Monday, 2 February 2009

Diary and information weight loss surgery

Ok weekend over and time for another posting. Wow the op is getting closer now…. My kids came to see me over the weekend which really nice. Although I did find it a little concerning… did they come to see me because it was my birthday? or are they concerned about the operation. I think it was allot of birthday and a little bit of concern. Or maybe it was to say goodbye to my 2 other firends after all the kids have know them as long as me. Still it was really nice to see them.

I woke up this morning and like most people found the country ground to a halt with the snow…. I drove into work quite normally… infact I was a bit worried when I first went onto the M25 I though it must be closed, there was not another car going my way at all…. It soon changed going past the M3 but the traffic was not as bad as a normal Monday morning… I ended up with the wifes Mini… yes Mini.. mind you it is a JCW Cooper S so it nips along a bit….so it was a pleasant drive into work…. The M4 was no where near as bad as a normal Monday…. I would like to say I did not make the effort due to my keenness and carp… but in reality Im a contractor days not at work means days lost pay… plus this month time sheets were delayed which meant it was essential to get to work… it is contracting reality in the office today… all contractors are in at work and all staff people are off…. When will companies learn make everyone a contractor do away with staff sickness…. even in the snow....

Ok I hope all this snow will not effect my operation… no I know the hospital is snow proof but the “staff” are not… I just hope hospital “staff” are more keen than the “staff” in our industry…. We will see…. Ok the next installment of operations, the

DS Douodenalswitch,

The BPD/DS combines restrictive and malabsorptive elements to achieve and maintain the best reported long-term percentage of excess weight loss among modern weight-loss surgery procedures.

The Restrictive ComponentThe BPD/DS procedure includes a partial gastrectomy, which reduces the stomach along the greater curvature, effectively restricting its capacity while maintaining its normal functionality.

Unlike the unmodified BPD and RNY, which both employ a gastric “pouch” and bypass the pyloric valve, the DS procedure keeps the pyloric valve intact. This eliminates the possibility of dumping syndrome, marginal ulcers, stoma closures and blockages, all of which can occur after other gastric bypass procedures.

In addition, unlike the unmodified BPD and RNY procedures, the DS procedure keeps a portion of the duodenum in the food stream. The preservation of the pylorus/duodenum pathway means that food is digested normally (to an optimally absorbable consistency) in the stomach before being excreted by the pylorus into the small intestine. As a result, the DS procedure enables more-normal absorption of many nutrients (including protein, calcium, iron and vitamin B12) than is seen after other gastric bypass procedures.

The Malabsorptive ComponentThe malabsorptive component of the BPD/DS procedure rearranges the small intestine to separate the flow of food from the flow of bile and pancreatic juices. This inhibits the absorption of calories and some nutrients. Further down the digestive tract, these divided intestinal paths are rejoined; food and digestive juices begin to mix, and limited fat absorption occurs in the common tract as the food continues on its path toward the large intestine.

HistoryThe standalone Duodenal Switch procedure (without the accompanying gastric bypass as used in weight-loss surgery) was originally devised by Tom R. DeMeester, M.D. to treat bile gastritis, a condition in which the stomach and esophagus are burned by bile. In 1988, Dr. Douglas Hess of Bowling Green, Ohio, was the first surgeon to combine the DS with the Biliopancreatic Diversion (BPD) form of obesity surgery. This hybrid procedure, known as the Biliopancreatic Diversion with Duodenal Switch (or the Distal Gastric Bypass with Duodenal Switch), solves many nutritional problems associated with other forms of WLS, and allows a magnificent eating quality when compared to other WLS procedures.

The Differences Between the BPD/DS and the RNY Procedures
In researching which type of weight-loss surgery to pursue, people often want to know the differences between the BPD/DS procedure and the more common Roux-en-Y procedure. Several people have written their own comparisons, which are listed below. By reading these peoples’ “take” on things, you may gain a greater understanding of exactly how the BPD/DS works.

