Re: Re: why all these religious wars about DS vs RnY?

November 27, 2001

In a message dated 11/27/01 12:15:57 PM, duodenalswitch

writes:

<<

Comments the like of which state that the DS causes malnutrition, fatal gas

attacks, stomach cancer, etc., can't be allowed to pass unnoticed. The same

is true for comments which unrealistically tout the superiority of the RNY.

In traversing these posts of bogus information, I reserve the right to

comment on my opinion of those who don't pay attention to what they are

doing when they choose a particular surgery.

>>

Nick: It is a fact that the malapsorption of the DS CAN CAUSE nutritional

deficiences. Sheesh - for someone who claims to know what they are talking

about, it is rather ridiculous to state that this is 'bogus information'!!!!!

To belittle this means putting people at possible severe risk if they don't

realize how crucial it is to take supplements and get protein in DAILY. Each

person's body adjusts differently over time and different people may require

a different set/strength of supplements but to say that they aren't needed

(which basically is what you're saying if you think that the DS cannot cause

nutritional deficiencies) is inaccurate.

These deficiencies take time to develop and often aren't noticed until they

are at such a serious level as to become life-threatening and/or so serious

at to require intensive intervention. Knowing this fact may make someone who

is leary of a malapsorptive procedure choose a proximal one but it is

necessary for anyone having a malapsorptive surgery to realize this and take

care of themselves. This fact certainly does not have to interfere with

normal lifestyle and, as long as people are getting proper aftercare, regular

bloodwork, taking their supplements/protein, I really don't think they will

encounter any deficiencies. But, one's body needs can change and the levels

of nutrients (especially the malapsorbed ones like fat-soluable vitamins and

protein) must be monitored to maximize health and catch any dips early.

As far as stomach cancer goes, this procedure has NOT been proven to carry

any increased risk, although stomach surgeries in GENERAL ARE considered a

risk factor. I am not sure if the sleeve gastrectomy would carry a lesser

risk (because the lower stomach is left totally intact), but I have read that

any alteration of the stomach *can* increase risk. I have posted various

articles online, so the archives would have such things and such references.

Deadly gas? I personally haven't experienced it but for those who have (and

I really don't think they are lying when they relay their experiences or are

deliberately trying to make things sound worse than they are), I'm sure it is

bothersome and a major concern. I do NOT think every post-op experiences

this, it could very well be related to what is eaten but the process of trial

and error to discover what bothers the intestines can be a long and

frustrating one.

I think it is irresponsible to pre-ops to call such possible outcomes of the

DS surgery as 'bogus information' because it is NOT. It may not be the

result of the majority of surgeries but some people DO experience it and

struggle with it (look at Joe Frost with severe protein deficiency).

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: 204 lbs/size sweet 16/large-MEDIUM in regular people's clothing!

November 27, 2001

In a message dated 11/27/01 2:13:15 PM, duodenalswitch writes:

<< I think the point being made by Nick..and why I bother to talk for

Nick I have no frigging idea because he is one of the most

intelligent, articulate, honest and accurate individuals I have ever

had the pleasure of calling friend....well that said, the rumours of

nutritional deficiencies are implied that they are NOT preventable.

As in, if you get the DS you WILL suffer from nutritional

deficiencies.

That is how it is presented, because it was presented exactly that

way to me. I had to research to discover that if I was NOT

compliant, this could be a side affect.

>>

Yes, being compliant goes a long, long way towards staying healthy and NOT

getting various nutritional deficiencies. However, there is *still* a chance

this could happen even if you try your best... For example, if your health

deteroriates or you have a condition that would interfere with your ability

to eat properly/often enough/etc., you *may* develop a protein deficiency or

other such deficiency not necessarily due to your not trying to get the

nutrients in. The good news is these deficiencies usually take quite a bit

of time to progress so it isn't like you'll get the flu and develop severe

problems after a few days.

Also, bodies change and our needs for various supplements change over time.

People *may* feel that if they are eating their protein and taking their

vitamins they won't need regular checkups or bloodwork (and, the bloodwork is

a pain -- 8-10 vials or so!), especially if past labwork was good. One may

need more protein if one up's exercise/activity level. One may need less of

a certain nutrient over time.... Also, nutrients can be within 'normal' range

but still be declining. It is possible that one can continue the 'old'

pattern of protein consumption and vitamin supplements but still develop some

kind of deficiency and this wouldn't be detected if that person did not have

regular checkups, etc.

For the most part, I do not think that the majority of post-ops will develop

serious malnutrition issues with good post-op care and attention to protein

and supplements. I considered this issue thoroughly because it would mean

that I'm totally dependent on certain things (vitamins, protein) to ensure

future health and I felt a little apprehensive about that. However, the

benefits of malapsorption and long term maintenance of weight were

overhwhelmingly positive factors when weighed against the issue of dependence

on supplements.

Taking my pills really doesn't phase me since I have worked it out around

mealtimes mainly. However, when I get really busy or am dependent on others

to have meals, this schedule can get out of whack (example: I don't eat

dinner until later and then this doesn't give me the 2-3 hours ideally

necessary for an empty stomach when I take my evening iron pills; I eat

breakfast too late and then have to fit the lunchtime pills and meal in so

that dinner won't be so late and hence the former scenario). I found this

particularly true when I was on vacation recently. My brother is a salesman

and doesn't eat regular meals and also has dinner quite late. Whenever we

waited for him my schedule was thrown off. If I stick to my pretty regular

'schedule' of eating, I'm fine and all my supplements get it, get absorbed,

etc.

I am extremely pro-DS myself and wouldn't have had any other surgery.

