Is duodenal switch too drastic?

[Bon Bon Jovi 5]

Hi everyone,

Just curious to hear what you all think: I'm on track to have my surgery in November. My starting weight in July was 338. This morning I was 306 (yay!) So I've lost a significant amount of weight already. I'm 5'9", so I definitely need to lose weight, and a lot of it.

But it does kind of seem like the place I chose is "selling" me on the duodenal switch a little bit hard. Maybe its because they know what I dont, but there's also part of me that thinks maybe it is too drastic and I'm being sold a more expensive procedure. I had never heard of the ds surgery before talking to the surgeon, so I was just thinking all wl surgery is the same. But it's clearly not, nor is the cost.

My family doctor seemed very surprised, almost shocked that the surgeon would advise any kind of surgery, especially a ds. But, then again, she is typically very conservative in treating anything.

Anyway, curious to hear what you all think. Have any of you had the same dilemma running through your mind?

[AZhiker 2,252]

Sure seems like overkill to me. I was offered a sleeve or bypass, and we decided bypass was the best option because of my GERD. There are absorption issues with bypass and a lot more with DS. Most people lose all the weight they need with the sleeve or bypass. What is the actual reason your surgeon wants you to have DS? There needs to be some solid rationale for this. If you feel something is fishy or his motives are simple financial, please find someone else. You need to fully trust that your surgeon has your best interests in mind - not just his own.

[Bon Bon Jovi 5]

1 hour ago, AZhiker said:

Sure seems like overkill to me. I was offered a sleeve or bypass, and we decided bypass was the best option because of my GERD. There are absorption issues with bypass and a lot more with DS. Most people lose all the weight they need with the sleeve or bypass. What is the actual reason your surgeon wants you to have DS? There needs to be some solid rationale for this. If you feel something is fishy or his motives are simple financial, please find someone else. You need to fully trust that your surgeon has your best interests in mind - not just his own.

He didnt really give a specific reason, he just said that the ds will result in the highest percentage of excess weight loss.

I am starting to have some "comorbidities" that are creeping in. Nothing crazy, but enough to convince that I better change some habits or I'm not going live to see my son grow up.

I assume those comorbidities are the reason he is saying that I should have the ds, but wouldnt other procedures also address those problems? I mean, my problem is that I weighed 330 pounds, when I should weigh around 170 pounds. When I was 170 pounds, I didnt have any of these problems. So it seems to me that if I get back down to 170, then that will fix things.

Is 160 pounds of total weight loss just an unrealistic goal with other options? I dont know the answer to that question. My surgeon definitely seems to think so.

[summerset 5,265]

1 hour ago, Bon Bon Jovi said:

He didnt really give a specific reason, he just said that the ds will result in the highest percentage of excess weight loss.

While this is true I hope he didn't stay silent on the possible negative side effects. There is no need for scaremongering but the more drastic the procedure, the more drastic the possible side-effects.

Over on the "Obesity Help" board there are way more DS patients than on this board, most of them raving about how good the procedure is. However, even these patients are admitting that quite a few of them have to still watch what they eat.

Quote

Is 160 pounds of total weight loss just an unrealistic goal with other options? I dont know the answer to that question. My surgeon definitely seems to think so.

I'm not sure if I got this right. Is it correct that your surgeon seems to think that it's unrealistic that you're going to lose 160 lbs?

Edited September 13, 2020 by summerset

[catwoman7 11,215]

it's a more drastic procedure and yes, many patients lose more weight with it, but like summerset said, the more drastic the procedure, the more the risk of side effects.

I would have considered DS if my insurance covered it (it didn't - only sleeve and bypass) because I started at 373 lbs (was 316 the morning of surgery), but I was able to lose all my weight with the RNY (I lost over 200 lbs). There are people on here who have lost all...or most...of their excess weight with the sleeve as well. It's easier to pull off that kind of loss with the DS because of the more extreme malabsorption, but you'll still have to work at it.

I'm surprised your regular doctor didn't think you needed ANY surgery. With a starting weight of over 300 lbs (and I was there, too), the chances of you losing a significant amount of weight and keeping it off are pretty slim (they less than 5% of people can do it). 300+ pounds is about where some surgeons will start discussing the DS option, - although many (actually most) of us get the RNY or VSG at 300+ lbs. If you're committed and work hard at it, you can get a ton of weight off when one of those surgeries as well.

[BigSue 1,389]

I started with a BMI over 60, and nobody even brought up DS as an option for me. To be honest, I thought DS was an outdated surgery that's not really being done anymore because of all the risks. I didn't realize it's still popular for high-BMI patients. The surgeon who did my RNY doesn't do DS. He recommended RNY to me rather than sleeve because of my high BMI, since RNY patients statistically lose a bit more than sleeve patients.

My understanding is that the sleeve is basically the first step in DS, and that's how the procedure was developed -- surgeons would do the DS in two separate surgeries for high-risk patients, and a lot of them didn't even need the second surgery because they lost enough weight with the sleeve alone. So, that is one option: get the sleeve first and have it revised to DS if necessary. You could also have a sleeve revised to RNY. I remember seeing a bariatric surgeon on YouTube say that he recommends the sleeve to all patients because you can always get it revised, but to me, that's crazy because I don't want to have more than one surgery!

