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Post by mlleelise on Jan 20, 2012 10:35:38 GMT -5
Good morning, everyone! Well, I was all set to go to CA for surgery on the 27th with Dr. Keshishian, when I found out that my Medicare Part A will pay for the hospital - but not at the hospital in Glendale. I am activating my Part B which pays for doctor fees, but again, that won't help in Glendale. Long story, short: my original plan was to go to Dr. Roslin in NY for a LAP DS; health insurance fell through. Now, with Medicare he and the hospital are totally covered. However,(this is a big however) I just found out that he always makes the common channel 125 to 150cm long with a 38 bougie. In his communication, he said he will NOT shorten it because he believes any shorter is very dangerous, long-term. Dr. Keshishian was going to do a 70cm channel, and open surgery (which I pretty much prefer)....but it's going to be self-pay. I'm not rich - far from it. But I want to make sure that the surgery is done right & will work. If that means self-pay, then it's self-pay. I'd like to hear from some Roslin patients & how they are doing with the longer common channel...and from longterm Dr. Keshishian patients. Thanks so much!!!
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Post by Girlrocker on Jan 20, 2012 10:45:14 GMT -5
I'm glad you further clarified and posted here, I think you will get really informed responses that will help you with this.
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Post by ricky136 on Jan 20, 2012 11:14:10 GMT -5
My surgeon does a 100 cm common channel. I will also be interested in the responses on the longer and shorter versions.
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Post by Deleted on Jan 20, 2012 12:09:44 GMT -5
Doesn't Dr. K. also use a hospital, in another location, that takes Medicare?
Lots and LOTS of people have a standard length CC around that size, and they do just fine. Personally I think the Hess method makes the most sense, where it's a matter of percentages of total small bowel length (and it's not just about the common channel, it's about how the alimentary and BP limbs are constructed). But the jury (of research) is out about whether the differences in results are really all the meaningful.
I have a 75 cm common channel, which is a little more than 10% of my total small bowel length, more like 12%. If I had 100 cm, it would be 14%, and 125 cm would be 18%. I daresay that 4% difference would be just about meaningless in terms of how much weight I lost or maintained. It might or might not make any difference in micronutrient malabsorption, but I rather doubt it.
I hope that helps put some of these numbers in better perspective.
Oh, also, that bougie size is pretty darned small, meaning you'd have a high degree of restriction that would last a LONG time.
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trxxyy
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Post by trxxyy on Jan 20, 2012 12:36:18 GMT -5
Doesn't Dr. K. also use a hospital, in another location, that takes Medicare? He also operates out of Delano Regional Medical Center in Delano, CA (north of Bakersfield). I had my DS there and although it is a small rural hospital I had great care. I think Dr. K. has a small wing of the hospital just for his patients, at least while I was there. It is a very, very small town but not too far from Bakersfield which is much larger. Sorry, I can't answer the Medicare question. -shelly
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Post by calendargirl on Jan 20, 2012 12:50:54 GMT -5
Here is an article written by Dr. Hess on the limb measurements: www.springerlink.com/content/qn23527k0nkh682n/Even with that info, it seems that many doctors have their own preferences with regard to stomach size and limb lengths... Dr. K is a very communicative doctor, and if you ask him about it, he will be more than willing to discuss his position on the subject. I hope you find the answers you are seeking.
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Post by dsnuts on Jan 20, 2012 13:56:21 GMT -5
Doesn't Dr. K. also use a hospital, in another location, that takes Medicare? He also operates out of Delano Regional Medical Center in Delano, CA (north of Bakersfield). I had my DS there and although it is a small rural hospital I had great care. I think Dr. K. has a small wing of the hospital just for his patients, at least while I was there. It is a very, very small town but not too far from Bakersfield which is much larger. I think the Delano hospital is better than the Glendale one. The Delano hospital is a center of excellence; Verdugo in Glendale is not.
