Subject: Warning: Rant Ahead (mixed signals aplenty)

[Guest guest]

In a message dated 12/12/01 9:12:15 PM Eastern Standard Time,

duodenalswitch writes:

<< So then the nutritionist said, " So, I'm gonna go tell

Dr. Gagner that I feel that you should have the RNY

instead. " >>

I agree with you. Where does that nutritionist get off deciding what surgery

YOU should have? When did *she* become God? For that matter, what the heck

is wrong with Gagner saying you should have an RNY? What gives with these

people?

As long as you qualify for the surgery based on either a BMI of 40 or above OR

100 lbs overweight, they should just get over it. Whats with the rush to RNY

right now? I know Gagner is supposed to be such a genious lap surgeon, but

I'd get another surgeon before I'd let him or his nutritionist talk you into

the RNY. Maybe he put his nutritionist up to it?

I don't like this at all, from either of them.

Carole

[Guest guest]

In a message dated 12/13/01 1:34:59 PM, duodenalswitch writes:

<< As long as you qualify for the surgery based on either a BMI of 40 or

above OR

100 lbs overweight, they should just get over it. Whats with the rush to RNY

right now? I know Gagner is supposed to be such a genious lap surgeon, but

I'd get another surgeon before I'd let him or his nutritionist talk you into

the RNY. Maybe he put his nutritionist up to it?

I don't like this at all, from either of them.

>>

Carole: I think it is pretty common of MANY surgeons to recommend an RNY

(which is proximal) over a malapsorptive surgery (the DS) in the high 30's or

very, very low 40's. I don't think that they can make one have an RNY but I

think it is pretty 'standard' across the board to have this kind of thinking

-- If one is really on the 'low end' (and I think the original poster was

UNDER 40 -- like 39 or something), I think the proximal surgery is usually

preferred. However, this being said, I've known quite a few people who had

lower bmis and got the DS (with GAgner as well as Dr. Ren). One gal from the

list mentioned that her stomach was made a little larger; I've also heard of

common channels going a little longer to compensate.

I definately don't think it's an impossibility to perform a DS on someone

with the 'lower bmis' but I think that the high 30s and 40-41 bmi are still a

gray area for MANY surgeons performing the DS.... And, Dr. Gagner is pretty

'pro-DS' for the most part. So, if he's recommending the RNY there must be

valid reasons why he would think it would be preferable. Not saying I'd get

the RNY even if he told me to or that I would agree with him. However, I

wouldn't say that he's totally off his rocker or way off on this assessment

---

I would say to the original poster stick with your guns and point out the

high weight loss maintenance that the DS offers. Suggest other compromises

where the DS can be made a little less 'malapsorptive' (larger stomach,

longer common channel) and see what he says about that. I think that he

really sticks to his 'magic formula' of 100 cm most of the time (and I know

that other surgeons do NOT necessarily agree with that), although he has

shortened people's common channels to 75 or so (maybe even 50?) before

surgery due to higher bmi, etc. I don't know if he thinks the longer common

channel is an effective tradeoff, but I would ask his opinion on this (and

making the stomach a bit larger?). A little negotiation and suggesting may

make him realize how SERIOUS you are and also help make him more comfortable

performing the procedure of choice, IMHO.

I think one reason Dr. Gagner *may* be leary to recommend the DS to those who

do not fit the traditional 'definition' of good candidates for a

malapsorptive procedure (usually this includes higher bmis) is that he's seen

a higher level of protein deficiencies and was pretty shocked by that. He

really emphasized this to me when I had my initial consult. He said that a

lot more people than he would have anticipated are coming in with protein

deficiencies and this was alarming.

The original poster *did* mention that the nutritionist based her pro-RNY

evaluation partially based on the person's diet and preferences. Perhaps an

overall lack of protein enjoyment was part of this assessment? I mean, it is

difficult to get 80 gms in -- One really does have to enjoy meat (in terms

that it offers the post protein per gram, etc.) and/or take in a lot of

protein supplements. Traditional snacks like yogurt, cottage cheese,

cheeses/other dairy, nuts, etc. are to be eaten more often than carb-based

treats... Yes, I think the surgery DOES alter one's cravings -- I've found

myself craving protein MUCH MORE than before (I was a typical 'carb addict'

pre-surgically). If someone honestly really DOESN'T enjoy protein, the

regimine of always eating so much protein (and/or consuming daily protein

shakes, etc.) could really get to be a bore after awhile. Then, they could

become protein deficient when they stop focusing on the protein over time...