However, I think that the decision to choose the DS is a serious one and

malapsorption issues are a valid concern. It is not true that people will

just 'spontaneously' develop them but I think that long-term it *could*

become more difficult to maintain compliance, especially if one feels and

looks great (why do I need all those pills? It may start with 'skipping' a

dose and then doing that more frequently, etc.). I think every post-op has

to guard against this mentality and make sure that they do get the bloodwork

and follow up even if they are taking great care of themselves otherwise.

I think most long term post-ops DO THIS but I can see where surgeons could

be concerned that there could be a tendancy not to or decrease commitment to

certain things years down the road....

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: 204 lbs/size sweet 16/large-MEDIUM in normal people's clothing

November 27, 2001

Hi Jane -

Your point misses the mark a bit. We aren't talking about what people have

done already, rather, the concern is about providing accurate information.

When someone makes some off-the wall comment about either surgery, people

here may use that misinformation to choose their own course.

For one, I won't let that slide by, not because I am in some sort of flame

war, but because I believe that we have a responsibility to the newbies to

let them know what our experiences are and what we have learned in our own

research.

Comments the like of which state that the DS causes malnutrition, fatal gas

attacks, stomach cancer, etc., can't be allowed to pass unnoticed. The same

is true for comments which unrealistically tout the superiority of the RNY.

In traversing these posts of bogus information, I reserve the right to

comment on my opinion of those who don't pay attention to what they are

doing when they choose a particular surgery.

Best,

Nick

Re: why all these religious wars about DS vs RnY?

> Dear Steve,

>

> My feelings exactly... Who cares. I also know RNYers (one is my

> mom's friend who is 12 years post-op in perfect health and at a

> perfect weight) and THEY are happy. Who am I to tell them that

> they're really not? I don't waste my time trying to tell them that

> my surgery is better than theirs, na, na, na, na, na....I also

> educated a good friend about the DS so she could help her college age

> daughter find a procedure and surgeon. The daughter went to a local

> hospital and is opting for an open RNY because the doctor was " nice " ,

> has no lap experience and told her open RNY is better anyway because

> he can see and feel everything. Oh well, her life, her body. Your

> eloquence is appreciated.

>

> Jane J.

> 230/151 (-79 lbs)

> Lap BPD/DS

> 4/26/01

>

> > The postings are really occupying too much bandwidth. Who cares???

> >

> > I have a good friend who had the RnY last December. She has done

> > quite well with it, at least so far. her courage in electing to

> have

> > the surgery is what got me interested in WLS in the first place.

> > previously, in my total ignorance, I had thought WLS was just for

> > kooks, the kind of folks who experimented with drugs and voodoo.

> > Then, my PCP, in desperation over my failing health, suggested

> > " stomach stapling " and referred me to a surgeon who does only RnY.

> > My PCP didn't know about ANY other alternatives.

> >

> > With reassurance from my friend who told me only the name of her

> > procedure and that I could look it up in the Web, and with the push

> > from my PCP, I started to do research over the Internet. I almost

> > fell for the Mini-Gastric Bypass before stumbling on the Duodenal

> > Switch site. Back to my friend: she didn't even know if she had

> > received a proximal, medial or distal RnY!! But, she is doing OK.

> > And, she's happy. And, she claims that she can eat just about

> > anything that she wants to eat. She's in New England, and I have

> not

> > had the opportunity to watch her eat to verify that claim. But,

> > really, who cares? If she's happy, then that's all that counts.

> I'm

> > happy that I found the DS and had that procedure instead of the

> RnY.

> > But, does it really matter all that much to anybody but me? I'm

> > just damned lucky that I didn't get the MGB!!!

> >

> > So, to reiterate, " Who cares? " If you don't like somebody's posts,

> > filter them to the trash. Don't try to teach a pig to sing.

> You'll

> > just irritate the pig, and the noise will drive everybody else

> crazy.

> >

> > --Steve

> > --

>

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

>

November 27, 2001

" .....Deadly gas? I personally haven't experienced it.... "

Well, let me tell you, some of MY gas could have been used in the trenches

in WWI.

We keep a candle burning in the bathroom to make it a bunch of minor

explosions rather than one BIG one.

And to those of you that are here for real information and aren't

sure....yes, I'm kidding my gas isn't that bad.

Mostly.

Ford

November 27, 2001

In a message dated 11/27/01 5:28:21 PM, duodenalswitch writes:

<< I believe this is what I wanted so clearly to be understood and is

well within the charter of this board. I did not want that one

statement to go unaddressed, because, in my opinion, it attacted the

source instead of the content and by inference could ultimately

damage a valuable resource to this board. And, my apologies for

giving the impression that I wanted you to either totally agree or

disagree with Nick.>>>>>

Theresa -- Nick talked about how such things he mentioned were inaccurate

(bogus) in the statement FOLLOWING the one you mentioned. Quote the entire

source, not just one paragraph. And, THAT'S what I had a problem with -- and

I do believe the term 'bogus' was used to refer to such statements. His

stating that things such as mention of stomach cancer and the fact that DS

causes malnutrition (it CAN! Can't say that is bogus information!!!) are

irrelevant or not accurate points about the negative aspects of the DS

surgery is what I was picking up on and trying to correct. I can't believe

that someone who DOES CLAIM to know so much can even state that malnutrition

is not a real and valid issue or concern with the Ds surgery.

I do NOT think I'm attacking the source but expressing extreme surprise that

he could make such a comment. It's rather amazing that Nick himself *can be*

so contentious and insulting to people at times and you will totally

disregard this -- but if I mention that I can't believe he would be so bold

as to claim that DS malapsorption is bogus (with some sarcasm that he employs

so frequently) you will state that I am tarnishing his reputation as a

valuable DS source!!!

