Revision vs reversal of BPD DS

[rosebud5532]

I had the BPD DS in May 2003 and lost almost 200 pounds (347 down to 150). I currently weigh 190-195 pounds, but I am thinking of a revision or reversal for the following reasons:

1) I can't stand the gas/BM issues anymore. I panic without my spray (poopourri is great). I live in constant anxiety surrounding BMs.
2) if I don't take Creon with every meal I develop this bad breath (not ketosis) that I can't tell I have unless a friend tells me. It has to be associated with the malabsorption cause the Creon helps.
3) I worry about all the nutritional issues. All the information newly being discovered may not be accessible for me with the malabsorption.
4) I worry about what this will be like long term.

i know weight gain is a real possibility. But, I have been taking enzymes that decreases the amount of malabsorption. I hope this will mean it is not such a drastic change and the weight gain will be minimized.

i really need to hear from people with a common channel of 200-250 cm. what are bathroom issues like? Gas? Diet restrictions? What supplements do you take? I can either leave some malabsorption, or almost totally reverse the malabsorption. 

I am looking at next January for surgery. One of my issues now is my love for sweets. I drink so many diet sodas, and I have read that they cause you to crave sweets. One of my plans is to deal with this. Hopefully, I can lose 20-30 pounds to give me a margin for after the revisions.

i really need all your advice, especially those if you who have had revisions or a 200 cm common channel.

thanks!

[caprice]

Would you be willing to give an honest appraisal of your carbohydrate intake? Not "net" carbs, rather, all carbs.

Carbs certainly could be contributing to your misery. There are other things, of course... Do you take probiotics? Have you added fiber such as chia seeds, flax seeds or psyllium husks to your diet?

Re: #3: Have you just started worrying about malabsorption, or have you worried all 11 years that you have had this configuration? Is there something that has happened lately to cause you to start worrying?

I'm not a revision, and my common channel is not excessively long. I would not want to lose the malabsorption that I enjoy. I have started taking digestive enzymes with my supplements, in the hope that they may be better absorbed. Particularly Calcium and D. We'll see how the next bone scan goes

[rosebud5532]

Thanks Caprice for your response.
Yes I have considered the amount of carbs that I eat. I know if I have a carb fest I pay for it in the end (pun vet much intended). Either way I go I have to watch my carbs.

i have been increasingly concerned about the nutritional issues over the past 3-4 years. For example. All of those wonderful omega 3s probably aren't absorbed. I would like to eat more of a vegetarian diet, but have to consume 100 gm of protein daily. 

To control these issues I have to watch carbs. To not gain weight I will have to make choices and diet. Both are going to take discipline, but I would have more flexibility for better nutrition with less malabsorption.  It is a tough decision. One big deciding factor will be if I can get my sweet tooth under control, wean off diet sodas, and watch my snacking. I know it will be a lifelong battle, but it will to control these GI issues with the DS.

one note about calcium absorption...make sue you are taking calcium citrate and that the words (elemental) appear after the ingredients. That means you are getting the specified amt in calcium, not calcium and fillers. I didn't know that and my bones took a hit with decreased calcium intake along with rapid weight loss. I'm not sue if enzymes will help your calcium absorption since that part of your bowel is bypassed. I take 150,000 units of vitamin D and 1500 mg calcium citrate daily.

again, thanks for your input.

[Ladytaz]

I was revised from a 100 cc common channel to a 200 cc common channel. Best thing I ever did. I had many of your symptoms which severely affected my quality of life. I also regained 100 lbs and was very sick and fatigued to the point of house bound. And like you I was addicted to the refined carbs. I was living on fast food and junk food, and of course that only made things much worse. Because of my intestinal configuration I suffered from chronic bacterial overgrowth. Even totally eliminating the bad carbs, which I did, the symptoms improved but never went away.
Long story short, I went back to my original surgeon and begged for a reversal. He told me I couldn't be reversed but I could be revised to a 200 cc. Best thing I ever did, along with giving up the refined carbs, sugar and gluten.
That was nearly 4 years ago. I lost the regain and then some and I am maintaining fairly easily. I did have my sleeve, which was left extremely large and offered no restriction, revised to a RNY pouch. Not the best idea but I wasn't really thinking too clearly at the time and luckily I have no bad effects because of it, but now I have restriction which has really made the world of difference. I no longer have the driving hunger I did, which is also in part to detoxing off the carbs, I am able to stick with a healthy way of eating and I feel better then ever.
I have absolutely no more of the issues that I did before. My gas and BMs are no different then before I had surgery. I do have constipation now, which is ironic because I lived with constant diarrhea for nearly 8 years. I am not lying when I say that in 8 years I never had a formed stool until my revision.
My labs are great and after having Reclast infusions my osteoporosis has improved significantly. In hindsight I would have done great with a longer common channel and smaller sleeve but what is done is done. You do have to be more careful about what you eat with a longer common channel but, as you have found, there is no free ride and any WLS requires changes in order to be successful.
How is your sleeve size? If it has stretched out you might want to see about getting a resleeve along with lengthening your common channel.
I had my DS in 2002 and I think back then the trend was a shorter common channel and larger stomach and I think now they are finding the opposite is working better.
Good luck in whatever you do.

