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Post by cherylbaker on Jun 26, 2014 15:50:13 GMT -5
Can someone who had a revision from bypass to ds please PM me. I need to talk to someone private. Do not want to just intrude on someone by pming them out of the blue..
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Post by Girlrocker on Jun 26, 2014 16:21:50 GMT -5
Hi Cheryl, I'll get back to you!
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Post by cherylbaker on Jun 26, 2014 18:09:43 GMT -5
Thanks fir wtiting.. i am just resigned to having to just take what I get. There are no other drs on the east coast. . So it is either do it and accept what I get or do nothing. . I honestly am tempted to do nothing but the slim hope that I will get my pyloric valve back and be able to take the nsaids even though it seems chances are very slim makes me want to do it. Since there is no other choices.. just pissed I got my hopes up for nothing. Prior to January of this year I thought there was nothing I could do and than got my hopes up when soneone told me about this revision. . Oh well such is.life I guess
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Post by Girlrocker on Jun 26, 2014 18:24:53 GMT -5
Thanks fir wtiting.. i am just resigned to having to just take what I get. There are no other drs on the east coast. . So it is either do it and accept what I get or do nothing. . I honestly am tempted to do nothing but the slim hope that I will get my pyloric valve back and be able to take the nsaids even though it seems chances are very slim makes me want to do it. Since there is no other choices.. just pissed I got my hopes up for nothing. Prior to January of this year I thought there was nothing I could do and than got my hopes up when soneone told me about this revision. . Oh well such is.life I guess Cheryl, I cannot begin to disagree with you more on this! And to fill others in - I think you need to hear from other veteran, experienced people here - you do NOT have to take what you can get. This is a giant surgery and step that is for the rest of your life. If Dr. Roslin will not assure you that you will have a DS done, and might do a distal bypass, and, can't explain to you the medical reasons, you are going to have to LIVE with that. It is true, there isn't a big list of surgeons that do this revision, thought it's increasing and growing; and traveling for surgery is very common. I have no idea what your schedule/timing/financial/employment situation is like, but I think you really need to re-think this, as I said, make the time. And while I know others who have been successful with the RNY and distal, I'm not one of them, neither are you, it's NOT our fault; and personally, there is NO way in hell I'd let someone do a distal bypass on me, fixing bad for broken. The only way I would even consider that is if my health left me no other choices (some people have had complicated co-morbidities making a DS unfeasible). I wouldn't have this reaction if you were talking a sleeve or, even a SADI. In the end, we all do what we have to, but none of our surgeons are king or god and you have to think long and hard about taking on a life-altering surgery such as this, going into a revision with 'whatever I can get' is not the way to enter into this. I'm reposting this link with the vetted surgeons, there are two others east coast - Greenbaum and Elairny. weightlosssurgery.proboards.com/thread/7262/revisions-vetted-surgeons-list-update2There is hope with this revision because surgeons do perform it; I don't know why you think you should settle for what you can get when you have not fully explored the other options and I can't emphasize enough how much you need to give this additional thought and consideration, not rush!
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Post by west4thavenue on Jun 26, 2014 20:06:29 GMT -5
I agree with Sharyl. "Settling" for a surgical procedure that isn't what you feel you really need doesn't seem worth it. Please investigate the options.
It is easy to feel desperate about addressing your obesity, I know. I certainly did when I went to see the surgeon. I was afraid I was a death's door (and as it turned out, I was!). All the research I did turned out to have been more than worth the considerable time and effort. For everything that all bariatric patients have to go through, it is important that you can feel the same way when it's all said and done.
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Post by fatmackn on Jun 27, 2014 16:16:11 GMT -5
U can have Skype consultations with surgeons in diff states/countries, many of whom don't carge. So it's not like u have to travel there 1st time
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Post by goodkel on Jun 27, 2014 20:51:53 GMT -5
If there is a suspicion of damage from a prior surgery, use this surgery to FIX those problems. Once that is healed, get the full DS.
What you get changes your whole life, it is not a matter to shrug off and "take what you can get."
This is YOUR decision to make, not some surgeon's.
It is your body. YOU are the boss here.
