Duodenal Switch

I would like to share my personal post-op experiences, fact based knowledge and background regarding my surgery which is a combination of the Vertical Sleeve Gastrectomy (VSG) and Duodenal Switch (DS), performed under 1 surgical procedure. It is medically known as a a gastric restriction with partial gastrectomy, pylorus-preserving duodenoileostomy and ileoileostomy to limit absorption. It is known by its formality as a bilio-pancreatic diversion with duodenal switch and abbreviated as BPD/DS or DS. A not so wordy way to say it is sleeve gastrectomy with duodenal switch or just the DS.

I had my laparoscopic duodenal switch procedure on Nov 14th, 2006 for the surgical medical treatment of morbid obesity that can kill you. I am still the same person within, only my outer shell has morph to what I once looked like before this disease imprisoned me. The most important thing that matters is, I have my health back and that means more to me than the actual weight loss.

What is your body if you are not healthy with your respiratory, circulatory, cardiac and digestive system working properly and have mobility to be able to do things on your own, independently with no limitations, no complications or becoming a fatality?

This is what bariatric surgery outcome has done for me, give me my health as well as my life back!

The Duodenal Switch (DS)

The DS procedure has been performed since 1988 and combines restrictive and malabsorptive elements to help achieve and maintain long-term weight loss:

1. by restricting the amount of food that can be eaten through a reduction in stomach size

2. limit the amount of food that is absorbed into the body through a rerouting of the intestines

3. have a metabolic effect induced by manipulating intestinal hormones as a result of intestinal rerouting

The overall effect is that DS patients are able to engage in fairly normal, free eating, while having the benefit of taking on the metabolism of a lean individual.

Friday, May 25, 2007

food intake

I wanted to write this since this is important to anyone reading this. I have all my life been conscious of my health and what I do. Prior to having bariatric surgery, there would be times I wasn't up to eating and didn't eat for the day. But once you become post-op, you cannot have that mentality or even let such action take into play. Having this surgery means you have to comply and take the daily regime serious. Sure you can miss a vitamin or supplement here and there. But when it comes to food intake, that is your life line and source to getting your nutrient to nourish your system and you HAVE TO get your protein in your body.

Not eating can cause your body to go into starvation mode and also cause certain organs to not function as it should. One being your brain and its cell as well as the blood supply that run through all your sytem from beating your heart to helping your organ do what it needs to supplying your brain via the spinal cord. Blood also has electrolytes and those electrolytes is what gives your heart that power to ignite and pump. If your electrolytes are low from not eating and nourish your body, you will get dizzy and even pass out. Headache is also contributing to poor or not eating as well as consumption of alcohol will deplete your nutrient intake. So what if you had all your vitamins and supplement, drank over 64 oz of water and taken your protein to what is needed. When you drink anything with liquor, you are depleting all you work for the day and it does dehydrate you as well. So think, before you take that drink with alcohol in it.

So, remember to eat if you are post-op and if you can't then find something that you can and make it smaller portion that you may eat throughout the day. I personally eat smaller meals and not the typical 3x a day meals. I have 4-6 x a day meals. I am not a snack person, but will have a yogurt or a banana or just drink milk with Unjury protein powder. I don't use a whole scoop in my milk. My taste buds have changed and I now can only add about 1/3 to 1/2 scoop into my glass of milk. I do use Unjury when I eat cereal. Again add 1/3 to 1/2 scoop. WIth bariatric surgery protein is prevalent. Just wanted to add this here to let other know, if you do experience like me to have bouts with no feeling up to eating anything at all. Just do what you must and do make sure you eat and DON'T skip a meal.

Wednesday, May 23, 2007

6 1/2 months post-op

I am 6 1/2 months post-op. Things are going well for me. Let me update here, since some like to read what's going on with me since I had DS surgery. I have hit my half way point for the year and lost a total of 62 lbs. Overall, I have lost a grand total of 120 lbs.

I am honestly doing well, no complaints or negative effects from having DS. My blood work from a few weeks ago came back within normal range with no red flags. I need to do another bloodwork for my 6th month update which is now. I haven't lost any weight by checking the scale, but I am losing since my clothes are falling off and needed a safety pin to tighten my pants. Pants size depends on maker and style. I am in some pants size 9-10 and in other pants 11-12. Have to take into account I do have a booty on me and do not like wearing tight pants. I can fit into medium pants. In total going from size 20-22 right before I had surgery to now a size 11-12, don't want to say 9-10 just as yet. That is a total of 10 sizes down. Not bad and I am taking my SWEET ASS TIME with my weight loss.