Laura E. in Phillips Ranch, CA
It's not easy to understand the differences between these surgeries! Hopefully, you've had a chance to read up on the ASBS site -- they have a paper there that gives some good info about the various surgeries that are done for obesity.

All weight loss surgeries work by making the stomach smaller (restrictive procedures band or balloon) and/or creating changes in the digestive tract which do not permit the body to absorb all of the fats in the food you eat (called malabsorptive procedures).The DS is a combination restrictive and malabsorptive surgery. The stomach is made smaller and the intestines are rerouted so that you can't absorb all the food you eat. Because of this malabsorption it's essential that you monitor your vitamin levels and take your prescribed vitamins for the rest of your life. It's also the malabsorption that can cause diarrhea if you eat too much fat. The undigested fat in your colon can cause gas problems, but they usually improve in the first 6 months after surgery.

The DS is similar to the RNY with respect to the intestinal bypass (malabsorptive) portion of the procedure. The lower part of this surgery is basically the same as a distal RNY. RNY's are done either proximal (with a shorter length of the intestines bypassed) or distal (with more of the intestines bypassed). Studies have shown that people who have distal bypasses have greater success at losing large amounts of weight and keeping it off.

The RNY and DS are very different with respect to what is done at the top end of the surgery -- the portion involving the stomach (the restrictive aspect of the surgery). The RNY doctors do a variety of things to make the stomach smaller -- most create “pouches” or transect (divide) the stomach. They then reroute the intestines by connecting them directly to the new stomach pouch, bypassing the duodenum. In the RNY/pouch procedures, the pyloric valve (which regulates the emptying of stomach contents into the duodenum) is bypassed and therefore doesn't function after surgery.

In the DS procedure, the surgeon creates a smaller stomach by removing about 75% of the stomach (which is called a partial gastrectomy). The top part of the gastric bypass is connected below the duodenum which keeps the upper part of the digestive process the same as before surgery (except that your stomach is smaller). Your pyloric valve continues to regulate the emptying of the stomach contents into the duodenum and all of the hormones and secretions that occur in the duodenum continue after surgery.

In RNY/pouch procedures, the duodenum and pyloric valve are bypassed and the intestines are connected to the newly created stomach pouch. Dumping happens when the stomach contents (unregulated by the pyloric valve which has been bypassed) dump directly from the new stomach pouch into the intestine. Eating sugars can cause dumping for many RNY/pouch patients. For this reason, they must be very careful of sugars. Some feel that this type of surgery with the dumping syndrome is the best option for people who eat a lot of sweets, since the dumping acts as a deterrent to eating sweets.

Since our pyloric valve and duodenum are left functioning as before, we DS patients don't have dumping syndrome, nor a risk of staple line problems, clogging of the anastamosis, ulcers at the stoma, etc. (remember, we don't have pouches or stomas). So, we don't have the problems with "stretching" the pouch or getting something stuck in the stoma -- because what we have is our real stomach, connected the same way it was before surgery to the duodenum.

By Craig in San Francisco

There are always a lot of questions about the difference between the Distal Gastric Bypass with Duodenal Switch (DS) and the more common Roux-en-Y (RNY) procedure. I have done a fair amount of research for myself and can tell you why I have chosen the DS procedure. The following is just my understanding and opinion.

Probably foremost is that the DS avoids altogether the complications with the RNY "anastamosis" -- that is the artificial outlet from the "stomach" pouch into the intestine. Some RNYers have had this opening "close up" on them, sometimes several times. At the very least, this means a very painful trip to the emergency room to have the opening "roto rootered" open again. Unable to eat or even drink water, you can get into trouble quickly.

In the regular RNY, a small pouch is created where the stomach meets the esophagus, and made into a new artificial stomach. The remaining stomach is either stapled off or separated from the pouch. A hole "about the diameter of a pen" is then made in the pouch, and a fresh-cut piece of small intestine is brought up and sewn to that hole.

