In Answer to the Why Question

[Someone asked why duodenal switch rather than RNY.  It's a pretty common question and I thought I'd answer it, though of course it's also answered in the early pages of this blog.  Still, just in case you have a life and don't want to go reading through the over 300 back entries.]

First, I'm not a "it was duodenal switch or nothing" person.  Had the DS not been there, I would have gotten an RNY.  I needed weight loss surgery.  I was fortunate and had the choice of both gastric bypass surgeries (duodenal switch and RNY) and the Lapband-- USC does all three.  After meeting with my surgeon (who generally tends to prefer the RNY for most patients, partly because he can do it lap rather than open) and doing my own research, I opted for the duodenal switch.

My surgeon's opinion was that the Lapband would not be a good choice for me given the amount of weight I had to lose.  In addition, I was really freaked out by the idea of having something inserted in me (feel the same way about breast implants).  It's just an odd phobia.  Finally, I wasn't sure how my insurance would cover the longer-term fill question.

So it was between the RNY and DS.  As I said, I opted for the DS.

Why?  There were a lot of reasons, the first of which was as a pre-op I already had problems with constipation, something that my surgeon said would probably be made worse by the RNY but improved or resolved by the DS.  Also, I didn't like the idea of worrying about dumping or having a list of foods I couldn't ever have, especially if that list was going to include a whole category like sugar.  I've got a ton of allergies and already have a huge "avoid" list which includes wheat and yeast and an even longer "limit" list.

Honestly though, the final deciding factor was that my surgeon said that research shows that DS surgery has the greatest success at getting patients who have BMIs over 50 to lose 80% of their excess weight and keep it off.  Since I had a BMI of 61 at that point, and had failed at so many other attempts, I wanted to choose the option with the greatest chance of success -- the support group I attend has several DS patients who had the surgery after either RNY or LapBands.  So part of my choice was motivated by my fear of failure.

I had a text-book perfect surgery and recovery.  I don't have any of the worse side effects of the surgery, aside from terrible smelling and painful gas if  I eat too many simple carbs.  Since I love my husband (and don't like being in pain) I'm very very careful about that.  I do have issues with vomiting sometimes.  This is related to the restriction in my stomach size and the fact I have nasal drip from allergies.  Certain foods like rice are just impossible for me to tolerate.  My constipation issues are no worse, but not much improved.  A lifetime of anal retentive behavior cannot be solved so easily!

By the same token, my sister opted a month before me to have RNY surgery as she worried that with her carb addiction being able to eat sugar post DS wouldn't work for her.  Ironically, she's one of the ones who doesn't dump on anything.  But she avoids sugar all the same.  She's also had a great outcome, losing down to 190 from her high of 417 .    She has her own side effects -- the most serious of which is she can no longer absorb B-12 by any means other than IV treatment (pills and shots didn't work for her).  It's under control now, but was a bit scary for all of us at first.  Like me, she can't tolerate rice.  But even so, the trade off of improved heath and mobility was worth it for her.   She's very very happy with her choice and outcome, and well she should be.

You asked about supplements and their cost.  I take 1 Rx prenatal vitamin a day, 1 Allergy A&D vitamin and 1500 -- 2000 mg of calcium citrate in chewable form.  Total cost is about $40 a month, and that's with buying the more expensive chewable calcium (tablets are cheaper).  I also have 1 - 2 protein drinks a day -- I spend maybe $10 a month on the drink powder and bars.   My labs as of 20 months post-op are perfect.  There are other people who require more supplementing -- it just depends on how your body responds.  But the vitamins are really important and can't be overlooked post-op.

Comments

[Shannin]

Great explanation. The clinic I went to only offered RNY and Lap and since I had a BMI of 50, the choice was obvious. Had I done more research, I might have opted for DS but, in the end, I am very pleased with the 170 pounds gone for ever (half of the old me!). I also don't dump but I watch sugars very carefully...

[signgurl]

Great answer. It's always great to hear why someone chose one surgery over another.

After reading your entire blog pre-op, I was excited about having DS. I found out that my surgeon had done less than 25 as opposed to over 700 RNY's. That scared me into the RNY.

[*S*]

You know, Ezpy, you just gave me a big hint into my nausea. What if it is post-nasal drip? I'm going to go back on my Zyrtec (which I usually just take seasonally) and see if that helps. It's an easy enough thing to try.

*S*