My communication with my surgeon was strictly by email. I didn't see or speak to him until I met him in the hospital after I checked in the day before surgery. Scan what records/labs/tests you have so you can attach them to an email. If you don't have hard copies of all of these, get them.
There are other revision surgeons on the east coast and many, many people travel rather than compromise the rest of their lives with a surgery that they didn't want.
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Post by cherylbaker on Jun 28, 2014 10:25:19 GMT -5
Can someone tell me what procedure this looks like.. i have poor vision and therefore not a visual person and all these pictures mean nothing to me.. looking to try and understand what procedure this drawing represents Thanks for your help Bariatric proto db.tt/ukeSc4op
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Post by goodkel on Jun 28, 2014 16:20:04 GMT -5
Can someone tell me what procedure this looks like.. i have poor vision and therefore not a visual person and all these pictures mean nothing to me.. looking to try and understand what procedure this drawing represents Thanks for your help Bariatric proto db.tt/ukeSc4opI can't pull any picture up. However, you could print this or any of the other diagrams of the DS out and inform your surgeon that this is the surgery he is authorized to do: weightlosssurgery.proboards.com/thread/7985/images-ds
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Post by cherylbaker on Jun 28, 2014 18:22:31 GMT -5
Sorry I think I renamed the file but forgot to create a new link.. hopefully this one will work db.tt/FyL4pS3HAdmin note: I attached the picture for you. When you want to display a picture, click on the "Add Image to Post" in the upper left hand corner or the "Add Attachment" button in the upper right and follow the instructions.
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Post by Girlrocker on Jun 28, 2014 18:22:46 GMT -5
Hi Cheryl, I know you're trying to post the drawing that he did for you to show you what he said he was planning to do; I tried this link and the dropbox link you sent, but the picture isn't coming up. Can you try again? Also, do you and your family know that complication rate for a distal RNY is actually higher than the DS?
From what you further explained, it sounds like Dr. Roslin was trying to say what he 'might' do if he didn't think he could do a DS;
Or, did he say he wasn't sure you were a good candidate for the RNY to DS revision?
If he is saying you might not be a good candidate, is it because of any other existing co-morbidities or medical issues?
Or is he saying that he can't be absolutely sure until he gets in there and once he does, if he doesn't think he can do a DS he will for sure do a distal RNY instead?
It's ok to ask questions five times if needed, it's easy to get overwhelmed emotionally and get confused; don't hesitate to ask him to clarify. And you have the option of saying no, you don't want a distal RNY if he can't do the DS, you don't have to take what you can get. You can ask him if he can do the sleeve first, than the rest of the DS later if there's something that needs to heal first. Or you can see another surgeon and get a second opinion, like Greenbaum.
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Post by cherylbaker on Jun 28, 2014 18:23:22 GMT -5
Works for me
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Post by Girlrocker on Jun 28, 2014 18:34:15 GMT -5
Ok, you and I posted at the same time, I see it now, and here it is, should make this easier: Hi Cheryl, I know you're trying to post the drawing that he did for you to show you what he said he was planning to do; I tried this link and the dropbox link you sent, but the picture isn't coming up. Can you try again? Also, do you and your family know that complication rate for a distal RNY is actually higher than the DS? From what you further explained, it sounds like Dr. Roslin was trying to say what he 'might' do if he didn't think he could do a DS; Or, did he say he wasn't sure you were a good candidate for the RNY to DS revision? If he is saying you might not be a good candidate, is it because of any other existing co-morbidities or medical issues? Or is he saying that he can't be absolutely sure until he gets in there and once he does, if he doesn't think he can do a DS he will for sure do a distal RNY instead? It's ok to ask questions five times if needed, it's easy to get overwhelmed emotionally and get confused; don't hesitate to ask him to clarify. And you have the option of saying no, you don't want a distal RNY if he can't do the DS, you don't have to take what you can get. You can ask him if he can do the sleeve first, than the rest of the DS later if there's something that needs to heal first. Or you can see another surgeon and get a second opinion, like Greenbaum.
