Well, I am 8 months postop. What can I say? Things are going well with the exception that I have no desire to eat anything making that a bad choice in which I have to keep tabs on since that will cause my body to go into starvation mode, whack out my bloodwork levels and also causes the body to stall (which the latter doesn't bother me one bit). I care more about my health and that it doesn't go spiraling down. I have lost a total of 70 lbs which is not bad and a good pace, since the average for weight loss should be 10 lbs per month and at 8 months -70 lbs is good. I am wearing a size 9/10, but honestly I think clothes size are one size larger than what they were when I wore them back in the days. I will, when I have a chance, add a video blog on here. but, right now, there isn't much to say about my journey, except, I have to keep away from legumes and nuts. Those cause me to be a deadly gas chamber of nonstop flatus and I am not kidding. Nothing else causes me to pass such noxious nonstop gas as eating beans and almonds.
My hearing is diminishing and I can barely hear anymore. I had to see an otolarynologist today. He cleaned my ears so I can have me hearing test on Friday. This is not caused or contributed to bariatric surgery. Totally isolated situation. For a very long time, I did not want to disclose or let anyone know I am partially deaf. It isn't something I want to talk about or create topic since I was not born with this disorder or does it has anything to do with genetics. It was due to an event that occured and am unable to hear sound through my right ear. When people talk or I listen to the tv or radio, it sounds as though people are mumbling, whispering and quite muffled. I did have hearing aids before and it isn't something I wanted to wear because I didn't want anyone to know. Now, with the advancement in medicine and technology, they have very small hearing aids not noticeable. Let me get my hearing tested and take it from there. This is life. It is what it is and I make the best of it.
I don't like talking about my family but will, since I think the reason I have not been eating is the stress and worry over them. First of all, my mom had a stroke in her eye. I am in the process with the ophthalmologist for her treatment and surgery that is scheduled. Her eye pressure was extremely high and it cause damage from the hemorrhaging. Her eyesight will not be what it was before. My mom is 78 and taking 3 different types of eye medications for her eye to keep her pressure and condition under control.
My son-in-law started his combat training and soon after that will be on standby and leave to be redeployed from Spetember to November, yes re-deployed back to Iraq as an infantry soldier. He was with the 4th Infantry Division when he did his service and just returned back home in December 2006. This will be his 2nd tour as a combat soldier in Iraq. He will be stationed for 15-18 months. This is serious. stressful and difficult times of worrying again for his safety and return when his tour of duty is completed. My daughter wants to stay in Germany and loves it there. I have plans to go there next year, as well as, do alittle jet setting. We will go to London, Swizterland, Luxenburg as well as go around Germany and do a 3 city Italy excursion to Milan, Rome and Venice. My daughter wants me to go to my paternal family homeland which is Poland. I don't know if I will. Time will tell. Hope everyone is doing well.
Monday, July 16, 2007
Sunday, July 8, 2007
Research. studiy and overview of BPD-DS through noted bariatric
Roux-en-Y Gastric Bypass: The "Gold Standard" is getting tarnished
The Roux-en-Y (RNY) has a number of significant disadvantages. The chief problem with the RNY is its high failure rate at nearly 50%.
Dr. MacLean LD of the Royal Victoria Hospital and McGill University in Montreal, Canada, found in his 5-year longitudinal study that nearly half of the super-obese patients were a failure with the RNY.
Dr. Bloomston of the University of Florida College of Medicine, Division of Digestive Disorders, only 26% of super obese patients returned to within 50% of their ideal body weight.
Dr. Smith of Salt Lake, Utah, found after a 7 year review of 3,855 patients who had the Roux-en-Y, the average weight loss was 77.5 lbs.
Even when a review of the effectiveness of the RNY procedure in the general population (as opposed to just the super obese), long-term studies consistently show weight regain beginning after 3 years. Excess weight loss decreased to a range of 50-60% at 4-6 years and only 47-49% at 10-15 years.
Dr. Mitchell of the Neuropsychiatric Research Institute in Fargo, North Dakota, reported that 3 of his subjects "weighed more at long-term follow-up than before the operation.
Dr. Wolfel from the Department of Surgery, University of Erlangen-Nuremburg, Germany concluded that the RNY failed to provide "adequate or prolonged control of morbid obesity" and that "none of the 1119 patients ever moved out of the category of "morbid obesity".
