Modified Duodenal Switch

[Lara in Arkansas 4]

Newbie and SO excited about surgery....at least I think I'm excited! Initially went to my first appointment thinking I would have the gastric sleeve, but left leaning toward having the Modified Switch. Would love to hear how others surgery went - I want the good, bad and ugly. I would love to hear from any other "switchers"!

[California Guy 131]

I had the Modified DS (SADI-S) in April 2020. Since the beginning of the year, I have lost 102 lbs. Half was lost pre-OP. The results have exceeded my expectations and I'm really pleased. It is a challenging process requiring a lot of will power to make difficult changes. Take this opportunity now that you are on a restrictive liquid diet to forget the foods you used to eat. Build a new long term nutritional plan and follow it. I hope your surgery goes smooth and your recovery is quick.

[Lara in Arkansas 4]

@california guy,

Thank you for response. I am very excited, just nervous (as is normal)! Congrats on your weight loss!

@Ms. Mocie,

I honestly don't know other than the modified version is reportedly less invasive and easier? I am hoping it's easier recovery wise as well.

[Ronnysgal 56]

I had the surgery on Feb 22nd of this year, so I am a little over a month out. Mine is long story as I had a Gastric Bypass in 2017 around the same time, and then almost exactly 2 years later, it had to be reversed due to stomach ulcers trying to perforate my stomach.
I gained a lot of weight back more then 50% of what I had lost in over the next two years, and had some other issues, so I went back to my surgeon and we decided I could do the modified DS switch.
I absolutely love it. I will say there are some interesting things that people mentioned that in MY case I have note experienced, like if I eat something that is fatty like cheese or bacon, that it will send me running to the bathroom where-in I would be treated to an explosion and a smell that only a mother could love and she would question it. This is not true in my case.

If anything at times I will need stool softener's to help go to the bathroom on occasion. Nothing like what I experienced post Gastric Bypass though. I am able to eat more at a sitting with the DS then after Gastric Bypass as well. I am being careful though to not over eat. If I had to do it all over again then I would opt for the DS

[RLeaT 26]

Hello!

I got the SADI-s on February 5th of this year, so I'm 7 weeks post op. Let me tell ya, my recovery has been kinda rough. I've had a lot of problems with indigestion/stomach gas that is really uncomfortable. I could hardly eat anything for a month, and I'm really just now able to eat some regular-ish foods. The dietician at my surgeon's office keeps reminding me that everyone's recovery is different and that this could be a 4-6 month process of my body adjusting.

The surgeon said I had acid reflux, and put me on high doses of PPIs, which didn't improve my issues at all. I'm a healthcare professional myself, and I know damn well that acid reflux can be caused by LOW acid production as well, so I took myself off the PPIs. Once I did that, my acid reflux improved significantly. I'd also like to note that what my surgeon was saying was acid reflux didn't feel like the typical esophageal burning or "heart burn"...it's more like a rumbling gas in my stomach with a feeling of having to burp without being able to burp. Just stuck, rumbling gas in my stomach that's soooo uncomfortable.

I also had constant low level nausea for the first month, but that has mostly resolved. My taste buds changed quite a bit and I couldn't tolerate sweet AT ALL...especially fruity fake sweet, so I had a hard time drinking gatorade when I was feeling dehydrated or the Protein Shakes I had purchased. I also had a constant bitter taste in my mouth. All of this is resolving though and isn't nearly as severe as it was that first month.

There are good days and bad days, but overall I am definitely improving. My energy is much better (I was horribly fatigued for the first month and had to take daily naps, which I never did before) and different foods are sitting better in my stomach. I still get pretty bad indigestion sometimes. Like right this second, my stomach is gurgling around and it's SO LOUD and uncomfortable. Luckily, I've found some great digestive bitters that help a lot.

That first month, I was a mess and regretting my surgery decision. I was miserable. Now, I have more hope and I'm realizing that my body is just healing, and that takes some time. Also, healing is not linear, and that's okay.

