------------------------------------------

> ----------------------

[Guest guest]

At 8:25 PM +0000 6/28/01, chull1@... wrote:

....ONE OTHER ISSUE IS THIS OFTEN REPEATED

QUOTE:

Following is what the American Society of Bariatric Surgery says

about the Biliopancreatic Diversion, including the Duodenal

switch:

" Extensive gastric bypass (biliopancreatic diversion). In this

more

complicated gastric bypass operation (figure 5), portions of the

stomach are removed. The small pouch that remains is

connected

directly to the final segment of the

small intestine, thus

completely

bypassing both the

duodenum and jejunum.

Not true. I just read my operative report. I have 3

cm. of active duodenum to which the ileal limb has been attached.

This provides for some iron absorption. Also, the sparing

of tissue upstream of the pyloric valve maintains the production of

" intrinsic factor " which is necessary for the absorption of

vitamin B12.

Can RNY-promoting surgeons match that?

--Steve

--

[Guest guest]

Steve,

Do you understand surgical reports? If so, maybe you can interpret mine if I type it out to find out how much of the duodenum is left active in my surgical report. Its not real long

Judie

Re: Is the Dueodenal Switch experimental? (long)

At 8:25 PM +0000 6/28/01, chull1@... wrote:

....ONE OTHER ISSUE IS THIS OFTEN REPEATED QUOTE:Following is what the American Society of Bariatric Surgery saysabout the Biliopancreatic Diversion, including the Duodenal switch:"Extensive gastric bypass (biliopancreatic diversion). In this morecomplicated gastric bypass operation (figure 5), portions of thestomach are removed. The small pouch that remains is connected

directly to the final segment of the small intestine, thus completely

bypassing both the duodenum and jejunum.

Not true. I just read my operative report. I have 3 cm. of active duodenum to which the ileal limb has been attached. This provides for some iron absorption. Also, the sparing of tissue upstream of the pyloric valve maintains the production of "intrinsic factor" which is necessary for the absorption of vitamin B12.

Can RNY-promoting surgeons match that?

--Steve-- ----------------------------------------------------------------------

[Guest guest]

I may be able to help also. Dr Welker will also gladly respond to your questions.

in Seattle

----- Original Message -----

From: Judie Hensel

Steve,

Do you understand surgical reports? If so, maybe you can interpret mine if I type it out to find out how much of the duodenum is left active in my surgical report. Its not real long

Judie

[Guest guest]

does Dr Welker have a new email address now or is he participating here?

J

Re: Re: Is the Dueodenal Switch experimental? (long)

I may be able to help also. Dr Welker will also gladly respond to your questions.

in Seattle

----- Original Message -----

From: Judie Hensel

Steve,

Do you understand surgical reports? If so, maybe you can interpret mine if I type it out to find out how much of the duodenum is left active in my surgical report. Its not real long

Judie----------------------------------------------------------------------

[Guest guest]

At 8:05 PM -0700 6/28/01, Judie Hensel wrote:

Steve,

Do you

understand surgical reports? If so, maybe you can interpret mine

if I type it out to find out how much of the duodenum is left active

in my surgical report. Its not real long

Judie

Judie,

Mine says quite clearly: " ...through these two [laparoscopic

incision] ports the duodenum was dissected, separated from the

pancreatic head 3 cm distal to the pylorus and transected [cut

transversely] with an endo GIA stapler. "

I can give yours a shot if you like (I'm no expert), but 's

suggestion that your local docs might be of assistance is a good

one.

Best,

Steve

--

[Guest guest]

Dr Welker is not on this list. Will write you off list

in Seattle

Re: Re: Is the Dueodenal Switch experimental? (long)

I may be able to help also. Dr Welker will also gladly respond to your questions.

in Seattle

----- Original Message -----

From: Judie Hensel

Steve,

Do you understand surgical reports? If so, maybe you can interpret mine if I type it out to find out how much of the duodenum is left active in my surgical report. Its not real long

Judie----------------------------------------------------------------------

[Guest guest]

Hello Steve. Take notice. I referred her to Dr Welker, the surgeon who did her surgery and dictated the surgical report. LOL (My surgeon also) I was a medical and surgical nurse for years before specializing in mental health. Reading and understanding op reports was expected.

in Seattle

----- Original Message -----

From: Steve Goldstein

At 8:05 PM -0700 6/28/01, Judie Hensel wrote:

Steve,

Do you understand surgical reports? If so, maybe you can interpret mine if I type it out to find out how much of the duodenum is left active in my surgical report. Its not real long

Judie

Judie,

Mine says quite clearly: "...through these two [laparoscopic incision] ports the duodenum was dissected, separated from the pancreatic head 3 cm distal to the pylorus and transected [cut transversely] with an endo GIA stapler."