Needless to say, we will definately agree to disagree on this ad infinatum.

I am sorry that you took such offense at my attempt to clarify a statement

made that I thought was misleading. Now, If I had said 'Nick, you stupid!

How can you say that?' I definately would have been guilty of name-calling

and trying to say that Nick's opinion and comments weren't of value

(something I do believe he has said about those who chose RNY). Instead, I

said -- how can such an intelligent person say something likethis????? I

think these are two different statements altogether but obviously you

consider them to be synonymous.

<<<<In the future, if you would prefer to take a discussion off line with

me, I am more than willing to do so, if instead of posting your

reponse on the board, you respond to me initially offline! I believe

that is fair and then noone feels that they are playing " my last word

stands " .>>>>>

Why would I have to initially post to you offline? Good Lord! When I first

responded to you I never anticipated this kind of ongoing dialogue about

something which to me seemed minor at first but apparently is something more

judging by what you are saying. I think your concern is much deeper than a

disagreement about my attempt to clarify the importance of malapsorption and

the fact that I considered his statements downplaying it. This is why I

strongly suggest that you take it to that level offline because it doesn't

involve anyone else on the list, but you and I.

I'm saying that this is not something that I think should go on the list when

it is apparently a disagreement about Nick (not about what has been said

necessarily). For whatever reason, you feel I personally 'attacked him'

because I expressed surprise that he could make a certain statement.

To clarify: My purpose was NOT to invalidate Nick's experience in the least.

I merely used a bit of sarcasm (which he dishes out an awful lot) to say

that I couldn't believe he would downplay such an important fact about the

surgery. If that was NOT his intent, then I think he should have clarified

his meaning by calling concerns over malnutrition issues 'bogus'. I would

have acknowledged that I misunderstood his intent. That would have been it.

However, it seems that you are insinuating that I have some other purpose to

my post and that I want to tarnish Nick's reputation or something. I think

that Nick can definately damage himself with nasty comments to others, by

name-calling (saying those who get the RNY are 'stupid) and whatnot... but my

being surprised by his disregard for a technical aspect of the surgery that

is a well known fact (not bogus) is not going to invalidate him as a member

of the board, imho.

I think Nick has a lot to contribute to the boards and is a valid member,

even if I totally disagree with the way he expresses himself at times.

Perhaps THIS is the crux of the issue you are bringing up --- and this would

involve Nick and my past history of posting, etc. and I don't think it really

has to do with the post at hand per se.

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: 204 lbs (plateau! Yuck)/size sweet 16

November 27, 2001

In a message dated 11/27/01 5:28:21 PM, duodenalswitch writes:

<< When does someone who does their follow-up, eats their protein and takes

their supplements become malnourished? When did I make a statement that

would include people who can't remember to take a vitamin and some calcium?

These miscreants lead you to believe that malnutrition is a common DS

problem.>>>>>

Nick: wow - that sheesh-back caused a lot of air to whirl around me as I

attempted to grab a rail or something so as not to be swept away.... ROFL

(NOTE: extreme but friendly sarcasm present)

To me, you didn't clarify or expand on your statement that malnourishment

with DS is bogus to include or exclude anyone, that was my point. You stated

that malnourishment was BOGUS (and, by association, that it is not a major

issue of concern, IMHO). I don't think malnutrition is a common DS problem

but it IS a very valid concern for anyone who is looking into the DS. And,

yes, I think it COULD possibly happen to those who don't intentionally forget

to take their vitamins, etc. My subsequent posts did go into some detail

about how extreme/prolonged illness or a change in required supplementation

*could possibly* result in malnutrition problems for those who are otherwise

compliant.

I think the chances are GREATLY reduced for those who are compliant and it

shouldn't prevent someone from having the surgery (thinking that they will

develop some serious deficiency that is totally out of their control), but I

think that it still CAN happen even if one tries their best. That is what

every post-op *should be* prepared for and the very reason that we are

supposed to have regular medical attention and labwork (at LEAST once a year)

to gauge all vitamin, protein and mineral levels, etc. and detect any

variations and address the problems early.

<<<<<< The great Wittgrove, himself, states that he discontinued the DS,

not because compliant patients have problems, but because he is worried that

people might not be compliant. When I made the statement, I presumed that

someone is intelligent enough to pay attention to their doctor and be

totally compliant. If someone chooses not to comply, blame them, not the

DS.>>>>>>

Hmmmmmm.... I don't know if I totally agree with you on this one. I can see

your point -- that someone SHOULD be totally compliant if they are to get the

DS and the problem isn't the DS surgery in this case but the post-op who

ignores post-op rules and regs for health (I think it's the best surgery out

there but I wouldn't state that it is appropriate for everyone - that's a

point on which we've disagreed before).

However, I can ALSO see how, over time long term, people can become less

attentive to the post-op program... Not because they are lacking in

intelligence per se or because they intentionally want to tempt fate but

because they feel so damn great, get very busy and occupied with their

everyday lives and little 'slips'/'lapses' become bigger ones eventually.

I think it's only part of human nature. It's kind of akin to the 'if it

ain't broke, don't fix it' philosophy: If labs are great and one feels

wonderful, is it so so so so urgent that you get those labs on time.. maybe

they can be delayed until you are a little less busy, etc.? Do you REALLY

need all THREE of those ADEK pills EVERY DAY (I realize that many people do

not take this many - just an example)? etc, etc. I'm not saying that

everyone will give in to this way of thinking but I'm sure it's more common

than you would think. I also think it something that EVERY post=op (except

the select few who are very organized, regimented and self-aware so as to

never miss a supplement) must struggle with and watch out for. I honestly

don't think it has to do with intelligence level.