With all of that being said, I lost 8lbs during my 2 week pre-op diet and have lost 52lbs since my surgery date. I only weigh myself every 2 weeks and it looks like I had a significant stall and only lost 3lbs between 2 of my weigh ins. I wasn't surprised at all about that because I hadn't felt like I had lost weight during those 2 weeks and everyone had warned me about the 3-6 week stall. No biggie. My next weigh day is in a week.

I'm noticing improvements in my mobility and the way I'm able to move my body now, which was my motivation for getting the surgery in the first place. That's incredibly encouraging and makes me feel positive about the surgery and my future.

I hope all of that helped! You said you wanted the good, the bad, and the ugly!

[seababe25 4]

Hi thanks for your post. I haven’t heard about the 3-6 week stall.,could you tell me more about that like when will that most likely occur? You lost a lot of weight 50 lbs in a short amount of time like 52 days! Wow!Congrats!! How old are you and how tall if you’re u don’t mind me asking?

[NurseAudge 1]

@RLeaT Wow! Your experience is very similar to mine! I had the SADI-S on 4/29/21 so I'm just now out of my first month post-op and it has only been in the past few days that I've started to feel more like myself. I think it was around week 2 ish that I started regretting my decision because of the nausea (better now), constipation (still experiencing that), couldn't get in enough fluids/protein daily (still working on that & even struggling to get in enough calories/day), and that feeling of gas/needing to burp but can't plus just various other reasons. I also can relate to not being able to tolerate the Protein Shakes I bought and also having a gross taste in my mouth that seemed to linger! But now I'm back to feeling glad I did and also realizing it takes time for my body to get used to it. I lost 17 lbs in my first 2 weeks post-op so that was encouraging but now my weight has been stalled for the past week ish. I'm just hoping getting in the Protein, fluids, & calories on a daily basis will become easier and easier and I'll start getting some energy back. So it's encouraging to read your experience and know I'm not alone and also that things have been much better for you lately. Hope all is well. Take care!

[Clueless_girl 16]

On 5/31/2021 at 9:29 AM, NurseAudge said:

@RLeaT Wow! Your experience is very similar to mine! I had the SADI-S on 4/29/21 so I'm just now out of my first month post-op and it has only been in the past few days that I've started to feel more like myself. I think it was around week 2 ish that I started regretting my decision because of the nausea (better now), constipation (still experiencing that), couldn't get in enough fluids/protein daily (still working on that & even struggling to get in enough calories/day), and that feeling of gas/needing to burp but can't plus just various other reasons. I also can relate to not being able to tolerate the Protein Shakes I bought and also having a gross taste in my mouth that seemed to linger! But now I'm back to feeling glad I did and also realizing it takes time for my body to get used to it. I lost 17 lbs in my first 2 weeks post-op so that was encouraging but now my weight has been stalled for the past week ish. I'm just hoping getting in the Protein, fluids, & calories on a daily basis will become easier and easier and I'll start getting some energy back. So it's encouraging to read your experience and know I'm not alone and also that things have been much better for you lately. Hope all is well. Take care!

So the pain, discomfort and nausea will last a whole month? I have tried all of the meds the surgeons prescribed for those issues and I have to take them religiously everyday for some relief. But I am just now into my 3rd week. Sometimes it happens in the evenings, sometimes it's all day. I even sleep with a hot water bottle to ease the pain. I got the go ahead to go onto the soft diet, but after a few days, the liquid diet is easier to stomach. I don't think I've hit my Protein and Water goals once...

[ChunkCat 660]

On 1/19/2024 at 11:38 PM, Clueless_girl said:

So the pain, discomfort and nausea will last a whole month? I have tried all of the meds the surgeons prescribed for those issues and I have to take them religiously everyday for some relief. But I am just now into my 3rd week. Sometimes it happens in the evenings, sometimes it's all day. I even sleep with a hot water bottle to ease the pain. I got the go ahead to go onto the soft diet, but after a few days, the liquid diet is easier to stomach. I don't think I've hit my Protein and Water goals once...

