As much as I've prepared myself today in going into my first appointment to meet my surgeon, dietician, nurse practitioner, and psychologist, I still was thrown. I kept telling myself to keep an open mind, knowing the doctor may want a different surgery from what I had my mind set on. I thought I was completely open minded and prepared for whatever happened. I wanted a sleeve and both he, and his nurse practitioner, felt I should have the DS surgery done.

It was like he wanted me to say 'Yes, I agree to the ds.' When, in actuality, he's doing the sleeve first, and in six months to a year, the second part. So why are they trying so hard for me to accept this instead of saying, 'Hey look. It's up to you. If you can't lose more than 75 in one year, let's go ahead with the second part.'

Is it for insurance purposes and are they trying to get an approval for the ds, even though they'll only do the sleeve for now?

But seriously, I just don't know how I feel about the ds. From what I've read it seems extreme. Long term results at two years out show a pretty equal weight loss between the sleeve and the DS, but the side effects with the DS are pretty startling. I trust my doctor since he's done hundreds, if not thousands, of these procedures. I really do. He feels I may not lose more than 75 pounds with the sleeve and I have 190-225 pounds to lose total. Can anyone tell me the best things they've gotten from this procedure and why did you choose this one?

Due to the malabsorption DSers need tons of vits/minerals. We don't absorb them well. Same with Protein. We need 100+ grams/day. I eat closer to 150.

A Dexa bone scan is a quick easy test. It shows how your bones are doing. Age and malabsorption can make one (more so a woman) more prone to osteoporosis. So it's great to have a preop baseline so you can see (as the years go by) if there's any change.

My common channel is 100. It was pretty much the standard at that time. But some did have longer and some shorter.

Oh okay, yeah I'm going to be getting DS but it's modified version of the original, so my common channel will be 300. My surgeon said he hasn't seen people with too many problems getting their Vitamin levels right with the patch due to the longer common channel, be he did say we were going to need at least 80 grams of Protein but the ultimate goal is 100. He said after about 6 months it should be easy because we can handle more intake than someone with like a sleeve, so hopefully all my levels check out when that time comes, I'd have to be malnourishment, and oh okay I will have to look into a dexa bone scan thanks for the info!

Sent from my iPhone using the BariatricPal App

*hate not have

Sent from my iPhone using the BariatricPal App

Sure thing.

Sounds as if you're getting the SIPS/SADI. That's generallly the WLS with the longer cc.

Sure thing.

Sounds as if you're getting the SIPS/SADI. That's generallly the WLS with the longer cc.

Is that the only difference between the DS and the SIPS, the longer cc?

Hi. I'm 11+ years out from a full DS.

I've heard of doctors mentioning the DS (as the second procedure) as something to think about if you don't do well enough with the sleeve (and keep it off) but yours does seems a bit more insistent. I guess he really thinks it will be necessary in your case given what you want to lose. But remember, the decision is ultimately yours. You'll do what your comfortable with. As for the insurance, I know many DSers who want to have that 2nd stage of the surgery within about 6 mos. The reason being is they may lose enough weight that their ins. co. might balk at another procedure & that sleever wants the switch to add the lifetime malabsorptive component.

Today most DSers have it done in 2 steps. Especially if you have a high BMI, it's just safer to keep you on the operating table for a shorter period of time. I'd ask the doctor what length he makes the common channel. Does he use a standard length of: 75, 100, 150? Or does he measure each patient individually? The length will also determine what (if any) types of side effects you may experience.

The DS is more extreme. There is potential for more side effects. Most are manageable if you're careful about what you eat and when. That doesn't mean I don't eat junk. I just had half a brownie. I'm at home now as I wouldn't eat something like that in public. I don't want to deal with the gas and/or stool issues that might occur.

But...there is also the benefit of your odds regarding losing & keeping it off.

As for Vitamins, I don't know many DSers who have luck with the Patches. It's just something I want you to think about. You must be committed to a lifetime of vitamins (I take 40+ per day) and blood tests (every 6 mos. or yearly depending on your surgeon). You should also probably have a Dexa Bone Scan (preop) so you'll have a baseline to be compared to as you age and as your malabsorption kicks in.

While the amount of my vit/minerals may have shocked you (others do take fewer, but we all take a good amount) there's no diabetes issues, cholesterol issues, CPAP, etc. You might want to make a pros/cons list to figure out what you can live with and what you can't.