Carol, I'm NOt saying I totally disagree with you here. I'm just saying that

I don't think that Gagner's assessment (and the nutritionist's) are based on

pure speculation alone. I think they truly do want what they think is best

for the patient. Those of us who have chosen the DS are ready to take the

supplements, get the medical life-long aftercare and focus on protein first.

I don't think everyone necessarily is. In other words, I think the surgery

is superior BUT it relies heavily on patient compliance and I don't think

that everyone is ready to make that commitment. This is the point on which

we don't see eye to eye, I think.

If the original poster wants the DS, go for IT!!! Try to emphasize various

'compromises' to minimize the malapsorption. If protein consumption is the

issue, try a high protein diet BEFORE surgery (I did this because I wasn't

sure I would enjoy it or be able to do it -- I actually lost 7 lbs before my

surgery doing this! LOL). I don't think Gagner would refuse to do the DS.

I think he just wants to present his point of view as to why he thinks the

RNy would be better. As a pretty pro-DS surgeon, he may hold more

traditional views of when DS isn't good (really low bmi, for example) and

perhaps the original poster will be one of those who 'push the boundaries' of

people's thinking on this issue. After all, the DS originally wasn't open to

all but the highest bmi patients. I had a starting bmi of 45 and years ago I

wouldn't have been considered (even by Gagner) to be a good candidate for the

DS! As it was, I came prepared to debate the issue with him but he

agreed it would be great for me but he just wanted me to understand all the

potential complications (including the protein issues).

All the best,

lap ds with gallbladder removal

January 25, 2001

Dr. Gagner/Mt. Sinai/NYC

10 months post-op and still feelin' fabu

preop: 307 lbs/bmi 45

now: 198 lbs/bmi 28/size sweet 16 but squeezin' into a 14! LOL

[Guest guest]

In a message dated 12/13/2001 2:12:57 PM Central Standard Time,

ruisha@... writes:

> Perhaps an

> overall lack of protein enjoyment was part of this assessment? I mean, it

> is

> difficult to get 80 gms in -- One really does have to enjoy meat (in terms

> that it offers the post protein per gram, etc.) and/or take in a lot of

> protein supplements.

I really don't prefer meat, but easily get lots of protein in. I don't

constantly keep track of my protein intake, but did a for a few days a while

back and I was getting well over 100 g a day in. I do trick myself into

eating more protein because I know I have to. Preop I would have preferred

to go days without eating meat. I do often eat a steak for breakfast because

that is 37 grams (in a little 6 ounce steak) out of the way right away. By

the way a grilled cheese sandwich has 12 grams of protein. I eat lots of

cheese and often eat nuts. If I make spaghetti, I put twice the amount of

meat in the sauce than I used to. I then use more sauce than pasta and that

tricks me into eating way more protein. Anything that I make, I put about

twice the meat in it that I used to examples are stir fry, chicken noodle

soup, etc. I do have to say that I love roast chicken and make that quite

often because it is protein I enjoy.

Dawn

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!

[Guest guest]

In a message dated 12/13/01 11:00:38 PM, duodenalswitch

writes:

<< I do trick myself into

eating more protein because I know I have to. Preop I would have preferred

to go days without eating meat. I do often eat a steak for breakfast because

that is 37 grams (in a little 6 ounce steak) out of the way right away. By

the way a grilled cheese sandwich has 12 grams of protein. I eat lots of

cheese and often eat nuts. If I make spaghetti, I put twice the amount of

meat in the sauce than I used to. >>

Dawn: I eat a LOT of dairy, too -- mainly cheeses. I've ALWAYS loved

cheeses. And, I'm grateful that I don't have any negative experiences with

dairy products since I get a lot of protein from them. I eat a variety of

nuts (I LOVE almonds!), too.

I also used to go for days without meat -- But, now I find that I enjoy it

more. It's a 'quick fix' for protein in terms of grams per ounce. I've

come to love seafood/shrimp much more post-op, too! I still enjoy carbs

but find I usually just can't eat as much as I did pre-op.

All the best,

lap ds with gallbladder removal

January 25, 2001

Dr. Gagner/Mt. Sinai/NYC

10 months post-op and still feelin' fabu

preop: 307 lbs/bmi 45

now: 198 lbs/bmi 28/size sweet 16 but squeezin' into a 14