Guest guest Posted September 29, 2001 Report Share Posted September 29, 2001 I finally had my first MD consult for WLS this past week. The doc and I discussed RNY and DS; he recommended DS due to my high BMI (~62) and I had expected that from reading this list and various websites. What I wasn't ready for was his statements that the DS is controversial even within the bariatric surgery community.... then on top of that, a friend of mine who also wants WLS saw her MD this week and was told not to go with the DS b/c of the " dangerousness " and that he and folks in his practice have done a bunch of revisions b/c people either get malnourished or can't stop losing weight (she said he told of one woman who was 76 lb. when she came for a revision). I thought I had done my homework and was feeling very comfortable with the thought of DS, believing it would be highly preferable than the RNY for me (higher percentage of excess weight loss, no dumping, more normal eating, less risk for regain). Now I'm a little freaked out. Oh yeah, the doc also said that very few insurance companies will pay for the DS, even if they pay for the RNY -- in part b/c the DS isn't in the NIH guidelines.... I need help here. I'm terrified of surgery in general, but am willing to have WLS in order to get healthy and have a more " normal " life. BUT I don't want to put myself through this only to be morbidly obese again in 10 years (my fear of having the RNY) OR having to have other surgeries b/c I can't stop losing weight and go to the other extreme.... Can anyone tell me why the DS is so " controversial " even within the bariatric community? My doc's answer wasn't really satisfying (he stated he thinks its mostly b/c they don't know how to do it, but based on my friend's experience, her doc had more against it than that). Am I missing something about this whole thing? Also, did anyone have huge problems getting insurance to pay for DS v. RNY? Any thoughts or musings would be helpful.... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 29, 2001 Report Share Posted September 29, 2001 seems to me some surgeons doing only the RNY make up some stats and claims that the DS is dangerous, not approved by insurance companies etc.....when truth be told they just dont want to nor have the time to inquire about it or learn how to do it. Bottom line is they can do many more RNYs in a day than the DS which is much more specialized and requires extra training many are not willing to do. Dr Welker does both so therefore he is not biased. He simply says this when you are faced with making a decision on what is best for you: " Are you willing to put up with the problems from the waist up or the waist down?? " (meaning the RNY has pouch problems etc and the DS sometimes has bowel problems) To me, the smelly poops and occasional diahrhea is nothing compared to an egg sized stomach and stoma closure and vomitting problems. Judie Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 29, 2001 Report Share Posted September 29, 2001 , Statements like you have heard come from ill informed doctors who have no business commenting unless they have participated in, or at least read up on the most recent statistics. Point in fact is that any revision is a possibility for ANY surgery.. not just WLS or DS, I have YET to meet anyone in my two years of study who had a revision for malnourisment or losing too much. Your body will adjust just like it has all along and stop losing after about two years. I refer you to the Hess report which can be found at www.duodenalswitch.com and the advice of a surgeon who does the DS as to his experience. Assuming that the surgeon uses common measurements (alimentary limb 250 and common channel 80-100 and gastric reduction to 5 oz), I would expect you would have an outcome like the rest of us 90% excess weightloss maintained over 5 years. I wish you luck in your decision, please dont take just one person's word for any kind of surgery or procedure.. do your homework until YOu are comfortable with the risks vs the benefits. I for one would do it again and again and again. Im getting my life back and damn glad about it. Sue post op 9/11/01 -25lbs/bmi 50 Dr. Warden/Lifeshape Group Ocean Sps, MS. > I finally had my first MD consult for WLS this past week. The doc > and I discussed RNY and DS; he recommended DS due to my high BMI > (~62) and I had expected that from reading this list and various > websites. What I wasn't ready for was his statements that the DS is > controversial even within the bariatric surgery community.... then on > top of that, a friend of mine who also wants WLS saw her MD this week > and was told not to go with the DS b/c of the " dangerousness " and > that he and folks in his practice have done a bunch of revisions b/c > people either get malnourished or can't stop losing weight (she said > he told of one woman who was 76 lb. when she came for a revision). > > I thought I had done my homework and was feeling very comfortable > with the thought of DS, believing it would be highly preferable than > the RNY for me (higher percentage of excess weight loss, no dumping, > more normal eating, less risk for regain). Now I'm a little freaked > out. Oh yeah, the doc also said that very few insurance companies > will pay for the DS, even if they pay for the RNY -- in part b/c the > DS isn't in the NIH guidelines.... > > I need help here. I'm terrified of surgery in general, but am > willing to have WLS in order