Look, I didn't run to the DS. I was told in 2003, I had to have WLS. I ignored that for 1 year. I told no one. Then in 2004, I realized I had to do something (as my cholesterol was 302 and everyone in my family dies of heart issues). I was also a touch below diabetic. I went to 3 hospital programs and at one of them, I learned about the DS. Once I realized I just couldn't lose/keep the weight off on my own; I decided the DS was probably the right one for me. It's a very personal decision as all of the WLS have good & bad points.

Thank you so much, Post Op!

I totally missed this post earlier somehow. It was packed with some really great information. I will ask him about the length of the channel. I will admit, when he strongly urged me to do this procedure, I was completely unprepared (even though I knew it was a possibility) and shocked on the inside, but trying not to show it on the outside.

After a couple of days have passed, I'm feeling better about it. More so because I will get a bunch of weight off with the sleeve first, which means I'll have more absorption time to build up on my minerals and vitamins. I guess I just saw some videos on Youtube that freaked me out.

I'm not kidding.

One woman looked like she was doing a side of crack cocaine along with a healthy dose of meth on a daily basis. She started the procedure looking like she was in her mid thirties and a year later she looked like she belongs to AARP. I honestly felt nauseous watching her, scared that was going to be me.

But soon, I came to the realization this probably isn't the best sample size of this procedure. Who knows why she looked like that. It's hard telling. Maybe she didn't take her daily vitamins or maybe she really does do a healthy side of crack cocaine after her two bites of fish--I don't know.

But really, good job with all the weight loss. It says you had the surgery in 2004-05? Have you had any regain and how do you feel? Do you ever get nauseous taking that many vitamins?

re: the aging thing - who knows what else might be going on with that person. She may have not taken very good care of herself.

I definitely look older after losing 220 lbs, but nothing that extreme. Pre-surgery, people were always surprised at how old I was, because I looked 10 years younger. Now, I look my age. Yes - I do have some wrinkles after losing that much weight, but I'm almost 60. People my age have wrinkles... I guess if it's really awful, you could always have a facelift, but that woman on youtube was probably an extreme example. And again, you don't know what else was going on with her that might have been a factor.

re: the aging thing - who knows what else might be going on with that person. She may have not taken very good care of herself.

I definitely look older after losing 220 lbs, but nothing that extreme. Pre-surgery, people were always surprised at how old I was, because I looked 10 years younger. Now, I look my age. Yes - I do have some wrinkles after losing that much weight, but I'm almost 60. People my age have wrinkles... I guess if it's really awful, you could always have a facelift, but that woman on youtube was probably an extreme example. And again, you don't know what else was going on with her that might have been a factor.

I'm glad to hear that. It's just amazing you lost that much weight! Is it hard to keep it off? I read that after time, fat will redistribute itself and help with the overall 'aging' appearance. Have you noticed any of that?

yes - I've also heard in a few places that sometimes the fat redistributes and you start looking better. I'm not that far along yet since I'm still on the borderline between losing and maintenance. I decided awhile ago to just let my body decide when it's ready to stop, and the weight loss is so slow now (2-3 lbs a month), that I always think I'm in maintenance, and then..ta da..a week later, I'm down another pound.

I work at it all the time, but I wouldn't say it's been super difficult. I weigh, measure, and log everything I put in my mouth - so that's kind of a pain, but I'm going to keep doing it because I need to do whatever I can to keep that weight from coming back on. I am *not* going back to where I was - or even halfway there!! I do deal with food cravings, but again, so far my desire to stay at a normal weight is way stronger than my desire to blow my plan. I've been up and down 50-60-70 lbs so, so many times in my adult life and I know how easy it is to gain it back if you're not diligent. Of course, the altered G/I tract makes it easier than before, but it could still happen if i'm no careful

I am a sleever. I would need to loose 200 pounds to lose all my excess weight. At almost 1.5 years I have lost 175 pounds.

I look solidly 10 to 14 years younger than my age. The men that approach me in public and ask me out are 26 to 30. I had a pretty face before I lost weight and I still have a pretty face.

I think how you eat post op determines if you look healthy or not. A lot of WLS patients stay on low calories forever, slowing down their metabolism and denying themselves essential fats. I eat keto, and the few other sleevers I know that eat Keto all look younger than their age. Most people that lose weight with keto even without surgery don't age by dropping a lot of weight they look younger. The fat helps with that.