Even if it weren't for the ineffective weight loss followed by weight regain, additional multiple problems with the RNY make it at best a poor second-choice surgery to the biliopancreatic bypass with duodenal switch. The weightloss that is achieved through the RNY appears to be primarily dependent upon the removal of the pyloric valve, leaving the individual without a regulator of food movement into the small intestine. This results in the well-known phenomena called "dumping syndrome" which can cause an individual to feel sick or even faint. Supporters of the procedure actually refer to this unpleasant side effect as a benefit because it helps the patient form an aversion to sugar.
The extremely small "pouch" (approximately 1 oz) created in the RNY procedure to replace the stomach causes vomiting whenever the patient eats even the slightest amount beyond what the pouch can handle. In addition, the patient cannot eat and drink at the same time. Meat intolerance is reported in the majority of the patients, even 7 years after their operation. Patients will vomit or get food stuck in their pouch if food is not mashed into the tiniest peaces before swallowing.
An additional problem with the Roux-En-Y is the occurrence of ulcers.
Dr. Sanyal of the Department of Medicine at Medical College of Virginia, Richmond, Virginia, reports a rate of stenosis and ulceration of 12.5% and 12% respectively. MacLeans reported, "Stomal ulcer occurred in 16%". Wolfel reported a 12% rate of ulceration.
Ulceration is practically absent in the BPD/DS procedure. The complications caused by the RNY procedure are not limited to the first months/years following the surgery. In a recent 13-16 year follow-up of 100 patients, Dr. Mitchell states "68.8% (of the patients) reported continued problems with vomiting and 42.7% with "plugging, 42.9% had heartburn and 31.6% reported diarrhea… 8 had died". Dr. Wolfel in a 10-year follow-up study of transected and stapled gastric bypass along with horizontal gastroplasty, reported a 39% rate of vomiting, a 45% rate of heartburn and an 18% rate of cramps.
Biliopancreatic Diversion with Duodenal Switch: The Platinum Standard
The original Biliopancreatic Diversion procedure introduced in 1979 by Dr. Scopinaro used a distal gastrectomy. This procedure has been known as BPD/DG.
In 1989, Dr. Hess of Wood County Hospital, Bowling Green, Ohio, combined DeMeester's Duodenal Switch procedure with Biliopancreatic Diversion to the new BPD/DS procedure. The resultant procedure achieved gastric restriction with normal gastric function including the pyloric valve. Marginal ulceration and the dumping syndrome were eliminated. Dr. Hess sums up the primary advantages of the BPD/DS procedure:
"There is no isolated stomach, no foreign body or band required. There is preservation of the pylorus, no dumping syndrome, no marginal ulcers, and good weight loss".
According to Health Net's "Guide to Evidence-Based Medicine" - the "Clinical Practice Guidelines" for physicians, the Biliopancreatic Bypass surgery (BPD) is a procedure that bypasses a large part of the intestine with a concomitant resection of the excluded part of the stomach." Sugerman reports, "The biliopancreatic diversion has had excellent weight loss results".
Dr. Deitel of Mature Medicine Canada, North York, Ontario, Canada, reports: "The BPD has produced the most effective and sustained loss of excess weight of any of the operations thus far". Forestieri in discussing the merits of restrictive versus malabsorptive processes notes, "Without a doubt, the BPD gives good results in terms of weight loss and more stability than gastric restriction procedures". Dr. Hess found that after an 8 year period his "super obese" patients (BMI >50) continued to have a weight loss in the 70% excess.
Dr. Balsiger, Department of Visceral and Transplantation Surgery, Inselpital, Unitversity of Bern, Switzerland, reports that BPD is "arguably one of the most effective bariatric procedures in inducing and maintaining weight loss".
Reports of the efficacy of BPD/DS shows
Dr. Hess reported excess weight loss of 80% at 2 years and 70% at 8 years.
Dr. Marceau adopted the duodenal switch procedure and reported 73% excess weight loss at 51 months.
Dr. Baltasar reported excess weight loss of 70.1% at 1 year, 75% at 2 years, 75% at 3 years and 81.2% at 4 years.
Dr. Rabkin reported a mean excess weight loss of 73% at 4 years.
In summary, the BPD/DS have reported long-term weight loss in the range of 69%-80%. BPD/DS are the most effective procedures for weight loss in existence today.
Safety of the BPD/DS procedure:
Having shown the efficacy, the key remaining question becomes the safety of this procedure.
Operative and late mortality rates of the BPD and BPD/DS procedures are shown to be comparable to other gastric bypass procedures.
Dr. Deitel reported that with the duodenal switch modification of the BPD: "This procedure is followed by surprisingly few complications, mainly some soft stools and malodorous gas in a minority".