Everyone's recovery is different. I had no pain after a few weeks, other than some internal tugging of the stitches when I changed positions. But I am still on a PPI, those are wise to take for a while after surgery. My nausea eased around 2 months after surgery. I was taking meds for it every day (promethazine), twice a day. This isn't because of the DS, this is because any procedure on your stomach can cause nausea for a while. But again, for some it is brief, some it is longer.

Focusing on hydration goals is important in the first few weeks because it is hydration that will keep you out of the ER with dehydration. Our bodies have enough Protein stores to get us through those first few weeks. After that, protein is a slow, steady progress sort of thing. I was about 3 months out before I could hit my protein goals. I get about 120 grams a day now. But I hit my Water goal from day 2, because I desperately wanted to avoid dehydration!! How are you feeling now?

[Clueless_girl 16]

I'm 6wks out now and I still have nausea and stomach pain everyday. I can do maybe 24oz of water/gatorade zero a day at most. The nausea isn't limited to food, it affects my Water and Vitamins too. The most I've been able to eat at 1 time is 1.5 greek yogurt cups, the least is like 3 small bites of food the entire day. I'm back in the hospital because my potassium was critically low, they checked to see if my gallbladder was the issue and it's not. They did say recovery is different for everyone but that it is still abnormal that I am having this much trouble eating. It's especially weird bc other than the pain and nausea I feel okay, despite how low my labs have been at each followup.

I guess I was too ambitious in trying to hit water, Protein, and Vitamin goals all at once. But of the 3 you'd say hydration should be the priority over vitamins? I wish someone had tips on how to deal with the stomach pain. I am taking gas x, hyoscyamine, omeprazole, and ondansetron religiously at least 2 times a day. Not to mention reheating a hot water bottle during the day and sleeping with it at night. All of that just so I can get out of bed and walk around.

[ChunkCat 660]

On 2/14/2024 at 1:35 PM, Clueless_girl said:

I'm 6wks out now and I still have nausea and stomach pain everyday. I can do maybe 24oz of water/gatorade zero a day at most. The nausea isn't limited to food, it affects my Water and Vitamins too. The most I've been able to eat at 1 time is 1.5 greek yogurt cups, the least is like 3 small bites of food the entire day. I'm back in the hospital because my potassium was critically low, they checked to see if my gallbladder was the issue and it's not. They did say recovery is different for everyone but that it is still abnormal that I am having this much trouble eating. It's especially weird bc other than the pain and nausea I feel okay, despite how low my labs have been at each followup.

I guess I was too ambitious in trying to hit Water, Protein, and Vitamin goals all at once. But of the 3 you'd say hydration should be the priority over Vitamins? I wish someone had tips on how to deal with the stomach pain. I am taking gas x, hyoscyamine, omeprazole, and ondansetron religiously at least 2 times a day. Not to mention reheating a hot water bottle during the day and sleeping with it at night. All of that just so I can get out of bed and walk around.

I had nausea until about 8 weeks out. It was constant and impacted my ability to eat, drink, and take my vitamins. A few things helped me (and others like me) that may help you:

1. Ondansetron only takes the edge off of nausea for me. It is rather ineffective for my body. I have much better results with promethazine, it actually manages to eradicate the nausea for a number of hours. I'd ask about a prescription to try it, at this point it is worth trying something else for the nausea and they have a number of meds out there that can help with this. I took it several times a day.

2. My surgeon told me to be gradual with my addition of vitamins. I had to take the chewable B complex everyday, and the little B1 pill because my complex didn't have enough B1 in it alone. But these were pretty gentle on my stomach. The actual Multivitamins though he said are rather activating for the stomach and some people can struggle to incorporate them early after surgery. It could be these are contributing to your stomach pain and nausea, especially if your Multivitamin contains Iron, as it can be a little hard on a new tummy. So talk to your doctor about this, perhaps they can switch you to a bariatric B complex and let you try adding in the multivitamin closer to 3 months than all at once right now.