Also upping you calories and keeping them up helps. Calories and Protein should be pegged to your lean muscle mass. People who have been super morbidly obese for a long time have more muscle and denser bones because carrying all that weight changes your body. I have between 100 and 130 grams of protein a day.

Also what is 100% of excess weight for a morbidly obese person is will be different than a person that was never morbidly obese. I am probably pretty close to 100% right now with my extra muscle and loose skin.

Again on the aging, I never had the huge fat neck that some people have I always had a neck and could wear regular chokers even at 370 pounds. People that have a ton of neck and face fat do usually age terrible if they drop a ton of weight because they have loose skin in their face. That is just genetics and weak jaw lines.

If my doctor would have suggested the DS I would have considered. It is extreme but it does work THE BEST. Still I wouldn't want the malabsorption issues, which is why I have worked so hard on my food and eating right. Eating correctly on keto in a way that sustainable to me, that does not feel like a diet has been the key to my weight loss. After 9 months I feel like my weight loss was due to my food and lifestyle, not my sleeve. I decided when I had the sleeve, if I didn't get to a certain weight with it, I would get a revision to the DS. I have been very successful with the sleeve, and no further surgery is needed, except plastics to remove the skin.

If your health is in bad condition and you need to lose weight fast, I wouldn't hesitate to have the DS.

Edited December 24, 20169 yr by OutsideMatchInside

I am a sleever. I would need to loose 200 pounds to lose all my excess weight. At almost 1.5 years I have lost 175 pounds.

I look solidly 10 to 14 years younger than my age. The men that approach me in public and ask me out are 26 to 30. I had a pretty face before I lost weight and I still have a pretty face.

I think how you eat post op determines if you look healthy or not. A lot of WLS patients stay on low calories forever, slowing down their metabolism and denying themselves essential fats. I eat keto, and the few other sleevers I know that eat Keto all look younger than their age. Most people that lose weight with keto even without surgery don't age by dropping a lot of weight they look younger. The fat helps with that.

Also upping you calories and keeping them up helps. Calories and Protein should be pegged to your lean muscle mass. People who have been super morbidly obese for a long time have more muscle and denser bones because carrying all that weight changes your body. I have between 100 and 130 grams of protein a day.

Also what is 100% of excess weight for a morbidly obese person is will be different than a person that was never morbidly obese. I am probably pretty close to 100% right now with my extra muscle and loose skin.

Again on the aging, I never had the huge fat neck that some people have I always had a neck and could wear regular chokers even at 370 pounds. People that have a ton of neck and face fat do usually age terrible if they drop a ton of weight because they have loose skin in their face. That is just genetics and weak jaw lines.

If my doctor would have suggested the DS I would have considered. It is extreme but it does work THE BEST. Still I wouldn't want the malabsorption issues, which is why I have worked so hard on my food and eating right. Eating correctly on keto in a way that sustainable to me, that does not feel like a diet has been the key to my weight loss. After 9 months I feel like my weight loss was due to my food and lifestyle, not my sleeve. I decided when I had the sleeve, if I didn't get to a certain weight with it, I would get a revision to the DS. I have been very successful with the sleeve, and no further surgery is needed, except plastics to remove the skin.

If your health is in bad condition and you need to lose weight fast, I wouldn't hesitate to have the DS.

Thanks so much for this. You don't know how reassuring it is to read someone who lost that much weight on a sleeve alone. I weighed in at 371 and want to lose 225 pounds--that's why he suggested the DS. Knock on wood, I've always been very healthy outside my sleep apnea and hypothyroidism--oh yeah, and cancer when I was 26 . I don't have diabetes or high blood pressure, so I guess that's why he said I'm a great candidate, I guess.

He just feels a sleeve can only take me so far and it wouldn't have the lasting results that a ds would have. He hasn't gone into it further yet, but I'm guessing at six months in I'd have the second surgery. Not sure how that works if my bmi drops below 50, or hopefully maybe even 40. How would I qualify then?

I look so young now, not even a single wrinkle on my face at 41, so yeah, I'm nervous. My plan of attack is low carb, high protein with very healthy veggies and berries. I want to work out six days a week to try and combat the loose skin as much as possible with a daily slather of Aquafor (best stuff for healing dry and cracked skin), and as much Water as I physically can get down, even if that means constant sipping all day.