I think people start out with EVERY intent to follow their surgeon's orders

TO THE LETTER. They want to get all that protein in and take all their

vitamins. This exhuberance *could* wane over time and the spector of severe

deficiencies, which is ALWAYS THERE regardless (it is, in essence, literally

BUILT INTO the surgery), can be downplayed in a healthy post-op's mind over

time. I don't agree that surgeons should openly discourage the DS (they do

show a very biased attitude when they will dole out the equally-distal RNY

without so much as a peep about the potential for future problems but bitch

and moan about the dangers of the DS). I just think that the very real risk

of malnourishment should never be downplayed or overlooked and that it may

become easier and easier to do so the longer one is post-op and the longer

one has positive experience with post-op labs, etc.

In other words, the risk remains the same regardless of whether one has three

months, one year or a decade of healthy post-op life. It can crop up at ANY

TIME if someone breaks from the routine of supplements and protein OR if

someone skips doctors visits/labs EVEN THOUGH they are totally faithful to

their supplement/protein routine. However, if someone has been healthy for

a longer period of time, they may mistakenly feel they have some 'immunity'

or a sort of 'freedom' to let things slide (a little at first, of course) and

this *COULD* result in a deficiency even if they have a 'perfect' track

record. That's my point.

<<<<<<As to the gas, yes, sometimes we have it. As I recall, not that long

ago,

when I was a pre-op, I had occasion to break wind, too. Sometimes it was

with great frequency. Why should I be surprised to have gas as a post-op?

As to it being a significant problem, I scarcely believe that it is as great

a problem as the RNY crowd would have us believe. Does our poop stink?

Sure. Did it stink before surgery. Well, as I recall . . . yep.>>>>>>

I think for some people, it IS a big problem. I never really had gas as a

pre-op and I don't have excessive gas as a post-op. I can honestly say that

this problem is NOT one that affects my life except at home on ocassion (my

gas comes in the evening when it does and then ... well, let's just say

everyone thinks that my 2 1/2 year old has pooped in his pants! Both my mom

and dh have commented to this effect when I've had a strong fart!! LOL). I

can extrapolate that if I had this type of gas frequently it *could be* quite

embarassing and others would most likely comment about the strength of such

flatulence. The odor *can* linger more than a regular pre-op fart (although

this doesn't always happen) and *can* be much stronger than a pre-op fart.

I totally agree with you that any blanket statements about how everyone who

had the DS is stinky or must wear charcol underwear is totally erroneous.

But, there is a range of experience for post-op DSers and some of these folks

themselves (not RNY proponents) have described in great, agonizing detail how

bathroom smell and/or flatulence has impacted their daily lives in a negative

manner. I think that the good news about this is: IT CAN BE CORRECTED and

ALMOST ALWAYS ISN'T PERMANANT! :) It may take awhile, but trying charcol,

devrom, flagyl and altering one's diet, etc. CAN help reduce this side effect

to a level where it is comfortable and not embarassing. I also think

that distal RNY folk could suffer similar fates and many pro-RNY folk do not

distinguish between these two surgeries which carry the same 'name'

essentially-- the proximal and distal RNY are really two different animals

and post-op lifestyle and requirements are likewise different.

<<<<<<Do any of the things above rise to the level that RNY patients would

have us

believe to be the DS reality? Do you really think so? Nah. No way.>>>>>>

I see more now that your entire argument is in reponse to pro-RNY folk

whereas I read your statement about malapsorbtion in isolation and not as a

rebuttal to RNY proponents in particular. I have had experience with various

RNY surgeons and patients and some of them have distorted views of the DS

procedure (or have an almost total lack of knowledge). I think they have a

totally different view of obesity and how to 'control' it than I do for the

most part. But, I also think that many of them honestly believe that the

proximal procedure is 'safest' for them in the long run. Some people just

DON'T want to mess with maximum malapsorption and the onus of lifelong

responsibility it puts on someone.

For example, I've heard that some young women DO want to get pregnant (most

often for the first time) and they think it would be healthier on the body,

etc. to do this with a less malapsorptive procedure. While I don't think it

is necessarily dangerous to become pregnant post-op DS, I think that it

requires much monitoring and there is always a possiblity that things *could*

go out of wack (just as there is always the possibility of something going

'wacky' with any pregnancy and delivery - they are not often predictable).

Many opt for the 'lapband' over the RNY due to this very fact.

I think that a proximal procedure *can be* much less effective in the long

run. I also think the whole concept of having to 'punish' yourself and

suffer from and develop such unnatural habits towards eating is quite

offensive and certainly akin to developing some kind of post-op eating

disorder (I have commented on this before in much earlier posts, too).

HOWEVER, I can also see where someone *could be* put off by the seriousness

of possible deficiencies that can develop post-op DS. Sure, they are pretty

easy to avoid but there are no guarantees that one will NEVER experience any

in their post-op life (I realize that you've mentioned this in a balanced way

in your posts). I don't have any problems with my post-op lifestyle and

feel I've been FREED and am now finally able to develop a normal and healthy

relationship with food. I'm glad that the lapband at least now can provide

people with another proximal option over the RNY. I can only hope that all

WLs patients at least look at ALL options and are able to get balanced

information (the good, the bad, the ugly and the beautiful) on the DS. I'm

all with ya there!

