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Post by Deleted on Jul 23, 2013 20:33:30 GMT -5
Dr. Keshishian JUST CALLED ME. VERY NICE OF HIM. HE BASICALLY SAID HE WOULDNT RECCOMEND A RNY TO A FAMILY MEMBER AND THAT ITS "CRAP," AS IS THE BAND. He did agree an RNY would take away the acid producing section of the stomach and disconnect it from the mouth. But he said this can cause a "silent asthma" in that the acid wont come up to the mouth when it needs to and that food would sit in the esophagus. He said he would do a loose Nissen wrap with a partial DS. He said he would have my weight loss rely on the malabsorption component and do the intestinal bypass, but potentially NOT do a sleeve to avoid the high pressure. Possibly a very gentle sleeve depending on my medical records. But likely the intestinal portion of the DS and not a sleeve, making the weight loss from the malabsorption and not from any restrictive property. He said the original DS from DeMeester was actually for acid reflux. Finally, he doesn't do a fixed common channel. (I wanted a 150 conservative cc). He does it as a percentage of total length, which usually results in a common channel of 50-100. So that's another opinion. But he definitely was against an RNY -- not even for weight loss reasons but for health reasons. Wow, he didn't pull any punches. Very interesting and sounds like a good plan. I don't have his medical knowledge but I agree with his perception of the RNY. Good luck!
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Post by Deleted on Jul 23, 2013 20:37:43 GMT -5
Hey, if Dr. K. says it's doable, then I'm pleased.
I have developed a pretty good batch of GERD since my DS, and I had a relatively generous gastric reduction.
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Post by Girlrocker on Jul 23, 2013 23:21:39 GMT -5
That's Dr. K! After being here, having him as my surgeon, I would never recommend the RNY to anyone, and not just because mine failed and made me miserable. But your situation is different. He's really amazing, besides highly skilled and, fair. I was interested to hear what he'd have to say about all the pros/cons, and he gave you a honest portrait and for the big picture. Also glad to hear you are consulting Dr. Rabkin as well, I think you're gathering a lot of really important information. I'm relieved to hear you have options to consider, and look forward to hearing what Rabkin has to say. Rootin' for you!
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Post by Paula on Jul 24, 2013 15:20:15 GMT -5
Another who will say to avoid the RNY like the plague. The RNY honestly does not sound like the right tool for you based on all I've read from you, nyboi. It wasn't the right tool or me either. Think long and hard. You have a number of us here who revised from an RNY for a reason. Don't let he pressure of "omg Im gaining weight" get you into a situation you may end up having to revise. Wait to see what Dr. Rabkin says, then think hard about what Roslin, Keshishian, and Rabkin all think. Go with your gut
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jeg
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Post by jeg on Jul 24, 2013 15:56:46 GMT -5
nyuboi, I know you've tested and scoped to Kingdom Come, but I was trying to understand what causes such copious amounts of stomach contents to be sitting around hours after eating. Is there a restriction to your stomach emptying?
My daughter has gastroparesis, and wakes up vomiting at night. She is trying to control it with medications, but still has a lot of problems. Oddly enough, one of the surgical methods of treatment proposed was to have a gastric sleeve procedure; to remove most of the stomach, so that the remainder can more efficiently contract to propel food into the intestines. This might make her life better; even though she is thin, she might get better nutrition with a smaller stomach.
Prior to my RNY 10 years ago, I had GERD. I did not see the operative report, but I am pretty sure the surgeon did a Nissan fundiplication at that time. Where many people had trouble with frequent vomiting after RNY due to pouch distention, I could never "successfully" vomit. I had dry heaves, which is just delightful with a large incision. And later on, if I forgot and ate too much, that food was going NOWHERE until it digested. No sticking the finger down the throat to empty the stomach and ease the pain. I also was not able to burp for several years.
If I had it all to do over again, I would be on Dr. K's doorstep. If he has an entire stomach to work with (since you have not had RNY or a sleeve yet), I would think that doing the Nissan the way he is talking about would serve you better than a RNY. And I say that, as someone who had the RNY, and a bit of a too good cure for GERD.