[rosebud5532]

Thanks for the reply Ladytaz. My sleeve was 100 ml, but now is stretched. Sometimes I can eat a large amount, other times not so much. I definitely will need to do portion control. I am hoping since I have decreased malabsorption with the enzymes that I won't have such a marked difference in absorption after a revision. Bas
i have an ulcer in the Antrum of my stomach, so I don't know if deselecting is an option. Also, about 1x a month I get this horrible heart burn that has sent me to the ER for relief.we don't know why. Can't figure any target foods. 

Did you take digestives enzymes prior to reversal? If so, what type (I take 24,000 unit caps 4-6 a day to control that breath thing I described). Did you have the breath issues also? 

What vitamins do you have to take?

Another thing I suffer from is he hemorrhoids. If I have a run of bad diarrhea (always carb related) they flare up. My bum is on fire after that. Treating with over the counter stud, but I also don't want to have that type of surgery.

Basically, I will now have to deal with my relationship with food. I didn't really have to do that with my rapid weight loss. 

If I had to do over, I would take a small pouch and 200 cm common channel. 

Thanks again,

Rosebud5532

[Deleted]

Mar 12, 2014 12:37:09 GMT -5 Ladytaz said:

I was revised from a 100 cc common channel to a 200 cc common channel. Best thing I ever did. I had many of your symptoms which severely affected my quality of life. I also regained 100 lbs and was very sick and fatigued to the point of house bound. And like you I was addicted to the refined carbs. I was living on fast food and junk food, and of course that only made things much worse. Because of my intestinal configuration I suffered from chronic bacterial overgrowth. Even totally eliminating the bad carbs, which I did, the symptoms improved but never went away.
Long story short, I went back to my original surgeon and begged for a reversal. He told me I couldn't be reversed but I could be revised to a 200 cc. Best thing I ever did, along with giving up the refined carbs, sugar and gluten.
That was nearly 4 years ago. I lost the regain and then some and I am maintaining fairly easily. I did have my sleeve, which was left extremely large and offered no restriction, revised to a RNY pouch. Not the best idea but I wasn't really thinking too clearly at the time and luckily I have no bad effects because of it, but now I have restriction which has really made the world of difference. I no longer have the driving hunger I did, which is also in part to detoxing off the carbs, I am able to stick with a healthy way of eating and I feel better then ever.
I have absolutely no more of the issues that I did before. My gas and BMs are no different then before I had surgery. I do have constipation now, which is ironic because I lived with constant diarrhea for nearly 8 years. I am not lying when I say that in 8 years I never had a formed stool until my revision.
My labs are great and after having Reclast infusions my osteoporosis has improved significantly. In hindsight I would have done great with a longer common channel and smaller sleeve but what is done is done. You do have to be more careful about what you eat with a longer common channel but, as you have found, there is no free ride and any WLS requires changes in order to be successful.
How is your sleeve size? If it has stretched out you might want to see about getting a resleeve along with lengthening your common channel.
I had my DS in 2002 and I think back then the trend was a shorter common channel and larger stomach and I think now they are finding the opposite is working better.
Good luck in whatever you do.

I will need to see your data because I have seen absolutely zero data to indicate that your assumptions (which I marked in bold) are in fact true. There is research out there showing that in fact small sleeves versus larger sleeves had no benefit.

Although I am only six months out I do not have significantly more gas than I did before surgery, and I do have formed stools. It isn't rock solid but varies from loosely formed at times to more tightly formed at other times. Eating too many carbs can make things uncomfortable and obviously eating too much fat can cause issues as well. Like anything in life there has to be a healthy balance.

[Ladytaz]

Mar 12, 2014 17:23:19 GMT -5 @illinids said:

Mar 12, 2014 12:37:09 GMT -5 Ladytaz said:

I was revised from a 100 cc common channel to a 200 cc common channel. Best thing I ever did. I had many of your symptoms which severely affected my quality of life. I also regained 100 lbs and was very sick and fatigued to the point of house bound. And like you I was addicted to the refined carbs. I was living on fast food and junk food, and of course that only made things much worse. Because of my intestinal configuration I suffered from chronic bacterial overgrowth. Even totally eliminating the bad carbs, which I did, the symptoms improved but never went away.
Long story short, I went back to my original surgeon and begged for a reversal. He told me I couldn't be reversed but I could be revised to a 200 cc. Best thing I ever did, along with giving up the refined carbs, sugar and gluten.
That was nearly 4 years ago. I lost the regain and then some and I am maintaining fairly easily. I did have my sleeve, which was left extremely large and offered no restriction, revised to a RNY pouch. Not the best idea but I wasn't really thinking too clearly at the time and luckily I have no bad effects because of it, but now I have restriction which has really made the world of difference. I no longer have the driving hunger I did, which is also in part to detoxing off the carbs, I am able to stick with a healthy way of eating and I feel better then ever.
I have absolutely no more of the issues that I did before. My gas and BMs are no different then before I had surgery. I do have constipation now, which is ironic because I lived with constant diarrhea for nearly 8 years. I am not lying when I say that in 8 years I never had a formed stool until my revision.
My labs are great and after having Reclast infusions my osteoporosis has improved significantly. In hindsight I would have done great with a longer common channel and smaller sleeve but what is done is done. You do have to be more careful about what you eat with a longer common channel but, as you have found, there is no free ride and any WLS requires changes in order to be successful.
How is your sleeve size? If it has stretched out you might want to see about getting a resleeve along with lengthening your common channel.
I had my DS in 2002 and I think back then the trend was a shorter common channel and larger stomach and I think now they are finding the opposite is working better.
Good luck in whatever you do.