I am in no hurry or rush to lose weight and want to prevent my skin from sagging or hanging on my body. My skin is firm and tight on me. I am 6 months out, have lost over 60+ lbs and don't have that condition and may not see it, since I only have 40+ lbs to go till I reach my goal of 140 lbs. That is a good note in my book. I do not think I will need plastic surgery on my tummy, side or to have any upper or lower body lift. The only noticeable that I see are my inner thighs. The skin is a bit loose, but it isn't bad to be honest. If I wear stocking it won't show and with pants on, you don't see any "defects". With clothes off, it isn't really that bad at all. I do wear a lot of shorts and especially black spandex biker shorts that hugs and contour my body with a tank top over it and my body isn't disproportioned. Sure, my tummy is still a bit swollen, but it isn't bad at all. As I lose more weight, I will see how my body will morph. I have less than 45 lbs to lose until I reach my goal of 140 lbs. I want to look healthy and appealing, not a bag of bones protruding out of my skin or looking like a twig. My breast are still there and haven't deflated after 60+ lbs lost. They don't have that great significant puffy volume as before, but it is looking very nice and healthy and I still have the "twin girls". Yet, they do look mighty fine. My arms look ok as well. Bear in mind, I have gone from 305 lbs to 165 lbs on my own, to gain back 85 to be 250 prior to my bariatric surgery. I do not have stretch marks on my skin or have any other concerns with my skin due to weight loss and I am glad about that. My skin I can say is firm, very smooth and what I consider tight. Time will tell, since I still have as I said another 40+ lbs to lose.

Regarding food, I am able to eat pasta that I make and its good. I use italian sausages or ground beef to make my marinara sauce and that gives me good protein intake. Sometimes, I just eat the marinara and meat and lay off the pasta. I made sauteed corned beef with potatoes, onions and tomatoes and had that with some white rice. I can't eat much of the rice, it does fill me up fast, but Libby's canned corned beef has a lot of protein and that is what I did eat a good portion of. I will have ground beef made into a burger, add some mozzarella to melt on it and some marinara sauce and that is my pizza burger. It does taste good. I will change the cheese to monterrey jack or fontina cheese. I will also make an italian sausage with grilled onion, green and red peppers. Italian sausage is very hearty and filling for me. I can only have 1/2 of it. But will eat my veggies, oh yeah, love eating veggies. Seafood is great for me. I do have my weekly share of seafood. Still, can't eat poultry. Let me make a list of what I am able to eat:

* ribeye steak
*filet mignon
* pork tenderloin
* lamb
* ground beef
* italian sausage
* ham
* salami
* corn beef

* shrimps
* codfish
* mero fish
* king fish
* grouper
* tilapia
* salmon
* crab
* lobster

* rice (long or short, but only a few teaspoons)
* pasta (freshly made or boxed angel hair or size 9)
* potatoes (mashed, fries (very small amount), baked, salad)
* any type of vegetables
* bananas
* watermelon


* milk (fat free/lactose free, 1 qt Lactaid fat free milk daily)
* tea (prefer ice tea with lemon, ready made with sugar or splenda)
* water of course
* coffee (caffeine free and I only like and drink swedish mocha)

* Special K with berries
* Cherrios
* whole grain bread and has to be toasted
* mini bagel and it has to be toasted (takes a long time to digest though)
* Pillsbury biscuits you make at home (has to be the buttermilk, the other one doesn't sit right with me)
* cinnamon rolls you bake in the oven with frosting
* Chef Boyardee spaghetti with meatballs
* soup
* chili
* yogurt (prefer blueberry or strawberry & banana)

* eggs
* any type of cheese
* butter
* cream cheese
* olive, vegetable, sesame, peanut oil (won't make me sick)

not able to eat, tolerate or digest
* chicken or turkey (any part or cooking methods)
* english muffin (painful to digest)
* almonds (gives me a bad digestion problem)
* carbonated beverage (digestive pain from HELL)
* untoasted bread (any type)
* pizza crust or any heavy dough breading

Regarding snacks, I can eat cheese nips, but not too many. I am able to eat 1 twinkie. I can eat cookies, cake and ice cream. But as I said, I don't eat these regularly. Yet, it is there as a choice. I don't need to be deprived of food or make any food a taboo for me. The option is there if I ever want it. Just have to have things in moderation, know what you are eating and not binge on it. Eventhough, I gained to be SMO, I was never much of an eater or over ate to begin with. It is nice that I can have snacks and certain food if I want it at my disposal. I don't crave it, have guilt trips or think it is bad for me. It is there if I want it and that is all I have to say about it.

The idea is to live as normally as you can and understand that any type of bariatric surgery is only a tool to work with, not a sole remedy or solution to your dilemna. You are in control as to how to utilize it and how to live with it. Also, the main focus is on health and it is accomplished through weight loss. This is not a contest to see how much or how fast you lose weight. Remember, the focus is on health and you improving your lifestyle to not be limited or disabled due to the cause of morbid obesity disease.