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Post by cherylbaker on Jun 28, 2014 18:48:08 GMT -5
Yes i redid the link... OK the story is long but I will post so there is no comfusion. They gave me the authorization forms to sign and the procedure said revision from bypass to ds BUT the description was that of a bypass (small pouch bypassing intestine bla bla) I got upset cause of the girl who posted here that he did the sadi on her without really telling her. I asked him about it and he said "oh" and flipped the paper over and wrote a bunch of technical wording of a procedure which since I am not a dr did not understand and than said other procedure would only be done if this one not poasible.. i Still wasn't sure 1) what all those technical things meant and 2) why on earth he would say he would do a bypass when u already have a bypass. So I told him I do not understand those terms are you going to undo my bypass sleeve my old stomach and then do a ds. He said this is what I am going to do and drew the picture. He said all that's important is the metabolic reset and the other stuff does not matter. I said well I do not understand the picture are you going to do the 2 limba and a common channel and he said well I was going to do a loop. I said well I want the 2 limbs and common channel and he said well if that's what you want it is a longer surgery and I said I know but that's what I want. He seemed annoyed and got up to go and I started asking more questions and he than went on this big long speal about the research in Canada on the sadi and how in his practice he has not seen how it makes any difference and than said that people on the Internet seem to think they know everything and that most of the stuff on the Internet is just not correct.. by this time I was in tears (didn't even get to tell him that it was HIS research I was reading on the Internet .. or ask the other questions I had cause I was upset).. He did reach his hand out comforting me saying not to be emotional and then left.. So that's the whole long story and I was going to call him up on monday to try and discuss again but than remembered he is gone on vacation next week and do won't be available. Sigh.. oh he did somewhere in their say I was a great candidate and that 99 percent chance everything would be fine but since I never understood the picture or his technical words I was left insecure as to what operation was going to be fine. He kept saying he does not know about the blood flow and that would make a difference. I said wouldn't that show on the tests I took and he said they only show do much. But so what if there is a blood flow issue. . Does that mean he cannot do anything with my old stomach.. or does that just effect the pyloric valve.. i mean the picture he made looked like a sleeve to me which I thought was the metabolic reset part but how do you get a sleeve if you do not have the old stomach.. He did not see to like my questions at all which Is why I git upset cause I like to fully understand things and I do that by asking questions. . Whew that was even longer than I thought
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Post by west4thavenue on Jun 28, 2014 19:06:13 GMT -5
Cheryl, if my surgeon had given me a bunch of noncommittal whooey like that, I would have walked. Don't go into the OR with him. Find another surgeon who will communicate better with you. This is no one for you to partner with on such a life-changing venture.
And, BTW..."Don't get emotional." -- Did he really say that? What the hell kind of planet is he from? And this is his response to your tears?!? Cheryl. Please.
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Post by Girlrocker on Jun 28, 2014 19:32:20 GMT -5
Cheryl, first, believe it or not, you sound SO much better already, stronger and exactly how you should - asking questions, wanting answers, asking your surgeon to please clarify... "all that's important is the metabolic reset and the other stuff does not matter" - um, it MATTERS, because there's no metabolic reset with a distal RNY, and the SADI is too new and unknown yet, no data or track record. It's possible it will be a viable alternative, something a little less demanding the DS but with many similar benefits, but no way to know that now, and no one should have one without giving their consent. I'm relieved you're sharing the details. I hope you will elaborate on some of the other pressures you are feeling regarding scheduling/timing, family, and so on. There is NO story too long to ever tell us here, this is what a support community is all about.
I can't tell from that drawing either what he means, honestly. It's a little slower here on the weekends, particularly since it's summer, but others here who are very experienced will weigh in. I really think you need a second opinion, and with him on vacation, now is the best time to do it.
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Post by newyorkbitch on Jun 28, 2014 19:34:44 GMT -5
Cheryl are you in NY?
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Post by cherylbaker on Jun 28, 2014 19:46:22 GMT -5
Yah know I really do not care about his poor bedside manor. All I care us I want the full ds that he had been preaching and preaching. I do not drive due to my vision so it's not like I can just drive Down to NJ to meet a new Dr and start over. Not to mention my daughter having her baby and than I will need to be 100% for gramma daycare. seriously the guy is capable of doing a ds revision . I was thinking of writing a note and bringing it with me to NY stating in no uncertain terms what I want and expect and make him sign it . I mean if HE can't do it no dr would be able to do it. It's not like he isn't capable. Would this be disrespectful to him or unreasonable?