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Post by teachmid on Jan 20, 2012 16:41:50 GMT -5
He also operates out of Delano Regional Medical Center in Delano, CA (north of Bakersfield). I had my DS there and although it is a small rural hospital I had great care. I think Dr. K. has a small wing of the hospital just for his patients, at least while I was there. It is a very, very small town but not too far from Bakersfield which is much larger. I think the Delano hospital is better than the Glendale one. The Delano hospital is a center of excellence; Verdugo in Glendale is not. A COE hospital is actually only an insurance designation.
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Post by teachmid on Jan 20, 2012 16:44:21 GMT -5
I personally would trust Dr. Keshishian to do the right thing for you. I did. I trust his professional judgement and experience. That being said, ask him. He is very approachable and loves to teach and answer questions. He says he wants his patients to be the best educated ones out there.
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Post by dsnuts on Jan 20, 2012 16:45:43 GMT -5
I think the Delano hospital is better than the Glendale one. The Delano hospital is a center of excellence; Verdugo in Glendale is not. A COE hospital is actually only an insurance designation. Doesn't the hospital have to meet certain standards to receive that designation?
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Post by Deleted on Jan 20, 2012 20:26:24 GMT -5
A COE hospital is actually only an insurance designation. Doesn't the hospital have to meet certain standards to receive that designation? Not really, except to have done a certain number of procedures. It's not much more than a quota system. But a hospital has to have the COE designation in order to take Medicare. So I would imagine that the OP could consider Delano for her surgery with Dr. K. That's worth checking out.
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Post by Deleted on Jan 20, 2012 20:26:57 GMT -5
Good morning, everyone! Well, I was all set to go to CA for surgery on the 27th with Dr. Keshishian, when I found out that my Medicare Part A will pay for the hospital - but not at the hospital in Glendale. I am activating my Part B which pays for doctor fees, but again, that won't help in Glendale. Long story, short: my original plan was to go to Dr. Roslin in NY for a LAP DS; health insurance fell through. Now, with Medicare he and the hospital are totally covered. However,(this is a big however) I just found out that he always makes the common channel 125 to 150cm long with a 38 bougie. In his communication, he said he will NOT shorten it because he believes any shorter is very dangerous, long-term. Dr. Keshishian was going to do a 70cm channel, and open surgery (which I pretty much prefer)....but it's going to be self-pay. I'm not rich - far from it. But I want to make sure that the surgery is done right & will work. If that means self-pay, then it's self-pay. I'd like to hear from some Roslin patients & how they are doing with the longer common channel...and from longterm Dr. Keshishian patients. Thanks so much!!! Dumb question: What's wrong with going to Delano?
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Post by mlleelise on Jan 20, 2012 23:13:21 GMT -5
Thanks for the input! I was going to the hospital in Glendale because that was the only hospital at which Dr. Keshishian was offering a special - nearly half off. This was to help the Glendale hospital get the COE certification. The special was the only way I could afford the surgery...until I found out I could get Medicare coverage. Back to the question about the common channel...Anyone else care to share your story of what size bougie and what length common channel you were given? Thanks again - this forum is AWESOME!
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Post by Deleted on Jan 20, 2012 23:51:36 GMT -5
My surgeon did not use a "bougie," preferring instead to operate via anatomical landmarks. My stomach size started out around 5 oz. and is probably a little more than double that now. That is not as much space as you might think .
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Post by Joanne on Jan 21, 2012 6:54:00 GMT -5
This topic comes up frequently.
First, to answer your question from a personal standpoint: I have a pretty standard Dr Roslin configuration. My stomach was made with a 38f bougie, and my common channel is 125CM. I lost past my goal weight to a normal BMI by about 10 pounds below that. I'm over two years out and so far have had no regain, and no problem maintaining.
For me, I still have plenty of restriction, and I like it that way. I eat small meals and am satisfied. I consider my restriction to be like a safety net - there's no way I could REALLY over-indulge in carbs because I would be too full. For example, if I were to go out for ice cream, I could comfortably eat an ice cream sundae with two scoops of ice cream, but no way possible to eat one with five scoops....things like that.
