Peggy D

The malabsorption of fat is the most likely culprit. It's something I learned many, many years ago in nursing school. Malabsorption of fat also causes the stool to be a gray color. Carbs, especially the simple carbs, can add to the problem as they are likely to cause diarrhea.

Aetna's Medical Clinical Policy Bulletins for obesity surgery says "BMI exceeding 40" (see section A) so you should be good to go unless your specific policy excludes coverage for bariatric surgery. You will probably have to click the first link to accept the conditions of using the site before you can see the obesity surgery policy.

I had a couple of strictures about 2½ weeks after my re-sleeve & conversion to a single-anastomosis duodenal switch (SIPS) which were dilated with a balloon via endoscopy. All has been fine since. The endoscopy was no different than the one you probably had during your pre-op work up.

As I said once before in another thread, for three years I had the goal weight on my ticker at 155 which would put me in a "normal" BMI. I revised that recently to 163 which was my lowest adult weight. But that was 40 years ago after going from 201 down to 163 on Atkins. When I saw my PCP last week she said that I don't really have any excess fat except my abdomen which is very hard to get rid of. I also don't much loose skin - just a bit in my upper thighs, below my butt cheeks & my upper arms. I have lost so much in my butt that I rock on the bones & have to sit on an inflatable or foam cushion. I see the surgeon following me in a couple of weeks & will talk to him then. BMIs don't take age & bone structure into consideration. For now, my current weight of 175 is probably very good for me. I am thrilled that I am no longer obese & am now just "overweight." I am going to look into some type of body contouring procedure just to get rid of some of this abdominal fat.

The site is NOT genepro.com, that is some genetics site. Try mulscegen.com. That link will take you to their shopping page for bariatric support. The tubs of the Protein powder are cheaper on Amazon.

I'm curious, so, you really can't have fruit ever? Or just in the beginning stages? Yes, forever. The list of foods you can never, ever have again. Also, no pre-made Protein Shakes. They must be powdered & made in no more than 4 ounces of Water only. I no longer see my operating surgeon for follow up because of a change in insurance. Let's say I've now been "liberated" by the team I now see.

For 3 years now I've had the goal weight on my ticker at 155 which would put me at a "normal" BMI. Now I don't think that's a good weight for me. I've now changed it to 163 which is my lowest adult weight. But that was 40 years ago & my body composition has changed a lot. I've discovered bones I didn't remember feeling before & have had to buy an inflatable cushion to sit on! My PCP said that even a weight of 170 would be good for me. I'll talk to her about it again when I see her next week & I'll also talk to the surgeon when I see him next month.

One of the things we nurses do is translate "doctor-speak" into what the non-medical person can understand. I see you've been able to change the name of the surgery you had. I remember it being difficult when I had to do it after my SA-DS.

You're actually much more likely to develop an intestinal obstruction from the other malabsorptive procedures (gastric bypass or traditional/classic DS) because of the extra cuts & anastomoses made. The single-anastomosis duodenal switch is no longer considered experimental. The surgeon I now see for follow up says it has been "mainstream" for over a year even though he doesn't do it himself at this time. Those who say it is experimental are typically the ones who don't do it. We all need to remember that every procedure, WLS or otherwise, was "experimental" at first. We all have to do what we feel is best for ourselves. I've posted many times that I did not want a DS three years ago when I had my initial sleeve gastrectomy because the amount of malabsorption of the classic DS & gastric bypass, with the 100-150 cm common channel, scared me. I also did not want the small, artificial opening between the stomach pouch & the intestines of the RNY GB. The SA-DS with only one anastomosis & the 300 cm common channel that I have is what I was comfortable having. Before I learned of the SA-DS I was planning on asking Dr. Srikanth to convert my sleeve to a DS but with a longer common channel. The SA-DS made that unnecessary. The longer common channel decreases the severity of most of the effects of malabsorption - diarrhea & gas, both of which can be foul-smelling, & Protein & Vitamin deficiencies. I had feelings of food sticking in my esophagus but that was due to having the hiatal hernia repaired. That no longer happens.

The first couple of months were rough. Because my sleeve had dilated, which is actually quite common, Dr Srikanth made it tighter this time. I actually spent one Saturday afternoon & evening in the ER getting IV fluids. The following Monday I had another endoscopy & he dilated a couple of strictures in my stomach. After that it was much easier to get the fluids & Protein in & keep them down. Now, nearly 5 months out, I can eat almost anything & rarely vomit but it does still happen. My stomach has not liked salmon since my first sleeve but I try every so often to see if it has improved. Another issue in the first couple of months was significant episodes of diarrhea but that has settled down now that I eat real food. Because of a change in my insurance, I am no longer followed by Dr Srikanth.

It's not a good idea to try to compare your weight loss journey with someone else. My weight loss after the SA-DS is considerably slower than someone who had the procedure as their initial WLS & whose BMI was higher on the day of surgery. Even after the initial gastric sleeve I had in August, 2013, my weight loss was slower than most. I had lost 44 lbs. in the 4 months pre-op but only another 32 lbs. in the first 6 months post-op. When I decided to have the SA-DS I was down 85 lbs. from my initial consult weight. I am currently down a total of 127 lbs., 42 lbs. since my revision consult. The main thing is that all of my co-morbidities have resolved.

No confusion, just curiosity. I find it can be difficult to make changes like that in your profile, even on the website on a computer.

Every surgeon has their own program. Some allow fruit & grains, others don't. My surgeon is very strict. Absolutely no fruit (too high in sugar), no grains (bread, cereal, pasta, etc.) ever. Post-op it is clear liquids only for the first week then add protein shakes for the next three weeks. Then, at week 5 start puree for two weeks, then soft for two more weeks & then, finally, progress to regular foods at week 9.