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Post by cherylbaker on Jun 28, 2014 19:46:39 GMT -5
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Post by newyorkbitch on Jun 28, 2014 19:55:00 GMT -5
Why not get a second opinion from another NY surgeon, like Dan Herron?
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Post by cherylbaker on Jun 28, 2014 20:00:17 GMT -5
Why not get a second opinion from another NY surgeon, like Dan Herron? Never l heard of him as a bypass to ds revision surgeon
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Post by newyorkbitch on Jun 28, 2014 20:05:12 GMT -5
I don't know about his revision experience but could certainly talk about your options. Smart guy, and no bullshit
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Post by Girlrocker on Jun 28, 2014 21:29:39 GMT -5
Yah know I really do not care about his poor bedside manor. All I care us I want the full ds that he had been preaching and preaching. I do not drive due to my vision so it's not like I can just drive Down to NJ to meet a new Dr and start over. Not to mention my daughter having her baby and than I will need to be 100% for gramma daycare. seriously the guy is capable of doing a ds revision . I was thinking of writing a note and bringing it with me to NY stating in no uncertain terms what I want and expect and make him sign it . I mean if HE can't do it no dr would be able to do it. It's not like he isn't capable. Would this be disrespectful to him or unreasonable? Actually that's not true, and exactly why you need a second opinion, maybe a third if necessary. This revision is not uncommon anymore, there are both other surgeons who do it, and extremely experienced surgeons who can advise. You are assigning your surgeon the 'god complex'. And you have to now get through your head that whatever his reputation has been prior, the Q/A, video he did, the fact that he has a reputation as an excellent cutter and revision specialist, he clearly has changed his philosophy and position. Does it suck? Yes. And I realize you have scheduling and timing constraints, as well as poor vision which makes traveling difficult. But I will say again, this surgery is for the rest of your life, you have to make the time to do this right. Or, if you want to proceed with him, than no, it's not disrespectful, as has been stated, to ensure your wishes are in your operative report, that he either does a DS or if he can't, closes you up, you do not want 'other', a SADI or a distal bypass. Have no idea if he'll agree to that but it is your right as a patient to be very clear.
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Post by cherylbaker on Jun 28, 2014 22:07:55 GMT -5
Well dr herron was mentioned here as a possibility and his info page had an email address so I emailed him asking if he could give me a second opinion ... due to time and travel restrictions I would like to keep on path here. I have my own issues with drs as I really have not had good luck and do not trust them. But dr roslin is certainly capable of doing the surgery it's just really a matter if I can trust him.. trust does not come easy for me. My friend was released today so hopefully I will get to find out what happened to her and hopefully that will she'd more light for me. I thank you guys for taking the time to talk me through this. I will also be calling the insurance company to find out my rights and responsibilities as far as they go. Guess I am back to holding onto some hope.. Thanks to you guys
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Post by Girlrocker on Jun 28, 2014 22:21:29 GMT -5
Well dr herron was mentioned here as a possibility and his info page had an email address so I emailed him asking if he could give me a second opinion ... due to time and travel restrictions I would like to keep on path here. I have my own issues with drs as I really have not had good luck and do not trust them. But dr roslin is certainly capable of doing the surgery it's just really a matter if I can trust him.. trust does not come easy for me. My friend was released today so hopefully I will get to find out what happened to her and hopefully that will she'd more light for me. I thank you guys for taking the time to talk me through this. I will also be calling the insurance company to find out my rights and responsibilities as far as they go. Guess I am back to holding onto some hope.. Thanks to you guys But the issue here isn't about trust and whether he is capable of doing the RNY to DS revision; what matters is what he is telling YOU. Doesn't matter what his reputation is. I still can't tell from what you are saying if he is painting you a worst case scenario possibility but you really don't have to worry about it. If he is saying it's likely you will have the DS but there is a possibility that once he opens you up he might change gears, if he is indicating to you he doesn't feel as strongly about the DS, and will give you a different procedure, you have to tell him no, outline it ahead of time. You do not sign undefined 'other'. Period. Your insurance company can't make that decision for you.
