Weightloss surgery yey or ney !

[kandy]

Ok i know its not a popular choice but i am veering towards weightloss surgery i have a consultation with a Dr with regards to having a duodenal switch i have met some very nice people who have had the surgery and have been told i qualify i will keep you all posted xx Kandy xx

 

[DQ]

Hi Kandy

In the end the only person who can make the choice is you. But you also know we're here with you every step of the way. As long as you think it through, investigate it properly. and it's what you want then we're here for ya babes xxx

 

[kandy]

Hey DQ,
I am ok i am not 100% sure as to how i feel about it yet !
I am doing ok with sensible eating in fact my appetite is alomst non exsistant most of the time but i am not losing anything i am stuck and no one knows why !

Worrying me a bit i have a feeling i have only the capacity to gain unless i ss again and i feel like i could but christmas isn't far off and if i start again its gotta be for the duration !

Hope your well lotsa love
xxxJulie xxx

 

[kandy]

Well a little info on the DS to start

What is it?

• Surgery that reduces the size of your stomach
• Significantly alters food absorption from the intestine
• Performed by keyhole surgery, which only leaves a few small scars

How does it work?

• Restriction of the stomach size so less food can be eaten
• Reduced food absorption as only 100cm (15%) of the bowel will absorb food (common channel – where food and digestive juices mix)

Why is it good?

• Excellent weight loss
• Able to eat relatively normally, although a high protein diet is essential
• Do not experience ‘dumping’ which is sometimes seen with Gastric Bypass
• Can resolve type 2 diabetes in up to 100% of cases

Why might it not be good?

• Major operation that alters the anatomy of the stomach
• Can only ever be partially reversed
• Malabsorption may cause diarrhoea (up to 6 bowel movements a day)
• Essential to have a high protein, low fat, low carbohydrate diet
• Life-long follow-up is essential
• Regular blood tests and vitamin supplements are crucial
What are the risks?

• Bleeding (1-5%)
• Join or suture leak (join or staple line) (1-5%)
• Narrowing at the surgical joins
• Hair thinning
• Protein malnutrition if supplements not taken or diet modified
• Vitamin deficiency and osteoporosis if supplements not maintained
What results can I expect?

• Excess weight loss of 70-80%
What do I need to do?

• Be committed to losing weight and follow dietary advice.
• Have regular blood tests and bone scans
• Take your vitamin supplements
• Attend your follow-up appointments
• Long term commitment

 

[Mini]

Hi Kandy,

Know what you mean about sensible eating and not losing anything...

As D_Q has already said your the only one who knows what is best for you and do ask loads of questions and please be sure to tell us about it as all I know is what I read.

We are here for you Kandy and I know your not entering into this lightly.

Please keep us posted as I would love to know how you get on.

Love Mini xxx

 

[DQ]

I'm doing ok honey. And I can totally understand where you are coming from. Information is power honey, so fill your head with all the info you can get xx

 

[Mini]

Hi Kandy,

Just been reading what you have posted on the surgery your thinking of and it is good in that it does not cause dumping which is such a horrific side effect to some of the other types.

Will you be having conselling before the operation or at any time to help you with it?

Love Mini xxx

 

[DQ]

If you have the surgery, will it be in the Uk or overseas? Sorry if I'm being too nosey just tell me to get lost!

 

[Crystal]

Hi there, sorry for barging in, but this is a really interesting thread as it's something I don't really know anything about...

Further to Mini's post 'Just been reading what you have posted on the surgery your thinking of and it is good in that it does not cause dumping which is such a horrific side effect to some of the other types.'

Can anyone tell me what 'dumping' is?

Whatever route you decide to take Kandy, I hope it all goes well for you...

x

 

[Mini]

Hi Crystal,

Here is an article on it.



Source: Dumping Syndrome=


Dumping Syndrome

William L. Hasler, MD

Current Treatment Options in Gastroenterology 2002, 5:139-145
Current Science, Inc. ISSN 1092-8472
Copyright © 2006 by Current Science, Inc.

Opinion StatementThe dumping syndrome consists of early postprandial abdominal and vasomotor symptoms, resulting from osmotic fluid shifts and release of vasoactive neurotransmitters, and late symptoms secondary to reactive hypoglycemia. Effective relief of symptoms of dumping syndrome can be achieved with dietary modifications to minimize ingestion of simple carbohydrates and to exclude fluid intake during ingestion of the solid portion of the meal. More severely affected individuals may respond to agents such as pectin and guar, which increase the viscosity of intraluminal contents, or to drugs such as the alpha-glucosidase inhibitor acarbose, which blunts the rapid absorption of glucose, and the somatostatin analog octreotide, which alters gut transit and impairs release of vasoactive mediators into the bloodstream.