Now that being said, I've been a part of the online DS community and have seen many people with longer common channels (even 150-200CM) have no problems getting to goal, and those with shorter ones struggle. I wish I could tell you that I even noticed a pattern that's related to common channel length, but I havent. I will tell you that I and others have seen patterns related to the outcomes in general by surgeon - but both Dr Roslin and Dr Keshishian patients seem to do well.
When considering common channel length, it's important to realize a few things.
1 - It's not just about the common channel. Everything works in synergy, like stomach size, and also the length of the other limbs. That's why it's important to look at individual surgeon outcomes.
2 - You can't compare common channel lengths among different surgeons. Dr K actually has a newletter article about this, and explains it like measuring an old fashioned phone cord. Our intestines are coiled up like a phone cord inside our bodies, so some surgeons will measure it coiled up, and others will pull at it in different levels of tension to measure it. So comparing a 75CM from Dr K to a 125CM from Dr Roslin is not a good comparison, and not the same as comparing a 75CM from Dr K to a 125CM from Dr K, if you know what I mean.
3 - Your overall starting bowel length can matter, which is why some surgeons use what is called the Hess Method. The Hess Method uses percentages of your overall bowel length to customize limb lengths for you. Not all surgeons use the Hess Method.
You have to make the decision that is right for you, and you'll probably get a variety of opinions. There are two schools of thoughts from DS surgeons on this - some, like Roslin and Anthone, make smaller stomachs and longer common channels. Others make larger stomachs and shorter common channels. I haven't noticed a difference in outcomes, but keep in mind that most people here are early out. Even those that are further out are maybe 5-8 years from surgery. I dont know if time will tell one way or another between weight regain vs long term nutrtional issues.
Both Dr K and Dr Roslin have excellent reputations, and I dont think there's a bad decision to be made from a clinical standpoint, you just have to do what is right for you. I know you're local in NY, so IMHO traveling to Dr K doesnt have much increased benefit vs going to Dr Roslin, unless you really determine that you want that short common channel. If your revision was from an RNY to a DS, I would go to Dr K, but you are a LapBand to DS revision, right? I know about 8-10 people in person that Roslin has revised from a LapBand and all are doing very well. I know two of them personallyt hat would be glad to talk to you if you want to drop me a PM I can connect you with them on Facebook.
Hope that helps
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Post by Joanne on Jan 21, 2012 6:57:04 GMT -5
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Post by Seeking Healthy on Jan 21, 2012 9:25:36 GMT -5
I am a Dr. K patient and my surgery was performed at the Glendale hospital. I received excellent care there and would not hesitate to go back.
As far as CC length. Dr. K uses the Hess method, a percentage of your overall length. What he told me during my consult was that for virgin patients he typically uses 10% of the overall length. For revisions he typically uses ~14% of the overall length. This is also dependent on what the individual patients issues and conditions were as well.
One thing for sure is that Dr. K will do what he thinks is best for you and does not put you in a "cookie cutter" mold or "one size fits all".