Dr. Forestieri reported that surgical complications of BPD are comparable to the gastric restrictive procedures. Postoperative complications are reported to be somewhat higher. Forestieri also reports, "BPD, on the other hand, requires careful management only when complications occur, as they do in a limited number of cases. Forestieri concludes, "When all of the above factors are considered these two types of surgeries are both viable options for the treatment of obesity".
Liver Failure?
Dr. Grimm, Dept of Internal Medicine (Gastroenterology Division), Naval Hospital, San Diego, California, reported a single case of liver failure and Langdon reports two cases of liver failure.
However, Grimm reports that the patient was non-compliant and anorexic. "She refused most oral medications prescribed in hospital, including metronidazole".
Dr. Langdon reports one patient "refused surgical takedown on multiple occasions" and the other patient "began (drinking) alcohol surreptitiously". And Grimm also reports "the rarity of liver disease after BPD contrasts sharply with the situation after the JI bypass …."
Dr. Murr, reported a single case of liver failure in a series of 11 patients. However, he also notes that this patient "refused to take the prescribed mineral and vitamin supplementation and never saw her physician".
In his series of 440 patients, Dr. Hess reported only a single instance of liver failure, which was associated with multiple organ failure. He concludes, "that liver disease is not a problem with this procedure".
Dr. Baltasar reports on a single case out of a series of 125 patients of liver failure.
Dr. Marceau reports, "After surgery, both liver function and morphology improved to the point where 3 out of 12 with preoperative cirrhosis were no longer considered cirrhotic after 10 years.
Metabolic Complications:
Protein Malnutrition (PM):
Dr. Totte reports only 2 cases of protein malnutrition in a series of 180 patients, and "in both cases the problem was attributable to a precise cause unrelated to the surgery." One patient "took up drinking, smoking, and cocaine abuse", while the other patient, her twin sister. In both cases a restoration of intestinal continuity left both patients in good general health. A third patient was reversed because "she was not able to reset her self-image of the new slimmer person" .
Dr. Hess reported in 1998 that 8 out of 440 patients (1.8%) undergoing the BPD/DS patients required revisions due to protein malnutrition or excess weight loss. Rather than choosing a fixed limb length, Hess chose to measure the small intestine and make the alimentary limb 40% of the total intestinal length while the common channel was made to be 10%. The mean common channel was increased from 50cm as in Scopinaro to 75cm.
Dr. Hess increased the common channel from 50cm to 100cm, his yearly revision rate on BPD/DS is only 0.1% per year compared with 1.7% for the BPD/DG Scopinaro procedure. This 17 fold reduction in revision rate demonstrates a substantial benefit of the BPD-DS Hess procedure over the BPD Scopinaro procedure.
Dr. Marceau also reported a reduction in hospitalization rate for malnutrition dropped from 1.72% per year with the BPD/DG procedure to 0.93% per year with the BPD/DS procedure.
Dr. Marceau on BPD and protein malnutrition concludes, "There are differences in surgical techniques that may account for the different results and different interpretations" and there are "3 factors that influence the degree of protein deficiency"
1. the size of the remaining stomach
2. the degree of restriction to nutrient ingestion
3. the initial nutritional state of the patient
In a modified version of the BPD/DS where temporary gastric restriction was obtained by use of a self-dissolving band, Dr Vasallo reprted "At 2 and 3 years follow-up there has been no case of dysproteinemia".
To summarize, PM rate between 1-3%. PM can be reduced by careful selection of the
gastric volume
common channel length
total alimentary length
In extreme cases, protein malnutrition can be resolved by elongation of the alimentary or common tracts.
Iron Deficiency/Anemia:
BPD/DS procedure has fewer problems with anemia and iron deficiency than the "gold standard" Roux-en-Y gastric bypass.
Vitamin Deficiency:
Dr. Baltsar reports "liposoluble vitamins should be monitored, but so far none of our patients have presented deficits".
Dr. Marceau reported that the serum levels of vitamin B12 were actually increased slightly in the BPD/DS procedure and the percentage of patients with abnormal serum B12 levels was 3% both pre and post operatively.
Dr. Clare reported that the incidence of Vitamin A and D deficiency in a group of patients with equal bilio and alimentary limbs was 0% and 1.4% respectively.
Dr. Marceau reports that serum levels of Vitamin A, B12, folic acid, phosphorus and magnesium were unchanged when compared to pre-operative levels.
In conclusion, fat-soluble vitamin deficiencies are rare and easily controlled through oral vitamin supplements. Vitamin B12 deficiency is not a problem whereas it is a problem in the RNY procedure.