<<<<<Okay, I've dismounted from the soap box and you are hereby

de-SHEESHed.>>>>

Whew! What a windstorm! ROFL Thanks for your reply -- You've clarified

some things about your position in my mind. I still think that it is

entirely possible for post-ops to develop a more lax attitude towards

supplements and protein... and that this has nothing to do with a lack of

intelligence. It is something that every post-op should be reminded of, imho

in order to guard against it.

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: 204 lbs (gained! Plateau! Yikes!)/size sweet 16

November 27, 2001

In a message dated 11/27/01 6:43:07 PM, duodenalswitch writes:

<< Yep, , you are hereby re-SHEESHed.

Yes, you can take what I said and massage it into something that it wasn't

and you have done so well. What you ended up with in no way reflects what I

originally said. You simply added too many " ifs. "

>>

Well, Nick: Try to clarify things a little more and people will not insert

any 'ifs' in the mix.... You did state that malapsorption issues with the DS

were bogus... You did NOT explain exactly who that statement applied to (or

who was excluded) until later. Some people seem to be able to interpret and

understand and read between the lines of what you say whereas I have a more

difficult time doing that with some statements that just don't make logical

sense to me.

You specifically advised that pre-ops not be told such 'lies' or

'insinuations' whereas I think pre-ops SHOULD think long and hard about

malapsorption and consider it a serious issue . Not that you said it isn't

serious but I thought your above statement downplayed the potential risk.

Post-op experience can and does vary GREATLY and CAN include such terrible

things as horrid gas, diahhrea and serious deficiencies. No, not everyone

experiences them but it IS there as a reality for some folk. To gloss over

it to me is doing a disservice to pre-ops, imho.

My point, regardless of whether you add or subtract people from your

statement about the focus on malapsorption being a post-op issue, is that

malapsorption should NOT be discounted or downplayed. I think it is possible

for this to occur the further post-op one gets wheras you seem to think that

an intelligent post-op would 'never' do such a dangerous thing as to alter

their supplement regime, not get routine. Such perils are NOT only discussed

by RNY folk but by post-ops themselves. I really don't think it's a

conspiracy of RNY folk but I do agree with you that an over-emphasis on such

things by pro-RNY people *can* discourage people from figuring out the whole

story themselves. As with any stereotype, there is a bit of truth to what

they are saying --- It may not apply to all post-ops or be totally accurate,

but it IS part of our overall reality.

You are not to be un-SHEESHED today.>>>>>

Aw,shucks -- guess I'm NOT going to get that little peck on the cheek to show

solidarity --- maybe a handshake? :) LOL

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: 204 lbs/size sweet 16

November 27, 2001

In a message dated 11/27/01 6:43:07 PM, duodenalswitch writes:

<<

They transsect the stomach and rearrange the intestines-how is this

different from the DS? They did 400-it sounds like he was working at this

for a while.

>>

Uhhh...the traditional BPD is radically different from the DS in terms of the

stomach. The BPD removes the antreum and makes a stoma-like connection

between the remaining stomach and intestines. The intestinal arrangement is

similar but the traditional BPD allowed for a 50 cm common channel whereas

the DS gives more duodenal space before the 'switch' and also traditionally

gives more room to the common channel (although it can also be as short as 50

cm in some cases).

And, since Dr. Wittgrove is formulating his stance based on the 'older'

surgery (which the DS was meant to alleviate), I don't think he has an

adequate understanding of the DS surgery and how it *can be* more

advantageous to the patient in terms of allowing more absorption while still

maximizing weight loss, etc.

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: 204 lbs/size sweet 16

November 27, 2001

Well, a great big SHEESH back at you, !

When does someone who does their follow-up, eats their protein and takes

their supplements become malnourished? When did I make a statement that

would include people who can't remember to take a vitamin and some calcium?

These miscreants lead you to believe that malnutrition is a common DS

problem. The great Wittgrove, himself, states that he discontinued the DS,

not because compliant patients have problems, but because he is worried that

people might not be compliant. When I made the statement, I presumed that

someone is intelligent enough to pay attention to their doctor and be

totally compliant. If someone chooses not to comply, blame them, not the

DS.

As to the gas, yes, sometimes we have it. As I recall, not that long ago,

when I was a pre-op, I had occasion to break wind, too. Sometimes it was

with great frequency. Why should I be surprised to have gas as a post-op?

As to it being a significant problem, I scarcely believe that it is as great

a problem as the RNY crowd would have us believe. Does our poop stink?

Sure. Did it stink before surgery. Well, as I recall . . . yep.

Do any of the things above rise to the level that RNY patients would have us

believe to be the DS reality? Do you really think so? Nah. No way.

Okay, I've dismounted from the soap box and you are hereby de-SHEESHed.

Best-

Nick

Re: Re: why all these religious wars about DS vs

RnY?

>

> In a message dated 11/27/01 12:15:57 PM, duodenalswitch

> writes:

>

> <<

> Comments the like of which state that the DS causes malnutrition, fatal

gas

> attacks, stomach cancer, etc., can't be allowed to pass unnoticed. The

same

> is true for comments which unrealistically tout the superiority of the

RNY.

>

> In traversing these posts of bogus information, I reserve the right to

> comment on my opinion of those who don't pay attention to what they are

> doing when they choose a particular surgery.

> >>

>

> Nick: It is a fact that the malapsorption of the DS CAN CAUSE

nutritional

> deficiences. Sheesh - for someone who claims to know what they are

talking

> about, it is rather ridiculous to state that this is 'bogus

information'!!!!!

> To belittle this means putting people at possible severe risk if they

don't

> realize how crucial it is to take supplements and get protein in DAILY.