Dr. Roslin is also well respected and has some very happy patients from what I read on the boards. I don't think you can go wrong with either surgeon. I am a bit prejudiced though and hold Dr. K in the highest regards. ;D
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Post by lovy19 on Jan 21, 2012 10:02:56 GMT -5
This topic comes up frequently. First, to answer your question from a personal standpoint: I have a pretty standard Dr Roslin configuration. My stomach was made with a 38f bougie, and my common channel is 125CM. I lost past my goal weight to a normal BMI by about 10 pounds below that. I'm over two years out and so far have had no regain, and no problem maintaining. For me, I still have plenty of restriction, and I like it that way. I eat small meals and am satisfied. I consider my restriction to be like a safety net - there's no way I could REALLY over-indulge in carbs because I would be too full. For example, if I were to go out for ice cream, I could comfortably eat an ice cream sundae with two scoops of ice cream, but no way possible to eat one with five scoops....things like that. Now that being said, I've been a part of the online DS community and have seen many people with longer common channels (even 150-200CM) have no problems getting to goal, and those with shorter ones struggle. I wish I could tell you that I even noticed a pattern that's related to common channel length, but I havent. I will tell you that I and others have seen patterns related to the outcomes in general by surgeon - but both Dr Roslin and Dr Keshishian patients seem to do well. When considering common channel length, it's important to realize a few things. 1 - It's not just about the common channel. Everything works in synergy, like stomach size, and also the length of the other limbs. That's why it's important to look at individual surgeon outcomes. 2 - You can't compare common channel lengths among different surgeons. Dr K actually has a newletter article about this, and explains it like measuring an old fashioned phone cord. Our intestines are coiled up like a phone cord inside our bodies, so some surgeons will measure it coiled up, and others will pull at it in different levels of tension to measure it. So comparing a 75CM from Dr K to a 125CM from Dr Roslin is not a good comparison, and not the same as comparing a 75CM from Dr K to a 125CM from Dr K, if you know what I mean. 3 - Your overall starting bowel length can matter, which is why some surgeons use what is called the Hess Method. The Hess Method uses percentages of your overall bowel length to customize limb lengths for you. Not all surgeons use the Hess Method. You have to make the decision that is right for you, and you'll probably get a variety of opinions. There are two schools of thoughts from DS surgeons on this - some, like Roslin and Anthone, make smaller stomachs and longer common channels. Others make larger stomachs and shorter common channels. I haven't noticed a difference in outcomes, but keep in mind that most people here are early out. Even those that are further out are maybe 5-8 years from surgery. I dont know if time will tell one way or another between weight regain vs long term nutrtional issues. Both Dr K and Dr Roslin have excellent reputations, and I dont think there's a bad decision to be made from a clinical standpoint, you just have to do what is right for you. I know you're local in NY, so IMHO traveling to Dr K doesnt have much increased benefit vs going to Dr Roslin, unless you really determine that you want that short common channel. If your revision was from an RNY to a DS, I would go to Dr K, but you are a LapBand to DS revision, right? I know about 8-10 people in person that Roslin has revised from a LapBand and all are doing very well. I know two of them personallyt hat would be glad to talk to you if you want to drop me a PM I can connect you with them on Facebook. Hope that helps Hi Joannne, I was not clear about common length channel, thank you so much for explaining .
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Post by California Poppy on Jan 21, 2012 10:44:21 GMT -5
For my gastrectomy, my surgeon used a 58Fr bougie, resulting in a 110mL (3.72 ounce) sleeve. At nearly 17 weeks post-op, I still have very good restriction (eating about three ounces of animal protein per meal, with very little room left for veggies).
My surgeon gave me a 150cm common channel (approximately 17.5% of total bowel length, considerably longer than the 10% recommended by Hess). I have no issues with loose stools; I have the opposite problem, really, and a transit time of four days.
I follow an extremely high-protein (approx 150 grams/per day), low-carb (avg 23 grams per day, with no simple carbs) diet, consuming about 800 calories per day, yet my weight loss (save for the few weeks immediately post-op, when my intake was less than 300 calories per day) is certainly slower than I'd expected/hoped (averaging 1.9 pounds per week).
I cannot say definitively that my relatively long common channel is a contributing factor in my sluggish weight loss, but if I could have a "do-over" I would prefer to have had a shorter (100cm) common channel.
I know that this is definitely a "YMMV" situation. But if, like me, you're someone who maintains a very high weight on very few calories, you might do well to make that fact clear to your surgeon, whomever you choose.
Best of luck to you! Since both of your (potential) surgeons get great reviews here, you're already ahead of the game.