Calcium Deficiency/Bone Loss:
Dr. Hess reports, "If the patients take their vitamin D and calcium they can maintain the proper levels and in some cases increase their calcium and vitamin D to levels higher than those before surgery."
Dr. Murr reports that two "noncompliant patients" who refused to take supplements developed metabolic bone disease. Murr also noted that for the distal gastric bypass there were no problems with bone demineralization; however, the common channel length was also modified from 50cm to 100cm.
Dr. Clare states that "A major factor in the appearance of disturbed bone metabolism is patient non-compliance with respect to diet and nutritional supplements. Fortunately, it responds to aggressive medical treatment" Clare did reported 3 cases out of 504 that required reversal due to disturbed bone metabolism, and "each of these patients had shown very poor compliance with respect to the recommended nutritional supplements."
Dr. Marceau recently reported that "10 years after surgery, overall bone density has not changed at hip level and the decrease at spine level was minimal (4%), much less than what was expected for aging alone…. In 33% bone density was increased … and in 15% density decreased more than was expected for ageing alone".
In conclusion, 10 years after surgery calcium loss appears not to be a problem with the BPD procedure.
Sufficiency of Data Regarding the Biliopancreatic Bypass:
Over a thousand BPD/DS procedures are done each year. The metabolic complication rates have dropped dramatically now that it is common practice to make the alimentary limb length 40-50% of the total intestinal length.
In 1998, Dr. Hess reported on a series of 440 patients who underwent BPD/DS followed up to 8 years.
Dr. Hess 1998 report covered 465 patients who underwent BPD/DS a mean of 4.1 years prior to his report. A recent report by Dr. Marceau included 909 BPD/DS patients studied over 10 years.
Dr. Baltasar 2001 report covers 125 patients who underwent BPD/DS.
Dr. Rabkin in 1998 reports on 105 patients who underwent BPD/DS.
Dr. Brolin stated in 1996 "It seems likely that a consensus panel on the same subject would be worthwhile in the next decade to carefully evaluate such procedures as biliopancreatic bypass …" . Specifically VBG has been shown to be rather ineffective, while BPD/DS has been shown to be safe an extremely effective.
There now exists a large body of evidence to show that the Biliopancreatic Diversion is safe and effective as long as the common channel length is increased to at least 75cm and either the gastric volume or the length of the alimentary limb is increased 150 ml compared with the original values proposed by Scopinaro of 250cm.
Several thousand patients have been reported on with follow-ups as long as 20 years. Over the last 3 years there have been numerous peer-reviewed articles showing the long-term safety and efficacy of this procedure.
The Roux-en-Y (RNY) has a number of significant disadvantages. The chief problem with the RNY is its high failure rate at nearly 50%.
Dr. MacLean LD of the Royal Victoria Hospital and McGill University in Montreal, Canada, found in his 5-year longitudinal study that nearly half of the super-obese patients were a failure with the RNY.
Dr. Bloomston of the University of Florida College of Medicine, Division of Digestive Disorders, only 26% of super obese patients returned to within 50% of their ideal body weight.
Dr. Smith of Salt Lake, Utah, found after a 7 year review of 3,855 patients who had the Roux-en-Y, the average weight loss was 77.5 lbs.
Even when a review of the effectiveness of the RNY procedure in the general population (as opposed to just the super obese), long-term studies consistently show weight regain beginning after 3 years. Excess weight loss decreased to a range of 50-60% at 4-6 years and only 47-49% at 10-15 years.
Dr. Mitchell of the Neuropsychiatric Research Institute in Fargo, North Dakota, reported that 3 of his subjects "weighed more at long-term follow-up than before the operation.
Dr. Wolfel from the Department of Surgery, University of Erlangen-Nuremburg, Germany concluded that the RNY failed to provide "adequate or prolonged control of morbid obesity" and that "none of the 1119 patients ever moved out of the category of "morbid obesity".
Even if it weren't for the ineffective weight loss followed by weight regain, additional multiple problems with the RNY make it at best a poor second-choice surgery to the biliopancreatic bypass with duodenal switch. The weightloss that is achieved through the RNY appears to be primarily dependent upon the removal of the pyloric valve, leaving the individual without a regulator of food movement into the small intestine. This results in the well-known phenomena called "dumping syndrome" which can cause an individual to feel sick or even faint. Supporters of the procedure actually refer to this unpleasant side effect as a benefit because it helps the patient form an aversion to sugar.
The extremely small "pouch" (approximately 1 oz) created in the RNY procedure to replace the stomach causes vomiting whenever the patient eats even the slightest amount beyond what the pouch can handle. In addition, the patient cannot eat and drink at the same time. Meat intolerance is reported in the majority of the patients, even 7 years after their operation. Patients will vomit or get food stuck in their pouch if food is not mashed into the tiniest peaces before swallowing.