Regarding vitamins and supplement here is my daily regime tally count

2 Ferro-Sequel Iron pills
8 Calcium Citrate, but will be changing to liquid calcium citrate
3 ADEK
3 Centrum liquid vitamins (6 tbsps total) got tired swallowing pills
1 400 IU vitamin E
1-2 Biotin
1 Drisdol prescribed 10,000 IU vitamin D (once a week)

I do change my method from swallowing pills to having liquid forms. Gotta remember this is for LIFE and you HAVE to take your vitamins and supplement with this surgical procedure. So, every once and awhile I change from pills to liquid form.

Monday, May 14, 2007

6 months post-op

Today, I am 6 months post-op. I had not had any complications whatsoever in my outcome with my bariatric surgery. I am healthy and doing well. Have to remember, anyone reading this blog of mine. I do not have gastric bypass, also known as RNY. I had a bilio-pancreatic duodenal switch which means, I still have portion of my stomach (only the outer curve of my stomach pouch was removed) and I do have my pylorus valve that allow food to pass from the stomach to the duodenum. In a RNY, this muscles is missing, hence it is called a gastric bypass. With the DS, you have this muscle and your stomach functions regularly. Therefore, there is no gastric bypass with this method of surgery and your digestion does function as normally as possible except there is a switch and with that a 2nd intestinal tract meant for your digestive juices to process, which then meets at a junction known as the common limb at the end of the small intestine.

Have to also remind those reading this, that with the DS, you have greater chance of malasbsorption also with it being a restrictive. You must live the rest of your life, taking vitamins and supplements. I take 10-12 pills a day and sometimes it is tiring and my tummy too full to digest, even if I haven't eaten much. I do swap to liquid vitamins to help me meet my quota of intake. This is something that is a must and you ignoring or not taking your vitamins and supplements can endanger your health. There are times, I am not up to par with it, but I do my best and consume what I can daily.

Moving along, I am still having difficulties with bread and can only eat toasted sliced bread. Multigrain is more better for me than white. I like toast with alittle butter and either vegetable, salmon or chives and onion cream cheese. I don't have toast every day, just whenever the moment hits me, it is there as an option to have with my eggs and bacon. For breakfast, I will have either western omelet with just some toast or an egg over easy with an Italian sweet sausage. I don't do english muffin. I have issues digesting it and takes a long time, so I avoid that. I can have a cinnamon bun, cornbread and am careful with the biscuit. Other things I have for breakfast is Special K with berries cereal with milk and 1/3 scoop of Unjury protein powder. I drink a lot of milk, about 1 quart a day or ice tea. For lunch, I eat a lot of seafood, either crab, salmon, shrimps or fish. I do eat potatoes, either baked or mashed. I can have a few fries, maybe about 5. Veggies are staple in my food intake. I will have a burger with no buns and do enjoy placing mozzarella, monterrey jack, fontina, cheddar or american cheese on it as it cook and melts. I also like adding marinara sauce on it. That in itself is a meal for me for lunch or dinner and drink my milk with Unjury protein powder with it. I still can't eat pizza, just can't digest the dough. I am able to eat spaghetti but has to be size 9 or angel hair. Chef Boyardee spaghetti with meatballs is something I can eat, tolerate and digest. I also make some meat sauce or marinara and lots of cheese, for my pasta, lol. I only eat ribeye steaks or filet mignon, no other. I cannot eat chicken or other poultry. It still makes me sick.

I went to my 6th month follow-up post-op visit. The surgeon told me my progress has been great and very steady. The weight is slow as it should be. I do not have skin issues on my stomach or arms. My neck and face have great tone, as per his words. I am only 40 lbs away from my goal and he prefers the weight loss to be slow. As of now, My tummy is still a bit puffy and asked him to check to see if I have a hernia. He examed me, told me to cough and then said no, it is still puffy and can take upto a year for it to go all down.

Another thing, we talked about stall. I am at a stall and he told me a stall is actually a very good thing and should not be seen as anything negative. With stalls, your body rest, isn't going thru any saggy or loose skin issues, since the muscles and other part are being re-distributed within. He told me the one with obssession with the scale and stalls, he tries to divert their attention from that and look at the overview of it, that the body needs to rest since continuous weight loss also deprives your body of the nutrients. With a stall, the body begins to take the nutrients and this is the time to up the protein and all. He told me, I am doing very well and will see that my body will start losing weight very slowly now and with frequent stalls since all I got left is 40 lbs to lose and my skintone has been very good. l follow my doc advice and let the loss from here till my 1 yr anniversay be slow and remember stalls are a good thing and actually a good thing for your health and safety which many don't see. Some whine and complain about it. But, with stalls the body rest and distributes itself. With rapid weight loss, it is muscle more that you are losing, not the fat product in your body, hence saggy or loose skin. Also, the amount or length of time you have been overweight does have a factor in your skin elasticity and how it shrinks as you lose the weight.

