RickM

That's basically what has already happened - most migrated over to Paclap's zoom meetings. The group was a legacy of when Paclap was in the Los Angeles area before they moved to San Francisco some twenty years ago, Over time, Keshishian adopted it and then it closed up around COVID time and most moved online to Dr. K or the Rabkins' Paclap group. There are probably other DS affiliated groups one can find, but those are the ones that I'm familiar with, being in CA. Off the top of my head, there are several DS docs in the NYC area - Roslin, Pomp, Herrin that I can think of that probably have groups that one can access.

My wife is about 17 years out on her BPD/DS, and at least until COVID changed things, we were in a local support group of primarily long term veterans, legacy of her surgeon who had moved out of town, so we got a lot of feedback over years on various issues people had. Since COVID, most practices went online with their patient support, and that is often available to anyone interested. A couple of suggestions. One is to look up Dr. Ara Keshishian - dssurgery.com - who is well regarded about all things DS and BPD. There is an extensive blog library on his site that you can look over and will probably find much of what you are looking for, though it may not be that well indexed. Another is paclap.com, from Pacific Laparoscopy, who is another BPD/DS specialist; they now have a monthly zoom meeting, IIRC on the second Tuesday evening of the month, and that usually has a number of veteran patients along with the doc who can offer suggestions on whatever problems you are having. With your early 80's date, did you have a DS with BPD, or the original Scopanaro BPD? The Scopanaro did seem to be more troublesome, primarily from its shorter common channel leading to sometimes excessive malabsorption. There are people and doctors out there who can help, though not necessarily in CO, which is one of the drawbacks of the procedure. Fortunately, most who are skilled with it know of the geographic problems and are used to dealing with patients remotely. Good luck,

Under the premise that the most important component of your car is the nut holding the steering wheel, I don't have a real preference; it's a tool and the most important part is still what's between the surgeon's ears. The doc who adopted our local support group, one who is well regarded for doing complex revisions, has mentioned that he has no real preference to them - he uses them if the hospital he is at has it and it is available, but he isn't specifically scheduling himself around it. My real concern is would the robot help a surgeon who is low on the learning curve, say on doing sleeves, be less likely to make a sleeve with a stricture? Or if the surgeon is one who is apprehensive about working around a fatty liver be less likely to close up and send the patient home without completing the job?

Presumably they are going off of lab tests and not a calendar, as with a sleeve you may not even need it unless there is something about you that makes you low (it's more of a bypass than a sleeve thing.) I've never supplemented it (other than what's in my multivitamin) and my levels have always been fine.

No direct experience, as the surgeons I am associated with primarily do the "traditional" BPD/DS, but the process would be the same. As to whether or not the sleeve is redone as part of the revision depends on the surgeon's preference and what condition the sleeve is in. The surgeon who has adopted our local support group only does the resleeve if it is needed, if there are any problems or defects with it. There were a lot of sloppy sleeves done in the early days of the VSG (say, 8-12 ago) as surgeons worked up the learning curve getting their techniques right ("twenty years of doing bypasses and they think they know how to do a sleeve...." to paraphrase one prominent surgeon.) As with any revision, count on weight loss being slower and less than with a virgin WLS (I like to think of it this way - our stomach was originally 32-64 oz capacity, and after WLS, even with some stretch and adaptation it may hold 6-8 oz,, so don't expect as big of a change the second time around.) If you are doing the revision for additional weight loss or correcting regain, try to seriously get a handle on why the first one had problems and correct those before proceeding. Good luck ...

Yes, plans vary all over the map; some will be allowed steak at the same point that others may still be on liquids. Some start on soft and mushy if tolerated while others go by strict schedule. Some surgeons will advance their patients ahead of their published schedule for various reasons. Some programs will have a fair amount of individual variability while others are very cookie cutter. Our program started with mushies and soft foods, though liquids were still a staple, particularly for protein early on, and some could progress faster than others depending upon their tolerances. Other programs that are stricter with slower progressions may be so because of how they do their sleeves or pouches - maybe they are more delicate than other surgeons', or maybe they just haven't explored quicker progression yet, or maybe they have and ran into problems that other programs didn't - we, as patient, just don't know. So it is best to consult with your medical team - let them know that you feel that you may be able to progress quicker and they may allow you to explore that, or maybe not.