An additional problem with the Roux-En-Y is the occurrence of ulcers.
Dr. Sanyal of the Department of Medicine at Medical College of Virginia, Richmond, Virginia, reports a rate of stenosis and ulceration of 12.5% and 12% respectively. MacLeans reported, "Stomal ulcer occurred in 16%". Wolfel reported a 12% rate of ulceration.
Ulceration is practically absent in the BPD/DS procedure. The complications caused by the RNY procedure are not limited to the first months/years following the surgery. In a recent 13-16 year follow-up of 100 patients, Dr. Mitchell states "68.8% (of the patients) reported continued problems with vomiting and 42.7% with "plugging, 42.9% had heartburn and 31.6% reported diarrhea… 8 had died". Dr. Wolfel in a 10-year follow-up study of transected and stapled gastric bypass along with horizontal gastroplasty, reported a 39% rate of vomiting, a 45% rate of heartburn and an 18% rate of cramps.
Biliopancreatic Diversion with Duodenal Switch: The Platinum Standard
The original Biliopancreatic Diversion procedure introduced in 1979 by Dr. Scopinaro used a distal gastrectomy. This procedure has been known as BPD/DG.
In 1989, Dr. Hess of Wood County Hospital, Bowling Green, Ohio, combined DeMeester's Duodenal Switch procedure with Biliopancreatic Diversion to the new BPD/DS procedure. The resultant procedure achieved gastric restriction with normal gastric function including the pyloric valve. Marginal ulceration and the dumping syndrome were eliminated. Dr. Hess sums up the primary advantages of the BPD/DS procedure:
"There is no isolated stomach, no foreign body or band required. There is preservation of the pylorus, no dumping syndrome, no marginal ulcers, and good weight loss".
According to Health Net's "Guide to Evidence-Based Medicine" - the "Clinical Practice Guidelines" for physicians, the Biliopancreatic Bypass surgery (BPD) is a procedure that bypasses a large part of the intestine with a concomitant resection of the excluded part of the stomach." Sugerman reports, "The biliopancreatic diversion has had excellent weight loss results".
Dr. Deitel of Mature Medicine Canada, North York, Ontario, Canada, reports: "The BPD has produced the most effective and sustained loss of excess weight of any of the operations thus far". Forestieri in discussing the merits of restrictive versus malabsorptive processes notes, "Without a doubt, the BPD gives good results in terms of weight loss and more stability than gastric restriction procedures". Dr. Hess found that after an 8 year period his "super obese" patients (BMI >50) continued to have a weight loss in the 70% excess.
Dr. Balsiger, Department of Visceral and Transplantation Surgery, Inselpital, Unitversity of Bern, Switzerland, reports that BPD is "arguably one of the most effective bariatric procedures in inducing and maintaining weight loss".
Reports of the efficacy of BPD/DS shows
Dr. Hess reported excess weight loss of 80% at 2 years and 70% at 8 years.
Dr. Marceau adopted the duodenal switch procedure and reported 73% excess weight loss at 51 months.
Dr. Baltasar reported excess weight loss of 70.1% at 1 year, 75% at 2 years, 75% at 3 years and 81.2% at 4 years.
Dr. Rabkin reported a mean excess weight loss of 73% at 4 years.
In summary, the BPD/DS have reported long-term weight loss in the range of 69%-80%. BPD/DS are the most effective procedures for weight loss in existence today.
Safety of the BPD/DS procedure:
Having shown the efficacy, the key remaining question becomes the safety of this procedure.
Operative and late mortality rates of the BPD and BPD/DS procedures are shown to be comparable to other gastric bypass procedures.
Dr. Deitel reported that with the duodenal switch modification of the BPD: "This procedure is followed by surprisingly few complications, mainly some soft stools and malodorous gas in a minority".
Dr. Forestieri reported that surgical complications of BPD are comparable to the gastric restrictive procedures. Postoperative complications are reported to be somewhat higher. Forestieri also reports, "BPD, on the other hand, requires careful management only when complications occur, as they do in a limited number of cases. Forestieri concludes, "When all of the above factors are considered these two types of surgeries are both viable options for the treatment of obesity".
Liver Failure?
Dr. Grimm, Dept of Internal Medicine (Gastroenterology Division), Naval Hospital, San Diego, California, reported a single case of liver failure and Langdon reports two cases of liver failure.
