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Post by goodkel on Jun 29, 2014 16:18:53 GMT -5
Your pyloric valve was not removed. It, like the bottom portion of your stomach, was just bypassed by the pouch that was created at the top of your stomach by the RnY. In a revision, the pouch is undone to allow food to reach the bottom of your stomach. The fundus (outer edge) is removed creating your sleeve. This resizes your stomach from approximately the size of a football to approximately the size of a banana. I also just posted an entry of Dr. Keshishian's blog about the SADI that might help you here: weightlosssurgery.proboards.com/thread/9185/dr-keshishian-on-sadi
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Post by cherylbaker on Jun 29, 2014 17:25:35 GMT -5
Thanks for that article. . In it it states the the one limb is soo long you will not get a backup. . Would there be a reason if one had a bypass that it would not be possible for this limb to be long enough to not have this back up? When I mentioned about the 2 limbs he did say something about not making it so you have a backup and smell coming out your mouth. . I had no idea what he was talking sbout..
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Post by goodkel on Jun 29, 2014 22:17:09 GMT -5
Thanks for that article. . In it it states the the one limb is soo long you will not get a backup. . Would there be a reason if one had a bypass that it would not be possible for this limb to be long enough to not have this back up? When I mentioned about the 2 limbs he did say something about not making it so you have a backup and smell coming out your mouth. . I had no idea what he was talking sbout.. The blog entry does not talk about the bypass, only the DS and the SADI. The back up he is referring to is bile reflux and the fact that in the SADI, because the length of the bowel where bile meets the duodendum is shorter than is normal, the risk of bile reflux significantly increases with this surgery. "In the duodenal switch operation, the bowel is partitioned in to two parallel limbs- one that carries the bilio-pancreatic juices and a parallel limb that bring the food down from the post pyloric duodenum. They then join and form the common channel. The length of the biliopancreatic limb is so long that it does not allow bile to reflux back into the duodenum or back to the stomach causing the complication of bile reflux gastritis. With the single anastomosis of the SADI, the length of the bowel where the bile meets the duodenum is shorter than it is in normal anatomy. This significantly increases the possibility of the bile reflux." Read more: weightlosssurgery.proboards.com/thread/9185/dr-keshishian-on-sadi#ixzz365NmP4GAI can't begin to speculate about what Dr. Roslin meant in a conversation I didn't hear. Smell coming out of your mouth? That makes no sense to me.
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Post by cherylbaker on Jun 30, 2014 2:11:53 GMT -5
I know it didn't talk about the bypass. . I was just trying to figure out how the limb could be so short that there would be a backup. I didn't know if you had had a bypass if the cutting that was done than made it so you wouldn't have a long enough limb and it would cause backup. I had read somewhere that even if thete was a backup that the pyloric valve would prevent it from backing up into your stonach. . I did not understand what he was taking about but by that point I was so upset anyway. I know progress is good and pioneering drs like dr roslin move development along but there has to be moderation andv discussion between patient and dr and not just move on to the next procedure without telling people. I guess the real problem is that they are calling both procedures ds' s. People who do not question their surgeon can really be given the sadi and told they had a ds and they have no idea they were really given a sadi. Time will tell if the sadi is good or not I guess.
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Post by goodkel on Jun 30, 2014 5:11:20 GMT -5
You did say this
The gastric problems that happen with the RnY (what you call "the bypass") have to do with the pouch and the problems it creates.
I don't know what you have in your mind about it, but the "back up" being referred to is all about bile.
Nothing else.
While they have been doing the SADI in Europe for awhile, it is for all intents, studies, long term weight loss, and insurance purposes an experimental procedure.
If a surgeon is paid for the SADI by calling it a DS, that is fraud. Both against you and the insurance company.
You would both be due a new surgery.
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Post by cherylbaker on Jun 30, 2014 5:42:36 GMT -5
You did say this The gastric problems that happen with the RnY (what you call "the bypass") have to do with the pouch and the problems it creates. I don't know what you have in your mind about it, but the "back up" being referred to is all about bile. Nothing else. While they have been doing the SADI in Europe for awhile, it is for all intents, studies, long term weight loss, and insurance purposes an experimental procedure. If a surgeon is paid for the SADI by calling it a DS, that is fraud. Both against you and the insurance company. You would both be due a new surgery. I was just trying to figure out if there was a way that being revision from a bypass could limit the size of the limbs when doing the revision is all. Just trying to make sence of the things he said. . But he definitely was planning on doing a sadi without telling me and calling it a ds. As far as I know the insurance co said he put in for a ds. Whether the insurance company lady I spoke with would know the difference I dunno. .
