more info on the controversy

July 15, 2000

Laurie--

I appreciated all your time and effort you put into your letter to inform

us of your research. Like you, I have been lurking around this board for a

month now and have never felt like I knew enough about this procedure to

participate in it. You have explained very nicely to the layperson a little

about what all the fuss is about. By the way, if there are problems, this

can be revised or reversed, so wouldn't that be a plus or would the damage

already be done? I don't know, just asking. My sister, mother, and niece

have all had the MGB with Dr. R and my husband and best friend are putting

there packages together now. They have been approved by BCBS state preferred

and Blue Care POS, respectively. they cannot wait to get a date and we will

be flying down to Durham together. My sister has lost over 100 lbs since

right before Christmas and does seemed to be bothered by a lot of food, but I

don't think she eats right. My mother had the MGB in May and has lost about

35 lbs, but she is 71 years old. She has greatly reduced her insulin and as

she looses weight she will hopefully be able to discontinue it. so as you can

see I am greatly interested in any into I can get. Talk to you later.

Ruth

July 15, 2000

Joannie,

Well I guess there are exceptions to every rule. My mom is in great

shape for the shape she's in. lol She had diabeties so I guess Dr. R. felt

like the benefits outweighed the risks. Anyway, she is doing great.

Ruth

July 15, 2000

Hi All,

This is my first post. I have been researching WLS on and off for a

year. I discovered the MGB site about a month ago and was thrilled!

I also have loved reading your posts over the past few weeks. I love

your honesty, passion, loyalty and mutual support. What a group.

Not

something you find everyday!

I hate to have to discuss this subject in my first post knowing how

it

has been stressful and frustrating for all of us over the last few

weeks, but my life has been revolving around it and I feel a very

strong need to share. My father is a neuroscientist in the medical

school at Ohio State University and he has had a lot of fears about

weight loss surgery in general and has been spurring me on in my

research lately. Let me say that he has always been supportive in my

life long struggle with my weight and over the last 10 years of my

struggle he has changed his view to what we now know. Nothing else

seems to work and it is not our fault. Our bodies betray us in ways

that other's don't. He had just finished reading Dr. R.'s patient

manual the same day that all the fuss started about Walter's post

here.

Please bear with me.... this will take awhile to get down on paper

sort of speak. I patiently read all of your long posts about this....

Due to his concern, my dad starting scanning the recent medical

literature and also set up a consultation with Dr. Ellison, the head

of the Department of Surgery for OSU who does all the open RNY's

there. Others do a modified RNY with a 5 inch incision to get the

hand in the belly at OSU. Just as a side note, he thinks some Drs.

at

Pittsburg Medical Center are the best out there right now for Lap

RNY.

I will get to my meeting with him later...

In the meantime, due to all the discussion in my personal life and on

this list, I emailed Dr. ann Mallory who is the current

director

of the Amercian Society for Bariatric Surgery (the society that held

the conference that Dr. R. presented at). I wanted to see if she had

any comment on the controversy over Dr. R's presentation and might

shed some light on Walter's sweeping generalizations about " all " and

" everyone " . Let me again say how frustrated I was feeling about the

need to do this, because I was already emotionally connected to MGB

and all of your stories. I am copy/pasting her reply below...

---- Original Message -----

To:

Sent: Tuesday, July 11, 2000 9:07 PM

Subject: Re: Mini Gastric Bypass

> Dear Ms. Malony,

>

> Dr. Rutledge's surgery is very similar to a loop gastric bypass

shown in figure six of the Story of Surgery for Obesity on our web

site <A HREF= " http://www.asbs.org/ " >ASBS - OBESITY - Bariatric

Surgery</A> . It was abandoned year ago secondary to severe bile

reflux. Dr. Rutledge states that he has altered the procedure such

that his patients do not have this problem.

>

>It is fair to say that his procedure is not considered " mainstream "

by most members of the ASBS. However, during the relatively short

history of the ASBS many new and different procedures have been

presented before the Society. Some of these have been met with

skepticism as was Dr. Rutledge's Mini Gastric Bypass. There were

laparoscopic as well as open bariatric surgeons who questioned his

procedure.

>

> Sincerely,

>

> ann Mallory

> Executive Director

>

The same day, my dad had several conversations with Dr. Ellison at

OSU, and gave him the patient manual. Dr. Ellison contacted a Dr.

Mason (at Iowa, I believe, but I may be wrong) who is suppose to be

the big acamedician/surgeon guru for RNY at this time. Both of their

intial response were the same. That its been done and it causes Bile

Reflux which can lead to cancer and liver problems.... more later.

It

has been such a crazy week with all of this it is hard to make it all

make sense.

With my dad translating some terms, I was beginning to understand

what

all the fuss was about and started to develop some questions and

concerns. I emailed these to both Dr. Mallory at ASBS and to Dr.

Rutledge. Neither has had a chance to respond yet. I am anxiously

waiting. I understand from your posts that Dr. R. was gone and

assume

that like most of us he may have 100's of personal emails waiting for

him. Here is the copy of my response to Dr. Mallory and my

questions...

Dear Dr. Mallory,

I cannot thank you enough for being courteous and professional enough

to reply to my email in such a timely manner. This debate is a huge

issue in the lives of many people looking for hope, help and

direction

for their struggle with obesity. Thank you.

I did go back and reread the history of obesity surgery on your

Association's site. I do believe that I did read it in my research

several months ago. I did notice the figure 6 that you pointed out

and its reference to loop gastric bypass, but I have to confess that

I

came away as frustrated as I have with every reference that I have

come across to date. While the story of the history went into detail

on the ill-effects of several major types of surgery over the years

and why they are no longer in practice, it did not do the same for

" the loop " .

I guess I feel that I am facing the same brick wall until I can tease

out some information about this old loop that is more specific than

how the small intestine was looped and attached to the new ( small,

horizontal pouch) stomach by hand (I am sure since the surgery was 20

years ago or so).

Your concern about bile reflux and increased risk of cancer of the

esophagus was shared by your colleague doing obesity surgery at OSU

as

he discussed it with my father (who is a neuroscientist prof in the

OSU school of medicine)today. Still I am left trying as a layman to

compare apples and oranges and make a decision. I now have many

more

specific questions and maybe you do not know and cannot find any data

to begin to answer them. Perhaps it would make a nice

research/professional publication for someone in your association who

is concerned about all of this. My questions are:

1. With all the hearsay and vocal criticism of Dr. Rutledge since

the

17th conference presentation and possibly before, have there been any

professional peer reviews written concerning other surgeons

misgivings? Isn't that where this type of professional discussion is

suppose to take place?

2. I have begun to see one of the reason for some of the confusion

between laypeople interested in surgery, Dr. Rutledge's website, and

the misgivings of others in your association. Your major area of

concern is representative of this problem. I am hearing doctors say

that the " old loop " caused bile reflux which over time lead to

precancerous and cancer in the esophagus. I am seeing Dr.

Rutledge's

patients, website, and hopefuls talking about the wonderful results

he

has had of 0% GERD Acid reflux problems after surgery and almost

100% cure of pre-existing GERD problems. I am beginning to

understand that we are not talking about the same thing. Am I

correct

in my newer understanding that bile reflux is a direct result of the

new stomach opening into the small intestines and that in a healthy

normal gut, there should not be any bile present in the stomach. So

bile reflux and stomach acid reflux are not the same thing?! What

still confuses me is that the RNY also puts the new stomach opening

close to the esophagus, but yet does not cause the same bile reflux

problem. Why, is that??? Does it have anything to do with end to

end

vs. side to end connections to the new stomach?

*** Since I wrote this, I now undestand that it is due to the

RNY

arm that puts a distance between the bypassed bile and pancreatic

fluid****

3. If the crux of the issue is the problems associated with bile

reflux, is there any good data from the rejected old loop bypass

patients to give us a timeline of this problem?? Did they have bile

and/or acid reflux problems quickly after surgery?? How long after

surgery did the bile reflux problem result in pre-cancerous or

cancerous tissue in the esophagus? 20 years ago, did they have any

medicines available to combat this problem? Today, Dr. Rutledge

prescribes a new medicine for all his patients that is

suppose to cut the risk of gall stones and bile acid problems. I

would have to take time to look up its name and that is all that I

know about it.