However, Grimm reports that the patient was non-compliant and anorexic. "She refused most oral medications prescribed in hospital, including metronidazole".
Dr. Langdon reports one patient "refused surgical takedown on multiple occasions" and the other patient "began (drinking) alcohol surreptitiously". And Grimm also reports "the rarity of liver disease after BPD contrasts sharply with the situation after the JI bypass …."
Dr. Murr, reported a single case of liver failure in a series of 11 patients. However, he also notes that this patient "refused to take the prescribed mineral and vitamin supplementation and never saw her physician".
In his series of 440 patients, Dr. Hess reported only a single instance of liver failure, which was associated with multiple organ failure. He concludes, "that liver disease is not a problem with this procedure".
Dr. Baltasar reports on a single case out of a series of 125 patients of liver failure.
Dr. Marceau reports, "After surgery, both liver function and morphology improved to the point where 3 out of 12 with preoperative cirrhosis were no longer considered cirrhotic after 10 years.
Metabolic Complications:
Protein Malnutrition (PM):
Dr. Totte reports only 2 cases of protein malnutrition in a series of 180 patients, and "in both cases the problem was attributable to a precise cause unrelated to the surgery." One patient "took up drinking, smoking, and cocaine abuse", while the other patient, her twin sister. In both cases a restoration of intestinal continuity left both patients in good general health. A third patient was reversed because "she was not able to reset her self-image of the new slimmer person" .
Dr. Hess reported in 1998 that 8 out of 440 patients (1.8%) undergoing the BPD/DS patients required revisions due to protein malnutrition or excess weight loss. Rather than choosing a fixed limb length, Hess chose to measure the small intestine and make the alimentary limb 40% of the total intestinal length while the common channel was made to be 10%. The mean common channel was increased from 50cm as in Scopinaro to 75cm.
Dr. Hess increased the common channel from 50cm to 100cm, his yearly revision rate on BPD/DS is only 0.1% per year compared with 1.7% for the BPD/DG Scopinaro procedure. This 17 fold reduction in revision rate demonstrates a substantial benefit of the BPD-DS Hess procedure over the BPD Scopinaro procedure.
Dr. Marceau also reported a reduction in hospitalization rate for malnutrition dropped from 1.72% per year with the BPD/DG procedure to 0.93% per year with the BPD/DS procedure.
Dr. Marceau on BPD and protein malnutrition concludes, "There are differences in surgical techniques that may account for the different results and different interpretations" and there are "3 factors that influence the degree of protein deficiency"
1. the size of the remaining stomach
2. the degree of restriction to nutrient ingestion
3. the initial nutritional state of the patient
In a modified version of the BPD/DS where temporary gastric restriction was obtained by use of a self-dissolving band, Dr Vasallo reprted "At 2 and 3 years follow-up there has been no case of dysproteinemia".
To summarize, PM rate between 1-3%. PM can be reduced by careful selection of the
gastric volume
common channel length
total alimentary length
In extreme cases, protein malnutrition can be resolved by elongation of the alimentary or common tracts.
Iron Deficiency/Anemia:
BPD/DS procedure has fewer problems with anemia and iron deficiency than the "gold standard" Roux-en-Y gastric bypass.
Vitamin Deficiency:
Dr. Baltsar reports "liposoluble vitamins should be monitored, but so far none of our patients have presented deficits".
Dr. Marceau reported that the serum levels of vitamin B12 were actually increased slightly in the BPD/DS procedure and the percentage of patients with abnormal serum B12 levels was 3% both pre and post operatively.
Dr. Clare reported that the incidence of Vitamin A and D deficiency in a group of patients with equal bilio and alimentary limbs was 0% and 1.4% respectively.
Dr. Marceau reports that serum levels of Vitamin A, B12, folic acid, phosphorus and magnesium were unchanged when compared to pre-operative levels.
In conclusion, fat-soluble vitamin deficiencies are rare and easily controlled through oral vitamin supplements. Vitamin B12 deficiency is not a problem whereas it is a problem in the RNY procedure.
Calcium Deficiency/Bone Loss:
Dr. Hess reports, "If the patients take their vitamin D and calcium they can maintain the proper levels and in some cases increase their calcium and vitamin D to levels higher than those before surgery."
Dr. Murr reports that two "noncompliant patients" who refused to take supplements developed metabolic bone disease. Murr also noted that for the distal gastric bypass there were no problems with bone demineralization; however, the common channel length was also modified from 50cm to 100cm.