3. When my stomach would hurt I'd massage it in clockwise motions with firm, but not painful, pressure. I got twisting stomach spasms for the first few weeks with any food or water and this was the only thing that helped ease the pain of them.

4. My PPI needed an extra dose and for me, omeprazole is worthless. Some people metabolize it fast and for some it just doesn't work as well. Have they considered switching you to Pantoprazole? It is often used in the hospital because it is so effective. It might be worth switching to it to see if it is any more effective for you. A lot of bariatric patients end up having to switch around to find the most effective one for them.

5. Hydration is crucial early out of surgery. They should have had you exclusively focusing on hydration for the first two weeks along with the B complex. It sounds like your electrolytes are off, probably because you are chronically dehydrated. Nausea is made MUCH worse by dehydration!! You are 6 weeks and still struggling. Unfortunately at this point you DO need to be trying to get in some Protein with your hydration to prevent malnourishment. Greek yogurt is great for this, but there are other options too. Have you tried any protein water powders like SEEQ or Syntrax Nectars? These are easier to stomach and come in nice flavors. SEEQ watermelon is seriously tasty. LOL Try some sample packets!! It is okay if you can't hit your full protein goals yet, every little bit helps. If the change in meds doesn't help you at all, I hope they consider doing some imaging and a scope to ensure you aren't experiencing something like a stricture. They are rare, but they do happen, and they can cause issues with progressing the diet.

6. Water flavoring packets can help with getting in more water, as does sipping it around the clock out of those tiny cups until you get the hang of getting more water in. It can and does feel like a full time job and you will feel like you are floating! This is normal. Electrolyte powders are a great addition to water at least once a day because they really help you get minerals you are missing since you aren't eating them in food! And try a variety of things and a variety of temperatures. Some hot broth or tea, some flavored water over ice, something room temperature, sometimes the tummy has an opinion about what the best temp is!

I am so sorry you are dealing with these issues 6 weeks out. It sounds like your team needs to be more proactive in trying different meds and doing some testing to figure out what is going on. Honestly, some do struggle like this for a while. On occasion some end up with TPN for a while to help them get the nutrition they need. It sounds like you aren't quite at that point because you are keeping some foods down, but it is an option if you continue to struggle and end up in the hospital repeatedly for low Vitamin levels. Some find a month or two of TPN can get them past the roughest part and then their systems are able to handle food and water without issue. It really depends on the person. But you don't want to go that route if you can avoid it... ❤️

Edited February 16 by ChunkCat

[Clueless_girl 16]

Thank you for the detailed information! I do take some of the medications you listed, tried flavoring my Water too. I dodn't know that dehydration could make nausea worse though. I felt fine in the hospital and was able to eat more, but as soon as I left the pain and intense nausea returned. I now have body aches to boot. So i was thinking that hydration and sleep should be my priorites at this point, maybe if i get those fixed i can eat more and feel better? I'm switching from water to electrolytes so add taste and electrolytes. I really don't want to rely on Protein Shakes bc I'd like to be able to eat with my family at some point in the next few months, even if it is just a little bit. Also be be able to go a long walk without feeling like collapsing from fatigue would be nice too. What is a TPN?

[ChunkCat 660]

10 hours ago, Clueless_girl said:

Thank you for the detailed information! I do take some of the medications you listed, tried flavoring my Water too. I dodn't know that dehydration could make nausea worse though. I felt fine in the hospital and was able to eat more, but as soon as I left the pain and intense nausea returned. I now have body aches to boot. So i was thinking that hydration and sleep should be my priorites at this point, maybe if i get those fixed i can eat more and feel better? I'm switching from Water to electrolytes so add taste and electrolytes. I really don't want to rely on Protein Shakes bc I'd like to be able to eat with my family at some point in the next few months, even if it is just a little bit. Also be be able to go a long walk without feeling like collapsing from fatigue would be nice too. What is a TPN?