The opening between the pouch and the intestine is called the anastamosis. Food can block this small opening, or scar tissue can swell it closed. It is also prone to ulcers and bleeding (and internal bleeding is serious), because the "cast iron" tough stomach tissue both is largely impervious to, and itself produces acid, while the tender intestinal tissue sewn to it is neither. [The stomach tissue is a naturally acid environment, while the intestinal tissue is alkaline -- which can make for less-than-chummy bedfellows.]

Another concern is that because the exit from the stomach to the intestine is simply a "hole," from which the stomach contents empty directly into the intestine, it is like a sink whose drain is always open. For this reason, RNY patients sometimes have trouble regulating blood sugar, which causes the very unpleasant "dumping syndrome."

The Duodenal Switch procedure is essentially a newer, arguably more advanced version of the RNY, which avoids all of the above-mentioned problems. DS surgeons are still few and far between. Most DS surgeons have done a many RNYs and have been ultimately dissatisfied with the procedure, which led them to perform the DS.

The DS procedure includes a “distal” gastric bypass, which means that more of the small intestine is by passed than in a "proximal" bypass, which some may worry about. (The RNY can be done with either a distal or a proximal bypass.) The DS’s distal bypass means that fewer nutrients and calories are absorbed than with a proximal bypass. This results in more successful weight loss, but it also means more vigilance is necessary in taking your vitamins and calcium supplements.

[After the DS procedure, patients will continue to absorb sugars completely, so it is important that we consume high-sugar foods in moderation. Proteins and carbohydrates will be absorbed incompletely at first, but the body will acclimate and absorb more of these nutrients with the passage of time.] Fats will never be completely absorbed following the DS, which means that eating high-fat foods can mean smelly and loose bowel movements. (But whose having surgery to keep eating lots of greasy foods?).

The biggest advantage of the DS is that you keep an honest-to-goodness stomach, [which is usually 150-200cc is size (as opposed to the 15-30cc pouch of the RNY)]. The pyloric valve remains intact and functioning just the way God intended it. The pyloric valve is a sphincter muscle that opens and closes to regulate the release of stomach contents into the digestive tract. The retention of the pyloric valve eliminates the dumping syndrome that is experienced by many RNY patients. The DS patient’s stomach can also "churn" food like it is supposed to. DS patients do not have problems with bleeding ulcers or blocked "anastamosis." They are also less likely than RNY patients to vomit unexpectedly.

The bypass portion of the operation is essentially the same as a regular RNY - the top part of one side of the "Y" brings the food down, but has been disconnected from the pancreatic juice and bile. The other top half of the "Y" brings down only that pancreatic juice and bile. They food and digestive juices mix only in the bottom part of the "Y," which results in a greatly abbreviated digestion time.

The RNY is a great operation. It is the one performed by the greatest number of surgeons, and I would not hesitate to undergo it if the DS were not available to me for whatever reason. These surgeries are the best kept secret in medicine, saving lives both figuratively and literally.

Ok that’s enough for today hopefull next time I will have had the op and will be talking about how it feels perhaps a little bit more about the procedure Im sure all will depend on the snow. I will also mention about the EndoBarrier. Costs will also be another brief mention, I have gathered a very brief cost for each operation, the figures will be a guide and im sure will be negotiable of different from hospital to hospital.Ok weekend over and time for another posting. Wow its getting closer now….

Thursday, 29 January 2009

Time for another posting. I am on my diet still fed up with the lack of choice of food, try a vegetarian fat free diet…. Fortunately I still don’t mind tinned tomatoes… baked beans are like a taste from heaven… cottage cheese on Ryvita… well I don’t care if I never see a Ryvita again… trouble is the packet keeps smiling at me every time I open it… do you think it knows we are now “friends” for life? I am hoping my diet will actually drastically improve once I have had the operation… I am sure it will… Im just looking forward to a nice piece of Poached salmon…. Mmm

Ok so I promised you more information…. Form what I know and from carrying out research,

Gastric Bypass
There are several varieties of bypass, but all involve the creation of a small stomach pouch to restrict food intake and bypasses of the duodenum and other segments of the small intestine to reduce the absorption of calories and nutrients from food. The operation is more extensive than for a band. This can be performed both open and laparoscopically (keyhole). I had one doctor argue with me that bypass operations could not be carried out using Keyhole surgery, but it can, although maybe not for everybody.