**** new medicien - Actigall***

4. The biggest difference that I can readily see from Dr. Rutledge's

diagrams of the revisions that he has made to the old loop surgery

is

the position and shape of the new stomach. Instead of round and high

as in your diagram in the history article and in the diagrams I have

seen of RNY procedures, he makes a thin, long, cigar shaped stomach

along the inside curve of the stomach and attaches the " loop " of

small intestine at the bottom of the cigar shape which places the

possible entrance of bile further away from the esophagus. Is this

the part that has never been done before? Which does not let us

readily compare the old loop to the MGB?

It appears that one has to be a master puzzle solver to begin to see

how it all fits together and I can see why professionals responses

seem to be vague and " advisory " rather than informative. It is not

easy to explain. If there are other concerns about Dr. Rutledge or

his procedure that are not libelous, I want to know them.

If you feel that some one else you are aware of is better suited to

respond to all of this, I would be glad to try to contact them. I

will be asking these same questions of Dr. Rutledge, Dr. Ellison(

sp?)

at OSU , and posting some form of them in the elist in case there are

others out there who have put it all together. There will be around

700 patients who will have had this procedure by the end of this

month

with many more scheduled. If there is truly cause for concern, it

should be addressed professionally and immediately. Otherwise, it

seems everyone is over reacting and causing undue alarm and stress

for patients.

Again, I cannot thank you enough for your quick response and

professional attitude. I realize that it may take longer to

formulate

a response to all of my concerns in this letter.

I so appreciate your input. I am interested in whether you are

currently doing obesity surgery and what type as well.

Sincerely,

Then, this Thursday, I tried to do some internet research on Bile

Reflux and GERD (stomach acid reflux). In my initial layman's

search,

I couldn't find much distinction between them. One of my growing

fears was that you could have " silent " symptoms of Bile Reflux for

years causing a lot of damage before you were aware. IT causes

irritation to the mucosal linings of the Esophagus and changes the Ph

balance in the Esphagus from alkaline to Acid which is what damages

the cells overtime and can (doesn't have to) lead to cancer cell or

liver problems (the liver is right next to part of the esophagus.)

So

far - I don't think it would happen without you knowing it. I think

you would have great pain and discomfort similar to GERD, but that it

might not happen for years. Again, this is my layman's conclusion

after a couple hours online. I want to hear a doctor explain it

thoroughly who has experience with it.

Yesterday, my husband, father and I met with Dr. Ellison. It was

evident within 2 minutes that he had his mind made up totally about

MGB and didn't want to discuss it. He quoted me from his email

response from Dr. Mason (I referred to him earlier) and said " ITs

bad. It was an experiment that has already been done and abandoned " .

He said that the old loop bypass or Billroth II was the perfect way

to cause rats to develop cancer of the esophagus. - Way to freak out

my research oriented father - I was ticked at his lack of opened

mindedness or even professional curiosity. I asked him why the

billroth II was still being done in many non- bariatric

gastrectomies

due to ulcers, stomach cancer and other gastric disorders ( research

quoted on the site by Dr. R and that gave us links for in her

posts). He replied that in non-bariatric surgeries at least half of

the stomach is left compared to only 1-2 oz (most WLS) and 3-4oz

( MBG) which leaves more space for the bile to get lost or go

elsewhere rather than up the esophagus. He also said that RNY bypass

is used when only small portions of the stomach can be kept for these

patients for the Bile Reflux reason only.

I told him boldly how frustrated I am that every source I turn to

does

not give me specifics on what exactly happened with the bariatric

patients who had the " old loop " or Billroth II. He said that he did

not know all the details besides the " well known Bile reflux longterm

complication " . He did say that the only source that he could think

of

off hand that might have a good explanation in it was a monolithe(?)

by Dr. Mason written in the 1970's in about a 200 pg booklet format.

It is on the history of Obesity Surgery. Since this was yesterday,

obviously I haven't found it yet. Has come across it in her

book research?

I tried to get him to discuss the risks associated with RNY. He

downplayed them and said that he had never had to undo or redo one,

but admitted that it would be difficult surgery if the first RNY had

been open. He said that his leak rate was less than 1%. He kept

reiterating that Bile Reflux was a terrible thing and you did not

want

it. He was totally unimpressed by Dr. R's data that so far he

reports

0% GERD and Bile Reflux, because he said that it would probably take

5-15 years to see it. He predicted that about 25% would develop it.

Don't ask me where he came up with that number. He did not think

that the new shape of the stomach pouch made in the MGB would make

any

difference because it was still relatively small and the pouch

doesn't

have any effect on the possibility of bile back up from the bypassed,

unused part of the loop. He said that he could understand why I

would

be drawn to its ease, but that he suspected that it was developed

because it was so much easier to do laproscopically.

Yes - I admit and agree that this guy had very pompous moments, but

on

the other hand, he is much more of a research oriented guy and not a

LA cashcow to quote a phrase. The best thing he said to me was that

beacuse MBG was such a beautifully simple procedure that if I had it

and were to develop severe Bile Reflux problems down the road that it

could easily be converted to an RNY to cure the Bile problem.

Okay... today I did a search on Dr. R's website for Bile Reflux. It

seems that he has been very busy trying to be true to his word and

has

added many new pages this month on this subject and other

complications. Thank you, Dr. Rutlegde. Now I would love to see a

page written by you discussing your thoughts on all of this. I

noticed that the % of patients reporting Bile Reflux problems has

gone

from 0% up to 6% now. I am anxious to see if that will change any

further as the follow up results on the first 2 years patients

continues and is completed. I hope all of you will take the time to

do the search and look at all the new pages.

Most of you all having done your own research probably already

figured

this out, but it took me awhile so I will risk repeating it. The

reason that there is such a greater risk of Bile Reflux problems with

loop ( be it the old loop, Billroth I and II and the MBG) is that the

bypassed part of the loop ( see the references on site to the

afferent

and efferent parts of the loop of the samll intestines) still has

bile

and pancreatic fluids running and draining through it and they can

come into contact with the new stomach pouch exit at the point where

the loop attaches to the new tummy. In our natural stomch exits

there

is a valve that shuts off after emptying and prevents bile and other

nasties from entering the stomach. The difference with the RNY is the

Y limb. The bypassed bile would have to back all the way up this

limb

to enter the new stomach exit in this procedure. That's why it is

used

to correct Bile reflux problems.

It seems like it all comes down to how much weight do you want to

attach to the possible risk of Bile Reflux complications down the

road. I think that Dr. R would say he is attempting to protect us by

his newer shaped pouch and by the use of zantac and Actigall in the

early months. Of course, we are all taking a risk on the longterm

outcome with MBG as it is.

I have one concern with the new studies concerning RNY and Billroth

II

quoted on the site. One seems to say that Billroth II cures

Esophagitis (which can be caused by either GERD or Bile Reflux) and

the other seems to say that corrrection to RNY is needed to treat it.

Am I reading these wrong??

Anyway, this is now a thesis, but I really needed to unload all of

this. My life has been consumed and stressed out by it the past

week.

That and reading all your posts. I look forward to more personal

posts in the future.

Again, my conclusion is informed weighing of the benfits and risks.

I just didn't get the sense that we all had all of this info. I am

encouraged that Dr. R. says that the 6% of post-ops who developed

Bile

Reflux symptoms are responding to Actigall and Zantac so far. I have

been concerned that some of you have posted about your very

tempermental tummies and seeing bile in your vomit. I don't think

you

are suppose to live with that and I am wondering if you are reporting

those symptoms to your own PCP and/or Dr. R.? It could be important.

At this point I still think I want MGB. I see my PCP on Wednesday.

I hope that this has helped to clarify and not to scare. That is not

my intent. I am about ready to move from my research phase back to

the

process of changing my life and health. We pride ourselves on being

informed? Right.

Hoping you'll let me stay-

Laurie in Ohio

36 yr old

BMI 45

July 15, 2000

In a message dated 7/15/00 5:55:59 PM Pacific Daylight Time,

crazyigues@... writes:

<< does seemed to be bothered by a lot of food, but I

don't think she eats right. My mother had the MGB in May and has lost about

35 lbs, but she is 71 years old. >>

Wow! I thought there was an age limit of 55? My mom is 67 and would LOVE

this surgery.