Introduction

The dumping syndrome complicates the course of 10% to 20% of patients who have undergone gastric surgery for ulcer disease or neoplasm. The most consistent functional defect in dumping syndrome is the rapid emptying of liquids from the stomach into the intestine. As a consequence, a constellation of symptoms develops in response to hydrodynamic and neurohumoral responses to this fluid and nutrient load. Early dumping symptoms, including diarrhea, abdominal discomfort, and vasomotor symptoms, occur in the initial 10 to 60 minutes after eating, whereas late dumping symptoms secondary to reactive hypoglycemia are manifest 90 to 240 minutes postprandially. Adaptation to these dumping symptoms may occur over time; however, a subset of patients experiences persistent, intractable symptoms.

Pathogenesis

Any surgery that involves section of the abdominal vagus may lead to development of dumping syndrome. The syndrome also may develop after operations that involve no nerve transection but that enhance the drainage of the distal stomach, including pyloroplasty, pylorectomy, or antrectomy. Recent investigations of pylorus-preserving gastrectomies for early gastric cancer report fewer problems with dumping syndrome, indicating the importance of the barrier function of the gastroduodenal junction [1]. Finally, surgeries such as fundoplications that impair accommodation of ingested food or that reduce proximal gastric compliance can lead to dumping syndrome [2, 3]. In general, all such procedures lead to the acceleration of emptying of liquids from the gastric remnant with variable effects on transit of solid meal residue [4]. Several pathophysiologic mechanisms underlie the development of rapid emptying in patients with dumping syndrome [5]. The loss of vagal input leads to impairment of receptive relaxation prior to meal bolus entry into the stomach and blunted intragastric accommodation. The volume of the gastric remnant may be too small to physically hold the ingested meal. Resection of the pylorus and antrum may eliminate the normal physiologic retarding function of the distal stomach. Finally, the construction of a gastrojejunostomy may bypass the duodenal mucosal receptors that normally participate in nutrient-mediated feedback inhibition of gastric emptying. Factors other than rapid liquid emptying most likely participate in the development of dumping syndrome, because most patients who exhibit rapid liquid emptying after vagotomy have no symptoms [6]. Furthermore, slowing the rate of nutrient entry into the intestine does not ameliorate all symptoms in patients who have dumping syndrome [7].

The symptoms of dumping syndrome are consequences of the exuberant postprandial delivery of nutrient liquids (and to a lesser degree solids) into the small intestine. The abdominal discomfort of dumping syndrome is reproducible by inflation of a small intestinal balloon, indicating that mechanical factors may contribute to generation of this symptom [8]. The rapid emptying of liquids evokes an osmotically driven movement of fluid from the intravascular space into the intestinal lumen. This augmented liquid volume in concert with the rapid transit observed after vagotomy promotes the development of urgent watery diarrhea in the early postprandial period [9]. Vasomotor symptoms result from both the contraction of the intravascular space as well as exaggerated postprandial release of vasoactive gut hormones including serotonin, bradykinin, substance P, gastric inhibitory peptide, neurotensin, and vasoactive intestinal polypeptide [10, 11]. In healthy individuals who have had no gastric surgery, nutrients are digested and absorbed in the proximal intestine. After vagotomy or gastric drainage surgery, liquid meal residue overwhelms the normal absorptive capabilities of the proximal gut and exposes the distal small intestine to a considerable nutrient load. Mucosal tissues of the ileum and colon are the source many of the peptides released in excess. Furthermore, early dumping syndrome is associated with activation of the renin-aldosterone axis with increases in plasma renin activity and aldosterone and decreases in atrial natriuretic peptide [12]. In the late postprandial period, reactive hypoglycemia may develop as a consequence of exaggerated release of insulin and glucagon-like peptide 1 [13*]. The norepinephrine level also increases during the late postprandial period. In healthy volunteers, intravenous infusion of glucagon-like peptide 1 produces tenfold increases in insulin levels with development of hypoglycemia [14].

Clinical features

Approximately 75% of patients experience early dumping symptoms, which include alimentary symptoms of pain, diarrhea, gas, borborygmi, bloating, and nausea as well as vasomotor symptoms such as flushing, palpitations, diaphoresis, lightheadedness, tachycardia, and syncope. Symptom severity can range from minor postprandial abdominal symptoms to disabling diarrhea and loss of vascular tone [15]. Physical examination may be normal or exhibit profound orthostatic or supine tachycardia and hypotension. When severe, the dumping syndrome can be debilitating, producing a 30% weight loss compared with preoperative levels.

Late dumping symptoms such as diaphoresis, palpitations, tremulousness, hunger, weakness, confusion, and syncope occur less commonly than early dumping symptoms and are believed to result from reactive hypoglycemia. Not all patients with late dumping syndrome exhibit low enough glucose levels to produce symptoms, suggesting a role for other undefined factors in the pathogenesis of late symptoms.