Dr. Srikanth is very meticulous. My original sleeve & gall bladder surgery took about 3 hours. More than half of that was the gall bladder as it had some HUGE stones & was adhered to everything around it. My sleeve revision & SA-DS last December took about 7 hours. Again, he had to be very careful doing the part around the duodenum because of adhesions from the previous surgery. I also had a hiatal hernia repair. Just out of curiosity, why do you have your surgery listed as "gastric sleeve" when you had a single-anastomosis duodenal switch? I know the SA-DS/SIPS includes a sleeve, but the more significant component is the switch.

There is a separate forum here just for Mexico & Self-Pay Weight Loss Surgery. That forum may help you find the right doctor & clinic for you. For DS questions, please come back here for DS-specific help.

I've mentioned before that, as a nurse, I've never been comfortable with the anatomical changes made with the RNY gastric bypass, especially the artificial hole connecting the stomach pouch to the intestines. I didn't have the DS back in 2013 because the amount of malabsorption with the 100-150 cm common channel scared me & still does. I had a conversion from the sleeve gastrectomy to a single-anastomosis duodenal switch with a 300 cm common channel in December, 2015, & am happy with it.

It's going to take some time for your body to adjust to its new configuration. I have always had chronic constipation & this SA-DS has "cured" that. For the first 2 months I had multiple episodes of explosive diarrhea. It took me about that 2 months to be somewhat predictable. Even now, at 4+ months out, I still have episodes of loose stools but not very often, maybe every week or two. I usually have a B.M. every day now but sometimes I go 2-3 days.

Every time I go to the doctor they get a different measurement. Over the last 5 years or so I've been as tall as 5' 6.75" & as short as 5' 4". I KNOW that 5' 4" was just the nurse writing it down incorrectly because she did not say that. For now I'm sticking with the 5' 6" I was around my birthday last year & won't get measured more often than once a year.

It's highly unlikely that you won't lose a significant amount of weight with a DS just because of the malabsorption. However, it is possible to "sabotage" it just as it is with any WLS, by eating what you shouldn't. After all, it's just a tool. Have you had your sleeve checked to see how much it may have dilated since the initial surgery? Even though I was only able to eat about 4.5 ounces when I had a "pouch-restriction test" done, my sleeve had dilated enough to have it re-sleeved. There are several reasons why my weight loss after my SA-DS is slower. I had already lost about half of my excess body weight, my BMI was just 35 & I'm 66 years old.

I had the sleeve done August, 2013, & stabilized at a loss of 85 pounds. I had a revision of the sleeve & conversion to a SA-DS on December 29, 2015. I'm currently down another 35 pounds. Most importantly, all of my co-morbidities have finally resolved. They hadn't resolved after the first sleeve even with the 85-pound loss so that was the main motivation for me to have the SA-DS.

I had my sleeve done in August, 2013, & then had a revision of the sleeve & conversion to a single-anastomosis duodenal switch December 29, 2015, all covered by Aetna. I still had the co-morbidities I did before the first sleeve, some improved, some not, & my BMI was just over 35 at the time of my revision consult. I believe my surgeon also used the argument that my highest recorded BMI was just over 50 before the first sleeve.

I've posted my story several times in other threads which you can find by clicking my name. To make the long story short(er), I had my sleeve 8/22/2013 & then on 12/29/2015 a revision of the (dilated) sleeve & the single-anastomosis duodenal switch. I also had my hiatal hernia repaired at the second surgery. A hiatal hernia can certainly be a cause of reflux symptoms. Personally, I would not have a gastric bypass. I don't like the artificial opening from the stomach pouch to the intestine. The duodenal switch (classic or SA-DS) has the sleeve gastrectomy that leaves you with a fully-functional stomach, just much smaller. I chose not to have a DS at the time of my original sleeve because the amount of malabsorption scared me. But 2 years later I was still at a BMI of just over 35, on 4 insulin injections a day, Metformin, atorvastatin (Lipitor) & 3 blood pressure meds so I decided something more had to be done. I am now 2½ months post-op & am off all insulin & the atorvastatin. One blood pressure med is discontinued & the other (a combo) is half what it was & I will probably be off of it by the end of the month. We did try decreasing the Metformin, but that didn't work - yet. And - drum roll - as of today, my BMI is below 30! I am no longer obese.

If I had it to do over & the single-anastomosis duodenal switch had been available when I had my sleeve in 2013, I hope I would have done that rather than the sleeve. The amount of malabsorption with the classic DS scared me then & still does. I did lose close to 100 pounds after the sleeve & then a panniculectomy but regained about 20 pounds. I had a revision of the sleeve & then the SA-DS on December 29, 2015, & am now down 115 pounds from my pre-sleeve starting weight. I’d like to get down to the goal weight I have on my ticker, 155, because that would put me in the “normal” BMI range. But I’d be thrilled to get down to 163 which was my lowest adult weight about 43 years ago. With this SA-DS, I just might make it!

For the OP, If I had it to do over & the single-anastomosis duodenal switch had been available when I had my sleeve in 2013, I probably would have done that rather than the sleeve. The amount of malabsorption with the classic DS scared me then & still does. I did loose close to 100 pounds after the sleeve & then a panniculectomy but regained about 20 pounds. I had a revision of the sleeve & then the SA-DS on December 29, 2015, & am no down 115 pounds from my pre-sleeve starting weight.

I had a sleeve to single-anastomosis duodenal switch revision with a 300 cm common channel. I didn't have a DS or gastric bypass initially because the amount of malabsorption with a 100-150 cm common channel scares me. If this SA-DS had been around 3 years ago I might have gone for it.