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Post by Deleted on Jan 21, 2012 10:53:32 GMT -5
For my gastrectomy, my surgeon used a 58Fr bougie, resulting in a 110mL (3.72 ounce) sleeve. At nearly 17 weeks post-op, I still have very good restriction (eating about three ounces of animal protein per meal, with very little room left for veggies). My surgeon gave me a 150cm common channel (approximately 17.5% of total bowel length, considerably longer than the 10% recommended by Hess). I have no issues with loose stools; I have the opposite problem, really, and a transit time of four days. I follow an extremely high-protein (approx 150 grams/per day), low-carb (avg 23 grams per day, with no simple carbs) diet, consuming about 800 calories per day, yet my weight loss (save for the few weeks immediately post-op, when my intake was less than 300 calories per day) is certainly slower than I'd expected/hoped (averaging 1.9 pounds per week). I cannot say definitively that my relatively long common channel is a contributing factor in my sluggish weight loss, but if I could have a "do-over" I would prefer to have had a shorter (100cm) common channel. I know that this is definitely a "YMMV" situation. But if, like me, you're someone who maintains a very high weight on very few calories, you might do well to make that fact clear to your surgeon, whomever you choose. Best of luck to you! Since both of your (potential) surgeons get great reviews here, you're already ahead of the game If you are only consuming 800 calories a day, that is why your weight loss is slow. I am not sure how you are getting 150gms of protein with only 800 calories total but you are NOT eating enough. Even if the 800 calories is after you subtract the % we malabsorb, you still are not eating enough and your body thinks you are starving. Pre-op I would maintain my weight on 900 calories and gain at around 1000. Post-op the more I ate (of the right food) the more I lost, I think my poor body was really happy to be done with it's 40 year diet!
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Post by mlleelise on Jan 21, 2012 10:58:06 GMT -5
Joanne, Thank you for the AWESOME explanation - and the link to Dr. K's article. I have been obsessing over this, since I found out that I have Medicare available to me - and could stay right here in NY for the surgery. Everything was all in place for surgery in CA; got the loan, airline tickets, rental car, and hotel (which we'll lose $ on, since we had to pay 6 nights in advance) To be honest, Dr. K's personality is the most appealing to me - very open to questions, etc. I brought up the question about common channel length to Dr. Roslin, and it wasn't received well - like I was challenging his expertise..which I guess it sounded like I was. But otherwise he has been great. As my husband has pointed out, for follow-up care and complications, it will be SO much easier to go to the Westchester Hospital, than to fly back to CA. Is the difference between the two top-notch doctors worth going into debt for $18,000?? After reading all of your insightful comments, probably not. It is really wonderful that we have a forum to turn to for information & advice. I hope I can pay it forward in the years to come!
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Post by mlleelise on Jan 21, 2012 11:09:05 GMT -5
For my gastrectomy, my surgeon used a 58Fr bougie, resulting in a 110mL (3.72 ounce) sleeve. At nearly 17 weeks post-op, I still have very good restriction (eating about three ounces of animal protein per meal, with very little room left for veggies). My surgeon gave me a 150cm common channel (approximately 17.5% of total bowel length, considerably longer than the 10% recommended by Hess). I have no issues with loose stools; I have the opposite problem, really, and a transit time of four days. I follow an extremely high-protein (approx 150 grams/per day), low-carb (avg 23 grams per day, with no simple carbs) diet, consuming about 800 calories per day, yet my weight loss (save for the few weeks immediately post-op, when my intake was less than 300 calories per day) is certainly slower than I'd expected/hoped (averaging 1.9 pounds per week). I cannot say definitively that my relatively long common channel is a contributing factor in my sluggish weight loss, but if I could have a "do-over" I would prefer to have had a shorter (100cm) common channel. I know that this is definitely a "YMMV" situation. But if, like me, you're someone who maintains a very high weight on very few calories, you might do well to make that fact clear to your surgeon, whomever you choose. Best of luck to you! Since both of your (potential) surgeons get great reviews here, you're already ahead of the game. Now THAT concerns me. Like you, I subsist on a very low calorie diet now, pre-op; around 800 cals per day to MAINTAIN. I do NOT want to continue to eat like this. I also suffer with constipation now, and that was one of the reasons the DS was appealing to me: I would like loose stools for a change. This alarms me...don't want to end up with the same issues later. I've got to think about this for awhile..