Regards,

Debbie in IL

Daughter MGB 8/9 Cigna (3rd appeal)--BMI 45

Counting on Cigna for Debbie (BMI 40) ins letter sent 7/14

July 15, 2000

Very informative post. It's interesting to hear the comments. I'll

have to go read the new pages you mentioned, too. Thanks.

> Again, my conclusion is informed weighing of the benfits and risks.

> I just didn't get the sense that we all had all of this info. I am

> encouraged that Dr. R. says that the 6% of post-ops who developed

> Bile Reflux symptoms are responding to Actigall and Zantac so far. I have

> been concerned that some of you have posted about your very

> tempermental tummies and seeing bile in your vomit. I don't think

> you are suppose to live with that and I am wondering if you are reporting

> those symptoms to your own PCP and/or Dr. R.? It could be important.

The times I have had it, it has been *caused* by the Actigall, which is

a form of bile salts.

Having bile enter the stomach apparently is not a bad thing or they

wouldn't have invented Acticgall. But if you take the Actigall first,

and don't eat, then eat an hour or so after taking it, that's a mistake

-- you will vomit and it will be nasty tasting and full of bile. And

when I had this problem once for more than 2-3 days, I quit the Actigall

for about 3 days and it cleared up, so I am going to assume it's the

Actigall that caused the problem until somebody comes up with a better

idea.

Now, I have the *exact* same reaction to a strong dose of tetracycline

which is also supposed to be taken with food. One day I didn't eat food

with it, and I barfed all over the side of the highway.

So in both cases, I don't think you can blame the surgery (in the case

of the tetracycline, that was before surgery).

Getting bile in the *esophagus* from bile backup is the big issue with

the old loop, as I understand it and that is why the lower stomach

should cure the problem. The bile constantly irritates the lining of

the esophagus and causes a precancerous condition.

Other than vomiting, I haven't had any bile backing up into my throat at

all, but I sure did *BEFORE* surgery -- lots of nights I'd wake up with

it coming up my throat. BLECH.

> At this point I still think I want MGB. I see my PCP on Wednesday.

> I hope that this has helped to clarify and not to scare. That is not

> my intent. I am about ready to move from my research phase back to

> the

> process of changing my life and health. We pride ourselves on being

> informed? Right.

> Hoping you'll let me stay-

>

> Laurie in Ohio

> 36 yr old

> BMI 45

July 15, 2000

> Hi All,

>

> This is my first post. I have been researching WLS on and off for

a

> year. I discovered the MGB site about a month ago and was

thrilled!

> I also have loved reading your posts over the past few weeks. I

love

> your honesty, passion, loyalty and mutual support. What a group.

> Not

> something you find everyday!

>

> I hate to have to discuss this subject in my first post knowing how

> it

> has been stressful and frustrating for all of us over the last few

> weeks, but my life has been revolving around it and I feel a very

> strong need to share. My father is a neuroscientist in the medical

> school at Ohio State University and he has had a lot of fears about

> weight loss surgery in general and has been spurring me on in my

> research lately. Let me say that he has always been supportive in

my

> life long struggle with my weight and over the last 10 years of my

> struggle he has changed his view to what we now know. Nothing else

> seems to work and it is not our fault. Our bodies betray us in

ways

> that other's don't. He had just finished reading Dr. R.'s patient

> manual the same day that all the fuss started about Walter's post

> here.

>

> Please bear with me.... this will take awhile to get down on paper

> sort of speak. I patiently read all of your long posts about

this....

>

> Due to his concern, my dad starting scanning the recent medical

> literature and also set up a consultation with Dr. Ellison, the

head

> of the Department of Surgery for OSU who does all the open RNY's

> there. Others do a modified RNY with a 5 inch incision to get the

> hand in the belly at OSU. Just as a side note, he thinks some Drs.

> at

> Pittsburg Medical Center are the best out there right now for Lap

> RNY.

> I will get to my meeting with him later...

>

> In the meantime, due to all the discussion in my personal life and

on

> this list, I emailed Dr. ann Mallory who is the current

> director

> of the Amercian Society for Bariatric Surgery (the society that

held

> the conference that Dr. R. presented at). I wanted to see if she

had

> any comment on the controversy over Dr. R's presentation and might

> shed some light on Walter's sweeping generalizations about " all "

and

> " everyone " . Let me again say how frustrated I was feeling about

the

> need to do this, because I was already emotionally connected to MGB

> and all of your stories. I am copy/pasting her reply below...

>

> ---- Original Message -----

> From: <MalloryGN@a...>

> To: <dmalony@c...>

> Sent: Tuesday, July 11, 2000 9:07 PM

> Subject: Re: Mini Gastric Bypass

>

> > Dear Ms. Malony,

> >

> > Dr. Rutledge's surgery is very similar to a loop gastric bypass

> shown in figure six of the Story of Surgery for Obesity on our web

> site <A HREF= " http://www.asbs.org/ " >ASBS - OBESITY - Bariatric

> Surgery</A> . It was abandoned year ago secondary to severe bile

> reflux. Dr. Rutledge states that he has altered the procedure such

> that his patients do not have this problem.

> >

> >It is fair to say that his procedure is not

considered " mainstream "

> by most members of the ASBS. However, during the relatively short

> history of the ASBS many new and different procedures have been

> presented before the Society. Some of these have been met with

> skepticism as was Dr. Rutledge's Mini Gastric Bypass. There were

> laparoscopic as well as open bariatric surgeons who questioned his

> procedure.

> >

> > Sincerely,

> >

> > ann Mallory

> > Executive Director

> >

> The same day, my dad had several conversations with Dr. Ellison at

> OSU, and gave him the patient manual. Dr. Ellison contacted a Dr.

> Mason (at Iowa, I believe, but I may be wrong) who is suppose to be

> the big acamedician/surgeon guru for RNY at this time. Both of

their

> intial response were the same. That its been done and it causes

Bile

> Reflux which can lead to cancer and liver problems.... more later.

> It

> has been such a crazy week with all of this it is hard to make it

all

> make sense.

>

> With my dad translating some terms, I was beginning to understand

> what

> all the fuss was about and started to develop some questions and

> concerns. I emailed these to both Dr. Mallory at ASBS and to Dr.

> Rutledge. Neither has had a chance to respond yet. I am anxiously

> waiting. I understand from your posts that Dr. R. was gone and

> assume

> that like most of us he may have 100's of personal emails waiting

for

> him. Here is the copy of my response to Dr. Mallory and my

> questions...

>

> Dear Dr. Mallory,

>

> I cannot thank you enough for being courteous and professional

enough

> to reply to my email in such a timely manner. This debate is a

huge

> issue in the lives of many people looking for hope, help and

> direction

> for their struggle with obesity. Thank you.

>

> I did go back and reread the history of obesity surgery on your

> Association's site. I do believe that I did read it in my research

> several months ago. I did notice the figure 6 that you pointed out

> and its reference to loop gastric bypass, but I have to confess that

> I

> came away as frustrated as I have with every reference that I have

> come across to date. While the story of the history went into detail

> on the ill-effects of several major types of surgery over the

years

> and why they are no longer in practice, it did not do the same for

> " the loop " .

>

> I guess I feel that I am facing the same brick wall until I can

tease

> out some information about this old loop that is more specific than

> how the small intestine was looped and attached to the new ( small,

> horizontal pouch) stomach by hand (I am sure since the surgery was

20

> years ago or so).

>

> Your concern about bile reflux and increased risk of cancer of the

> esophagus was shared by your colleague doing obesity surgery at OSU

> as

> he discussed it with my father (who is a neuroscientist prof in the

> OSU school of medicine)today. Still I am left trying as a layman

to

> compare apples and oranges and make a decision. I now have many

> more

> specific questions and maybe you do not know and cannot find any

data

> to begin to answer them. Perhaps it would make a nice

> research/professional publication for someone in your association

who

> is concerned about all of this. My questions are:

>

> 1. With all the hearsay and vocal criticism of Dr. Rutledge since

> the

> 17th conference presentation and possibly before, have there been

any

> professional peer reviews written concerning other surgeons

> misgivings? Isn't that where this type of professional discussion

is

> suppose to take place?