[catwoman7 11,215]

4 minutes ago, BigSue said:

I started with a BMI over 60, and nobody even brought up DS as an option for me. To be honest, I thought DS was an outdated surgery that's not really being done anymore because of all the risks. I didn't realize it's still popular for high-BMI patients. The surgeon who did my RNY doesn't do DS. He recommended RNY to me rather than sleeve because of my high BMI, since RNY patients statistically lose a bit more than sleeve patients.

My understanding is that the sleeve is basically the first step in DS, and that's how the procedure was developed -- surgeons would do the DS in two separate surgeries for high-risk patients, and a lot of them didn't even need the second surgery because they lost enough weight with the sleeve alone.

you're right - the sleeve is phase 1 of the DS, and the DS used to be commonly done in two stages (now it's often done as one surgery). A lot of people did fine with just the first stage (sleeve), so it's become a stand-alone surgery.

I don't think the DS is very common, even among high BMI patients. And a lot of surgeons don't do it. I think it's a pretty complicated surgery, and there are more risks involved than there are with VSG and RNY.

another issue is that although most physicians are very familiar with sleeve and RNY these days, not so many are familiar with the ins and outs of DS. Some of the DS patients on other sites have said they often have to "educate" their PCPs on what their needs, issues, and requirements are.

[Circlesis 59]

Statistics show better long term results with DS. I’m revising from sleeve to DS for this reason.

In retrospect I wish I had the chance to do it all at once instead of sleeve only. I’m not a super high BMI.

Then again at the time I had sleeve done 6 years ago, I didn’t think there was any way that I would ever regain so there’s that. 🤷‍♂️

[Bon Bon Jovi 5]

On 9/13/2020 at 4:36 AM, summerset said:

While this is true I hope he didn't stay silent on the possible negative side effects. There is no need for scaremongering but the more drastic the procedure, the more drastic the possible side-effects.

Over on the "Obesity Help" board there are way more DS patients than on this board, most of them raving about how good the procedure is. However, even these patients are admitting that quite a few of them have to still watch what they eat.

I'm not sure if I got this right. Is it correct that your surgeon seems to think that it's unrealistic that you're going to lose 160 lbs?

That's how I took it. He was kind of confusing, so it's possible I misunderstood. He asked what I hoped to get out of the surgery. So I told him that I felt like if the surgery could help me to get down to a healthy weight, I could reach my goal weight and maintain it through healthier food and exercise habits. Seemed like a realistic expectation to me, but he immediately cut me off and started lecturing me on the concept of one's body having a set weight that it tries to stay at and that since I'm overweight, my set weight is higher than it used to be, and the surgery just helps change that set weight. Of course this is my understanding of what he said and may not be accurate. It seemed to me from the way he was talking that he believed my expectations of what surgery would achieve were not realistic.

[catwoman7 11,215]

1 hour ago, Bon Bon Jovi said:

That's how I took it. He was kind of confusing, so it's possible I misunderstood. He asked what I hoped to get out of the surgery. So I told him that I felt like if the surgery could help me to get down to a healthy weight, I could reach my goal weight and maintain it through healthier food and exercise habits. Seemed like a realistic expectation to me, but he immediately cut me off and started lecturing me on the concept of one's body having a set weight that it tries to stay at and that since I'm overweight, my set weight is higher than it used to be, and the surgery just helps change that set weight. Of course this is my understanding of what he said and may not be accurate. It seemed to me from the way he was talking that he believed my expectations of what surgery would achieve were not realistic.

A lot of us were told that, it seems. We're usually given a goal which more-or-less aligns with the "average" weight loss, which for RNY is about 70% of excess weight (more for DS - I think it's 85%, IIRC). According to statistics, only about 10-15% of us make it to a normal BMI, so he's probably being realistic and doesn't want to set you up for disappointment if you don't make it. However, people can and do make it - there are several examples right here on BP. Anyway, long story short, I was told that as well....as were many of us.

[Postop 411]

I'd be curious who your doctor is and whether he is recommending the traditional DS or the modified one that is more commonly done today.

I was smaller than you 15+ years ago when I had the traditional DS. A couple of doctors didn't feel I needed it. After doing the research and a lot of thought, I believed it was best for me. But it's a very personal decision. One factor in my decision making process was I wanted a procedure that was known for letting you lose the most weight and have the greatest chance to keep it off. I have done that. However, there are negatives you learn to deal with. Such as when to eat junk and/or complex carbs. I don't eat either in public or during the day. Those are done at night so if I have gas or stool I can deal with it at home.