Tuesday, May 8, 2007

7 months post-op

I am almost 7 months post-op. This weekend I went to buy summer clothes. I refused to buy any clothese during my first 6 months, since I did have clothes from previous weight loss in my storage room and was feasible during the winter and cold months. Now, the weather is warn and I never went out much. I purchaased 6 pairs of short, 1 cpari pants size 10 , a nice strapless summer dress and a few tank tops. I bought the pants size large and they are big on me. I do have a butt, but miscalculated that I am a medium, although I feel bigger and bought a size large. I've also bought a sewing machine as an actual necessity since my clothes will need to be taken in here and there. i was wearing pants with safety pins on it and realized it is time to buy clothes. Other than that, I had a nice time shopping.

Regarding Memorial Day, I relaxed and enjoyed my time. I made chicken and decided to taste test a wing to see if I can now tolerate eating chicken. NOPE!!!! Threw it up as previous times. Maybe, on my 9th month post-op I will be able to eat chicken again. Doesnt' hurt or harm me to try it again. I am still having occurrence with not being hungry, but will eat since that is my source to protein intake and helping my body sustain it vital organs. I am at a stall and to me that is not a bad thing. My body needs the rest and to redistribute its weight. I do not want to lose more than 10 pounds a month and work it to keep it steady pace. I have lost 65 lbs and am right on track with being almost 7 months soon and maximum for my criteria would be 70 lbs. I do not have skin issues as of yet, except for my inner upper thighs, but it isn't bad at all. Just a bit flabby. Due to not feeling much in eating, my protein intake is a bit slacking. I am reaching about 50 gms when I should be within the range of 80-120 gms of protein. I need to concentrate on my protein intake and am waiting on my vitamins and supplement deliveries.

Wednesday, May 2, 2007

WLS is like any other surgery

I get a lot of messages from people on OH asking me to update my blog and wanting to know how I am and what is the latest on me. I guess, the only thing I have to say is, I am not like certain people that wake up every single morning thinking and talking about their WLS. It is not on my mind constantly or in my thoughts for topic every day 24/7. Although, I am just beginning my journey with only 6 months into it, I don't check the scale obssessively and I only think about the surgery only when I have to eat something and hope it digest well or remember to take my vitamins and supplements.

To me, WLS is like any other surgery. It was done for a specific medical purpose to help me regain my health. It is like having your appendix, tonsils or a tumor removed, surgically correcting a problem with one of your vital organs within or having reconstructive surgery such as an abdominalplasty or breast lift/repair. It is just another surgery to me to improve your health and life moves on. I don't talk about the surgery at all. If I need advice, have a question or am having a certain concern, I have 4 very close friends that had WLS and are all over 3+ years post-op that I can count on being my mentors. Beyond that, I don't talk with them about WLS, unless it is a topic of concern. That is the way I am.

I know some live every breath talking about it, even for years, but not me. I don't talk about my other surgeries, so why would I talk about this one. Just common sense to me. That is the way I feel about it. I will write on this blog about certain events that relates to my experiences having it since the 1st year is the one with the most impact from it. But honestly, I don't put much thought as to living as a post-op. I am living as a person, who had bariatric surgery to improve and help me with my health and one benefit from it was weight loss. But, I don't brag about it or push it on people saying, hey I had wls, blah, blah, blah.

So, it has been 6 months since I had the surgery. All I can say is, I live for life. It has been one of the many surgeries I have had throughout the years that help me improved my health. Like I said, I have had other surgeries and this one happens to be one of them. The surgery help me improve my health, since my life was getting limited and pretty bad as time was going by.

I no longer using the CPAP machine or wear a Darth Vader mask, eventhough, I upgraded last year to a nasal pillow mask known as Adam Circuit. But, I don't use the Cpap or mask anymore. I give credit to that to having bariatric surgery since it help take off some weight off my tiny body that was crushing my lungs and respiratory system with the weight I had on me. I've suffered from severe obstructive sleep apnea (OSA) with 110 apneic episodes which is extremely serious and dangerous, at a CPAP setting of 12. But, no more. I still have a collapsed oropharynx and hypopharynx that needs surgery to repair it. But, I don't want anymore surgeries, especially done to my throat, having them slice it open and digging in there leaving me a huge scar on my throat. I have been through hell with so many surgeries performed on me. I had abdominalplasty in which they stretched my skin down like a window blind to remove the scars on my stomach and repaired my stomach muscles, a few years back. I won't get into that or the details. Just wanted to say, I had reconstructive surgery which was abdominalplasty. I am just glad to be alive, breathe this free air and appreciate life for what it has to offer.