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Post by goodkel on Jun 29, 2014 8:49:03 GMT -5
It sounds to me like he was trying to slip you a SADI. Make sure you have hard copies of any pre-op testing you have already done. You can scan them and send them by email to other surgeons. Most surgeons will give you a consultation by email or phone. You don't have to visit them in person at this stage. Contact Herron and Greenbaum and see what they have to say about a revision to the DS. You can explain your issues about travel and usually they will allow you to complete your pre-op testing from home via your pcp.
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Post by goodkel on Jun 29, 2014 8:52:46 GMT -5
Cheryl, if my surgeon had given me a bunch of noncommittal whooey like that, I would have walked. Don't go into the OR with him. Find another surgeon who will communicate better with you. This is no one for you to partner with on such a life-changing venture. And, BTW..."Don't get emotional." -- Did he really say that? What the hell kind of planet is he from? And this is his response to your tears?!? Cheryl. Please. Yes. This. I know he can be abrupt. But, he should be clear with you and not try to bully you into a surgery you don't want.
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Post by cherylbaker on Jun 29, 2014 11:06:04 GMT -5
Cheryl, if my surgeon had given me a bunch of noncommittal whooey like that, I would have walked. Don't go into the OR with him. Find another surgeon who will communicate better with you. This is no one for you to partner with on such a life-changing venture. And, BTW..."Don't get emotional." -- Did he really say that? What the hell kind of planet is he from? And this is his response to your tears?!? Cheryl. Please. Yes. This. I know he can be abrupt. But, he should be clear with you and not try to bully you into a surgery you don't want. Well finally heard from my friend. I have to wonder if his attitude was due to her problems and him not wanting to have me expecting something that can't happen. We had the same surgeon back in 2000 (although we did not know each other than) and her operation was open therfore different than mine. . But apparently when he opened her up (yes she had to have open again due to other issues) he found some odd rny process was done which left him unable to reuse her old stomach. She is not quite sure what he ended up doing totally as she was in pretty bad shape pain wise but will be talking to him about it at follow up.. she seems to think he redid her pouch and shortened her intestine (is that a distal?? Not that familiar with distal).. I dunno it seems like this is something that should be known with the operative report from her original rny or the cat scan that was done recebtly.. but i am not a dr..
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Post by goodkel on Jun 29, 2014 13:02:04 GMT -5
If you do not have it, your first step is getting a hard copy of your original RnY surgery report. Your friend's situation may be due to something unique to her physiology or prior medical history. You should not compare yourself to her. Some surgeons prefer an open surgery for revisions because it allows them a better view to see everything going on inside. Here is a helpful article from Dr. Keshishian's site: Duodenal Switch and DistalGastric Bypass (ERNY) More Different Than Similar Duodenal Switch and the Distal Gastric bypass (or ERNY) are only similar to the extent that they are both weight loss surgical procedures. Patients have quoted others that "ERNY (Distal RNY, or Gastric Bypass) is like the DS with a smaller stomach." As that may be superficially true, it is misleading. The physiology of these two operations is very different. The food tolerance, nutritional requirements, complications, benefits and side effects of the DS and ERNY are different, and cannot be interchanged. In order to appreciate the physiologic and functional differences between these two operations while reviewing gastric bypass alternatives, we should first have a clear understanding of the anatomical differences. Figure 1 In a patient who has not had any gastrointestinal (GI) surgery (Figure 1), the esophagus, stomach, small bowel (composed of three segments of Duodenum, Jejunum, and Ileum) colon and the rectum are all connected end to end and form a long tube. There are few side branches (ducts of the salivary glands, biliary three, pancreatic ducts, and appendix). The side branches are involved in one form or another with the function of the absorption and digestion. The order in which their secretions are added is also important. The function of appendix does not appear to be of any significance. The anatomy of the gastric bypass differs significantly from before surgical state (Figure 2) and is described below. Figure 2 The stomach pouch (1) is created by transecting the top part of the stomach from the majority of the rest of the stomach (4). A RNY limb (3) is connected to it. The connection point is the gastro-jejunostomy (2) anastomosis. The food