>

> 2. I have begun to see one of the reason for some of the confusion

> between laypeople interested in surgery, Dr. Rutledge's website,

and

> the misgivings of others in your association. Your major area of

> concern is representative of this problem. I am hearing doctors

say

> that the " old loop " caused bile reflux which over time lead to

> precancerous and cancer in the esophagus. I am seeing Dr.

> Rutledge's

> patients, website, and hopefuls talking about the wonderful results

> he

> has had of 0% GERD Acid reflux problems after surgery and

almost

> 100% cure of pre-existing GERD problems. I am beginning to

> understand that we are not talking about the same thing. Am I

> correct

> in my newer understanding that bile reflux is a direct result of

the

> new stomach opening into the small intestines and that in a healthy

> normal gut, there should not be any bile present in the stomach.

So

> bile reflux and stomach acid reflux are not the same thing?!

What

> still confuses me is that the RNY also puts the new stomach opening

> close to the esophagus, but yet does not cause the same bile

reflux

> problem. Why, is that??? Does it have anything to do with end to

> end

> vs. side to end connections to the new stomach?

> *** Since I wrote this, I now undestand that it is due to the

> RNY

> arm that puts a distance between the bypassed bile and pancreatic

> fluid****

> 3. If the crux of the issue is the problems associated with bile

> reflux, is there any good data from the rejected old loop bypass

> patients to give us a timeline of this problem?? Did they have

bile

> and/or acid reflux problems quickly after surgery?? How long

after

> surgery did the bile reflux problem result in pre-cancerous or

> cancerous tissue in the esophagus? 20 years ago, did they have any

> medicines available to combat this problem? Today, Dr. Rutledge

> prescribes a new medicine for all his patients that is

> suppose to cut the risk of gall stones and bile acid problems. I

> would have to take time to look up its name and that is all that I

> know about it.

> **** new medicien - Actigall***

>

> 4. The biggest difference that I can readily see from Dr.

Rutledge's

> diagrams of the revisions that he has made to the old loop surgery

> is

> the position and shape of the new stomach. Instead of round and

high

> as in your diagram in the history article and in the diagrams I

have

> seen of RNY procedures, he makes a thin, long, cigar shaped stomach

> along the inside curve of the stomach and attaches the " loop " of

> small intestine at the bottom of the cigar shape which places the

> possible entrance of bile further away from the esophagus. Is this

> the part that has never been done before? Which does not let us

> readily compare the old loop to the MGB?

>

> It appears that one has to be a master puzzle solver to begin to

see

> how it all fits together and I can see why professionals responses

> seem to be vague and " advisory " rather than informative. It is

not

> easy to explain. If there are other concerns about Dr. Rutledge or

> his procedure that are not libelous, I want to know them.

>

> If you feel that some one else you are aware of is better suited to

> respond to all of this, I would be glad to try to contact them. I

> will be asking these same questions of Dr. Rutledge, Dr. Ellison(

> sp?)

> at OSU , and posting some form of them in the elist in case there

are

> others out there who have put it all together. There will be

around

> 700 patients who will have had this procedure by the end of this

> month

> with many more scheduled. If there is truly cause for concern, it

> should be addressed professionally and immediately. Otherwise, it

> seems everyone is over reacting and causing undue alarm and stress

> for patients.

>

> Again, I cannot thank you enough for your quick response and

> professional attitude. I realize that it may take longer to

> formulate

> a response to all of my concerns in this letter.

>

> I so appreciate your input. I am interested in whether you are

> currently doing obesity surgery and what type as well.

>

> Sincerely,

>

> Then, this Thursday, I tried to do some internet research on Bile

> Reflux and GERD (stomach acid reflux). In my initial layman's

> search,

> I couldn't find much distinction between them. One of my growing

> fears was that you could have " silent " symptoms of Bile Reflux for

> years causing a lot of damage before you were aware. IT causes

> irritation to the mucosal linings of the Esophagus and changes the

Ph

> balance in the Esphagus from alkaline to Acid which is what damages

> the cells overtime and can (doesn't have to) lead to cancer cell or

> liver problems (the liver is right next to part of the esophagus.)

> So

> far - I don't think it would happen without you knowing it. I

think

> you would have great pain and discomfort similar to GERD, but that

it

> might not happen for years. Again, this is my layman's conclusion

> after a couple hours online. I want to hear a doctor explain it

> thoroughly who has experience with it.

>

> Yesterday, my husband, father and I met with Dr. Ellison. It was

> evident within 2 minutes that he had his mind made up totally about

> MGB and didn't want to discuss it. He quoted me from his email

> response from Dr. Mason (I referred to him earlier) and said " ITs

> bad. It was an experiment that has already been done and

abandoned " .

> He said that the old loop bypass or Billroth II was the perfect

way

> to cause rats to develop cancer of the esophagus. - Way to freak

out

> my research oriented father - I was ticked at his lack of opened

> mindedness or even professional curiosity. I asked him why the

> billroth II was still being done in many non- bariatric

> gastrectomies

> due to ulcers, stomach cancer and other gastric disorders (

research

> quoted on the site by Dr. R and that gave us links for in

her

> posts). He replied that in non-bariatric surgeries at least half

of

> the stomach is left compared to only 1-2 oz (most WLS) and 3-4oz

> ( MBG) which leaves more space for the bile to get lost or go

> elsewhere rather than up the esophagus. He also said that RNY

bypass

> is used when only small portions of the stomach can be kept for

these

> patients for the Bile Reflux reason only.

>

> I told him boldly how frustrated I am that every source I turn to

> does

> not give me specifics on what exactly happened with the bariatric

> patients who had the " old loop " or Billroth II. He said that he

did

> not know all the details besides the " well known Bile reflux

longterm

> complication " . He did say that the only source that he could think

> of

> off hand that might have a good explanation in it was a monolithe

(?)

> by Dr. Mason written in the 1970's in about a 200 pg booklet

format.

> It is on the history of Obesity Surgery. Since this was yesterday,

> obviously I haven't found it yet. Has come across it in her

> book research?

>

> I tried to get him to discuss the risks associated with RNY. He

> downplayed them and said that he had never had to undo or redo one,

> but admitted that it would be difficult surgery if the first RNY

had

> been open. He said that his leak rate was less than 1%. He kept

> reiterating that Bile Reflux was a terrible thing and you did not

> want

> it. He was totally unimpressed by Dr. R's data that so far he

> reports

> 0% GERD and Bile Reflux, because he said that it would probably

take

> 5-15 years to see it. He predicted that about 25% would develop

it.

> Don't ask me where he came up with that number. He did not think

> that the new shape of the stomach pouch made in the MGB would make

> any

> difference because it was still relatively small and the pouch

> doesn't

> have any effect on the possibility of bile back up from the

bypassed,

> unused part of the loop. He said that he could understand why I

> would

> be drawn to its ease, but that he suspected that it was developed

> because it was so much easier to do laproscopically.

>

> Yes - I admit and agree that this guy had very pompous moments, but

> on

> the other hand, he is much more of a research oriented guy and not

a

> LA cashcow to quote a phrase. The best thing he said to me was

that

> beacuse MBG was such a beautifully simple procedure that if I had

it

> and were to develop severe Bile Reflux problems down the road that

it

> could easily be converted to an RNY to cure the Bile problem.

>

> Okay... today I did a search on Dr. R's website for Bile Reflux.

It

> seems that he has been very busy trying to be true to his word and

> has

> added many new pages this month on this subject and other

> complications. Thank you, Dr. Rutlegde. Now I would love to see a

> page written by you discussing your thoughts on all of this. I

> noticed that the % of patients reporting Bile Reflux problems has

> gone

> from 0% up to 6% now. I am anxious to see if that will change any

> further as the follow up results on the first 2 years patients

> continues and is completed. I hope all of you will take the time

to

> do the search and look at all the new pages.