I went with the sleeve because, fundamentally it does the same thing as an RNY - amount of weight loss, regain resistance, etc., but "costs" less in terms of trade offs and potential problems. The sleeve is predisposed toward GERD problems (that simply means that more people in that population will suffer from that problem than in the genera; population. In contrast, the RNY is predisposed to marginal ulcers, dumping and reactive hypoglycemia.. It is also fussier in supplement need - you can get into more trouble if you are lazy about your supplements with an RNY, while a sleeve can be closer to that ideal of getting all of your nutrition from your food, if one is so inclined (and your natural body cooperates.) Even with all the supplements in line, there is still a greater risk of iron issues or osteoporosis with the RNY as its malabsorption is focused on minerals. And, the marginal ulcer risk makes it more limited with some medications (it is the origin of the "no NSAID" rule in bariatrics - the sleeve based procedures are more tolerant in that area. If I need something stronger than the VSG, then the DS is readily available, as it starts with a sleeve and adds a stronger malabsorbing component than the RNY offers, so there is better weight loss and most importantly, regain resistance provided there if needed. Finally, there is the "Plan B" factor of what if it doesn't work for me and I have/want to revise? The sleeve is readily revisable to either the RNY or the stronger DS, while the RNY is something of a dead end procedure which is very difficult to revise (it can be done, but there are few surgeons around who are qualified to do so.) Overall, that is why I would start with the VSG and move up later if needed (or if I was starting from a very high BMI or otherwise challenging metabolic situation, I would go straight to the DS and avoid the risk of having to revise the bypass if it wasn't strong enough.)

The weight figure for the package should be accurate (otherwise they are defrauding you) but size of "pieces" can vary on a product like that, But if you take however many grams there are in a "serving", there should be 3.5 (or whatever is stated) servings of that many grams in the package.

Was it your family doctor or bariatric surgeon who ordered the endoscopy? If family doc, was your bariatric surgeon in the loop on it! My thoughts is that there are a lot of things (potentially) going on in the blind look of the RNY (remnant stomach, duodenum, bile and pancreatic ducts, etc.) that aren't covered by an endoscopy as with the normal anatomy. So for instance, you may not be seeing any ulcers in your pouch, but there may be one in the remnant stomach. I would want to make sure that someone intimately familiar with your altered anatomy is in the loop on this.

Look at the nutrition label on the package (I know, it's ice cream, and we're not interested in its' nutrition!) I will tell you something like a serving is 2/3 cup, which might be 90g for a cheap ice cream with a lot of air whipped into it, or maybe 130g for a premium ice cream with a lot of butter fat in it,) and that there are 3 servings in that pint. Use that weight for your figuring. If you only want a quarter of the pint, then multiply that gram figure for a 1/3 pint serving by 3/4 (Uggg, fractions!) or 75%.

A few points (or counterpoints) on these diets. Any of these restrictive diets can lead to some weight loss for a while, because it takes some time for us to adjust to the restrictions and adapt to overeating the permitted foods. For example, our popular low carb diets of today - the average American/Western diet has 3-400 g of carbohydrates in it, so if you restrict that to some random small number - 40, 20, 20, 10 - it really doesn't matter - that's 1000 calories or more. Even if you eat "as much bacon as you want..." you likely aren't used to eating that much of it so you will be eating fewer calories than before. Until you adapt to that and let you bacon consumption rise to or beyond your previous carbohydrate consumption. Give it a few months. A few years ago I did a low fat diet for a while as we were poking at a specific medical condition where that can be beneficial. Even though I could have as much whole grains and root vegetables (potatoes, carrots, etc.) as I wanted, I wasn't used to eating that much of those things so I lost weight, though that wasn't the intent. If you go back to when the low fat diet fad was at its peak, there were lots of doctors recommending it, and lots of science behind it. What they were missing, as with today's diets, is the "uh oh" of what's missing and how that affects us long term. There are essential nutrients associated with fats that were being missed, just as there is essential nutrition associated with carbohydrates. Back in the day before effective diabetes meds and insulin, that is the way diabetics ate, as that was the only way for them to keep any control over their blood sugar. It wasn't particularly healthy, but it was the only thing that kept them alive with that condition. The science that is touted in promoting these diets tends to be fairly narrow, siting just one or a couple of factors that benefit from the diet, while ignoring the rest of the body's systems. If one has a condition that requires such limitations, then one follows it, but also these days has the help of other specialists, such as RDs, who can help in compensating for what's missing in the diet by adopting other foods or supplements to balance things out. Today's average diet is very high in processed foods which tend to be high in sugar, particularly added sugars and sugar analogs, and we can certainly benefit from cutting those out, but it is easy to go into overkill mode and cut out carbohydrates that provide us with essential nutrition without them going overboard on the free sugars that are doing us harm. Similarly, when low fat was the fad of the day, most people then were overdoing fats - lots of butter, deep fried everything, country gravy on everything, etc. but soft drinks came in 6 oz bottles not big gulp quarts. So they could benefit from lower fat diet - but not no fat as they were deficient in some essential nutrients.