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Post by cherylbaker on Jul 5, 2014 17:25:48 GMT -5
So just as an update on this. I shad sent dr Herron a note asking him if he did bypass to ds revisions and if I could get a second opinion from him. Unfortunately it took to long for him to get back to me but he said he dues do them but DOES NOT do the "loop ds" that was shown in the picture (I had sent him the picture dr roslin drew]... So I am soooo glad I heard from you guys about this loop thing so I knew to ask and I recommend anyone having a ds (especially with dr roslin ) ask about this cause he clearly was planning on the loop thing. . What I do not understand is how they can get away with calling it a ds .. i mean it had its own name right.. This loop thing is the sadi right.. Seems wrong
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Post by goodkel on Jul 5, 2014 20:01:05 GMT -5
I couldn't tell you. I found Dr. Roslin's drawing difficult to understand. There are easier to understand illustrations here: weightlosssurgery.proboards.com/thread/9186/ds-sadi-comparison-picturesHere is Dr. K.'s explanation of the SADI: With the single anastomosis of the SADI, the length of the bowel where the bile meets the duodenum is shorter than it is in normal anatomy. This significantly increases the possibility of the bile reflux. The second difference is the selective nature of the reduced absorption of the fat in the duodenal switch, in comparison to that of the carbohydrates. Duodenal switch operation has two absorptive lengths- the Alimentary channel, which is involved with protein and carbohydrate absorption, and the common channel that absorbs, fat, protein and carbohydrates. One can make changes to the common channel and impact the fat absorption significantly more than that of the carbohydrate and the proteins. In SADI procedure, that common channel and the alimentary limb are both the same- there is no way to selectively adjust the fat absorption without making significant changes to that of the protein and carbohydrate absorption. Read more: weightlosssurgery.proboards.com/thread/9185/dr-keshishian-on-sadi#ixzz36e46RT00If you are still going to go with Roslin, be sure to write "I do not authorize the SADI configuration" in a highly visible place (and initial it) on the surgery authorization before you sign it.
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Post by cherylbaker on Jul 5, 2014 20:24:54 GMT -5
I couldn't tell you. I found Dr. Roslin's drawing difficult to understand. There are easier to understand illustrations here: weightlosssurgery.proboards.com/thread/9186/ds-sadi-comparison-picturesHere is Dr. K.'s explanation of the SADI: With the single anastomosis of the SADI, the length of the bowel where the bile meets the duodenum is shorter than it is in normal anatomy. This significantly increases the possibility of the bile reflux. The second difference is the selective nature of the reduced absorption of the fat in the duodenal switch, in comparison to that of the carbohydrates. Duodenal switch operation has two absorptive lengths- the Alimentary channel, which is involved with protein and carbohydrate absorption, and the common channel that absorbs, fat, protein and carbohydrates. One can make changes to the common channel and impact the fat absorption significantly more than that of the carbohydrate and the proteins. In SADI procedure, that common channel and the alimentary limb are both the same- there is no way to selectively adjust the fat absorption without making significant changes to that of the protein and carbohydrate absorption. Read more: weightlosssurgery.proboards.com/thread/9185/dr-keshishian-on-sadi#ixzz36e46RT00If you are still going to go with Roslin, be sure to write "I do not authorize the SADI configuration" in a highly visible place (and initial it) on the surgery authorization before you sign it. That is a great idea thank you. Yes I am still going with dr roslin.
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Post by Girlrocker on Jul 6, 2014 2:43:57 GMT -5
And, to that, add no distal bypass too!
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Post by cherylbaker on Jul 6, 2014 5:47:42 GMT -5
And, to that, add no distal bypass too! Question I just do not understand. . What if he gets in and finds my old stomach unfeasible. What than? Just close shop and forget it? I don't think the insursnce Co is going to pay for that. . Just curious. A revision is not as simple as straight ds.. There are a lot of what ifs. ...