My insurance pays 85% for skin removal if deemed necessary--which they even said on the phone that losing that much weight will more than likely be necessary. I wonder how that works if the insurance covers skin removal but I'd want a lower body lift. I wonder if the surgeon gives an adjusted price for any work done above a skin removal --I know, I know...you don't have to say it. I'm getting my cart ahead of the horses

@@Finding_Stacy

We are close in age, I doubt losing weight will age you. I didn't have any wrinkles before and I don't have any now.

As a person living with a lot of loose skin, it is never too early to start worry about it. Having a plan helps. It is a pain to live with.

I wear a size 10/12 now and I could easily be an 8 or smaller without the skin.

Honestly most people that have the sleeve and RNY that need to lose 200 pounds never get there. It has nothing to do with the tools but a lot to do with the people. People that over weight are food addicts. I was one. Unless people can mentally fix their issues with food, they are going to fail once they heal from the initial surgery, because surgery just doesn't do it all for you. So if someone has 200lbs or more to lose, the sleeve/RNY is probably only going to get 100 pounds off of them in the first 6 to 9 months. Then it is a lot of good old fashioned will power and making the right choices.

If people follow their program and don't advance their stages, you relearn how to eat again like a baby, and you learn to love good healthy food. Most people advance their food stages, reintroduce carbs early and start on sliders ASAP like eat crackers with tuna fish on soft foods . Those people won't hit goal and will start to regain at one year or close after.

Stacy, it's a single vs. double anastomosis.

Edited December 24, 20169 yr by Postop

Yes that's the one I am getting and @@Finding_Stacy yes I think that's one of the main differences

Sent from my iPhone using the BariatricPal App

Hi. I'm 11+ years out from a full DS.

I've heard of doctors mentioning the DS (as the second procedure) as something to think about if you don't do well enough with the sleeve (and keep it off) but yours does seems a bit more insistent. I guess he really thinks it will be necessary in your case given what you want to lose. But remember, the decision is ultimately yours. You'll do what your comfortable with. As for the insurance, I know many DSers who want to have that 2nd stage of the surgery within about 6 mos. The reason being is they may lose enough weight that their ins. co. might balk at another procedure & that sleever wants the switch to add the lifetime malabsorptive component.

Today most DSers have it done in 2 steps. Especially if you have a high BMI, it's just safer to keep you on the operating table for a shorter period of time. I'd ask the doctor what length he makes the common channel. Does he use a standard length of: 75, 100, 150? Or does he measure each patient individually? The length will also determine what (if any) types of side effects you may experience.

The DS is more extreme. There is potential for more side effects. Most are manageable if you're careful about what you eat and when. That doesn't mean I don't eat junk. I just had half a brownie. I'm at home now as I wouldn't eat something like that in public. I don't want to deal with the gas and/or stool issues that might occur.

But...there is also the benefit of your odds regarding losing & keeping it off.

As for Vitamins, I don't know many DSers who have luck with the Patches. It's just something I want you to think about. You must be committed to a lifetime of vitamins (I take 40+ per day) and blood tests (every 6 mos. or yearly depending on your surgeon). You should also probably have a Dexa Bone Scan (preop) so you'll have a baseline to be compared to as you age and as your malabsorption kicks in.

While the amount of my vit/minerals may have shocked you (others do take fewer, but we all take a good amount) there's no diabetes issues, cholesterol issues, CPAP, etc. You might want to make a pros/cons list to figure out what you can live with and what you can't.

Look, I didn't run to the DS. I was told in 2003, I had to have WLS. I ignored that for 1 year. I told no one. Then in 2004, I realized I had to do something (as my cholesterol was 302 and everyone in my family dies of heart issues). I was also a touch below diabetic. I went to 3 hospital programs and at one of them, I learned about the DS. Once I realized I just couldn't lose/keep the weight off on my own; I decided the DS was probably the right one for me. It's a very personal decision as all of the WLS have good & bad points.

Thank you so much, Post Op!

I totally missed this post earlier somehow. It was packed with some really great information. I will ask him about the length of the channel. I will admit, when he strongly urged me to do this procedure, I was completely unprepared (even though I knew it was a possibility) and shocked on the inside, but trying not to show it on the outside.