>

> Most of you all having done your own research probably already

> figured

> this out, but it took me awhile so I will risk repeating it. The

> reason that there is such a greater risk of Bile Reflux problems

with

> loop ( be it the old loop, Billroth I and II and the MBG) is that

the

> bypassed part of the loop ( see the references on site to the

> afferent

> and efferent parts of the loop of the samll intestines) still has

> bile

> and pancreatic fluids running and draining through it and they can

> come into contact with the new stomach pouch exit at the point

where

> the loop attaches to the new tummy. In our natural stomch exits

> there

> is a valve that shuts off after emptying and prevents bile and

other

> nasties from entering the stomach. The difference with the RNY is

the

> Y limb. The bypassed bile would have to back all the way up this

> limb

> to enter the new stomach exit in this procedure. That's why it is

> used

> to correct Bile reflux problems.

>

> It seems like it all comes down to how much weight do you want to

> attach to the possible risk of Bile Reflux complications down the

> road. I think that Dr. R would say he is attempting to protect us

by

> his newer shaped pouch and by the use of zantac and Actigall in the

> early months. Of course, we are all taking a risk on the longterm

> outcome with MBG as it is.

>

> I have one concern with the new studies concerning RNY and Billroth

> II

> quoted on the site. One seems to say that Billroth II cures

> Esophagitis (which can be caused by either GERD or Bile Reflux) and

> the other seems to say that corrrection to RNY is needed to treat

it.

> Am I reading these wrong??

>

> Anyway, this is now a thesis, but I really needed to unload all of

> this. My life has been consumed and stressed out by it the past

> week.

> That and reading all your posts. I look forward to more personal

> posts in the future.

>

> Again, my conclusion is informed weighing of the benfits and

risks.

> I just didn't get the sense that we all had all of this info. I am

> encouraged that Dr. R. says that the 6% of post-ops who developed

> Bile

> Reflux symptoms are responding to Actigall and Zantac so far. I

have

> been concerned that some of you have posted about your very

> tempermental tummies and seeing bile in your vomit. I don't think

> you

> are suppose to live with that and I am wondering if you are

reporting

> those symptoms to your own PCP and/or Dr. R.? It could be

important.

> At this point I still think I want MGB. I see my PCP on

Wednesday.

> I hope that this has helped to clarify and not to scare. That is

not

> my intent. I am about ready to move from my research phase back to

> the

> process of changing my life and health. We pride ourselves on

being

> informed? Right.

> Hoping you'll let me stay-

>

> Laurie in Ohio

> 36 yr old

> BMI 45

Laurie,

I was really impressed by your research and the ability to get it

all on paper..I had the surgery 21/2 months ago and i can tell you I

have had acid reflux once, i threw up once and it was only air, I can

tell you I have lost 55 pounds and can tie my shoes, get out of a

chair, walk without having my knees swell, and i could go on and

on..my outlook on life is totally different..I feel great..I don't

deny myself anything, i eat what i want and have no problems. I

believe Dr. Rutledge is a brilliant Dr. and if he thought he was

going to hurt us he would abandon the procedure. he is a very

compassionate man but i know you have heard that over and over on

this site..WE LOVE THIS MAN...This surgery is going to effect

different people in different ways as does all surgery..we who have

had babies did not all have the same type of labor..You seem to be a

brilliant person who has done a great deal of research and in the end

you said you were leaning toward the MGB, that tells me you still

find this the safest procedure as far as WLS goes..Take care and

thanks for all the information you came up with..it helps to know it

all.

Zoey

4/20/2000

262/208

Louisiana

Cigna Approved

July 15, 2000

Laurie,

I applaud you on your very detailed letter. It has given me a new perspective.

However, as already having GERD, I personally am not that concerned about this

procedure. I have enjoyed reading all the information that you provided. It is

nice to know that someone can backup their concerns such as you have. I commend

you for detailed research and look forward to many more of your posts as you

find out the info that we laymen so desperately need.

As a victim of fen-phen I would hate to delve into something else that could

effect my life so dramatically.

Thank you for your post.

Joannie Lee

Irving, Tx.

July 15, 2000

I meant " dramatically " as in negative.... Gawd, I should be shot some daze!

Joannie

Re: more info on the controversy

Laurie,

I applaud you on your very detailed letter. It has given me a new

perspective. However, as already having GERD, I personally am not that

concerned about this procedure. I have enjoyed reading all the information that

you provided. It is nice to know that someone can backup their concerns such as

you have. I commend you for detailed research and look forward to many more of

your posts as you find out the info that we laymen so desperately need.

As a victim of fen-phen I would hate to delve into something else that could

effect my life so dramatically.

Thank you for your post.

Joannie Lee

Irving, Tx.

July 15, 2000

Hi Laurie,

Thank you so much for your post. It is very informative and helpful. It

helps clear up some vague questions I had in my mind about things like acid

reflux compared to bile reflux, and why the bile could come up past the top

of the stomach with a Billroth type connection but probably not with an

RNY.

I would love to hear the answers to your other questions. I would

especially like to know how soon bile reflux problems showed up in earlier

Billroth patients. The more information we all have, the better.

I'm still looking forward to having the MGB. One of the things that drew

me to it in the first place is its easy reversability, along with its short

surgery and recovery times. With everything I know, I still feel it is the

best choice. But I love information, and I want all the information I can

get.

Thanks,

Sara

waiting for insurance approval

dmalony@... wrote:

> Hi All,

>

> This is my first post. I have been researching WLS on and off for a

> year. I discovered the MGB site about a month ago and was thrilled!

> I also have loved reading your posts over the past few weeks. I love

> your honesty, passion, loyalty and mutual support. What a group.

> Not

> something you find everyday!

>

> I hate to have to discuss this subject in my first post knowing how

> it

> has been stressful and frustrating for all of us over the last few

> weeks, but my life has been revolving around it and I feel a very

> strong need to share. My father is a neuroscientist in the medical

> school at Ohio State University and he has had a lot of fears about

> weight loss surgery in general and has been spurring me on in my

> research lately. Let me say that he has always been supportive in my

> life long struggle with my weight and over the last 10 years of my

> struggle he has changed his view to what we now know. Nothing else

> seems to work and it is not our fault. Our bodies betray us in ways

> that other's don't. He had just finished reading Dr. R.'s patient

> manual the same day that all the fuss started about Walter's post

> here.

>

> Please bear with me.... this will take awhile to get down on paper

> sort of speak. I patiently read all of your long posts about this....

>

> Due to his concern, my dad starting scanning the recent medical

> literature and also set up a consultation with Dr. Ellison, the head

> of the Department of Surgery for OSU who does all the open RNY's

> there. Others do a modified RNY with a 5 inch incision to get the

> hand in the belly at OSU. Just as a side note, he thinks some Drs.

> at

> Pittsburg Medical Center are the best out there right now for Lap

> RNY.

> I will get to my meeting with him later...

>

> In the meantime, due to all the discussion in my personal life and on

> this list, I emailed Dr. ann Mallory who is the current

> director

> of the Amercian Society for Bariatric Surgery (the society that held

> the conference that Dr. R. presented at). I wanted to see if she had

> any comment on the controversy over Dr. R's presentation and might

> shed some light on Walter's sweeping generalizations about " all " and

> " everyone " . Let me again say how frustrated I was feeling about the

> need to do this, because I was already emotionally connected to MGB

> and all of your stories. I am copy/pasting her reply below...

>

> ---- Original Message -----

>

> To:

> Sent: Tuesday, July 11, 2000 9:07 PM

> Subject: Re: Mini Gastric Bypass

>

> > Dear Ms. Malony,

> >

> > Dr. Rutledge's surgery is very similar to a loop gastric bypass

> shown in figure six of the Story of Surgery for Obesity on our web

> site <A HREF= " http://www.asbs.org/ " >ASBS - OBESITY - Bariatric

> Surgery</A> . It was abandoned year ago secondary to severe bile

> reflux. Dr. Rutledge states that he has altered the procedure such

> that his patients do not have this problem.

> >

> >It is fair to say that his procedure is not considered " mainstream "

> by most members of the ASBS. However, during the relatively short

> history of the ASBS many new and different procedures have been

> presented before the Society. Some of these have been met with

> skepticism as was Dr. Rutledge's Mini Gastric Bypass. There were

> laparoscopic as well as open bariatric surgeons who questioned his

> procedure.

> >

> > Sincerely,

> >

> > ann Mallory

> > Executive Director

> >

> The same day, my dad had several conversations with Dr. Ellison at

> OSU, and gave him the patient manual. Dr. Ellison contacted a Dr.