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Post by newyorkbitch on Jul 6, 2014 6:58:01 GMT -5
I think this is a bad idea…you cannot constrain your surgeon to this extent without discussion - I mean if I were your surgeon and we didn't have a good understanding and I didn't have some flexibility to use my judgment when you are open…I'd cancel your surgery. At some point you have to trust your surgeon or find somebody else. You need to talk to Roslin, immediately, and get some clarification and make a plan with him that is comfortable for you and for him. Call him now.
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Post by cherylbaker on Jul 6, 2014 7:48:41 GMT -5
Yes that is what I thought also. Unfortunately since he sprang this whole thing on me at the last moment and than left the country on a trip no discussion was possible. I will be attempting to talk to him on Monday or Tuesday before surgery. Glad I am not totally off in thinking he has to have some leeway since a revision is not as clear cut as a straight ds
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Post by newyorkbitch on Jul 6, 2014 8:27:51 GMT -5
Write him an email, or write a letter and fax it to him.
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mistercy
Full Member
Posts: 228
Surgery Type: DS
Surgery Date: 03/26/2013
Surgeon: Mitchell Roslin
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Post by mistercy on Jul 6, 2014 10:11:04 GMT -5
Cheryl, I've been counseling another Roslin patient who also is a revision, and supposed to get surgery in a week. Roslin also pushed the SADI, calling it a "less invasive" DS. Since Roslin is out of town, he talked to the surgical coordinator at Lenox Hill, making it clear that he wanted a regular DS, not the SADI, and he is looking forward to discussing it with Roslin upon his return. Roslin seems to be pushing out the single loop lately, especially with lightweights, maybe trying to become a pioneer in the field. Like you, this patient was not initially clear about the differences between the two procedures. I was a Roslin patient, and agree with everything that NYB is telling you. Make sure Roslin is crystal clear that he knows your preference. However, since revisions are tricky things, you don't want to hamper his ability to do what is in the best interest of your health once he gets in there. Wishing you the best!
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Post by Girlrocker on Jul 6, 2014 10:33:39 GMT -5
Revisions are very different, I have said as well, repeatedly, that there's no way for them to know the full story, how your RNY was done, the technique used to staple your pouch, if there are adhesions, scar tissue or anything else until they open you up. We are trying to help you navigate based on the concerns you have talked about. You have said that you thought you were being "slipped a SADI" or a distal RNY. And not very happy with either. Sometimes you have said you will "take whatever he can give you", not out of trust for your surgeon or knowledge about the procedures, but external pressures you have mentioned, from scheduling to family pressure and their lack of understanding about the difference between bariatric procedures. Also not the place to make a decision from that is something you have to live with the rest of your life.
You do need to talk to your surgeon, but before you do, you also need to be very clear on what it is YOU want. None of us, your surgeon included, can make that decision for you. Or ease all your fears and anxiety about the revision process. You have to be sure that this is the route you want to go, and, what is the plan you can live with if he can't do a DS. We can provide you experiences, opinions, information, but the decision is yours. I have also said personally, I wouldn't want a distal bypass, it was never an option for me nor was the band over bypass. I feel like both are worse and bad on top of one failed procedure. I think the SADI has the makings of a viable player as a new procedure, a "kinder, gentler" DS in terms of malabsorption; many vetted surgeons are studying it, some doing it already, there's just no data yet for long term outcome/success. For me it was the DS, a sleeve or nothing, the SADI wasn't an option then and that wasn't even 3 years ago. But I'm not you.
If you are truly fine with whatever options he will pursue when he opens you up and in the event he can't do a DS, and this is an EDUCATED decision about all the alternatives, not an emotional one, move forward. If there is a procedure you don't want under any circumstances and he should close you up instead, you DO need to both to discuss tthat with your surgeon and have it in writing.
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Post by goodkel on Jul 6, 2014 12:10:08 GMT -5
Exactly what Sharyl said.
It is just as important to know what you don't want and make that very clear.
Personally, I would not tolerate waking up to a surgery, a life that I hadn't fully and enthusiastically bought into from the start.
The options I would choose would have been full DS, VSG with a date to complete the DS, this surgery for repairs fix hernias remove adhesions with a date for the DS after healing.
Or I would switch surgeons to one with a reputation for having the skill to complete difficult DS surgeries in one step and not surprising his patients with a surgery that they did not request. A surgeon like Dr. Keshishian.