After a couple of days have passed, I'm feeling better about it. More so because I will get a bunch of weight off with the sleeve first, which means I'll have more absorption time to build up on my minerals and vitamins. I guess I just saw some videos on Youtube that freaked me out.

I'm not kidding.

One woman looked like she was doing a side of crack cocaine along with a healthy dose of meth on a daily basis. She started the procedure looking like she was in her mid thirties and a year later she looked like she belongs to AARP. I honestly felt nauseous watching her, scared that was going to be me.

But soon, I came to the realization this probably isn't the best sample size of this procedure. Who knows why she looked like that. It's hard telling. Maybe she didn't take her daily vitamins or maybe she really does do a healthy side of crack cocaine after her two bites of fish--I don't know.

But really, good job with all the weight loss. It says you had the surgery in 2004-05? Have you had any regain and how do you feel? Do you ever get nauseous taking that many vitamins?

No, no regain. But most DSers do have some. It's generally good as many get too low during the initial weight loss phase.

I don't have any problems with my vits/minerals. But I take them constantly throughout the day. It isn't as if you can just take them all at once. It has become second nature to me. I'd feel very weird if I didn't take them. As a matter of fact when I had to have my gb out in 2008, I couldn't take them for 5 days. I was nuts. It just didn't feel right not to take them, lol.

I feel good. No question, I've had challenges. It took a long time till I felt like myself after the surgery.

Things have come up in the ensuing years. (That's why it's so impt. to have a good team that will help throughout the rest of your life). But I weighed them against the things I knew were coming if I kept gaining.

@@Finding_Stacy

We are close in age, I doubt losing weight will age you. I didn't have any wrinkles before and I don't have any now.

As a person living with a lot of loose skin, it is never too early to start worry about it. Having a plan helps. It is a pain to live with.

I wear a size 10/12 now and I could easily be an 8 or smaller without the skin.

Honestly most people that have the sleeve and RNY that need to lose 200 pounds never get there. It has nothing to do with the tools but a lot to do with the people. People that over weight are food addicts. I was one. Unless people can mentally fix their issues with food, they are going to fail once they heal from the initial surgery, because surgery just doesn't do it all for you. So if someone has 200lbs or more to lose, the sleeve/RNY is probably only going to get 100 pounds off of them in the first 6 to 9 months. Then it is a lot of good old fashioned will power and making the right choices.

If people follow their program and don't advance their stages, you relearn how to eat again like a baby, and you learn to love good healthy food. Most people advance their food stages, reintroduce carbs early and start on sliders ASAP like eat crackers with tuna fish on soft foods . Those people won't hit goal and will start to regain at one year or close after.

My doctor said something similar. He said the average weight loss is only 75 pounds. Of course I'm thinking why? If it can help you lose 75, why not 80, 100, or 150, even? But like you said, I too have read and seen in videos people talking about already eating mashed potatoes three weeks in. I think, and this is just my personal observation, is that many people can find they can still eat the variety of food that always gave them comfort and still lose. The same food that caused them to be in this situation to begin with.

But unfortunately, that positive side effect most likely ends somewhere around the ninth month when the stomach stretches, and instead of eating only a few bites, they now can eat a half a plate, or even a whole plate, several times a day, and that's where the tipping point is for many regainers. Again, just my observation.

I know we're all brainiacs before we are actually thrown into these situations, and I can talk like an expert because I'm not forced into it quite yet. I'm just trying to learn from others, both good and bad. For instance, I'm going to try my damnedest to not stretch my stomach by overeating or drinking, and to keep it 'small' as long as possible. The longest I've ever done low carb was ten months and I got a 100 off. I'm thinking if I can apply that same strategy with this tool, hopefully I'll be ahead of the game, and the longer I can keep it, the sooner new habits will hopefully be retrained into this thick skull of mine. So no mashed potatoes. No candy. No milkshakes (I've seen this one quite a bit and it always shocks me). So, we'll see soon if I can put my money where my mouth is.

One thing I strongly urge people to do, something my mom taught me when I was in Jr. High, is to do your daily neck exercises. Stretch your head back as far as you can then say your vowels in an over exaggerated fashion, stretching your facial and neck muscles in the process. This should help with double chins and tightening up your facial muscles. I always start with fifty a day, but after surgery I'll probably be doing two and three sets of fifty.