> Mason (at Iowa, I believe, but I may be wrong) who is suppose to be

> the big acamedician/surgeon guru for RNY at this time. Both of their

> intial response were the same. That its been done and it causes Bile

> Reflux which can lead to cancer and liver problems.... more later.

> It

> has been such a crazy week with all of this it is hard to make it all

> make sense.

>

> With my dad translating some terms, I was beginning to understand

> what

> all the fuss was about and started to develop some questions and

> concerns. I emailed these to both Dr. Mallory at ASBS and to Dr.

> Rutledge. Neither has had a chance to respond yet. I am anxiously

> waiting. I understand from your posts that Dr. R. was gone and

> assume

> that like most of us he may have 100's of personal emails waiting for

> him. Here is the copy of my response to Dr. Mallory and my

> questions...

>

> Dear Dr. Mallory,

>

> I cannot thank you enough for being courteous and professional enough

> to reply to my email in such a timely manner. This debate is a huge

> issue in the lives of many people looking for hope, help and

> direction

> for their struggle with obesity. Thank you.

>

> I did go back and reread the history of obesity surgery on your

> Association's site. I do believe that I did read it in my research

> several months ago. I did notice the figure 6 that you pointed out

> and its reference to loop gastric bypass, but I have to confess that

> I

> came away as frustrated as I have with every reference that I have

> come across to date. While the story of the history went into detail

> on the ill-effects of several major types of surgery over the years

> and why they are no longer in practice, it did not do the same for

> " the loop " .

>

> I guess I feel that I am facing the same brick wall until I can tease

> out some information about this old loop that is more specific than

> how the small intestine was looped and attached to the new ( small,

> horizontal pouch) stomach by hand (I am sure since the surgery was 20

> years ago or so).

>

> Your concern about bile reflux and increased risk of cancer of the

> esophagus was shared by your colleague doing obesity surgery at OSU

> as

> he discussed it with my father (who is a neuroscientist prof in the

> OSU school of medicine)today. Still I am left trying as a layman to

> compare apples and oranges and make a decision. I now have many

> more

> specific questions and maybe you do not know and cannot find any data

> to begin to answer them. Perhaps it would make a nice

> research/professional publication for someone in your association who

> is concerned about all of this. My questions are:

>

> 1. With all the hearsay and vocal criticism of Dr. Rutledge since

> the

> 17th conference presentation and possibly before, have there been any

> professional peer reviews written concerning other surgeons

> misgivings? Isn't that where this type of professional discussion is

> suppose to take place?

>

> 2. I have begun to see one of the reason for some of the confusion

> between laypeople interested in surgery, Dr. Rutledge's website, and

> the misgivings of others in your association. Your major area of

> concern is representative of this problem. I am hearing doctors say

> that the " old loop " caused bile reflux which over time lead to

> precancerous and cancer in the esophagus. I am seeing Dr.

> Rutledge's

> patients, website, and hopefuls talking about the wonderful results

> he

> has had of 0% GERD Acid reflux problems after surgery and almost

> 100% cure of pre-existing GERD problems. I am beginning to

> understand that we are not talking about the same thing. Am I

> correct

> in my newer understanding that bile reflux is a direct result of the

> new stomach opening into the small intestines and that in a healthy

> normal gut, there should not be any bile present in the stomach. So

> bile reflux and stomach acid reflux are not the same thing?! What

> still confuses me is that the RNY also puts the new stomach opening

> close to the esophagus, but yet does not cause the same bile reflux

> problem. Why, is that??? Does it have anything to do with end to

> end

> vs. side to end connections to the new stomach?

> *** Since I wrote this, I now undestand that it is due to the

> RNY

> arm that puts a distance between the bypassed bile and pancreatic

> fluid****

> 3. If the crux of the issue is the problems associated with bile

> reflux, is there any good data from the rejected old loop bypass

> patients to give us a timeline of this problem?? Did they have bile

> and/or acid reflux problems quickly after surgery?? How long after

> surgery did the bile reflux problem result in pre-cancerous or

> cancerous tissue in the esophagus? 20 years ago, did they have any

> medicines available to combat this problem? Today, Dr. Rutledge

> prescribes a new medicine for all his patients that is

> suppose to cut the risk of gall stones and bile acid problems. I

> would have to take time to look up its name and that is all that I

> know about it.

> **** new medicien - Actigall***

>

> 4. The biggest difference that I can readily see from Dr. Rutledge's

> diagrams of the revisions that he has made to the old loop surgery

> is

> the position and shape of the new stomach. Instead of round and high

> as in your diagram in the history article and in the diagrams I have

> seen of RNY procedures, he makes a thin, long, cigar shaped stomach

> along the inside curve of the stomach and attaches the " loop " of

> small intestine at the bottom of the cigar shape which places the

> possible entrance of bile further away from the esophagus. Is this

> the part that has never been done before? Which does not let us

> readily compare the old loop to the MGB?

>

> It appears that one has to be a master puzzle solver to begin to see

> how it all fits together and I can see why professionals responses

> seem to be vague and " advisory " rather than informative. It is not

> easy to explain. If there are other concerns about Dr. Rutledge or

> his procedure that are not libelous, I want to know them.

>

> If you feel that some one else you are aware of is better suited to

> respond to all of this, I would be glad to try to contact them. I

> will be asking these same questions of Dr. Rutledge, Dr. Ellison(

> sp?)

> at OSU , and posting some form of them in the elist in case there are

> others out there who have put it all together. There will be around

> 700 patients who will have had this procedure by the end of this

> month

> with many more scheduled. If there is truly cause for concern, it

> should be addressed professionally and immediately. Otherwise, it

> seems everyone is over reacting and causing undue alarm and stress

> for patients.

>

> Again, I cannot thank you enough for your quick response and

> professional attitude. I realize that it may take longer to

> formulate

> a response to all of my concerns in this letter.

>

> I so appreciate your input. I am interested in whether you are

> currently doing obesity surgery and what type as well.

>

> Sincerely,

>

> Then, this Thursday, I tried to do some internet research on Bile

> Reflux and GERD (stomach acid reflux). In my initial layman's

> search,

> I couldn't find much distinction between them. One of my growing

> fears was that you could have " silent " symptoms of Bile Reflux for

> years causing a lot of damage before you were aware. IT causes

> irritation to the mucosal linings of the Esophagus and changes the Ph

> balance in the Esphagus from alkaline to Acid which is what damages

> the cells overtime and can (doesn't have to) lead to cancer cell or

> liver problems (the liver is right next to part of the esophagus.)

> So

> far - I don't think it would happen without you knowing it. I think

> you would have great pain and discomfort similar to GERD, but that it

> might not happen for years. Again, this is my layman's conclusion

> after a couple hours online. I want to hear a doctor explain it

> thoroughly who has experience with it.

>

> Yesterday, my husband, father and I met with Dr. Ellison. It was

> evident within 2 minutes that he had his mind made up totally about

> MGB and didn't want to discuss it. He quoted me from his email

> response from Dr. Mason (I referred to him earlier) and said " ITs

> bad. It was an experiment that has already been done and abandoned " .

> He said that the old loop bypass or Billroth II was the perfect way

> to cause rats to develop cancer of the esophagus. - Way to freak out

> my research oriented father - I was ticked at his lack of opened

> mindedness or even professional curiosity. I asked him why the

> billroth II was still being done in many non- bariatric

> gastrectomies

> due to ulcers, stomach cancer and other gastric disorders ( research

> quoted on the site by Dr. R and that gave us links for in her

> posts). He replied that in non-bariatric surgeries at least half of

> the stomach is left compared to only 1-2 oz (most WLS) and 3-4oz

> ( MBG) which leaves more space for the bile to get lost or go

> elsewhere rather than up the esophagus. He also said that RNY bypass

> is used when only small portions of the stomach can be kept for these

> patients for the Bile Reflux reason only.

>

> I told him boldly how frustrated I am that every source I turn to

> does

> not give me specifics on what exactly happened with the bariatric

> patients who had the " old loop " or Billroth II. He said that he did

> not know all the details besides the " well known Bile reflux longterm

> complication " . He did say that the only source that he could think

> of

> off hand that might have a good explanation in it was a monolithe(?)

> by Dr. Mason written in the 1970's in about a 200 pg booklet format.