Laparoscopic surgery involves making a series of small incisions and inserting long tube-like instruments through them. The abdomen will be filled with gas to help the surgeon view the abdominal cavity. A camera will be inserted through one of the tubes that will display images on a monitor in the operating room. In this manner, your surgeon will be able to work inside your abdomen without making a larger incision. Specialized instruments are used to laparoscopically perform the Roux-en-Y Gastric Bypass. This is the same gastric bypass as has been performed with the traditional open approach (large incision), but with superior results.

Roux-en-Y Gastric Bypass (RGB)
Roux-en-Y gastric bypass surgery uses a combination of restriction and malabsorption to ensure a significant weight loss. During the procedure, the surgeon creates a smaller stomach pouch. The surgeon then divides the small intestine and attaches it to the pouch. The type of connection bypasses a large portion of the small intestine, which absorbes calories and nutrients. Having the smaller stomach pouch causes patients to feel fuller sooner and eat less food; bypassing a portion of the small intestine reduces the amount of calories that can be absorbed by the body.

Biliopancreatic diversion Gastric Bypass (BPD)
In this more complicated version, portions of the stomach are removed and the small pouch that remains is connected directly to the final segment of the small intestine. This means that most of the small intestine (duodenum and jejunum) is bypassed, resulting in substantial reductions in calorie and nutrient absorption.
The diagram shows what effect a Biliopancreatic diversion has on the stomach 1) The small intestine is connected to the stomach pouch 2) here we show the removed portion of stomach area. 3) The Pancreas
The risks of gastric bypassAs with any surgery, there are operative and long-term complications and risks associated with gastric bypass, including:
Bleeding (haemorrhage).
Complications due to anaesthesia and medications.
Pulmonary emboli (blood clots on the lung).
Deep vein thrombosis.
Dehiscence (wound breakdown).
Leaks from staple line.
Injury to the spleen.
Marginal ulcers.
However, the risks of the procedure nowadays are very small. Most published reports show that the overall mortality rate for gastric bypass surgery is less than 1%. It’s also important to note that not only does bypass result in reduced absorption of calories, it may also reduce absorption of important vitamins and minerals such as iron, vitamin B-12 and calcium. Deficiencies in these nutrients can lead to many problems. Iron deficiency causes anaemia and weakness and deficiencies in calcium can cause osteoporosis. Lack of daily B-12 can lead to neurological problems. This is why patients undergoing gastric bypass are recommended to take a daily vitamin and mineral supplement. "Dumping syndrome," in which the consumption of sugar causes abdominal cramping and diarrhoea, can also occur. Some people will also regain some weight in subsequent years.
The general criteria used to determine whether you're a candidate are listed below:
BMI >40
BMI 35-40 with co-morbidities (other medical conditions such as diabetes, heart disease, etc)
Well-informed, motivated patient
Previous attempts at medical weight loss programs
Absence of endocrine orders that cause obesity

What are the benefits of gastric bypass?For the seriously obese, the benefits of the gastric bypass procedure very much outweigh the risks. In general:
75% of patients are expected to lose 75 to 80% of their excess body weight, most of which is lost in the first two years following surgery.
Major improvements in risk factors for heart disease and cancer.
Around 70-80% of patients with hypertension will be off medication and cholesterol levels will fall.
Most type II diabetics will be cured.
There will be major improvements in a whole range of weight-associated conditions. These could include sleep apnoea, asthma, joint pain, arthritis, reflux, fatigue, shortness of breath.
Patients report less depression, improved self-esteem and confidence along with an overall increased sense of well-being.