Here is Dr. Alvarez's (VSG surgeon in Mexico) take on gastroparesis: I have also seen, from another angle, that extreme cases of gastroparesis is treated surgically with a cousin to the RNY, so yes, it does seem that WLS of either the sleeve or RNY form would not only be compatible but beneficial to your condition. As always, consult with the surgeons on this, and I would also make sure that they are experienced in this type of complication as there might be some different techniques used in these cases, so it's good to deal with someone who has been down this road before. Good luck,

It really gets down to how bad your GERD (everybody gets occasional heartburn, that's just being human) and what is causing it. If it is caused be a hiatal hernia, which is quite common amongst obese people, then that will be fixed during your surgery. However, there can be other causes more specific to you that may not be fixed, in which case the RNY may be the better choice. If you haven't had one, I would suggest getting an EGD (endoscopy) to find out what's happening down there and guide you in your decisions. Some surgeons routinely order them pre-op, and others don't, but I think it's a good idea to answer questions like this. Having a surgeon who is well experienced with doing sleeves (not just bariatrics) is also helpful, as it takes practice for them to consistently get the sleeve right. When I had mine done ten years ago, there were a lot of sloppy sleeves being done as that soon after the sleeve started being approved by US insurance and most surgeons were still working their way up the learning curve. That is less of a problem now (at least here in the States) as most surgeons here are well up that learning curve, but there are still newbies at is out there and they should be avoided, particularly if things are marginal in the reflux department.

In general, if the surgery is to treat a complication, then it is not considered a weight loss procedure, but a procedure to treat that complication, so the basic WLS rules don't apply (including the "one WLS per lifetime" rule that some insurance imposes.) It's mostly a matter of how it is coded in the billing department, but the surgeon and his staff should be able to handle this. If not, find a different surgeon who can. Good luck,

Yes, there is sugar in the milk that is in the mix, so it can't be classed as "sugar free" but if they don't add any additional sugar, then it is "no sugar added". The mainline instant breakfast does have sugar in there (second ingredient after nonfat milk and before maltodextrin) but the no sugar added version will have some other sweetener in there instead - sucralose, aspartame, sugar alcohols, etc. "No sugar added" is a newish label that is working its way into the nutrition label, and overall is a good thing, as it is the added sugar that is typically the biggest problem. A package of frozen strawberries can't be said to be sugar free, as the strawberries have sugar naturally occurring in them, but they can be "no sugar added" if all they are are strawberries that have been frozen. I have seen some studies that indicated that on the order of 70-80% of the packaged goods on the shelves have some form of added sugar in them, This is distinct from intrinsic sugar, or sugar that is naturally occurring in foods - milk, fruit, vegetables - almost anything grown in the ground - which is typically much less of a problem as it is usually bound into the fiber of the plant and more slowly absorbed than the added free sugar. Is the instant breakfast a recommended product for your program? Typically it is not as it is more of a "meal replacement" product that is moderate in protein as opposed to the protein shakes that are primarily protein, (20-30g protein per serving vs. about 5g for instant breakfast. Usually we are looking for high density protein early on as we can consume so little for a while. That said, I did (and do still) mix instant breakfast with protein powder as I was not having any big problem with protein intake, even early on, and chose to blend in the instant breakfast to give a better overall nutritional profile than just the protein powder alone. There is no right or wrong answer, but just a consideration, particularly if one is struggling to get in their requisite protein at the start. Good luck in your coming adventure!

You're just fine, better even, without the sugary drinks - at least you don't have that addiction to get over! You have gotten a good clue with the banana, and it doesn't have to be fruit or juice, any kind of complex carb will do, and it doesn't have to be much. As with everything, a bit of moderation is often the key. From what I have seen, those who are the most adamantly low carb, counting them out, not exceeding some magic number, etc. are the most affected. Sometimes we hear responses to your problem such as "isn't it wonderful -that's the smell of burning fat!" More accurately it is the smell of not eating your vegetables. We will drop ketones as long as we are burning our fat stores, irrespective what kind of diet is being used, but we don't need to take things to extremes. When I had labs pulled, I was dropping ketones as expected, so I guess one could say that I was "in ketosis", but I never had those type of symptoms as I never kept my carbs all that low - it wasn't sugary stuff, just vegetables, legumes, some berries in the yogurt, etc., yet my weight loss was still very rapid as my caloric deficit was fairly high. So, there is a balance one can achieve in this. It sounds like you have decent habits to begin with, but adapting things to work with the radically reduced intake that we have for a while can be tricky. Good luck with it....