> It is on the history of Obesity Surgery. Since this was yesterday,

> obviously I haven't found it yet. Has come across it in her

> book research?

>

> I tried to get him to discuss the risks associated with RNY. He

> downplayed them and said that he had never had to undo or redo one,

> but admitted that it would be difficult surgery if the first RNY had

> been open. He said that his leak rate was less than 1%. He kept

> reiterating that Bile Reflux was a terrible thing and you did not

> want

> it. He was totally unimpressed by Dr. R's data that so far he

> reports

> 0% GERD and Bile Reflux, because he said that it would probably take

> 5-15 years to see it. He predicted that about 25% would develop it.

> Don't ask me where he came up with that number. He did not think

> that the new shape of the stomach pouch made in the MGB would make

> any

> difference because it was still relatively small and the pouch

> doesn't

> have any effect on the possibility of bile back up from the bypassed,

> unused part of the loop. He said that he could understand why I

> would

> be drawn to its ease, but that he suspected that it was developed

> because it was so much easier to do laproscopically.

>

> Yes - I admit and agree that this guy had very pompous moments, but

> on

> the other hand, he is much more of a research oriented guy and not a

> LA cashcow to quote a phrase. The best thing he said to me was that

> beacuse MBG was such a beautifully simple procedure that if I had it

> and were to develop severe Bile Reflux problems down the road that it

> could easily be converted to an RNY to cure the Bile problem.

>

> Okay... today I did a search on Dr. R's website for Bile Reflux. It

> seems that he has been very busy trying to be true to his word and

> has

> added many new pages this month on this subject and other

> complications. Thank you, Dr. Rutlegde. Now I would love to see a

> page written by you discussing your thoughts on all of this. I

> noticed that the % of patients reporting Bile Reflux problems has

> gone

> from 0% up to 6% now. I am anxious to see if that will change any

> further as the follow up results on the first 2 years patients

> continues and is completed. I hope all of you will take the time to

> do the search and look at all the new pages.

>

> Most of you all having done your own research probably already

> figured

> this out, but it took me awhile so I will risk repeating it. The

> reason that there is such a greater risk of Bile Reflux problems with

> loop ( be it the old loop, Billroth I and II and the MBG) is that the

> bypassed part of the loop ( see the references on site to the

> afferent

> and efferent parts of the loop of the samll intestines) still has

> bile

> and pancreatic fluids running and draining through it and they can

> come into contact with the new stomach pouch exit at the point where

> the loop attaches to the new tummy. In our natural stomch exits

> there

> is a valve that shuts off after emptying and prevents bile and other

> nasties from entering the stomach. The difference with the RNY is the

> Y limb. The bypassed bile would have to back all the way up this

> limb

> to enter the new stomach exit in this procedure. That's why it is

> used

> to correct Bile reflux problems.

>

> It seems like it all comes down to how much weight do you want to

> attach to the possible risk of Bile Reflux complications down the

> road. I think that Dr. R would say he is attempting to protect us by

> his newer shaped pouch and by the use of zantac and Actigall in the

> early months. Of course, we are all taking a risk on the longterm

> outcome with MBG as it is.

>

> I have one concern with the new studies concerning RNY and Billroth

> II

> quoted on the site. One seems to say that Billroth II cures

> Esophagitis (which can be caused by either GERD or Bile Reflux) and

> the other seems to say that corrrection to RNY is needed to treat it.

> Am I reading these wrong??

>

> Anyway, this is now a thesis, but I really needed to unload all of

> this. My life has been consumed and stressed out by it the past

> week.

> That and reading all your posts. I look forward to more personal

> posts in the future.

>

> Again, my conclusion is informed weighing of the benfits and risks.

> I just didn't get the sense that we all had all of this info. I am

> encouraged that Dr. R. says that the 6% of post-ops who developed

> Bile

> Reflux symptoms are responding to Actigall and Zantac so far. I have

> been concerned that some of you have posted about your very

> tempermental tummies and seeing bile in your vomit. I don't think

> you

> are suppose to live with that and I am wondering if you are reporting

> those symptoms to your own PCP and/or Dr. R.? It could be important.

> At this point I still think I want MGB. I see my PCP on Wednesday.

> I hope that this has helped to clarify and not to scare. That is not

> my intent. I am about ready to move from my research phase back to

> the

> process of changing my life and health. We pride ourselves on being

> informed? Right.

> Hoping you'll let me stay-

>

> Laurie in Ohio

> 36 yr old

> BMI 45

>

July 15, 2000

Laurie...

WOW...gosh you even beat out for the longest most thought

provoking email award! But as a wannabe..i thank you..each bit of new

information and research done is a help to me in my quest to make the best

decision. Please keep us informed on what you hear back and new things you

learn. After all...isn't that why we are here? To learn and support?

Holly in Illinois

July 15, 2000

Joannie, I too saw that on Dr. R's site and I emailed him. I'm 57 and I had

the surgery. There are lots of us over 55 who have had the surgery and we do

as well afterward as the younger folks!

Flo...old and in land

Re: more info on the controversy

>I thought this surgery was only performed on people 55 and younger??? Did

I miss something?

>

>Joannie

> -----Original Message-----

> My mother had the MGB in May and has lost about

> 35 lbs, but she is 71 years old. She has greatly reduced her insulin

and as

> she looses weight she will hopefully be able to discontinue it.

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

-

>

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

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> This message is from the Mini-Gastric Bypass Mailing List at

Onelist.com

> Please visit our web site at http://clos.net

> Get the Patient Manual at http://clos.net/get_patient_manual.htm

>

July 15, 2000

I thought this surgery was only performed on people 55 and younger??? Did I

miss something?

Joannie

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

My mother had the MGB in May and has lost about

35 lbs, but she is 71 years old. She has greatly reduced her insulin and as

she looses weight she will hopefully be able to discontinue it.

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

This message is from the Mini-Gastric Bypass Mailing List at Onelist.com

Please visit our web site at http://clos.net

Get the Patient Manual at http://clos.net/get_patient_manual.htm

July 15, 2000

Flo Ballengee wrote:

>

> Joannie, I too saw that on Dr. R's site and I emailed him. I'm 57 and

> I had the surgery. There are lots of us over 55 who have had the surgery and

> we do as well afterward as the younger folks!

>

> Flo...old and in land

STOP BRAGGING, YOU SKINNY THING, OR I'LL HAVE TO GET TRISH TO RESORT TO

HER SPECIAL POWERS!!! (Put on the Tiara, Trish, times' a' wastin'!)

July 16, 2000

Laurie,

Thank you so much for sharing your research about bile reflux and the MGB. I

share your concern about long-term consequences, and am holding off

scheduling my MGB until I consult with another surgeon about doing a lap RNY.

The online and real-life support that MGB patients have through the website

and this e-mail group are a big draw, and Dr. Rutledge seems very caring. I'm

just not sure it's the safest surgery in the long run.

I am grateful that we have an open forum to discuss this controversy, and

look forward to hearing more.

Thanks again,

Ellen in Chapel Hill

July 16, 2000

Quoting :

> CarlMuckerheide wrote:

> >

> > ,

> > I guess my nursing backround makes me read between

the

> > lines, but my gut feel, tells me Laurie was probably

> > a set up. I have never heard anyone ramble on,

> > jumping from Dr to Dr, problem to problem, as this

> > fine young lady did. She is in then she is gone.

>

> Yep. I have to agree with you.

>

> There have been four pop up like that in the past 12

hours, all having

> some " other " procedure or " trying to decide " on some

other procedure and

> it's always a completely *different* procedure, too,

and they are all

> no-names. Most are aol and hotmail so far, too.

>

> I think Walter is writing something and is stealing

the commentaries.

>

> > And I can't understand what the flap is over Walter

L.

> > It's money period. I don't hire a Lawyer to be my

> > guardian angel 10-15 yrs down the road. I hire him

to

> > bare his teeth and get my job done.

>

> Oooh, you should say that on the list.

>

> > I know being

> > in the medical field the " good ole boy syndrome " and

> > Walter reeks of swimming in their same circle. My

> > question is why does he want on our list? We only

> > defend Dr R/ What can he gain? I must be missing

> > something here/

> > Lv judi in Fla

>

> I think he's writing something and he will use the

commentaries and get

> other comments from *other* doctors about those

commentaries, and then

> put it all together as if he wrote it.