Each

> person's body adjusts differently over time and different people may

require

> a different set/strength of supplements but to say that they aren't needed

> (which basically is what you're saying if you think that the DS cannot

cause

> nutritional deficiencies) is inaccurate.

>

> These deficiencies take time to develop and often aren't noticed until

they

> are at such a serious level as to become life-threatening and/or so

serious

> at to require intensive intervention. Knowing this fact may make someone

who

> is leary of a malapsorptive procedure choose a proximal one but it is

> necessary for anyone having a malapsorptive surgery to realize this and

take

> care of themselves. This fact certainly does not have to interfere with

> normal lifestyle and, as long as people are getting proper aftercare,

regular

> bloodwork, taking their supplements/protein, I really don't think they

will

> encounter any deficiencies. But, one's body needs can change and the

levels

> of nutrients (especially the malapsorbed ones like fat-soluable vitamins

and

> protein) must be monitored to maximize health and catch any dips early.

>

> As far as stomach cancer goes, this procedure has NOT been proven to carry

> any increased risk, although stomach surgeries in GENERAL ARE considered a

> risk factor. I am not sure if the sleeve gastrectomy would carry a lesser

> risk (because the lower stomach is left totally intact), but I have read

that

> any alteration of the stomach *can* increase risk. I have posted various

> articles online, so the archives would have such things and such

references.

>

> Deadly gas? I personally haven't experienced it but for those who have

(and

> I really don't think they are lying when they relay their experiences or

are

> deliberately trying to make things sound worse than they are), I'm sure it

is

> bothersome and a major concern. I do NOT think every post-op experiences

> this, it could very well be related to what is eaten but the process of

trial

> and error to discover what bothers the intestines can be a long and

> frustrating one.

>

> I think it is irresponsible to pre-ops to call such possible outcomes of

the

> DS surgery as 'bogus information' because it is NOT. It may not be the

> result of the majority of surgeries but some people DO experience it and

> struggle with it (look at Joe Frost with severe protein deficiency).

>

> 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: 204 lbs/size sweet 16/large-MEDIUM in regular people's clothing!

>

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

>

November 27, 2001

***BLUSH***

Nick

Re: why all these religious wars about DS vs RnY?

> I think the point being made by Nick..and why I bother to talk for

> Nick I have no frigging idea because he is one of the most

> intelligent, articulate, honest and accurate individuals I have ever

> had the pleasure of calling friend....well that said, the rumours of

> nutritional deficiencies are implied that they are NOT preventable.

> As in, if you get the DS you WILL suffer from nutritional

> deficiencies.

>

> That is how it is presented, because it was presented exactly that

> way to me. I had to research to discover that if I was NOT

> compliant, this could be a side affect.

>

> The same could be said that if you are a pedistrian in San Francisco,

> you will get hit by a car. When indeed the accurate statement is

> that if you are not diligent in San Francisco, and wait when the

> light turns green, you seriously increase your risks for being hit by

> a car.

>

> I do not see one inaccurate statement made by Nick and I would stand

> by what he says....but then...flock it...I love Nick!

>

> Laughing,

> Theresa

> Dr. Jossart

> 11-19-01

>

> Still looking for the truck that hit her last week!

>

> > Nick: It is a fact that the malapsorption of the DS CAN CAUSE

> nutritional

> > deficiences. Sheesh - for someone who claims to know what they are

> talking

> > about, it is rather ridiculous to state that this is 'bogus

> information'!!!!!

> > To belittle this means putting people at possible severe risk if

> they don't

> > realize how crucial it is to take supplements and get protein in

> DAILY. Each

> > person's body adjusts differently over time and different people

> may require

> > a different set/strength of supplements but to say that they aren't

> needed

> > (which basically is what you're saying if you think that the DS

> cannot cause

> > nutritional deficiencies) is inaccurate.

> >

> > These deficiencies take time to develop and often aren't noticed

> until they

> > are at such a serious level as to become life-threatening and/or so

> serious

> > at to require intensive intervention. Knowing this fact may make

> someone who

> > is leary of a malapsorptive procedure choose a proximal one but it

> is

> > necessary for anyone having a malapsorptive surgery to realize this

> and take

> > care of themselves. This fact certainly does not have to interfere

> with

> > normal lifestyle and, as long as people are getting proper

> aftercare, regular

> > bloodwork, taking their supplements/protein, I really don't think

> they will

> > encounter any deficiencies. But, one's body needs can change and

> the levels

> > of nutrients (especially the malapsorbed ones like fat-soluable

> vitamins and

> > protein) must be monitored to maximize health and catch any dips

> early.

> >

> > As far as stomach cancer goes, this procedure has NOT been proven

> to carry

> > any increased risk, although stomach surgeries in GENERAL ARE

> considered a

> > risk factor. I am not sure if the sleeve gastrectomy would carry a

> lesser

> > risk (because the lower stomach is left totally intact), but I have

> read that

> > any alteration of the stomach *can* increase risk. I have posted

> various

> > articles online, so the archives would have such things and such

> references.

> >

> > Deadly gas? I personally haven't experienced it but for those who

> have (and

> > I really don't think they are lying when they relay their

> experiences or are

> > deliberately trying to make things sound worse than they are), I'm

> sure it is

> > bothersome and a major concern. I do NOT think every post-op

> experiences

> > this, it could very well be related to what is eaten but the

> process of trial

> > and error to discover what bothers the intestines can be a long and

> > frustrating one.