Here is an interesting article with regard to the diabetic "cure" thing

Ok I think I have gone on long enough for this blog I was going to mention the DS but I will leave that for next time. Another type of operation which is less invasive came to my attention today which is the EndoBarrier is under going clinical trails. I will mention a bit more about this one next time to, it look quite interesting.

These factual blogs seem a bit boring but I think people might find it interesting the different types of op available…. Well this is also to fill in time until I start my own real life pages….

So until next time.....

Tuesday, 27 January 2009

Ok I think before I go any further with my blogging I should make one thing clear these blogs are my own opinions and information I have found or been told. None of this should be considered as absolute or relied on… anyone should consult their own doctor or consultant and what he/she says is fact…. Even if it differs from my observations or bloggs…. Everything I do write is how I see it….. so this is a legal disclaimer from any actions any one takes as a result of my blogs…. If my blogs differ then by all means use them as a point of argument with a doctor… I have found there are some pretty ill informed doctors out there especially when it comes to this type of operation. This is the very reason I started the blog to try and make information more available….

Right it may be time for a little explanation of the different type of Weight Loss Surgery (WLS) available….

Banding (this is my operation)

The Band is placed around the upper part of the stomach creating a small pouch. Above the area of band placement is a small ‘pouch’. The small pouch fills with food once full you experience a feeling of fullness. A person with a well adjusted gastric band is less likely to experience the sensation of hunger. This food slowly falls through the small hole which is created by the band, like and hour glass into the main stomach where the food is eventually digested. There is a nice little video clip on the band manufacturers web site which shows the basic operation of the band the link is,gb,-,midband-how-to-fit-the-gastric-band-midband.html please note this is the band I am having fitted, I am not showing any bias as I am sure others out there will be better or worse. It depends on the surgeons preference.

Band adjustment, the band can be adjusted externally to make the hole smaller or larger depending on weight loss and the rate the food goes through. I haven’t experienced this yet I will write my own experiences as they happen. During the operation a valve is placed just below the breast bone under the skin. Adjustment of the band is made via a needle inserted through the skin into the valve. Saline solution is put into the band or removed from the band as required.

Food needs to be chewed very thoroughly before swallowing otherwise it will just block the hole. The surgeon explained to me it is supposed to make you fed up with the process of eating therefore making you less interested in eating if it is too much effort. There are a number of foods which must be avoided, namely bread, pasta, rice and red meat. Skins of things like apples pears even peas are also a problem… ok so I suppose mushy peas are still ok. It is the same old adage you need to eat less food to loose weight having the operation will assist in this but will not completely solve the problem if you want to cheat. You can eat soups chocolate and ice cream but that defeats the object of what you are trying to achieve. Still lots of calories going through the hole. So this isn’t the miracle, eat what you want and still loose weight cure. It is a lifestyle changing (helped by the band) to loose weight cure. I see it as “oooh I cant manage another big mac or even a big Mac cause I’ve got a band fitted” as fact, rather than a usual half hearted attempt at refusal as I devour it….. its much easier to say no when it is not possible, than the normal giving in and saying one more wont do any harm…. By the way another disclosure my blogs are not being sponsored by MacDonalds or any other food company

Problems, there can be several problems which can develop from the band, I will discuss those later, on another blog…. I need to do a bit more research first.

The advantages is the band is completely reversible. It is a relatively minor operation I understand only around 30 minute. In in the morning and, out in the afternoon.

You can obtain funding from your local PCT (I did) provided you meet certain criteria. This varies from area to area. But if you have a BMI of more than 40 plus another “qualifying” illness such as Diabetes you should qualify. In my experience most doctors are unaware of the procedures available so don’t offer any consultation. I originally lived in Essex under 2 different doctors they had no idea and didn’t want to find out. I think this is a sad situation. Still fortunately I moved to Surrey happened to mention it to the first doctor I saw and she knew about it, knew the local surgeon who performs the operations and recommended me for it. 2 weeks later I was seeing my new Diabetic consultant she was excited about me doing this, and thought it was a very good idea, so also recommended it. I sat with my doctor we filled in a couple of forms, he sent them of to the PCT and they approved the application within weeks. I am not suggesting for one moment it is a “post code lottery” type thing at all, I was just lucky to move into an area where the local surgeon performs these operations. Its just that you may have a local doctor who does not know about these things don’t let it put you off…. It put me off for 4 years…. 4 years I could have been healthier. Anyone considering this please find out as much as you can from the web…. If you are prepared to fund the operation yourself then it will cost around £5-7000, again search on the web. This op is available abroad but consider the disadvantages, the band will need adjustments so where will they be done? If there are any problems, will your local doctors or surgeons help? Just questions you need to find out about, or at least think about. How much will you save for potentially more hassle.