I wish you the best in the quest to find the best answer for your health.
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Post by nyuboi on Jul 24, 2013 16:46:34 GMT -5
A lot of good information. Thank you, everyone. Dr. Roslin only sees patients on Wednesdays during the summer, so it might be a week before I can get in to see him to discuss this stuff. Not sure if I want to mention consulting other doctors on an e-mail to him...
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Post by nyuboi on Jul 24, 2013 16:48:50 GMT -5
THIS IS FROM DR. FIELDING AT NYU: Sounds like he would also be still willing to do the DS.
Paul, from what you say, you have severe GERD. I think a bypass is probably a better choice, as it almost always cures reflux . However a DS is still an option if you have a hiatal hernia that can be fixed at the same time. Come in to see me and bring any tests you have. At the very least you need a current esophogram which you could do the day I see you. I do Nissens all the time but there's no doubt that given your weight, a roux y or Ds is a better option George Fielding
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Post by newyorkbitch on Jul 24, 2013 17:41:01 GMT -5
If Roslin has a problem with your getting second opinions, that's a red flag right there.
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Post by horsnhound on Jul 24, 2013 19:19:16 GMT -5
Please google Barretts and make sure that before you make the decision for DS that Barretts is ruled out. I really wanted the DS but due to severe reflux that caused Barretts, my surgeon was not willing to do any kind of sleeve on me. I am now having severe magnesium deficiency problems (weekly mag infusions for the last 2.5 years and no improvement yet) from 10 years of daily Nexium use.
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Post by Deleted on Jul 24, 2013 20:03:59 GMT -5
Please google Barretts and make sure that before you make the decision for DS that Barretts is ruled out. I really wanted the DS but due to severe reflux that caused Barretts, my surgeon was not willing to do any kind of sleeve on me. I am now having severe magnesium deficiency problems (weekly mag infusions for the last 2.5 years and no improvement yet) from 10 years of daily Nexium use. I have Barret's and I am going to have a DS. My surgeon tried to talk me into RNY but I told him I would not do an RNY. There is no data I can find supporting the thesis that a sleeve exacerbates GERD, in fact a longitudinal gastrectomy is one of the alternatives to a Nissen Fundiplication. BTW, I have Barret' because I didn't realize I had severy GERD so I didn't take prilose or otc nexium unless I thought I needed it...that was stupid and now my GERD is well controlled with omeprazole.
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Post by horsnhound on Jul 25, 2013 5:42:44 GMT -5
No, not recommending against DS. Never said that in my post. I said my surgeon (several actually) did NOT recommend the DS for ME because of my Barretts and the fact that if not controlled it can lead to esophageal cancer. I was further informed that RNY was first established as an anti-reflux surgery. I have been off the Nexium for the last year - intractable hypomagnesia-once it gets to that point-is a long and arduous process to correct. The fact that not everyone on long term PPI therapy gets intractable hypomagnesia goes without saying. However only a year and a half ago did they start to issue warnings about it on media ads.
Illinids-good luck to you...sincerely. My research goes back to 2002. I have been on OH before it was OH (Spotlight Health) as well as a myriad of other boards. In 2006 when Cirangle started doing the VSG I met with him several times. I was told no sleeve due to Barretts. I spent years reading the VSG and DS boards just hoping to prove my surgeons wrong about reflux. Unfortunately I have found reflux to be a serious and very common side effect for VSG and much later out, the DS. Esophageal cancer scares the bloody shit out of me-horrible way to die and a 5% survival rate is just not worth it to me when I can have a weight loss surgery that will proverbially kill two birds with one stone ( weight loss and reflux). I am choosing to listen to my various surgeons and have the RNY. Not my first choice (VSG) nor my second choice (DS). But for me and my condition, the SAFEST choice.