> >

> > I think it is irresponsible to pre-ops to call such possible

> outcomes of the

> > DS surgery as 'bogus information' because it is NOT. It may not be

> the

> > result of the majority of surgeries but some people DO experience

> it and

> > struggle with it (look at Joe Frost with severe protein deficiency).

> >

> > 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: 204 lbs/size sweet 16/large-MEDIUM in regular people's

> clothing!

>

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

>

November 27, 2001

Nick wrote:

> The great Wittgrove, himself, states that he

> discontinued the DS, not because compliant

> patients have problems, but because he is

> worried that people might not be compliant.

That's not quite accurate, Nick. Wittgrove made that comment about their

short-lived BPD series. Alvarado has never done the Duodenal Switch

procedure.

> As to the gas, yes, sometimes we have it. As I recall, not

> that long ago, when I was a pre-op, I had occasion to break

> wind, too. Sometimes it was with great frequency. Why should

> I be surprised to have gas as a post-op? As to it being a

> significant problem, I scarcely believe that it is as great

> a problem as the RNY crowd would have us believe.

I actually think that RNYs have this issue just as much as DS folks, but

it's not talked about as much for whatever reason. I have seen the topic

on RNY boards though, especially among more medial to distal RNY

patients.

M.

---

in Valrico, FL, age 39

Lap DGB/DS by Dr. Rabkin 10/19/99

Starting weight 299, now 153

Starting BMI 49.7, now 25.5

Starting size 26/28, now 10/12

http://www.duodenalswitch.com/Patients/M/melaniem.html

Direct replies: mailto:melanie@...

November 27, 2001

Yep, , you are hereby re-SHEESHed.

Yes, you can take what I said and massage it into something that it wasn't

and you have done so well. What you ended up with in no way reflects what I

originally said. You simply added too many " ifs. "

You are not to be un-SHEESHED today.

Best-

Nick

Re: why all these religious wars about DS vs RnY?

>

> > ,

> >

> > So then, what you are saying is that the statements Nick made are

> > accurate. Every single component of living can have a what if. Jim

> > Fixx, noted health guru and jogger died of a heart attack at a very

> > early age.

> >

> Theresa: I do not want to get into semantics about Nick's post. I

> brought up the fact that stating that there are nutritional risks with

> the DS IS a valid and true statement whereas his post seemed to

> insinuate that this was merely 'hogwash'. He did not clearly state

> that his beef was with those who imply that such nutritional defects

> are inevitable but merely stated that making a connection about

> nutritional deficiencies and DS is an inaccuracy.

>

> I do not think the statements that Nick made are accurate. They may

> have been incomplete and needed to be expanded upon and this is why I

> wrote the reply to clarify that the DS DOES carry nutritional risk.

> Such risks can be greatly reduced with proper aftercare and

> supplementation/protein but they will ALWAYS be there. There may be

> situations in one's life where one has little control over the

> development of malnutrition (such as severe and prolonged illness,

> etc) although it is true that keeping up with one's supplemention is

> the most likely way one will avoid deficiencies as a post-op.

>

> To me, my posts which are meant to clarify certain things about

> malnutrition and DS are not to be taken as a battle of wills between

> Nick and I... Why are you insisting that any response I have to Nick

> is either totally agreeing with him or totally disagreeing with him?

> I thought his post needed clarification and did NOT want preops to

> downplay the importance of nutritional risks with the DS surgery.

> Let's not make my feeling the need for additional information and

> clarification an issue of contention.

>

> If you do feel the need to discuss this further for any reason, please

> privately e-mail me about it. I really don't think that it adds

> anything to the list to keep insisting that I agree with Nick or

> not... I thought I was adding clarification to his posts where things

> weren't clear to me. IF Nick has problems with any responses I've

> made, he's welcome to e-mail me as well. So far, I haven't heard

> anything from him. I don't think he needs people to 'stick up for

> him' on this list -- He is totally able to express himself and does so

> often! LOL

>

> 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

> n

>

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

>

November 27, 2001

said:

> That's not quite accurate, Nick. Wittgrove made that comment about their

> short-lived BPD series. Alvarado has never done the Duodenal Switch

> procedure.

From Wittgrove's website:

Bilio Pancreatic Diversion

The most powerful operation currently available, but accompanied by

significant nutritional problems in some patients. We're concerned about

this, and no longer recommend the operation for most patients.

This very powerful operation involves removal of approximately 2/3 of the

stomach, and re-arrangement of the intestinal tract so that the digestive

enzymes are diverted away from the foodstream, until very late in its

passage through the intestine. The effect is to selectively reduce

absorption of fats and starches, while allowing near-normal absorption of

protein, and of sugars. Calorie intake is much reduced, even while

normal-sized food portions are eaten.

Although this operation is very powerful, patients are subject to

increased risk of nutritional deficiencies of protein, vitamins and

minerals. Vitamin supplementation recommendations must be carefully

followed, and dietary intake of protein must be maintained, while intake of

fat must be limited. Patients are annoyed by frequent large bowel movements,

which have a strong odor. Excess fat intake leads to irritable bowel

symptoms, and may lead to rectal problems.