I can give yours a shot if you like (I'm no expert), but 's suggestion that your local docs might be of assistance is a good one.

Best,

Steve-- ----------------------------------------------------------------------

[Guest guest]

Hi Everyone,

I'm not sure where I got the idea, but I was thinking that bad breath was a

rare side effect not a common one. This worries me. It's bad enough to be

stinking up the bathroom - I don't want to be breathing gross breath on

everyone wherever I go. Post ops - please share your experiences on this

topic.

Amy Kreitzburg

July 3 (oh my is that coming up fast)

Dr. Hess

" However, anemia, hypocalcemia, and hypoalbuminemia have been

reported in patients undergoing this procedure.[3] Furthermore,

diarrhea and halitosis are common side effects. "

We need to find reference [3] to verify this. There might be some

validity in this. Certainly halitosis is common, but is the claim of

diarrhea being common true?

[Guest guest]

At 2:26 PM -0400 6/29/01, Amy K wrote:

>Hi Everyone,

>

>I'm not sure where I got the idea, but I was thinking that bad breath was a

>rare side effect not a common one. This worries me. It's bad enough to be

>stinking up the bathroom - I don't want to be breathing gross breath on

>everyone wherever I go. Post ops - please share your experiences on this

>topic.

As far as I know, my breath is no worse post-surgically than pre-. --Steve

--

Steve Goldstein, age 61

Lap BPD/DS on May 2, 2001

Dr. Elariny, INOVA Fairfax Hospital, Virginia

Starting (05/02/01) BMI = 51

BMI on 06/29 = 44

[Guest guest]

Here here, I don't want to have bad breath either. It's bad enough now, LOL.

I guess I could carry around a box of Altoids...do they have sugar?

Re: Re: Is the Dueodenal Switch experimental?

(long)

Hi Everyone,

I'm not sure where I got the idea, but I was thinking that bad breath was a

rare side effect not a common one. This worries me. It's bad enough to be

stinking up the bathroom - I don't want to be breathing gross breath on

everyone wherever I go. Post ops - please share your experiences on this

topic.

Amy Kreitzburg

July 3 (oh my is that coming up fast)

Dr. Hess

" However, anemia, hypocalcemia, and hypoalbuminemia have been

reported in patients undergoing this procedure.[3] Furthermore,

diarrhea and halitosis are common side effects. "

We need to find reference [3] to verify this. There might be some

validity in this. Certainly halitosis is common, but is the claim of

diarrhea being common true?

----------------------------------------------------------------------

[Guest guest]

> I'm not sure where I got the idea, but I was thinking that bad

breath was a

> rare side effect not a common one. This worries me. It's bad

enough to be

> stinking up the bathroom - I don't want to be breathing gross breath

on

> everyone wherever I go. Post ops - please share your experiences on

this

> topic.

Amy: I also have not heard that bad breath was a common side effect

of the DS. I think Sharon responded (she had a traditional BPD) that

it can be a side effect of the BPD, but not the DS (which preserves

the pyloric valve). I'm not saying it is not possible but I haven't

experienced this phenomenon nor have I heard of anyone really talking

about it as post-ops.... Perhaps a state of ketosis (when one loses

rapid weight while consuming an excess of protein) can result in

halitosis (and an odor that eminates from the body's pores as well)?

DS post-ops may put themselves into ketosis if they consume too much

protein for their bodies and in this circumstance I can see where they

might develop halitosis. I would think in this case it would be

reversible if caught in time and protein levels lowered.

BTW, the bathroom issue doesn't have to be that bad. I have had an

unusually great time of it, I think so I'm not going to say that

everyone has the same experience as me. But, I just want to say that

there are post-ops who do NOT experience severe, persistent gas,

diahhrea, etc.

all the best,

lap ds with gallbladder removal

January 25, 2001

five months post-op and still feelin' fab!

pre-op: 307 lbs/bmi 45

no

[Guest guest]

,

Regarding ketosis, I am a veteran of the Atkins diet, so I can attest

that it causes bad breath (my wife will certianly vouch for that!).