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Post by ginany on Jul 25, 2013 11:52:46 GMT -5
In 2006 I had an RNY with Dr Sapala. Of course I gained about 60 pounds back. I went to Dr Roslin for a revision. He told me he cant do a revision on me because Dr Sapalas "micropouch" is usually too high and too small, and I would have to get the band. Upon all the advise of the Vets I spoke to Dr Keshishian. He said there was absolutely no reason why this could not be done. I went back to Dr Roslin and he ran some tests and agreed . Here I am a year and a half later very happy with my DS.
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jeg
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Post by jeg on Jul 25, 2013 13:57:07 GMT -5
I found an article on Dr. Keshishian's website, which sounds like what he was speaking about: www.dssurgery.com/newsletters/achalasia.phpThere are a lot of good articles on his site. It is the most informative surgeon's webpage that I have found.
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Post by PrettyGirlBounce on Jul 25, 2013 14:08:54 GMT -5
Having dealt with what seems like every possible complication known to man with my RNY, I can unequivocally say that I would rather have NO WLS than a RNY or lapband (or both, which I ended up with before my DS). I never thought I would say that but it is the cold, hard truth and something I feel very strongly about.
It seems Dr. K's approach is logical, reasonable and very much a "meet in the middle" solution. I hope everything works out for you. Keep us posted.
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Post by Deleted on Jul 25, 2013 15:23:02 GMT -5
I found an article on Dr. Keshishian's website, which sounds like what he was speaking about: www.dssurgery.com/newsletters/achalasia.phpThere are a lot of good articles on his site. It is the most informative surgeon's webpage that I have found. Thanks for the link ...this will be a great resource if Dr Marshall tries to push me to the RNY.
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Post by nyuboi on Jul 29, 2013 18:22:03 GMT -5
This just in from Dr. Roslin's surgical coordinator:
Hi Paul, I got an approval from your insurance company for the surgery, I have the following dates available 8/6 and 8/13, please let me know which date works for you asap. You also need to get medical clearance from your pcp as well as blood work, ekg, chest x ray, and urinalysis. ----------------------------------------------------------
I AM APPROVED FOR AN RNY, NOT A DS.
So I am NOT taking a surgery date or going on the books until I can talk in person to Dr. Roslin on Wednesday about the DS and stuff.
Keshishian said do a DS without the sleeve, just a strong intestinal bypass, I will mention this idea to Dr. Roslin. The problem is not just my GERD, but my vomiting at night continues. A lot. When I had my endoscopy last Thursday, they saw food in my esophagus from the night before. This means, despite the motility tests saying otherwise, that I have some sort of motility disorder. Not everything is emptying my esophagus right away. I may have some form of achalasia. I am not convinced that extreme vomiting can be coming from acid reflux alone.
I am relieved the insurance company did not fight me. I thought they would. Guess the co-morbidities pushed it through. Now it's just a question of if I am a good candidate to cancel and seek new approval for the DS.
I never heard from Dr. Rabkin.
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Post by nyuboi on Jul 29, 2013 18:23:12 GMT -5
nyuboi, Did they do biopsies with your endoscopy? Did the gastro check for Barretts? No because they didn't want to irritate the esophagus right before the Bravo implant/pH testing. Having another endoscopy on Thursday by my regular GI who is going to biopsy the polyps in my stomach and all... NEGATIVE for barretts and h. pylori and all that, had it done last week. Just a hiatal hernia.