I have gone on a bit today and probably bored any one who was interested by now, so I will close for now and talk about the other types of op during my next bollog!!

Next time,
Bypass and DS (Duodenal Switch)

Monday, 26 January 2009

How did I get here

I’m sure there will be plenty of time to say how I got here the childhood drama the excuses as the why I am who I am... but to be honest there isn’t really an excuse... eating too much makes you this size and the only way is to stop eating..... I’ve tried the all familiar "diets" yes the F (fart) plan.... the weight watchers everything...... I’ve tried all the pills... you name them the last being acomplia which has just been banned..... I suppose all pills work to a certain extent but when you come off them the weight just goes back on.

My operation is next Tuesday 3rd February..... I cant wait is the honest truth.... I have been on a poor excuse of vegetarian diet for the last 2 weeks, one week to go... even trying low fat vegetarian sushi… ehhh whats the point of vegetarian sushi… can it be called sushi… anyway I digress….. this diet is not to loose weight but to condition the liver to make the operation easier... having said that eating tin tomatoes and fat free cottage cheese takes some will power.... my boss said to me if you can do this why cant you do it for ever..... ahhh yes but in theory anyone will try a diet for so long then that day comes when you think on just one bacon sandwich will not cause a problem.... but as all dieters know it is the slippery slope to putting back on the pounds because one bacon sandwich becomes oh bacon and egg the sausage bacon and egg and so it goes..... I would love to have the will power but even on this diet there have been time I look in the cupboard and think oh no one will notice a few biscuits.... but you know.... the drive for me is this operation... I dont particularly want my liver damaged during the operation so that is enough incentive to stick to the diet.... I’ve been on the diet for 2 weeks and have officially lost 5.5 kg... that’s 12 pounds..... now in the scheme of things if Posh lost that weight she would be like an ironing board... ok ok.. I know she like an ironing board already, but she’s nice... anyway with me losing 5.5kg means my little finger has slimmed down a bit... but hey its in the right direction.... so I am ending this blog on a high of already loosing weight....


Friday, 23 January 2009

The start of my blogging days

Well I am about to start on a journey which I thought I would share with anyone who is interested... ok so that is no one then....

the journey is in hope to try re-find myself... why was I lost??... yes most definitely... here I am sitting here in a body made for 3 people... I am hoping to get 2 of my life long friends to leave.... its ok but having the body for 3 makes things very difficult as you can imagine.... you are saying why does my journey start now?... well I have tried all the usual stuff and now resorting to surgery.... yes drastic measures... I feel like sharing my journey because it has got of to a rocky start with lots of misinformation... even some doctors don’t know what this is about..... I have tried for 4 years to have surgery but no doctor (until now) has been prepared to talk about it... I now realise thats not because they don’t want to help.. they do... but through pure ignorance... they just don’t know what its all about and more worrying they don’t seem to want to find out.... I have a job if a new piece of equipment comes out I am itching to find out all about it... I suppose it is my engineering training... so I am hoping for anyone who is considering surgery for weight loss or who has had it might find this blogg encouraging and maybe informative..... it could be a journey full of tears… hopefully not likely as I try and put a bright if maybe slightly cynical view on everything…

So this is the first blogg.. I will hopefully post again soon with more details of what is going to happen and when and map the progress over the coming years and if I get bored the coming months... so here goes….