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Post by Joanne on Jan 21, 2012 11:14:42 GMT -5
Joanne, Thank you for the AWESOME explanation - and the link to Dr. K's article. I have been obsessing over this, since I found out that I have Medicare available to me - and could stay right here in NY for the surgery. Everything was all in place for surgery in CA; got the loan, airline tickets, rental car, and hotel (which we'll lose $ on, since we had to pay 6 nights in advance) To be honest, Dr. K's personality is the most appealing to me - very open to questions, etc. I brought up the question about common channel length to Dr. Roslin, and it wasn't received well - like I was challenging his expertise..which I guess it sounded like I was. But otherwise he has been great. As my husband has pointed out, for follow-up care and complications, it will be SO much easier to go to the Westchester Hospital, than to fly back to CA. Is the difference between the two top-notch doctors worth going into debt for $18,000?? After reading all of your insightful comments, probably not. It is really wonderful that we have a forum to turn to for information & advice. I hope I can pay it forward in the years to come! You're welcome. Dr Roslin isn't going to win any personality contests , but I've gotten to know him pretty well over the past few years. He's a NY'er all the way, so he has that edge to his personality that you do have to get used to. On the positive side, he is super responsive. On the rare times my brother (also a Roslin DS'er) or I have needed him he emails or calls within minutes. I've had appointments with him that last 3 mintues, and other times he's sat with me for over an hour talking about all things DS. It just depends on his mood and schedule, I think. I do find he's way more accessible in the Westchester office vs the NYC office. I'm not trying to convince you either way....I really think you're in the proverbial catbird seat, you cant make a bad decision here - I would go with the one you feel most comfortable making. Have you ever seen his presentation on revisions? No matter which surgeon you decide upon, this will help you.
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Post by Joanne on Jan 21, 2012 11:16:30 GMT -5
For my gastrectomy, my surgeon used a 58Fr bougie, resulting in a 110mL (3.72 ounce) sleeve. At nearly 17 weeks post-op, I still have very good restriction (eating about three ounces of animal protein per meal, with very little room left for veggies). My surgeon gave me a 150cm common channel (approximately 17.5% of total bowel length, considerably longer than the 10% recommended by Hess). I have no issues with loose stools; I have the opposite problem, really, and a transit time of four days. I follow an extremely high-protein (approx 150 grams/per day), low-carb (avg 23 grams per day, with no simple carbs) diet, consuming about 800 calories per day, yet my weight loss (save for the few weeks immediately post-op, when my intake was less than 300 calories per day) is certainly slower than I'd expected/hoped (averaging 1.9 pounds per week). I cannot say definitively that my relatively long common channel is a contributing factor in my sluggish weight loss, but if I could have a "do-over" I would prefer to have had a shorter (100cm) common channel. I know that this is definitely a "YMMV" situation. But if, like me, you're someone who maintains a very high weight on very few calories, you might do well to make that fact clear to your surgeon, whomever you choose. Best of luck to you! Since both of your (potential) surgeons get great reviews here, you're already ahead of the game. Now THAT concerns me. Like you, I subsist on a very low calorie diet now, pre-op; around 800 cals per day to MAINTAIN. I do NOT want to continue to eat like this. I also suffer with constipation now, and that was one of the reasons the DS was appealing to me: I would like loose stools for a change. This alarms me...don't want to end up with the same issues later. I've got to think about this for awhile.. I agree with Michele that I dont think this person is eating enough food. I eat WAY more calories than I did as a pre-op. I betcha I eat 2500-3500 calories a day, and am wearing a size 6.