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Post by nyuboi on Jul 29, 2013 18:27:44 GMT -5
nyuboi, I know you've tested and scoped to Kingdom Come, but I was trying to understand what causes such copious amounts of stomach contents to be sitting around hours after eating. Is there a restriction to your stomach emptying? My daughter has gastroparesis, and wakes up vomiting at night. She is trying to control it with medications, but still has a lot of problems. Oddly enough, one of the surgical methods of treatment proposed was to have a gastric sleeve procedure; to remove most of the stomach, so that the remainder can more efficiently contract to propel food into the intestines. This might make her life better; even though she is thin, she might get better nutrition with a smaller stomach. Prior to my RNY 10 years ago, I had GERD. I did not see the operative report, but I am pretty sure the surgeon did a Nissan fundiplication at that time. Where many people had trouble with frequent vomiting after RNY due to pouch distention, I could never "successfully" vomit. I had dry heaves, which is just delightful with a large incision. And later on, if I forgot and ate too much, that food was going NOWHERE until it digested. No sticking the finger down the throat to empty the stomach and ease the pain. I also was not able to burp for several years. If I had it all to do over again, I would be on Dr. K's doorstep. If he has an entire stomach to work with (since you have not had RNY or a sleeve yet), I would think that doing the Nissan the way he is talking about would serve you better than a RNY. And I say that, as someone who had the RNY, and a bit of a too good cure for GERD. I wish you the best in the quest to find the best answer for your health. Very interesting about your daughter. With regards to the stomach emptying, the gastric emptying study came back normal where I ate the radioactive eggs and all. My stomach empties fine. My esophagus is the issue and no one can seem to give me an accurate or consistent diagnosis. I do not believe GERD would cause the type of vomiting I experience at night so I think it's more than that. But the motility studies showed no achalasia. So I don't have much to go on, no one is really sure. Dr. Roslin just seels an RNY is safest with these issues I suppose. UPDATE: I do think the vomiting is connected to damage done to my esophagus by the lapband. GI said it probably remains dilated and never returned to normal.
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Post by nyuboi on Jul 29, 2013 18:33:31 GMT -5
If Roslin has a problem with your getting second opinions, that's a red flag right there. Once I quoted Dr. Inabnet (off the vetted list at Mt. Sinai) and Dr. Roslin said "Well then let him operate on you. I Do more revisions in one week than he does in a year." So I have to be careful the way I present other doctors. I am going to be blunt about what Dr. K said then. Another time I went to say all other doctors in NY said and he finished the sentence and said "do an RNY, they all said to do that..." This was when Dr. Roslin was the only one suggesting a DS before we knew of the issues. I said "actually, no, I got mixed reviews. Dr. Inabnet said RNY better for reflux but that he is willing to do a DS with a longer common channel, Fielding said he would do either, and Alfons Pomp and Marc Bessler said RNY only. (Pomp told me bathroom horror story where the patients landlord was trying to evict them cause of the smell...) He will hear out what other doctors say as Long as I present it the right way... This is all just so weird cause Dr. Roslin is MR. DS, he rarely recommends an RNY.. He said he did two last year. The majority of his practice is revisions, sleeves, and DSes. He just doesn't think its as safe as an rny for me. I was going to ask him more on email or the phone, but I Decided its best to go in and see him for such an important conversation. Driving to the city on Wednesday before I take an RNY surgery date. Going to see if theres anyway we can do a DS without making my conditions worse.
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Post by nyuboi on Jul 29, 2013 18:36:34 GMT -5
THIS IS FROM DR. FIELDING AT NYU: Sounds like he would also be still willing to do the DS. Paul, from what you say, you have severe GERD. I think a bypass is probably a better choice, as it almost always cures reflux . However a DS is still an option if you have a hiatal hernia that can be fixed at the same time. Come in to see me and bring any tests you have. At the very least you need a current esophogram which you could do the day I see you. I do Nissens all the time but there's no doubt that given your weight, a roux y or Ds is a better option George Fielding I would do a LOT of research on Fielding, the Lapband spokesman, who has multiple lawsuits against him. Yeah I know. He personally has a lap-band. I don't like how pro-lapband NYU is, that's the negative of him. But I know he has long done DSs even before he came to the U.S. He definitely has experience with it and seems respected. I know about the lawsuit from a NY Post article, but Dr. Roslin was quoted it in as saying "I would let Fielding operate on me anyday, he is an excellent surgeon." And Mt. Sinai didn't want to step on his toes when they found out I consulted him. Don't get me wrong.. he already had a strike against him cause he wanted to try to keep my band in at first. Imagine how bad my esophagus would have been then.