to get healthy and have a more " normal " > life. BUT I don't want to put myself through this only to be > morbidly obese again in 10 years (my fear of having the RNY) OR > having to have other surgeries b/c I can't stop losing weight and go > to the other extreme.... > > Can anyone tell me why the DS is so " controversial " even within the > bariatric community? My doc's answer wasn't really satisfying (he > stated he thinks its mostly b/c they don't know how to do it, but > based on my friend's experience, her doc had more against it than > that). Am I missing something about this whole thing? > > Also, did anyone have huge problems getting insurance to pay for DS > v. RNY? > > Any thoughts or musings would be helpful.... > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 29, 2001 Report Share Posted September 29, 2001 Hi , I just looked at the U.S. News and World Report rankings of hospitals and their specialties. Mount Sinai, where I will have my first consult soon, is listed as number 3 in the nation in gastroenterology. At least four surgeons there perform this surgery. Would a hospital with this level of expertise find itself in the midst of a " controversy " which implies that the procedure is disreputable? I would wonder. Froehlich Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 29, 2001 Report Share Posted September 29, 2001 , The risk of requiring revision is fairly small (1-3%). Most of the revisions result from psychological problems or substance abuse. Belive it or not, a certian percentage of DS patients become anorexic, and other patients cannot adjust to being thin (if you can believe it). Alchol and drug abuse is a sure way to ruin your health with the DS. These are the reasons that surgeons do the psychologic screanings (they arn't doing it to be sadistic). What remains is a small percentage (about 1%) of patients that do have problems with loosing to much weight or with protient malnutrtion. Joe Frost is a case and point. What is done in these cases is a restoration of intestinal continuity (though the smaller stomach remains). The result is moderate weight gain and restoration of health in those that suffered malnutrion. On the other hand the re-operation rate for the NIH approved VBG procedure approaches 30%, and likewise for the lap band. I don't have the exact numbers on the RNY, but several percent have to be converted from proximal to distal because they don't loose enough weight. Dr. Clare did a comprehensive study of 37 reversals of the BPD (without DS). Dr. Hess and Marceau also discuss the issues throughly. So yes, you might loose to much weight or you might be one of the rare ones to not loose enough, but the probabilities are > 95% loose 50-90% of their excess weight and keep it off for many years. Hull > I finally had my first MD consult for WLS this past week. The doc > and I discussed RNY and DS; he recommended DS due to my high BMI > (~62) and I had expected that from reading this list and various > websites. What I wasn't ready for was his statements that the DS is > controversial even within the bariatric surgery community.... then on > top of that, a friend of mine who also wants WLS saw her MD this week > and was told not to go with the DS b/c of the " dangerousness " and > that he and folks in his practice have done a bunch of revisions b/c > people either get malnourished or can't stop losing weight (she said > he told of one woman who was 76 lb. when she came for a revision). > > I thought I had done my homework and was feeling very comfortable > with the thought of DS, believing it would be highly preferable than > the RNY for me (higher percentage of excess weight loss, no dumping, > more normal eating, less risk for regain). Now I'm a little freaked > out. Oh yeah, the doc also said that very few insurance companies > will pay for the DS, even if they pay for the RNY -- in part b/c the > DS isn't in the NIH guidelines.... > > I need help here. I'm terrified of surgery in general, but am > willing to have WLS in order to get healthy and have a more " normal " > life. BUT I don't want to put myself through this only to be > morbidly obese again in 10 years (my fear of having the RNY) OR > having to have other surgeries b/c I can't stop losing weight and go > to the other extreme.... > > Can anyone tell me why the DS is so " controversial " even within the > bariatric community? My doc's answer wasn't really satisfying (he > stated he thinks its mostly b/c they don't know how to do it, but > based on my friend's experience, her doc had more against it than > that). Am I missing something about this whole thing? > > Also, did anyone have huge problems getting insurance to pay for DS > v. RNY? > > Any thoughts or musings would be helpful.... > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 30, 2001 Report Share Posted September 30, 2001 In a message dated 09/29/2001 4:06:47 PM Central Daylight Time, jhensel@... writes: > To me, the smelly poops and occasional diahrhea is nothing > compared to an egg sized stomach and stoma closure and vomitting problems. > > And most importantly, the chance of regaining the weight!!! Dawn--South Suburban Chicago area Dr. Hess, Bowling Green, OH BPD/DS 4/27/00 www.duodenalswitch.com 267 to 165 5' 4 " size 22 to size 10 have made size goal no more high blood pressure, sore feet, or dieting Quote Link to comment Share on other sites More sharing options...
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