I will need to see your data because I have seen absolutely zero data to indicate that your assumptions (which I marked in bold) are in fact true. There is research out there showing that in fact small sleeves versus larger sleeves had no benefit.

Although I am only six months out I do not have significantly more gas than I did before surgery, and I do have formed stools. It isn't rock solid but varies from loosely formed at times to more tightly formed at other times. Eating too many carbs can make things uncomfortable and obviously eating too much fat can cause issues as well. Like anything in life there has to be a healthy balance.

You must have missed where I said "I think". I have no data, just anecdotal stories related to me over the years. I don't know what length your common channel is but there are other factors involved with intestinal issues then common channel length, such as food intake as you indicated. I also think who did your surgery and how makes a huge difference. My surgeon wasn't a big fan of malabsorption and I think that is why my sleeve was so large. Also in 2002 the DS was not commonly done and I would be surprised if my surgeon did more then a dozen before me. There was no such thing as vetted surgeons at that time. I have no idea how he learned the DS. For all I know he could have read the instructions in some book. I have no idea how he measured the common channel, whether my bowels were stretched or measured loosely. I also believe that something about the way my intestines were configured left me with a blind loop and thus constant bacterial overgrowth in my intestines. This was a common complication in older WLS so for all I know he may have performed a totally different surgery on me. All I know is that once I had my revision my symptoms were gone. I also never had a bout of reflux since then and prior to my revision I had terrible reflux, taking at least two Prilosecs a day and still had it.
I remember back in 2002 many people had the symptoms I had. One of my friends had a DS a few years after me and complained of constipation and it was the first time I ever heard of someone who had a DS with constipation. Maybe the technique has been refined and perfected over the years, I have no idea. And back in 2002 avoiding sugar and white flour wasn't stressed nearly as much as it is now and then only in regards to weight loss, not intestinal issues. I may sound dumb but I did not equate my issues with what I ate, only with the fact that I had malabsorption.

[Ladytaz]

My worst nightmare was an anal fissure. That was one of the worst pains imaginable. I had hemorrhoid surgery many years ago and since that they haven't been a problem but the fissure sure was.
The vitamins I am taking right now is calcium, iron, C, A, D, B12, magnesium, multivites and some others that I can't remember right now. According to my doctor since I don't malabsorb as much as I did I don't need to take as many vitamins as those with a shorter common channel. Even before my revision when I was pretty lax about supplementation the only issues they found was very low D, low Ferritin and osteoporosis. Very surprising to me but I had the full spectrum of labs suggested to me and that was all that was found. Some things were in the lower range and I followed Vitalady's suggestions to bring them up and I have my labs checked every six months and so far they are staying in the middle to top of the range. I never took any digestive enzymes so I don't know anything about them.
Have you talked to a revision surgeon? If I had it all over to do it again I definitely would have gotten a second opinion from an experienced surgeon but at the time I had my revision I was very sick and not really on top of things. I just wanted to feel better and I would have done anything at that point to get well. I honestly didn't want to have any WLS since I had all the negatives and not a single positive. If I could have had it reversed I would have but I was told it wasn't an option. I am glad it worked out the way it did though. I am able to keep my health and my weight loss. It doesn't get much better then that to me.

[rosebud5532]

Dr. McGuire in Dayton, Ohio did my surgery. One of his associates will do the revision. I have had problems with iron deficiency anemia and thought I would need a reversal to solve that issue, but found an iron IV replacement that I am no allergic to, so I have a workable solution to that problem.
At that time Dr. Maguire said he didn't know if a revision to 200 cm would help the breath thing or "bathroom issues", but I can't imagine that doubling my common channel would not help. I can have all the malabsorption reversed or just a portion. I would love to have all of it reversed, but worry about weight gain. I have to accept that my anatomy will never be normal.

Just a note to any pre-ops and newby post-op DS patients, there are things that don't show up right away after this surgery. Everyone is different. Things may be okay now with problems to follow. I didn't have the breath issue until the last 6-7 years. Digestive enzymes help this. I have had to iron infusions. Didn't have problems with that for a 5-6 years. I now have osteoporosis. It isn't benign. I don't know what the long term effects of this procedure is, nobody does.

So, if you are considering it read everything you can. Also, if you have had no problems, please keep in mind that you very we'll might. We need to be gentle with each other.