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Post by nyuboi on Jul 29, 2013 18:39:13 GMT -5
Please google Barretts and make sure that before you make the decision for DS that Barretts is ruled out. I really wanted the DS but due to severe reflux that caused Barretts, my surgeon was not willing to do any kind of sleeve on me. I am now having severe magnesium deficiency problems (weekly mag infusions for the last 2.5 years and no improvement yet) from 10 years of daily Nexium use. Barretts was ruled out last week. With the RNY I wont be living on Nexium anymore. (Also been on PPIs for 10 years of use,, I know theres some negative long term consequences of this stuff).
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Post by nyuboi on Jul 29, 2013 18:51:06 GMT -5
I found an article on Dr. Keshishian's website, which sounds like what he was speaking about: www.dssurgery.com/newsletters/achalasia.phpThere are a lot of good articles on his site. It is the most informative surgeon's webpage that I have found. " I would have to once again raise the issue of correct diagnosis, in that most achalasia patients have significant weight loss, and will probably not be in the need of any weight loss surgery.
An esophageal motility disorder however is something that I have seen as a complication of Adjustable gastric banding. In a quest for more weight loss, the band is continuously filled. There is a fairly large body of scientific published data (both case reports and small series) that talk about the problem of AGB causing esophageal motility disorders.The universal belief is however, that the conversion to alternative operations, Duodenal switch or gastric bypass will is at least some cases reverse the motility disorder."This is why they ruled out achalasia on me, because I was having weight gain and not weight loss. According to this though, I could still have some sort of motility disorder from the lapband. Interesting.
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Post by newyorkbitch on Jul 29, 2013 19:41:46 GMT -5
Personally, I think you're nuts to have Fielding do your DS. In NYC, if it's not Roslin, it should be Pomp or someone on his team; or someone on the Sinai team.
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Post by newyorkbitch on Jul 29, 2013 19:44:03 GMT -5
Maybe you should get your hiatal hernia fixed first, if it's that significant, and see if your GERD resolves.
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Post by nyuboi on Jul 29, 2013 19:47:00 GMT -5
Emailed Dr. K about the article, his response:
Hello, I think the problem that most GI specialist have is that they have not caught up with the science and the complications of Lap Band, and are still applying the old diagnostic criteria to patient with new problems. Good luck. Ara
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Post by nyuboi on Jul 29, 2013 19:48:32 GMT -5
Personally, I think you're nuts to have Fielding do your DS. In NYC, if it's not Roslin, it should be Pomp or someone on his team; or someone on the Sinai team. Not using Fielding. Under Dr. Roslin's care. Dr. Pomp said he would only do an RNY on me, no DS.
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Post by meq815 on Jul 29, 2013 19:55:31 GMT -5
Wow. I know Dr K is like a god here, but am I reading correctly- he called you within a half hour of you e-mailing him? That is certainly impressive....almost unheard of!
Good luck, Paul.
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Post by newyorkbitch on Jul 29, 2013 19:57:23 GMT -5
Did you talk to Dan Herron? Or Inabnet?
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Post by Leonie on Jul 30, 2013 15:38:10 GMT -5
Why don't you go to Dr K?
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Post by nyuboi on Jul 30, 2013 16:07:07 GMT -5
Spoke with Dr. Roslin. I am seeing him tomorrow for pre-op. They forced me on the phone with him today when I wouldn't schedule a 8/13 surgery date because of referencing DS. He did not speak highly of Dr. K., which I will leave out here. He said "I do more research on the DS than any surgeon in this country." He said "Your esophagus is too damaged from the lap-band, you can't get a DS. In hindsight it's a good thing we didn't do the revision all in 1 stage when the band came out." He said he has to make a low-pressure very small pouch on me. He is not willing to consider a DS it sounds like.
We have to remember this guy PUSHES the DS on everyone I send to him. He's not an RNY fan at all, he told me the statistics on it are going quickly down the toilet in the past. He hates lap-band and does mostly sleeves and DS's. So if he is saying I have to do an RNY, there might be something to it.
As of now, I am scheduled for RNY on 8/13.
Will try to talk more with him tomorrow, but it sounds like he is ruling out a DS for me because my esophagus is too far gone from the lap-band. (I really do vomit quarts at night of food sitting in my esophagus).
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