TPN is Parenteral Nutrition. It is nutrition through an IV. There are also forms of nutrition that can be given through the stomach.

I agree that focusing on hydration and sleep are important for you at the moment, but you can't totally ignore Protein at this point. You are 6 weeks out, not 1 week out. Right now you really SHOULD be relying on protein shakes! shakes count towards your fluid goals and will give you enough nutrition to combat the fatigue and weakness that comes from not eating enough. Most patients rely on Protein Shakes for the first 6 months after surgery to help them get enough protein in. I'm 3.5 months post op and I eat just fine, but I still need a shake in the morning to get 120 grams of protein a day! At the stage you are at, you should be drinking some Protein Shake every hour in addition to your water/electrolytes, so you keep a steady supply of nutrition up. Of course you can and should try eating too, as the nausea eases eating will be easier. But shakes will actually help your hydration goal, not hinder it. ❤️

[Clueless_girl 16]

Thank you for the advice! It's weird, a day or 2 after I last replied, the random nausea and intense abdominal pain practically disappeared on its own. Of course now I've been fighting with trying not to eat so fast I make myself sick and getting tired of eating the same thing over and over. Do you actually weigh out your food? I'm avoiding that because it reminds me of all the failed attempts at dieting. I doubt I'm hitting my Protein and Water goals still, but it's been an improvement from the past 6 weeks. You have to stay positive right? Do you actually eat 3 meals or at specific times? I'm still trying to recognize my body cues on that.

[ChunkCat 660]

1 hour ago, Clueless_girl said:

Thank you for the advice! It's weird, a day or 2 after I last replied, the random nausea and intense abdominal pain practically disappeared on its own. Of course now I've been fighting with trying not to eat so fast I make myself sick and getting tired of eating the same thing over and over. Do you actually weigh out your food? I'm avoiding that because it reminds me of all the failed attempts at dieting. I doubt I'm hitting my Protein and Water goals still, but it's been an improvement from the past 6 weeks. You have to stay positive right? Do you actually eat 3 meals or at specific times? I'm still trying to recognize my body cues on that.

I'm glad you are feeling better!! Learning to eat slow is definitely a challenge. I still catch myself sometimes. I get food bored too so I try to eat a variety of things.

I don't usually weigh out my food, but I do portion it out/estimate the portion and log it to make sure my macros are on target. It is crucial for DS patients to get enough Protein in and if you aren't tracking it you might not be getting enough. It'll eventually show in your labs, but once your protein level drops in labs it is a huge pain to get back up. So it is best to just track it... You don't have to be as exact as weighing, but a good estimation is worthwhile and will also teach you how to understand what correct bariatric portions are for you. My surgeon likes his patients to stay in ketosis for a while so I aim for 120 grams of protein, less than 50 total carbs (usually less than 40 total carbs for me to be safe), and I aim for about 100 grams of fat for good brain health.

I don't eat at specific times. That's too much planning. LOL I drink a Protein Shake as soon as I wake up, then eat a meal about an hour later, and eat every 3 hours after that until I go to bed! I usually end up eating about 5 times a day. I ascribe to the "eat less more often" method and so does my surgeon. I discovered soon after surgery that I need to eat within 3 hours, anything past that and I start to feel exhausted and have no energy and get moody. I feel my best if I eat within 3 hours of my last meal throughout the day... Sometimes eating is a protein snack like a bag of protein chips and a few pickles. Sometimes eating is more meal-like like Keto chicken tenders with steamed asparagus. But I always eat by that mark or I pay for it. I also pay for it if I don't get enough fluids in a day, so I watch that.

Monitoring your food and Water can feel triggering for some people due to past diet attempts. But it is important to reframe it as a caretaking behavior as much as possible, especially for DS patients because our dietary needs are so important to be on target with.