But, that's me. You have to make the decisions that are right for you.
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Post by Girlrocker on Jul 6, 2014 12:25:46 GMT -5
And also know Cheryl, that when we say you must do what's right for you, we mean it and will support whatever you decide. It's not a 'brush off' when we say 'I wouldn't want those procedures but that's me'.Everyone really does have to do what is best for them, in their circumstances. I would just want to be very clear with my surgeon about those circumstances and what drives their decision, you should not be bullied or pushed into something you don't want. But again, only YOU can make that decision.
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Post by cherylbaker on Jul 6, 2014 13:30:43 GMT -5
Thanks guys. I know what I want always have picked my surgeon based on he was suppose to be the best for that surgery [ds].. my freak out was caused by his apparent change of support for the ds. I believe he is capable of doing what I want just a question as to if he will do what I want even if it is not what he wants (which he said he would.. but i am not very trusting of drs). From what I know ... getting the old stomach back is the hard part on a revision. To me that is the most important part.. if that can't be done it just seems silly to do anything. . But it probably isn't silly. Sonething else could help me.. but if sonething can be repaired than a second surgery would be required.. i don't think I would want to go through that. I also do not think a sleeve alone would be good enough for me.. but i could be wrong.. but that should never be the problem. My problem is if he cannot put the stomach back. My friend could not get hers back due to the horrible job that was done on her rny. She does not know what he did to her plumbing but she also does not care. I dunno what I would want. Can you have a pouch with the ds plumbing reworking? Would that be too hard having such a small pouch and than malobsorption on top of that?? My problems now are I am starving shortly after eating and I have trouble eating a lot of food and cannot take nsaids. All of which are solved by putting my stomach back and sleeving it. As far as I know none can be solved if I can't have my stomach back.. except if he removes the old stomach like he did for my friend I could take nsaids and I guess he could do something to make malobsorption which could help. I dunno..
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Post by cherylbaker on Jul 6, 2014 16:50:08 GMT -5
And also know Cheryl, that when we say you must do what's right for you, we mean it and will support whatever you decide. It's not a 'brush off' when we say 'I wouldn't want those procedures but that's me'.Everyone really does have to do what is best for them, in their circumstances. I would just want to be very clear with my surgeon about those circumstances and what drives their decision, you should not be bullied or pushed into something you don't want. But again, only YOU can make that decision. I thank you for saying this. . I have felt like it was just a "brush off" but figured it was just me being too sensitive again. And I guess If I do sonething only cause I an bullied into it than I guess that is my decision (not a smart one).. but thanks for your unconditional support
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Post by west4thavenue on Jul 6, 2014 20:09:18 GMT -5
And also know Cheryl, that when we say you must do what's right for you, we mean it and will support whatever you decide. It's not a 'brush off' when we say 'I wouldn't want those procedures but that's me'.Everyone really does have to do what is best for them, in their circumstances. I would just want to be very clear with my surgeon about those circumstances and what drives their decision, you should not be bullied or pushed into something you don't want. But again, only YOU can make that decision. I thank you for saying this. . I have felt like it was just a "brush off" but figured it was just me being too sensitive again. And I guess If I do sonething only cause I an bullied into it than I guess that is my decision (not a smart one).. but thanks for your unconditional support That is an inherent problem in communicating solely through the written word. You can't see body language or hear tone of voice. And I know exactly what you mean about being "too sensitive". I have been guilty of the same thing. Sometimes you can read things two ways.
Cheryl, I hope that everything you have been offered here has been taken into your consideration. You have had some very well expressed concerns that lots of us have shared with you. It's easy to get emotional about this very radical life-changing surgery, but we all have to strive for a solid rationale at the same time. I believe the people who have weighed in on your decision in the past 2 - 3 weeks have done so out of concern for you. Everyone here has a little bit different experience, and opinions are not always the same. But we all seem to be pretty emphatic about this one point...DS is huge. I think people take the time to write to you because they care about you. I know that is why I'm here writing this right now!
I would hate for you or anyone else to choose this surgery based upon emotions or because they believe the alternatives are poor or that it has to happen right now. There is a lot of opportunity for buyer's remorse with the DS for people who are not well informed. This is forever.