However, Ketosis is not caused by too much protien but rather by a

LACK of cabohydrates. You can eat cream cheese all day (very little

protien, no carbs, all fat) and be deeply in Ketosis. If fact, Atkins

recommends this as the optimum for quick weight loss (along with

Macadamia nuts). I am considering going on Atkins just before the

surgery to drop some lbs, but it is not a good long term solution (I

devloped protien in my urine).

One other question, what length was you " common limb " . Was it 100cm

or greater. I am trying to understand the correlation between

bathroom issues and the length of the " common/alimentary limb " .

Thanks,

Hull

>

> > I'm not sure where I got the idea, but I was thinking that bad

> breath was a

> > rare side effect not a common one. This worries me. It's bad

> enough to be

> > stinking up the bathroom - I don't want to be breathing gross

breath

> on

> > everyone wherever I go. Post ops - please share your experiences

on

> this

> > topic.

>

>

> Amy: I also have not heard that bad breath was a common side

effect

> of the DS. I think Sharon responded (she had a traditional BPD)

that

> it can be a side effect of the BPD, but not the DS (which preserves

> the pyloric valve). I'm not saying it is not possible but I

haven't

> experienced this phenomenon nor have I heard of anyone really

talking

> about it as post-ops.... Perhaps a state of ketosis (when one

loses

> rapid weight while consuming an excess of protein) can result in

> halitosis (and an odor that eminates from the body's pores as

well)?

> DS post-ops may put themselves into ketosis if they consume too

much

> protein for their bodies and in this circumstance I can see where

they

> might develop halitosis. I would think in this case it would be

> reversible if caught in time and protein levels lowered.

>

> BTW, the bathroom issue doesn't have to be that bad. I have had an

> unusually great time of it, I think so I'm not going to say that

> everyone has the same experience as me. But, I just want to say

that

> there are post-ops who do NOT experience severe, persistent gas,

> diahhrea, etc.

>

> all the best,

>

> lap ds with gallbladder removal

> January 25, 2001

>

> five months post-op and still feelin' fab!

>

> pre-op: 307 lbs/bmi 45

> no

[Guest guest]

In a message dated 6/30/01 1:21:30 AM, duodenalswitch writes:

<< However, Ketosis is not caused by too much protien but rather by a

LACK of cabohydrates. You can eat cream cheese all day (very little

protien, no carbs, all fat) and be deeply in Ketosis. If fact, Atkins

recommends this as the optimum for quick weight loss (along with

Macadamia nuts). I am considering going on Atkins just before the

surgery to drop some lbs, but it is not a good long term solution (I

devloped protien in my urine).>>>>

Well, it is caused by protein in absence of carbs... it is measured as an

excessively

high protein level, no? It is when one eats proteins to the exclusion of

carbs and other nutrients, that was what I mean to say by 'too much protein'.

The test itself measures protein in the urine, so it is an indication that

one's body has 'too much protein'.

I think that post-op DSers may develop ketosis because they are erring on the

side of caution with the protein and perhaps getting too much in. I don't

think ketosis is a given (sometimes the opposite occurs and the person takes

too little protein in. The key is finding a happy balance, I guess). I

don't think it is necessarily a side effect of the surgery unless one's

pylorus isn't working properly post-op.

This is an interesting issue that some people have brought up. Ideally, the

sleeve gastrectomy of the DS is supposed to keep the pyloric valve intact.

However, some post-ops experience a kind of dumping syndrome (could be

something else that they are identifying as dumping syndrome or could be the

real McCoy). This would indicate that their pylorus may be 'slow' or

semi-paralyzed or injured in some way. I'm not sure about the mechanics, but

I'm sure many nerve impulses are involved with digestion. I don't think the

sleeve gastrectomy necessarily interferes with any of these but maybe some

bodies view it as an injury and the stomach heals slower. I don't know if

such loss of pyloric function is permanant or is only present while the

stomach is healing. I don't know how common or uncommon it is but I don't

think any research has really been done on this issue.

<<<

>>>>

Mine is 100 cm. I haven't had many problems at all in that department. I

get as on occasion but haven't had loose stools since the first three weeks

(not uncontrolled diahhrea but they were 'loose').... I have regular

movements once a day (in the morning upon waking). Sometimes I'll have one

at night or early morning. Rarely during the day (this is when my intestines

are bothering me).

all the best,

lap ds with gallbladder removal

January 25, 2001

five months post-op and feelin' fab!

pre-op: 307 lbs/bmi 45

now: 241 lbs/bmi 34