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Post by Joanne on Jan 21, 2012 11:24:10 GMT -5
A few things I want to add to my above post on calories. With the DS, you have to get out of the habit of counting calories, because they hold no meaning. 800 calories, all simple carbs, is...well 800 calories 800 calories, all protein is more like 400 calories to our DS bodies. 800 calories of all fat is more like 160 calories to our DS bodies. So when I said above that I can eat about 3,000 calories per day - that is mostly protein, a moderate amount of fat, and some carbs thrown in. If I ate 3,000 calories of carbs a day I would surely gain weight. So the focus has to be on WHAT you eat, not HOW MUCH you eat. The DS easily solves the hunger problem. You will not be hungry because you can snack on things like cheese, olives, nuts, etc. literally all day long. You can feast on steak, fish, salads with cheeses and dressings. What the DS cannot solve is if you have a mental craving / need for sweets. It wont stop you from eating cake, ice cream, candy, etc. And you WILL most definitely absorb every one of those calories. It can fix your body, not so much your head. But here's a footnote to that.... Most dessert-y things like that cake and ice cream also have a considerable amount of fat. While you will absorb all of the sugary calories, you will at least have some benefit of not absorbing the fat. When I want ice cream, I pick premium brands with lots of fat. When I want cake, I pick cheesecake. Totally mind blowing. And, a kind of bottom line story that sums it up, as well as sums up Dr Roslin's personality since you asked about him: When I was contemplating my DS, I asked Dr Roslin how much fat he thought I could / should eat. His answer? "Whatever you want, you're going to shit it out anyway". Yeah, that sums it up
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Post by Deleted on Jan 21, 2012 11:40:30 GMT -5
For my gastrectomy, my surgeon used a 58Fr bougie, resulting in a 110mL (3.72 ounce) sleeve. At nearly 17 weeks post-op, I still have very good restriction (eating about three ounces of animal protein per meal, with very little room left for veggies). My surgeon gave me a 150cm common channel (approximately 17.5% of total bowel length, considerably longer than the 10% recommended by Hess). I have no issues with loose stools; I have the opposite problem, really, and a transit time of four days. I follow an extremely high-protein (approx 150 grams/per day), low-carb (avg 23 grams per day, with no simple carbs) diet, consuming about 800 calories per day, yet my weight loss (save for the few weeks immediately post-op, when my intake was less than 300 calories per day) is certainly slower than I'd expected/hoped (averaging 1.9 pounds per week). I cannot say definitively that my relatively long common channel is a contributing factor in my sluggish weight loss, but if I could have a "do-over" I would prefer to have had a shorter (100cm) common channel. I know that this is definitely a "YMMV" situation. But if, like me, you're someone who maintains a very high weight on very few calories, you might do well to make that fact clear to your surgeon, whomever you choose. Best of luck to you! Since both of your (potential) surgeons get great reviews here, you're already ahead of the game. Now THAT concerns me. Like you, I subsist on a very low calorie diet now, pre-op; around 800 cals per day to MAINTAIN. I do NOT want to continue to eat like this. I also suffer with constipation now, and that was one of the reasons the DS was appealing to me: I would like loose stools for a change. This alarms me...don't want to end up with the same issues later. I've got to think about this for awhile.. Like Joanne, I eat around 2500-3000 calories and am 6+ years out and wear a size 7. Most DSer's eat like that and lose all of the weight. Not to worry!!
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Post by mlleelise on Jan 21, 2012 11:41:03 GMT -5
That's hysterical!! ;D So, you DON'T have constipation issues, Joanne?? It sounds like a dream to be able to eat that way! I live now on 800 cal/day and definitely gain on 1000 cals. With a BMR of 33% of normal, I NEED malabsorption. Definitely. My only concern is that the malabsorption of a longer cc will not be enough to counteract my low BMR...and I'll still have to eat very low calorie, like California Poppy above, to lose. I'm probably asking dumb questions...but it would seem the longer the cc, the more absorption of nutrients and CALORIES - any kind of calories. Am I wrong on this?? Thanks! I truly appreciate your input - and everyone's input.