Like girlrocker/Sharyl said, we support you whatever you decide!
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angelise
New Member
Posts: 28
Surgery Type: DS
Surgery Date: 5/29/2014
Surgeon: Dr. Mitchell Roslin
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Post by angelise on Jul 7, 2014 11:47:22 GMT -5
Cheryl, Sorry to hear all the issues you are having. I know a lot of this was brought up though my post about SADI. I am glad you are getting it clarified before the procedure though. Good luck and let me know if there is anything you need.
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Post by cherylbaker on Jul 7, 2014 12:12:49 GMT -5
Cheryl, Sorry to hear all the issues you are having. I know a lot of this was brought up though my post about SADI. I am glad you are getting it clarified before the procedure though. Good luck and let me know if there is anything you need. No need to apologize. I am soooo gratefull I heard about this beforehand and hopefully the steps o will take will insure i get the real ds. Left my house at noon to drive to ny for surgery tomorrow. Since we will not be told what time surgery will be we have to go a day early on case surgery is in the am. I really hate this drive.. but.. Yiu do what you gotta do..
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Post by nursemelanie on Jul 7, 2014 14:57:47 GMT -5
Wishing you a great surgery and speedy recovery. VSG to DS w/gallbladder removal & repair of hiatal hernia 7-01-14/ Dr Boyce, Knoxville, TN /Age 40/5'8"/HW 287/SW 270/CW 264
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Post by Girlrocker on Jul 7, 2014 16:04:34 GMT -5
And also know Cheryl, that when we say you must do what's right for you, we mean it and will support whatever you decide. It's not a 'brush off' when we say 'I wouldn't want those procedures but that's me'.Everyone really does have to do what is best for them, in their circumstances. I would just want to be very clear with my surgeon about those circumstances and what drives their decision, you should not be bullied or pushed into something you don't want. But again, only YOU can make that decision. I thank you for saying this. . I have felt like it was just a "brush off" but figured it was just me being too sensitive again. And I guess If I do sonething only cause I an bullied into it than I guess that is my decision (not a smart one).. but thanks for your unconditional support Cheryl, definitely! I think too, there's a significant distinction between a surgeon having to change plans based on what he finds in there vs. trying right off the bat to push you/one to another procedure. It's just important you make a decision with a well informed head and not your emotions and that you have a very clear conversation with your surgeon about your wishes in all circumstances. I hope this is all helping you to sort things out and truly do what is best for you.
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Post by cherylbaker on Jul 7, 2014 16:10:47 GMT -5
Ok so here I am in ny. My surgury is scheduled for 745am. Not sure how long it takes 3 or so hrs right.. my husband will post an update as soon as he knows.
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Post by west4thavenue on Jul 7, 2014 16:14:26 GMT -5
Bon voyage, Cheryl! See you on the other side tomorrow!
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Post by cherylbaker on Jul 7, 2014 20:23:08 GMT -5
Thanks.. i hope I can get some sleep.. i am soo scared. I hate having all those things hooked up to me and all the beeping and especially I hate hate hate anesthesia. My poor daughter still has not had her baby. She's going in for an ultrasound tomorrow and a dr appt. She's Worried about me and having the baby and I'm worried about me and her having the baby and we are far apart. I hope we both do great tomorrow
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Post by west4thavenue on Jul 7, 2014 20:40:59 GMT -5
Cheryl, I am sorry you are feeling so scared. I hate feeling anxious and afraid, even though I am very, very good at it! You know what I do? When times are tough for me like that, I ask my doctor for valium. I'm not ashamed of that, either. He'll write me a small scrip just to get me through. I have been through some scary stuff the past couple of years, and I had to function in a calm manner.
No sense in blinking in the dark and going over the worst case scenario again and again all night. As soon as you get to the hospital in the morning, tell them you are crazy anxious and to go ahead and give you something to help you relax. They have good drugs there. Take something tonight, too, to help you rest if you can. Just make sure it's okay with the surgeon first.
Breathe deeply and stay positive. Have a good night.
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Post by cherylbaker on Jul 7, 2014 21:52:50 GMT -5
Thanks for the note. Been putting off trying to sleep cause every time i try my mind starts racing. .. but it is late going to just tough it out. . In 12 hrs the hard part begins (recovery)..
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