Diagnosis

The diagnosis of dumping syndrome relies on recognition of the characteristic symptom profiles in the patient who has undergone prior gastric surgery. Laboratory studies rarely are needed for diagnosis but may define nutritional deficits in patients with disabling illness and can provide evidence of hemoconcentration with early dumping syndrome and hypoglycemia with late dumping syndrome. In severely malnourished patients, anemia or hypoproteinemia may be observed. Responses to oral glucose (50 to 75 g in 300 mL) consistent with dumping syndrome include a rise in postprandial hemoglobin, increase in heart rate by 10 beats per minute or more, elevated plasma glucose 30 to 60 minutes after eating, and low glucose concentrations 120 to 240 minutes after meal ingestion [16*]. An early rise in breath hydrogen excretion after glucose ingestion indicative of rapid intestinal transit is reported to be a sensitive indicator of the dumping syndrome [16*]. Scintigraphic quantification of gastric emptying, especially of liquids, usually is abnormal in dumping syndrome but adds little to the clinical management in most cases. Rapid emptying is most impressive in the initial 15 minutes after meal ingestion [4].

Treatment

•​

Dietary manipulations form the mainstay of treatment of dumping syndrome and are reasonably effective in most patients. However, a subset of patients experience refractory symptoms that can lead to weight loss, fear of eating, and disability. These individuals are referred for consideration of medication or surgical therapy of severe dumping syndrome.

Diet and lifestyle

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Ingestion of a diet high in proteins and fats and low in carbohydrates with minimal intake of fluids during a solid meal is recommended.

•​

Nonnutritive fluids should be taken either after or before ingestion of solids.

•​

Inclusion of pectin to increase liquid viscosity may delay gastric emptying and reduce dumping symptoms [17].

•​

In patients who have undergone vagotomy, liquid emptying is more rapid when sitting than when supine [[URL="http://javascript<b></b>:void(0)"]7, 18]. Thus, assumption of a supine position after drinking liquids may be beneficial when other dietary measures are inadequate.

•​

Patients with late dumping symptoms secondary to postprandial hypoglycemia may respond to the ingestion of simple sugars when symptomatic.

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Pharmacologic treatment

•​

Pharmacologic therapies directed at reducing symptoms in dumping syndrome may act via several mechanisms.

•​

Agents that increase the viscosity of liquid meals delay emptying of food residue into the small intestine.

•​

Drugs that blunt glucose absorption can reduce exaggerated release of insulin and minimize postprandial hypoglycemia.

•​

Treatments that slow transit and block release of vasoactive mediators decrease the gastrointestinal, vasomotor, and endocrinologic manifestations of dumping syndrome

 

[Shimsham]

Kati,
whatever path you decide to tread, I hope it takes you to where you need to be.
(Personally I would be better off with a switch in my brain to move from thinking 'fat' to 'thin' )

Best of luck, girl!

Jeanie x

 

[Gill-cdthing]

its a big decision to make, and i wish you luck in making it,

 

[Isobel1965]

Hey Kandy-baby, I really think that it's great you have options to choose from and if surgery is the way forward, then you go for it if it's the path you want to take.

Wishing you lots of luck and sending lots of hugs, sweetie!

Let us know what you decide - a surgery diary would be fab and very helpful for other people in the same boat?!

Lotsa luv

 

[Isis]

Thinking of you and you know the support is here whatever you decide....

 

[bettyboo]

Its such a big decision. I had made an appointment to see a surgeon as well for the same procedure. I decided to do the lipotrim for a while instead.
Am happy with my decision. Hope it all goes really well for you.

x

Bettyboo

 

[Crystal]

Thanks for the info Mini... Again, Kandy - I wish you lots of luck with whatever you decide to do.. I hope everything goes well for you.
x

 

[Mini]

Your welcome Crystal.

 

[DQ]

Hey Kandy, when's the appointment??

 

[kandy]

Hi everybody ,
Well i wasn't expexcting so much interest but glad to tell you all i know !

The surgery is available in the uk and overseas i have a provisional consultation on 12th jan and am still undecided !

The consultation is £200 and the surgery is approx £9000 hope hubby doesnt read this although mr Patel from kings college hospital in london will see patients without GP referral and if he thinks they qualify he will apply for nhs funding (not guarenteed of course and i would imagine only if the obesity is of a dangerous level !
He does take private patients and after expenses are taken out of the fee all money is put back into the nhs which i was very impressed by i must admit .

The surgery has its risks although tyhe risks are lower than with the gastric band the roux n y and gastric bypass everyone reacts differently .

Welcome to London Weight Loss Surgery
This is the link to the london weightloss clinic .
I have a friend who has had her surgery with mr Patel 6 mths in lost 8 stone no complications .

This diary will be more about whether its a yes or no for surgery as i research and battle my demons !

Thanks for all your messages of support
Much needed XXXXXXXXXXX love Julie XXXXXXXXXXX

 

[DQ]

Sounds good, especially the plowing the fees back into the NHS. Really glad you are sharing this with us honey - so many people consider it and it's good to know that they're not alone.