I wouldn't either necessarily, particularly with a bypass that can be more prone to dumping, but some plans do permit it, usually in dilute form. I had a juice box in the hospital (but our diet was somewhat more "advanced" than most, being on soft and puree foods as well at that time.) There are many foods that may not be the greatest thing for weight loss intermediate to longer term that can be useful in small amounts in the shorter term transitional period - mashed potatoes are another common soft food item that has value at this time that we may rather stay away from later on (or maybe not - lots of potassium in there...) It's a big YMMV thing, and there is no definitive right or wrong answer, and sometimes specific problems, such as the OP's can have solutions that seem counterintuitive to some.

The bad breath (and possible BO as well) from ketosis is a result of minimal carbohydrate in your diet - not uncommon early on - and improves as your diet improves and varies. Some intentionally go "low carb" in the belief that it will improve their weight loss, which exacerbates the effect. Some programs intentionally call for some carbohydrate early on via foods like oatmeal, cream of wheat, diluted fruit juice as a means of preventing this along with the low energy and lethargy that many experience in the initial weeks.

The most compelling reason for the DS, particularly the "classic" or "traditional" BPD/DS (as distinct from the SIPS/SADI/Loop DS, which is a different procedure with its own, albeit similar tradeoffs,) is much better regain resistance than the other mainstream procedures like the RNY or VSG. It's hard to say where the SIPS fits into that spectrum as it is still a relatively new procedure, but I would expect it to be somewhere between the RNY and BPD/DS. The RNY is a mildly or minimally malabsorptive procedure; the caloric malabsorption dissipates after a year or two as the body adjusts to it so metabolically it winds up being similar to the VSG long term, This is why some doctors will classify the RNY as essentially only a restrictive procedure. However, the nutritional malabsorption is a long term thing that you need to accommodate. The DS malabsorption is a long term feature, so it continues working to help you maintain your weight over the long haul. With the RNY, as with the VSG, that is much more up to you. It is much more common for people with the RNY or VSG to have substantial regain problems than it is with the BPD/DS. I went with the basic VSG as I had lost around a third of my excess weight with diet and lifestyle changes (that we should all do anyway....) I went through when my wife had her BPD/DS and kept that off for several years before deciding to go with the VSG (which wasn't commonly done before) to complete the job - I didn't feel that I needed the extra power of the DS to maintain the loss longer term, and wasn't comfortable going the the RNY as it really doesn't do markedly more than the VSG, but "costs" about as much as the DS when it comes to long term compromises - the extra fussiness over supplements, etc. Further, it has additional long term potential problems with medication and medical treatment limitations that the DS and VSG don't have.. The simpler was the better option for my needs. If one has substantial metabolic problems (including diabetes) or a history of yoyo dieting, the DS is a better choice.

I lean toward the long term solution, as this is a long term problem (you didn't get this way overnight.) you should expect it to be a long term effort to solve it. I like to think in terms that this surgery, whichever you get into, is not a cure but more of a "do over" where you get set back more or less where you should be physically and you get to start over again. You need to learn how to avoid the traps that got you where you are now, and how to live to maintain a healthy weight in the long term. Many post op bariatric patients repeat the same process that they did when dieting - lose weight and then start to regain when they start going back to "normal" eating - it just takes longer, as it 2-3 years or more rather than just a few months or a year with basic dieting. We need to learn how to eat and live to maintain like a "normal" person, and that takes time More later, but I have a lap lane reserved at the pool at the gym in a few minutes. Time to work on that maintenance some more.