What I appreciate is I eat every couple of hours. As a binge eater, this appealed to me. I eat Protein (as much as I want). For a snack I'll have a triple cheeseburger with catsup. I don't eat the bun bc: 1. I always have to get in my protein first and the bun is too filling; and 2. I wouldn't eat those carbs unless I was at home. What I like about being able to eat much and often is I don't feel deprived. I constantly snack on cheese, nuts, cold cuts, Peanut Butter, etc. There is no counting calories w/the DS. Only protein grams (I average 125-150 day) and complex carb grams. That is what was and is important to me. but everyone has their own deal breakers of what they can't live with or live without.

It took 2 years postop for me to decide the DS had been right for me. I didn't want WLS, I wanted to do it on my own but I finally realized I couldn't. I stumbled onto the DS at the end of 2004, when I was going to seminars at different hospitals in Manhattan. I'd never heard of it, but realized if I had to have WLS this was the one I felt would work the best for me in the long term.

I do take 40+ vits/minerals day and have my bloods done every 6 mos. Some doctors require them done yearly. It depends on the doctor. Often after the bloods are done, I have to tweak my vits/mineral intake up or down. I've never missed a day of supplements as this is something you must commit to for the rest of your life if you have a DS.

I'd suggest a Pros/Cons list to figure out which (if any) of the WLS is the best for you. I found it very helpful when making my decision.

Edited September 14, 2020 by Postop

[Bon Bon Jovi 5]

10 hours ago, Postop said:

I'd be curious who your doctor is and whether he is recommending the traditional DS or the modified one that is more commonly done today.

I was smaller than you 15+ years ago when I had the traditional DS. A couple of doctors didn't feel I needed it. After doing the research and a lot of thought, I believed it was best for me. But it's a very personal decision. One factor in my decision making process was I wanted a procedure that was known for letting you lose the most weight and have the greatest chance to keep it off. I have done that. However, there are negatives you learn to deal with. Such as when to eat junk and/or complex carbs. I don't eat either in public or during the day. Those are done at night so if I have gas or stool I can deal with it at home.

What I appreciate is I eat every couple of hours. As a binge eater, this appealed to me. I eat Protein (as much as I want). For a snack I'll have a triple cheeseburger with catsup. I don't eat the bun bc: 1. I always have to get in my Protein first and the bun is too filling; and 2. I wouldn't eat those carbs unless I was at home. What I like about being able to eat much and often is I don't feel deprived. I constantly snack on cheese, nuts, cold cuts, Peanut Butter, etc. There is no counting calories w/the DS. Only protein grams (I average 125-150 day) and complex carb grams. That is what was and is important to me. but everyone has their own deal breakers of what they can't live with or live without.

It took 2 years postop for me to decide the DS had been right for me. I didn't want WLS, I wanted to do it on my own but I finally realized I couldn't. I stumbled onto the DS at the end of 2004, when I was going to seminars at different hospitals in Manhattan. I'd never heard of it, but realized if I had to have WLS this was the one I felt would work the best for me in the long term.

I do take 40+ vits/minerals day and have my bloods done every 6 mos. Some doctors require them done yearly. It depends on the doctor. Often after the bloods are done, I have to tweak my vits/mineral intake up or down. I've never missed a day of supplements as this is something you must commit to for the rest of your life if you have a DS.

I'd suggest a Pros/Cons list to figure out which (if any) of the WLS is the best for you. I found it very helpful when making my decision.

He just called it the duodenal switch. He didnt say anything about it being traditional or modified.

How much do you spend monthly on Vitamins? 40 vitamins a day for life seems crazy! That has to cost a small fortune!

[summerset 5,265]

18 hours ago, Bon Bon Jovi said:

It seemed to me from the way he was talking that he believed my expectations of what surgery would achieve were not realistic.

Most surgeons have a more realistic view on expected weight loss than their patients. That doesn't mean though that you can't get rid of 100% excess weight and maintain it.

What makes or breaks this "100% success" I have no idea. From what I saw on the boards over the years it definitely is possible but I've also seen people who've never reached a normal weight or who've reached a normal weight and gained back some weight.

In the end only time will tell and with time I mean "several years".

[Postop 411]

12 hours ago, Bon Bon Jovi said:

He just called it the duodenal switch. He didnt say anything about it being traditional or modified.

How much do you spend monthly on Vitamins? 40 Vitamins a day for life seems crazy! That has to cost a small fortune!

Definitely find out which DS it is. There is a difference in how much you could possibly lose, the side effects, the amount of supplements you'll need each day, etc. With the newer single DS you have fewer side effects, generally need fewer supplements, etc.

I buy vitamins/supplements every 6 mos. after my bloods (in case I need to increase/decrease my order after the bloods are read and I tweak the amount I take). I buy them pretty much online at a variety of places. I'd say I've gotten it down to about $700/year. Considering what I spent on the junk I ate fulltime before WLS I'm saving a ton of money. 😀

[Strivingforbetter 247]

I had the traditional DS and take 3 Vitamins a day,(calcium, ADEK, B12), and my blood panel is great. I'm three years post-op and have only regained 5 pounds. I've never been able to control my weight and not feel deprived, but the DS has solved that problem. My BMI was only 40 when I had my surgery.

Edited September 17, 2020 by Strivingforbetter