then taken by mouth enters the esophagus, gastric pouch, the RNY limb and travels down to to the small bowel entering Jejunum (junction of 10-11) in the case of the proximal gastric bypass and the ilium (in the case or the distal gastric bypass- ERNY). This food pathway, completely bypasses the secretory, and regulatory function of the stomach (4), Pyloric valve (5) and the absorptive function of the entire duodenum. Anatomy of Gastric Bypass 1 Stomach pouch 2 Gastro-Jejunostomy Anastomosis 3 The RNY limb (should be less than 150 cm to be defined as a proximal RNY) 4 Remnant stomach 5 Pyloric Valve 6 Liver 7 Gallbladder 8 Pancreas 9 Biliary Tree (AKA common bile duct) 10 Duodenum 11 Jejunum 12 Ileum 13 Colon The anatomy of duodenal switch operation is significantly different than that of the Gastric bypass operation (Figure 3). This results is a very different physiological performance. Figure 3 The food enters travels down the esophagus in to the stomach. It sits in the stomach (smaller than before surgery) and the normally occurring chemical reactions that usually take place in the stomach take place. When this process is complete, then the pyloric valve (f) allows the passage of the food to the small bowel. Duodenum (d) is where the absorption of the Iron and some Calcium takes place. This is one of the most important metabolic differences that is seen between DS and the RNY (both proximal and distal). Iron deficiency anemia is very common after RNY, especially in females with monthly menstrual cycles. The food then travels thru the alimentary limb (a) and joins the biliopancreatic limb (b) to form the common channel (c). The secretions from liver (h) and the pancreas (g) that have traveled down the biliopancreatic limb (b) are mixed with the food to allow for the absorption of the fat and protein and other minerals, nutrients, and vitamins. Anatomy of the Duodenal Switch a Alimentary limb b Biliopancreatic limb c Common Channel d Duodenum e Ilium f Pyloric Valve g Pancreas h Liver In the case of the distal gastric bypass the biliopancreatic limb and the alimentary limb are joined together to form a short common channel (thus called distal bypass). This allows for limiting the absorption of the fat and its associated minerals, nutrients and vitamins. However, since the food enters from esophagus to the small bowel, by only transitioning thru a small stomach pouch, the normally occurring chemical, secretory, and absorptive processes that take place in the stomach, pyloric region, and the duodenum (taking place in Duodenal switch, and normal anatomy) do not take place in Gastric bypass patients. This results in specific problems with nutritional deficiencies. In summary, distal gastric bypass, is not the same as the duodenal switch with a smaller stomach. Distal gastric bypass is a procedure that for the most part has been abandoned secondary to the high nutritional complication rates of significant protein calorie malnutrition, and deficiency of vitamins and minerals. These deficiencies are far more advanced that any seen in the Duodenal switch operation. I have done exhaustive research to locate any comparative study, case report, case series, that will compare these two procedures and have not located one. Please contact us at contact@dssurgery.com if you have any questions about duodenal switch surgery or the revision of a lap band surgery. www.dssurgery.com/newsletters/duodenal-switch-and-distal-gastric-bypass.php
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Post by cherylbaker on Jun 29, 2014 14:25:01 GMT -5
Awsome description of the processes in the procedures thank you so much. The pictures really confuse Me but with the wording it helps me understand the pictures better. I only recently [this January) came to realize how my inability to eat food and the resulting change to food which I tolerated was caused by my bypass and the removal of my pyloric valve. Things I wish I had learned earlier and which would I think have helped me by making adjustments so I could have helped with my maintenance of the weight I lost. I had made it my mission to get my pyloric valve back so I could better tolerate food and get this remnant stomach Gone so I can take nsaids. The past few days have been very stressful for me freaking out over the what ifs. . So far this year I have lost 22 lbs even without solving my problems just knowing how to adjust my eating to be able to eat protein without being sick. I am sure no matter what happens I will be okay and I think I need to just relax. I wish I knew things 5 months ago that I know now and I would have done things differently (like having reports etc sent to me instead of the surgeon as now I cannot get a copy in a reasonable time ) but you cannot change the past and have to make the best of where you are. I thank you guys for your support and knowledge. I don't know what I will decide to do but I realize now no matter what I decide it will be ok.. which is a much better place than I was 3 days ago.. thank you..
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