We have performed over 400 of these operations, and have analyzed our

results and outcomes over a long term. Although most patients obtain

excellent weight loss, and maintain good health and nutrition, we have been

concerned that some do not maintain contact with us, or follow a healthful

diet and vitamin regimen, and that this may lead to serious nutritional

disturbances, or the need to revise the operation. When compared to the

Gastric Bypass, in our hands, this operation achieves similar weight loss,

but at a higher risk of nutritional side-effects. Therefore, we recommend it

only in certain specific situations, and advise against its routine

performance. "

~~~~~~~~~~~~~~~~~~~

-

They transsect the stomach and rearrange the intestines-how is this

different from the DS? They did 400-it sounds like he was working at this

for a while.

Thanks -

Nick

November 27, 2001

> -

>

> They transsect the stomach and rearrange the intestines-how is this

> different from the DS?

Nick, the difference is that it doesn't include a duodenal switch. The

description below refers to their BPD series, of which our own Sharon

Snyder was a recipient. You are right though that a series of 400 may

not be accurately described as " short-lived " . Nevertheless, it is indeed

the Scopinaro BPD that is being discussed below, and not the DS.

> They did 400-it sounds like he was

> working at this for a while.

My personal is that they halted their BPD offering not because it wasn't

working, but because they had " perfected " their lap RNY procedure and

were seeing good results with it (and presumably patient non-compliance

not having as serious a potential for problems). Alvarado's published

lap RNY results are still the best anywhere; other RNY results pale in

comparison, for whatever reason. How many BPD-related nutritional

problems they actually saw is unknown. I know that Sharon and her Mom

and Cousin all had an Alvarado BPD and they are 10+ years post-op and

doing well.

M.

---

in Valrico, FL, age 39

Lap DGB/DS by Dr. Rabkin 10-19-99

http://www.duodenalswitch.com/Patients/M/melaniem.html

Direct replies: mailto:melanie@...

> Re: Re: why all these religious

> wars about DS vs RnY?

>

> said:

>

> > That's not quite accurate, Nick. Wittgrove made that

> comment about their

> > short-lived BPD series. Alvarado has never done the Duodenal Switch

> > procedure.

>

> >From Wittgrove's website:

> Bilio Pancreatic Diversion

> The most powerful operation currently available, but

> accompanied by

> significant nutritional problems in some patients. We're

> concerned about

> this, and no longer recommend the operation for most patients.

>

> This very powerful operation involves removal of

> approximately 2/3 of the

> stomach, and re-arrangement of the intestinal tract so that

> the digestive

> enzymes are diverted away from the foodstream, until very late in its

> passage through the intestine. The effect is to selectively reduce

> absorption of fats and starches, while allowing near-normal

> absorption of

> protein, and of sugars. Calorie intake is much reduced, even while

> normal-sized food portions are eaten.

>

> Although this operation is very powerful, patients are subject to

> increased risk of nutritional deficiencies of protein, vitamins and

> minerals. Vitamin supplementation recommendations must be carefully

> followed, and dietary intake of protein must be maintained,

> while intake of

> fat must be limited. Patients are annoyed by frequent large

> bowel movements,

> which have a strong odor. Excess fat intake leads to irritable bowel

> symptoms, and may lead to rectal problems.

>

> We have performed over 400 of these operations, and have

> analyzed our

> results and outcomes over a long term. Although most patients obtain

> excellent weight loss, and maintain good health and

> nutrition, we have been

> concerned that some do not maintain contact with us, or

> follow a healthful

> diet and vitamin regimen, and that this may lead to serious

> nutritional

> disturbances, or the need to revise the operation. When

> compared to the

> Gastric Bypass, in our hands, this operation achieves similar

> weight loss,

> but at a higher risk of nutritional side-effects. Therefore,

> we recommend it

> only in certain specific situations, and advise against its routine

> performance. "

>

> ~~~~~~~~~~~~~~~~~~~

>

> -

>

> They transsect the stomach and rearrange the intestines-how is this

> different from the DS? They did 400-it sounds like he was

> working at this

> for a while.

>

> Thanks -

>

> Nick

>

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

>

November 27, 2001

Hi -

Thanks for the clarification-

I have to agree about why they abandoned the BPD. They were also involved

with the AGB trials and abandoned it. Their results weren't anywhere near

as good as the ones for the AGB outside the US. I read some criticism of

them on the AGB lists that suggested that they weren't doing a good job with

the followups, fills, etc. As I recall, they didn't even complete the

trials.

Why would they need to if they are happy with their RNY mill?

Best-

Nick

November 27, 2001

Hi -

Oh boy! I get to be picky, too ! ! !

I will not focus on your entire post as it is getting to be my bedtime.

However, when you said " the DS gives more duodenal space before the

'switch', " you fail to take into account that DS surgeons vary substantially

in how much of the duodenum they leave attached to the pylorus. The range

is from 2 to 5 cm. with the NY surgeons tending to the shorter size. This

presents issues in absorption of vitamins. When you talk about taking 3

ADEKs, that is completely foreign to some of us in the west. Dr. K leaves a

longer piece of the duodenum and recommends only one multivitamin and 1500

mg. of calcium per day. This is a much easier regimen to follow, at least

for me. This might well account for why you see supplementation as more of

a challenge than I do.

Anyway, as far as everything else is concerned, you can have the last word.

I think that horse has been beaten to death. It will receive no more

flogging from me.

Okay - just a little smack on the cheek - (without sarcasm on my part).

Best -

Nick

November 28, 2001

In a message dated 11/28/01 1:04:54 AM, duodenalswitch writes:

<<

Give it a rest, -

Your constant massaging of my post is getting to be a bit boring.

>>

Nick - I have no interest in massaging your posts, just clarifying my point.

I was not the one who began this except to respond to a statement you made

about malnourishment and responding that I thought it should NEVER be

belittled or ignored and brought up possible scenarios as a post-op where

this would be possible.

You can be as bored as your little heart desires -- use the delete key

freely! It won't bother me a bit!

November 28, 2001

In a message dated 11/28/01 1:04:54 AM, duodenalswitch writes:

<< I will not focus on your entire post as it is getting to be my bedtime.