>

> He's a sleeze.

>

> Kind regards,

>

> >

> > Quoting :

> >

> > > The list went up by over 35 members in the two

days

> > after Lindstrom

> > > posted, and 3 of those were aliases he used and

one

> > was somebody who

> > > works for him, apparently (all hotmail and aol

> > accounts - you get 8

> > > alias names at aol).

> > >

> > > But that doesn't explain the other 30 -- like they

> > were summoned here or

> > > something. Quite odd. Several of us have been

> > waiting for a feeding

> > > frenzy to hit, but so far, nothing, until this.

> > >

> > > Anyway, she has a different address. She writes

in a

> > kind of

> > > scatterbrained style (reminiscent of " raven " ),

though.

> > >

> > > And she sure has access to a lot of doctors, which

> > seems a little fishy.

> > >

> > > It's astonishing to me that she can claim to do

all

> > this research but

> > > she couldn't do the basics of comparing the old

loop

> > to the MGB? This

> > > is similar to Raven, too -- no matter what was

given

> > to her, she didn't

> > > " see " it. Hmmm.

> > >

> > > As for the Billroth II gastrectomy stomach remnant

> > being larger than

> > > what Dr. Rutledge is doing, I don't think that's

> > correct, based on the

> > > pictures I've found so far.

> > >

> > > But let's see how many more people posting the

same

> > sort of thing come

> > > out of the woodwork to jump on the bandwagon.

> > >

> > > For now, I'm assuming she's legitimate.

> > >

> > > Kind regards,

> > >

> > > CarlMuckerheide wrote:

> > > >

> > > > ,

> > > > Do You think this Laurie is for real or you-

know-who

> > > > pulling our leg?

> > > > Lv Judi in Fla

> > > >

> > > > Quoting :

> > > >

> > > > > Very informative post. It's interesting to

hear

> > the

> > > > comments. I'll

> > > > > have to go read the new pages you mentioned,

too.

> > > > Thanks.

> > > > >

> > > > > <Snipped just for brevity>

> > > > >

> > > > > > Again, my conclusion is informed weighing

of

> > the

> > > > benfits and risks.

> > > > > > I just didn't get the sense that we all had

all

> > of

> > > > this info. I am

> > > > > > encouraged that Dr. R. says that the 6% of

post-

> > ops

> > > > who developed

> > > > > > Bile Reflux symptoms are responding to

Actigall

> > and

> > > > Zantac so far. I

> > > > > have

> > > > > > been concerned that some of you have posted

> > about

> > > > your very

> > > > > > tempermental tummies and seeing bile in your

> > > > vomit. I don't think

> > > > > > you are suppose to live with that and I am

> > > > wondering if you are reporting

> > > > > > those symptoms to your own PCP and/or Dr.

R.?

> > It

> > > > could be important.

> > > > >

> > > > > The times I have had it, it has been *caused*

by

> > the

> > > > Actigall, which is

> > > > > a form of bile salts.

> > > > >

> > > > > Having bile enter the stomach apparently is

not a

> > bad

> > > > thing or they

> > > > > wouldn't have invented Acticgall. But if you

take

> > > > the Actigall first,

> > > > > and don't eat, then eat an hour or so after

taking

> > > > it, that's a mistake

> > > > > -- you will vomit and it will be nasty

tasting and

> > > > full of bile. And

> > > > > when I had this problem once for more than 2-3

> > days,

> > > > I quit the Actigall

> > > > > for about 3 days and it cleared up, so I am

going

> > to

> > > > assume it's the

> > > > > Actigall that caused the problem until

somebody

> > comes

> > > > up with a better

> > > > > idea.

> > > > >

> > > > > Now, I have the *exact* same reaction to a

strong

> > > > dose of tetracycline

> > > > > which is also supposed to be taken with

food. One

> > > > day I didn't eat food

> > > > > with it, and I barfed all over the side of the

> > > > highway.

> > > > >

> > > > > So in both cases, I don't think you can blame

the

> > > > surgery (in the case

> > > > > of the tetracycline, that was before surgery).

> > > > >

> > > > > Getting bile in the *esophagus* from bile

backup

> > is

> > > > the big issue with

> > > > > the old loop, as I understand it and that is

why

> > the

> > > > lower stomach

> > > > > should cure the problem. The bile constantly

> > > > irritates the lining of

> > > > > the esophagus and causes a precancerous

condition.

> > > > >

> > > > > Other than vomiting, I haven't had any bile

> > backing

> > > > up into my throat at

> > > > > all, but I sure did *BEFORE* surgery -- lots

of

> > > > nights I'd wake up with

> > > > > it coming up my throat. BLECH.

> > > > >

> > > > > > At this point I still think I want MGB. I

see

> > my

> > > > PCP on Wednesday.

> > > > > > I hope that this has helped to clarify and

not

> > to

> > > > scare. That is not

> > > > > > my intent. I am about ready to move from my

> > > > research phase back to

> > > > > > the

> > > > > > process of changing my life and health. We

> > pride

> > > > ourselves on being

> > > > > > informed? Right.

> > > > > > Hoping you'll let me stay-

> > > > > >

> > > > > > Laurie in Ohio

> > > > > > 36 yr old

> > > > > > BMI 45

> > > > >

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

> > ----

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

> > > > > Experience MSN...

> > > > > Get 1 FREE* month of unlimited Internet

access!

> > > > >

> > > >

> >

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> > > > >

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> > ----

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

> > > > >

> > > > > This message is from the Mini-Gastric Bypass

> > Mailing

> > > > List at Onelist.com

> > > > > Please visit our web site at http://clos.net

> > > > > Get the Patient Manual at

> > > > http://clos.net/get_patient_manual.htm

> > > > >

> > > >

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> > >

> >

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July 23, 2000

Hi Laurie, It has been over a wk since you sent your 1ST & only

post.Don't let anything that was said make you change your opinion,or stop

your research,wls is far too vital, at least for me.Words spoken in the heat

of the battle often blister.I believe you were honestly sharing some insider

info w/us and I appreciate the effort.I believe it was a little off on the

timing,but I can spot a 'fixer' when I see one. Thanks and come on back to

the dialogue. Janet

>From: dmalony@...

>Reply-To: MiniGastricBypass (AT) egroups (DOT) com

>To: MiniGastricBypass (AT) egroups (DOT) com

>Subject: more info on the controversy

>Date: Sat, 15 Jul 2000 21:57:53 -0000

>

>Hi All,

>

>This is my first post. I have been researching WLS on and off for a

>year. I discovered the MGB site about a month ago and was thrilled!

>I also have loved reading your posts over the past few weeks. I love

>your honesty, passion, loyalty and mutual support. What a group.

>Not

>something you find everyday!

>

>I hate to have to discuss this subject in my first post knowing how

>it

>has been stressful and frustrating for all of us over the last few

________________________________________________________________________

Get Your Private, Free E-mail from MSN Hotmail at http://www.hotmail.com

July 23, 2000

Hi Laurie, It has been over a wk since you sent your 1ST & only

post.Don't let anything that was said make you change your opinion,or stop

your research,wls is far too vital, at least for me.Words spoken in the heat

of the battle often blister.I believe you were honestly sharing some insider

info w/us and I appreciate the effort.I believe it was a little off on the

timing,but I can spot a 'fixer' when I see one. Thanks and come on back to

the dialogue. Janet

>From: dmalony@...

>Reply-To: MiniGastricBypass (AT) egroups (DOT) com

>To: MiniGastricBypass (AT) egroups (DOT) com

>Subject: more info on the controversy

>Date: Sat, 15 Jul 2000 21:57:53 -0000

>

>Hi All,

>

>This is my first post. I have been researching WLS on and off for a

>year. I discovered the MGB site about a month ago and was thrilled!

>I also have loved reading your posts over the past few weeks. I love

>your honesty, passion, loyalty and mutual support. What a group.

>Not

>something you find everyday!

>

>I hate to have to discuss this subject in my first post knowing how

>it

>has been stressful and frustrating for all of us over the last few

________________________________________________________________________

Get Your Private, Free E-mail from MSN Hotmail at http://www.hotmail.com

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