As others have indicated, there isn't a lot of difference, once beyond the first few months' transition period, between the two as far as eating and socializing. We eat out monthly with a group of DS patients (somewhat more extreme malabsorption than the RNY - no dumping tendencies but sometimes reputed to be worse on potential bathroom issues) and you can't tell who is who - DS, RNY, VSG or no WLS. There is a transition period the first few months or year where the body is adjusting to the changes, both physical and dietary, where GI issues are not uncommon (do a search for the Al Roker White House SHART story; yeah, he pooped himself at the WH.) The VSG leans more toward constipation for a while (RNY can, too) but that's primarily from the limited diet - lots of protein and minimal carbohydrate/fiber and fats to keep things moving,) Fiber supplements are the order of the day for a while, and probiotics can help with general adaptation of the gut. The RNY will be somewhat fussier on supplement need, all things being equal, to counter the malabsorption. That usually isn't a problem if people are reasonably diligent on such things, but can be problematic if one tends toward being overly casual on such things. Some things may not respond to normal oral supplements; infusions to maintain iron levels are not unusual with the RNY (or DS) but are uncommon with a sleeve. You may run into medication tolerance issues - NSAIDs are the most common class of drugs that are sited (a big NONO with the RNY, but a better tolerated little nono with the sleeve or DS) but one may run into other drugs during ones life that may be restricted with the bypass (some of the osteoporosis drugs come to mind.) Other things that may be of concern, particularly as we get older, that aren't specifically lifestyle oriented are some common medical treatments and diagnostics are off the table with a bypass - owing to the blind remnant stomach and upper GI, a number of common endoscopic procedures aren't available (they're available by normal surgical means, but not endoscopically.) You mention longevity, which I assume you are referring to longevity of weight loss or resistance to regain. From what I have seen over the years, there doesn't seem to be a significant difference between the two - people seem to be as prone to major regain problems with either, to a roughly equal degree. The caloric malabsorption of the RNY tends to dissipate after a year or two, so metabolically, one is left in about the same position as one who had a sleeve (though the bypass patient may have lost weight a bit more easily.) To get a significant difference in regain resistance, one needs to look into the DS, particularly the "traditional" BPD/DS. It has a somewhat different set of trade offs, but is worth considering (particularly since the bypass is so difficult to revise if it doesn't yield the desired results.) Good luck - lots to think about, and none of it is easy!

I do an annual follow up with our surgeon, originally in his local office primarily staffed by his RN (the practice moved out of the area before either my wife or I had surgery, but they maintained the office and support group to support their local patients) and then via telecon after the RN retired and they closed the office. I think that it is much more important for the DS and RNY patients as they tend to be subject to more long term issues than sleevers, but I still like to keep up with it, looking at it mostly as keeping him on retainer so that I'm still in the files with current labs. That way, if our PCP has any questions in our care that may be relevant (...is this an issue from the surgery?...) she can call the surgeon and have a chat with him about it. Nominally, most everything relating to labs, etc. can be done by your PCP, your surgeon may have some additional labs that they prefer to do in addition to what your PCP may normally do for an annual, and they may have ranges that they prefer beyond the basic "normal" range that is flagged on the lab report. For instance, our surgeon prefers that the vit D levels be kept in the upper end or the typical normal range, so his experience with bariatric patients trumps the PCP's more limited experience.

I used them in the hospital. We use folding washable ones when eating out (if I remember to take it along - another habit lost to Covid!) On the down side, you have to clean it after you get home.

It is unusual, and I would question how successful it would be for additional weight loss purposes for the same reason that I am skeptical about revisions in the other direction - VSG to RNY for weight loss. Metabolically, they are too similar to provide a major difference over the long term; short term one can expect some loss, typically 20 lb +/- some from the restrictive dieting required around surgery time (though a few outliers do report good results.) More common are RNY revisions to either tighten the stoma or resize the pouch, either directly or via a lapband, None of those procedures have a great record, either. The best results that I have seen with any consistency is to revise to a DS (duodenal switch) but that is a very complex surgery that few surgeons are qualified to do (though doing the DS from a VSG is quite straightforward for a qualified DS surgeon.)

It is probably OK, but one of those things to check with your program about. Some programs are very averse to their patients drinking calories, and even want them off of their protein drinks after X weeks. They do have a point in that one common failure mode for WLS is getting in the habit of drinking calorie rich drinks, whether they be soda, SBUX drinks, bullet proof coffee or whatever, it's easier to consume excessive calories if you drink rather than eat them, so caution should be the word with them. That said, many continue to use protein or other high nutrient drinks as a convenience long term post op and do just fine, so if you are tracking you intake and remain aware of what (and how much) of what you are consuming and how that fits in with your weight loss or maintenance, go for it. Like many things, it is a tool that can be used for your benefit, or misused for your detriment. Side note, my wife is still highly restricted in how much she can eat, even after 15+ years, and has a daily smoothie of tangerine juice, banana, strawberries and protein powder along with her potassium and calcium supplements as a way getting in more of her daily nutrition and that works fine (and the dog is absolutely enraptured by it, too), In your case as a presumably recent post op, I would probably throw in some vanilla or unflavored protein powder as protein is usually our emphasis for a while.