Dr. Clare states that "A major factor in the appearance of disturbed bone metabolism is patient non-compliance with respect to diet and nutritional supplements. Fortunately, it responds to aggressive medical treatment" Clare did reported 3 cases out of 504 that required reversal due to disturbed bone metabolism, and "each of these patients had shown very poor compliance with respect to the recommended nutritional supplements."
Dr. Marceau recently reported that "10 years after surgery, overall bone density has not changed at hip level and the decrease at spine level was minimal (4%), much less than what was expected for aging alone…. In 33% bone density was increased … and in 15% density decreased more than was expected for ageing alone".
In conclusion, 10 years after surgery calcium loss appears not to be a problem with the BPD procedure.
Sufficiency of Data Regarding the Biliopancreatic Bypass:
Over a thousand BPD/DS procedures are done each year. The metabolic complication rates have dropped dramatically now that it is common practice to make the alimentary limb length 40-50% of the total intestinal length.
In 1998, Dr. Hess reported on a series of 440 patients who underwent BPD/DS followed up to 8 years.
Dr. Hess 1998 report covered 465 patients who underwent BPD/DS a mean of 4.1 years prior to his report. A recent report by Dr. Marceau included 909 BPD/DS patients studied over 10 years.
Dr. Baltasar 2001 report covers 125 patients who underwent BPD/DS.
Dr. Rabkin in 1998 reports on 105 patients who underwent BPD/DS.
Dr. Brolin stated in 1996 "It seems likely that a consensus panel on the same subject would be worthwhile in the next decade to carefully evaluate such procedures as biliopancreatic bypass …" . Specifically VBG has been shown to be rather ineffective, while BPD/DS has been shown to be safe an extremely effective.
There now exists a large body of evidence to show that the Biliopancreatic Diversion is safe and effective as long as the common channel length is increased to at least 75cm and either the gastric volume or the length of the alimentary limb is increased 150 ml compared with the original values proposed by Scopinaro of 250cm.
Several thousand patients have been reported on with follow-ups as long as 20 years. Over the last 3 years there have been numerous peer-reviewed articles showing the long-term safety and efficacy of this procedure.
Sunday, July 1, 2007
Staple food for me since having the DS
For breakfast, it's usually one of these
grilled salmon
western omelet with cheese and homefries
grilled ham & cheese or bacon, tomato and cheese
Special K cereal with milk and 3 tbsp Champion Nutrition vanilla protein powder
Optimum Nutrition Rocky Road with 10-12oz milk
For Lunch, it's usually
chicken
hamburger with grilled mushroom, bacon, onion and cheese on a bun
grilled Nathan's frank with Jack Daniel's bbq sauce, onion in sauce, mustard, melted cheddar cheese on a bun
steak
lobster
crabcake
shrimp (any style)
pasta any dish
rice any dish
cuban sandwich
For Dinner, it's basically whatever I want
steak dishes
chicken dishes
ground beef dishes such as meatloaf, lasagna, picadillo, etc
Japanese cuisine - beef negamaki, california rolls, teriyaki, miso soup, gyoza, tempura, sukiyaki, let me add house fried riceand general tso cause i can these
Latin cuisine - paella, monfongo, sweet plantains, rice and beans, tamales, alcapurria, canoas, pasteles, fricase, croqueta, octopus salad, churrasco
Greek cuisine - gyro, souvlaki with lots of tsasiki on both if these, dolmades
Mexican dishes such as taco, steak burritos, quesadillas, chili, fajita, nacho
Snacks is basically a meal for me and I have ON Rocky Road protein with milk to meet my protein quota or I may have with it or on its own - yogurt, protein enriched chocolate pudding, banana, etc
I do and can have drinks with my meals at the same time. It will not and does not wash or flush out the food. It will not cause a DSer stomach to be full before eating or cause them that they will are unable to eat due to the being full from drinking fluids, due to the contribution of having their pyloric valve intact and true stomach untouched (just the bottom curvature has been removed). This will make a DSer live like a non-op since there is no gastric bypass involved. The drinks I have on a usual basis are
milk (regular or lactose free, doesn't make a difference)
Tropicana Light & Healthy orange juice (DS can drink regular orange juice)
Koolaid with Splenda (either tropical punch or cherry flavor)
papaya shake made with frozen papaya, milk and Splenda
Tang
ice tea (but limiting it, due to caffeine)
Orange Fanta Zero soda (DSer can drink carbonated soda and it will not stretch their stomach!!!)
Various Protein supplemental powder with 10-12oz milk
Every once and awhile, I can and will have
tiramisu
creme brulee
flan
ice cream
cheesecake
cake
pies
cookies
pudding
croissant
english muffin
donut
etc.