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Post by Joanne on Jan 21, 2012 11:49:40 GMT -5
That's hysterical!! ;D So, you DON'T have constipation issues, Joanne?? It sounds like a dream to be able to eat that way! I live now on 800 cal/day and definitely gain on 1000 cals. With a BMR of 33% of normal, I NEED malabsorption. Definitely. My only concern is that the malabsorption of a longer cc will not be enough to counteract my low BMR...and I'll still have to eat very low calorie, like California Poppy above, to lose. I'm probably asking dumb questions...but it would seem the longer the cc, the more absorption of nutrients and CALORIES - any kind of calories. Am I wrong on this?? Thanks! I truly appreciate your input - and everyone's input. Yes and No. It's just not that straight forward. First of all, let's talk about anatomy and digestion. The common channel is where fats are absorbed, because fats can only be digested in the presence of the bile and digestive enzymes that are diverted away until they join the food in the common channel. But your body starts digestion of the other types of foods earlier, such as in the stomach and in the alimentary limb. So if your common channel is longer, and alimentary limb shorter (as an example), you might absorb SLIGHTLY more fat, but SLIGHTLY less protein...get it? But, I dont know of many studies that really quantify this, so it's very subjective. I look at my common channel this way. I have a 125CM. If using 100CM as a standard, and that means I might possible absorb slightly more fat, but not nearly as much as a pre-op. My personal experience tells me for sure that I am not absorbing the fat I eat. But what is also true is that the DS, in addition to just straight malabsorption, also has a metabolic effect. So in addition to just simply malabsorbing calories in, the DS also corrects broken metabolisms by altering insulin response and the way your body stores calories. Dr Husted* has a good explanation on his site: www.johnhustedmd.com/switch.htmAnd about the constipation - I do get constipated if I dont eat enough fat. If I eat enough fat, I'm regular and actually lose more weight. ETA: *This surgeon does not come recommended. I'm not recommending him at all, just pointing out the explanation on his site, which I think is helpful
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Post by Joanne on Jan 21, 2012 11:52:12 GMT -5
Let me ask you another question - what is your BMI? When I said I dont know of many studies that specifically study calories absorbed to CC length, there is one study that might be relevant. It studied CC length and outcomes by BMI. What it showed IIRC is that CC length didn't matter as much if the starting BMI was <60, but once BMI's approached 60 or above, that they length did make a big difference. Someone here probably has that study, if not I'll go look for it on www.dsfacts.com
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Post by Girlrocker on Jan 21, 2012 11:55:12 GMT -5
A few things I want to add to my above post on calories. With the DS, you have to get out of the habit of counting calories, because they hold no meaning. 800 calories, all simple carbs, is...well 800 calories 800 calories, all protein is more like 400 calories to our DS bodies. 800 calories of all fat is more like 160 calories to our DS bodies. So when I said above that I can eat about 3,000 calories per day - that is mostly protein, a moderate amount of fat, and some carbs thrown in. If I ate 3,000 calories of carbs a day I would surely gain weight. So the focus has to be on WHAT you eat, not HOW MUCH you eat. The DS easily solves the hunger problem. You will not be hungry because you can snack on things like cheese, olives, nuts, etc. literally all day long. You can feast on steak, fish, salads with cheeses and dressings. What the DS cannot solve is if you have a mental craving / need for sweets. It wont stop you from eating cake, ice cream, candy, etc. And you WILL most definitely absorb every one of those calories. It can fix your body, not so much your head. But here's a footnote to that.... Most dessert-y things like that cake and ice cream also have a considerable amount of fat. While you will absorb all of the sugary calories, you will at least have some benefit of not absorbing the fat. When I want ice cream, I pick premium brands with lots of fat. When I want cake, I pick cheesecake. Totally mind blowing. And, a kind of bottom line story that sums it up, as well as sums up Dr Roslin's personality since you asked about him: When I was contemplating my DS, I asked Dr Roslin how much fat he thought I could / should eat. His answer? "Whatever you want, you're going to shit it out anyway". Yeah, that sums it up Joanne, you quite simply, RULE. The common channel explanation, the analysis of the two surgeons, this break down on how DS patients process food. Thank you for taking the time to share this, I've not only book marked but copied your responses into a document to put into my ever-growing DS file.
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