Weight Loss/Maintenance

I researched for about 3 years before making a fully informed decision as to which surgery would be best for me.

*edited to add* I went from 302lbs to a maintained weight loss of 139lbs. I had surgery March 15th 2005.



As you well may know there are many types of surgery for weight loss.

Lap Band, least invasive of all surgeries but without the huge weightloss results. I have 2 friends who've had this and neither is happy with the results.

Roux en Y, Does not retain the pyloric valve therefore you lose the advantage of digestive juices and also RNY patients are prone to dumping syndrome. People who have the RNY have a pouch.

Sleeve Gastrectomy, the stomach is made smaller therefore your intake is restricted. this surgery is often done in preparation for the BPD/Ds on patients who are so obese that the entire surgery, the diversion with the switch could be life threatening. Stage two is often done after significant weight loss and health improvement.

Bileopancreatic Diversion with a duodenal switch is the most invasive of all the surgeries. The stomach is reduced in size to about 3-4 ounces (it will stretch a bit over time) and the intestines are re-routed. This is also the most successful of all the operations. Not only do you get the restrictive element but you get the malabsorption part too. IF you don't look after yourself properly, IE: take all of your vitamins and supplements, eat properly and stay hydrated the malabsorption can lead to serious problems.

I have found that most primary physicians are not well schooled in Bariatric Surgery. They seem to be of the opinion that they are all the same. You'll need a good Surgeon, a good Primary for follow up and probably an endocrinologist to monitor all your lab work/results.

When I was looking for a new Dr I prepared this for him.

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• I have had a combined restrictive-malabsorptive procedure in which the restrictive part will substantially resolve over time, but malabsorptive part is permanent.
• Because of this malabsorption, I need regular bloodwork to confirm I am absorbing enough protein, vitamins, and minerals. Please see the list that I have attached of blood tests that I need annually or more often if I am having a problem.
• I malabsorb DIFFERENT vitamins and micronutrients from gastric bypass patients, and I need you to NOT make assumptions based on what you may have read about regarding different procedures. In addition, time-release medications may not be appropriate for me.
• Fat-soluble vitamin and calcium malabsorption are primary concerns because of the duodenal bypass, and must be monitored closely -- and SPECIFIC tests that my surgeon recommends must be ordered routinely -- this is NOT negotiable. Calcium must be monitored via PTH and vitamin D3 -- perhaps not the usual tests you routinely order for non-DS patients, but none the less I will need this testing frequently and I will need your support in this matter. I may also ask you to provide me with or fax copies of my lab results to my DS surgeon, who has additional expertise in helping me manage my post-op long-term care. A copy of my annual lab requirement is attached.
• From time to time there may be specialized tests that my DS surgeon will request and I will need you to support and respect these requests.
• Other tests, such as albumin, liver function, etc., are also extremely important, as is a baseline and at least every other year I will need a DEXA scan.
• I do not absorb 80% of the fat that I consume, so please do not get concerned that I am eating too much fat. I also malabsorb about 30-50% of the protein and complex carbohydrates I eat, so I must eat more protein than you might think appropriate.
• My primary challenges with living with the DS are, in no particular order:
o Eating 80-100 g of protein/day
o Taking my supplements
o Monitoring my labs to head off any problems as quickly as possible
o Dealing with the stool and gas issues, both volume and smell, which in most cases may be a direct result of my diet: complex carbohydrates, especially white flour, increase the smell and volume of both, and too much fat can cause diarrhea
o Sometimes, constipation is also an issue.

• The intestinal bypass may result in imbalance in the bacterial flora and I may ask you to prescribe unusual antibiotics from time to time -- perhaps even prophylactically if I have difficulties with gas and diarrhea - I need to know if you have a problem with this. You may be interested in information I have access to about non-prescription probiotic replacement products that I would be happy to share with you, and which you might find useful with your "normal" patients with intestinal issues such as IBS as well.
• Because I have a normally functioning stomach, I should not have any particular problems with taking NSAIDs or anticoagulants, in contrast with RNY patients.
• NOT every problem I have will be DS-related, just as NOT every problem I had pre-op was obesity-related (an unpleasant and dangerous issue many morbidly obese patients have experienced). Nevertheless, my DS needs to be taken into consideration if problems
•
• arise, either as a source of the problem or as a consideration in how medication will be absorbed.
• As with any abdominal surgery patient, I have an increased risk of bowel obstructions, even years after my DS surgery. These can be because of bowel slipping into internal hernias, or holes in the mesentery, as well as into spaces that develop because I have lost abdominal fat. However, there is one very important issue that is particular to the differential diagnosis of bowel obstruction in DS patients (as well as, to a lesser extent, in RNY patients): we can have a complete intestinal obstruction and still be passing stool and gas, because the obstruction can be in the biliopancreatic limb (and thus the alimentary limb could still be fully patent). Thus, it may be necessary to order a CAT scan for me if I present with severe belly pain, even if I am still able to pass stool and gas.

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REQUIRED LAB orders.

ANNUAL DUODENAL SWITCH LAB ORDERS
Dx: POST-SURGICAL MALABSORPTION, 579.3a
Please Draw the Following:
• CBC
• COMPREHENSIVE METABOLIC PANEL
• FASTING LIPID PANEL
• FERRITIN
• FOLATE
• IRON
• MMA (Methylmelonic Acid)
• PHOSPHORUS
• PTH, intact with Calcium
• TSH
• VITAMIN A
• VITAMIN B6
• VITAMIN B12
• VITAMIN D, 25 HYDROXY
• ZINC
Note:
VITAMIN A REQUIRES 2 ML FROZEN SERUM
VITAMIN B6 REQUIRES PLASMA - FOIL WRAPPED
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I hope this helped And good luck to you !!

aA
kesha
edited to fix 130lbs to the correct 139lbs --darned fingers.