50% of the calories and 80% of the fat for the above delicacies are malabsorb in huge amount. 40% of the complex carb are also malabsorb. The simple carbs are not, yet I do not have an issues that it will cause me to gain weight, since I have eaten these sometimes 3-4x for a week with no effect or seen the scale move up in pounds. NOT ONCE in the 20 months since, I have been postop. I have eaten up to 220g carbs for the day and still it will not cause any weight gain for me since that only comes out to 132g of carbs for me.
Most important thing for me is protein first and I try to get at least 20g as a minimum per meal with a minimum of 90-100g daily. If I know it will not reach my quota, I take shakes throughout the day. I only consume the protein drinks because I am unable to get all my protein from food. Next important thing is complex carb. I like to limit it to a maximum of 160g of carbs daily with DS absorption calculation. After these 2, I am able to enjoy having some simple carbs with a limit to be 50g carbs daily as the maximum for the day. Although, I try not to go over that, just to be conscious, eventhough as I said, that amount hasn't affected my weight and I have gone as hig as 80g simple carb and still has no effect on me.
grilled salmon
western omelet with cheese and homefries
grilled ham & cheese or bacon, tomato and cheese
Special K cereal with milk and 3 tbsp Champion Nutrition vanilla protein powder
Optimum Nutrition Rocky Road with 10-12oz milk
For Lunch, it's usually
chicken
hamburger with grilled mushroom, bacon, onion and cheese on a bun
grilled Nathan's frank with Jack Daniel's bbq sauce, onion in sauce, mustard, melted cheddar cheese on a bun
steak
lobster
crabcake
shrimp (any style)
pasta any dish
rice any dish
cuban sandwich
For Dinner, it's basically whatever I want
steak dishes
chicken dishes
ground beef dishes such as meatloaf, lasagna, picadillo, etc
Japanese cuisine - beef negamaki, california rolls, teriyaki, miso soup, gyoza, tempura, sukiyaki, let me add house fried riceand general tso cause i can these
Latin cuisine - paella, monfongo, sweet plantains, rice and beans, tamales, alcapurria, canoas, pasteles, fricase, croqueta, octopus salad, churrasco
Greek cuisine - gyro, souvlaki with lots of tsasiki on both if these, dolmades
Mexican dishes such as taco, steak burritos, quesadillas, chili, fajita, nacho
Snacks is basically a meal for me and I have ON Rocky Road protein with milk to meet my protein quota or I may have with it or on its own - yogurt, protein enriched chocolate pudding, banana, etc
I do and can have drinks with my meals at the same time. It will not and does not wash or flush out the food. It will not cause a DSer stomach to be full before eating or cause them that they will are unable to eat due to the being full from drinking fluids, due to the contribution of having their pyloric valve intact and true stomach untouched (just the bottom curvature has been removed). This will make a DSer live like a non-op since there is no gastric bypass involved. The drinks I have on a usual basis are
milk (regular or lactose free, doesn't make a difference)
Tropicana Light & Healthy orange juice (DS can drink regular orange juice)
Koolaid with Splenda (either tropical punch or cherry flavor)
papaya shake made with frozen papaya, milk and Splenda
Tang
ice tea (but limiting it, due to caffeine)
Orange Fanta Zero soda (DSer can drink carbonated soda and it will not stretch their stomach!!!)
Various Protein supplemental powder with 10-12oz milk
Every once and awhile, I can and will have
tiramisu
creme brulee
flan
ice cream
cheesecake
cake
pies
cookies
pudding
croissant
english muffin
donut
etc.
50% of the calories and 80% of the fat for the above delicacies are malabsorb in huge amount. 40% of the complex carb are also malabsorb. The simple carbs are not, yet I do not have an issues that it will cause me to gain weight, since I have eaten these sometimes 3-4x for a week with no effect or seen the scale move up in pounds. NOT ONCE in the 20 months since, I have been postop. I have eaten up to 220g carbs for the day and still it will not cause any weight gain for me since that only comes out to 132g of carbs for me.
Most important thing for me is protein first and I try to get at least 20g as a minimum per meal with a minimum of 90-100g daily. If I know it will not reach my quota, I take shakes throughout the day. I only consume the protein drinks because I am unable to get all my protein from food. Next important thing is complex carb. I like to limit it to a maximum of 160g of carbs daily with DS absorption calculation. After these 2, I am able to enjoy having some simple carbs with a limit to be 50g carbs daily as the maximum for the day. Although, I try not to go over that, just to be conscious, eventhough as I said, that amount hasn't affected my weight and I have gone as hig as 80g simple carb and still has no effect on me.
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