Barbara's Weight Loss Surgery Journey & Resources : Duodenal Switch (DS) : Intro page

I launched this site in July 2005 just as I was about to embark on my weight loss surgery journey, in the hopes of providing information to assist others considering bariatric surgery and facing the challenge of making an informed decision as to which procedure would be best for them.

As the Roux-en-Y (RNY) Gastric Bypass is the most common WLS procedure performed in North America, there is a lot of information available online and from others who elected to have this surgery in my opinion, because many didn't know or fully understand their options or potential outcomes. I could have been one of them had I not researched all available options and interviewed many individuals who had selected either the RNY or the Duodenal Switch (DS).

My conclusion was that the DS was the only procedure that would best meet my expectations in terms of quality of eating and in terms of sustaining my weight once I had reached my weight loss goal.

The fact that the DS leaves the pyloric valve in tact, whereas the RNY bypasses it, meant that my stomach would continue to do the work it has always done whereas with the RNY, the individual's mouth takes on the role of chewing the food. That's the simplified answer. I encourage you to check out the WLS Comparison Chart page and the Duodenal Switch page and make your own decision.

If you're considering weight loss surgery but aren't sure if it's the right move, you're probably a candidate if:

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April 28, 2006 update re: Out of Country (OOC) Prior Approval

Given the volume of Canadians from Ontario who have found this website and emailed me with questions or requests for help with the Prior-Approval for Out of Country coverage process, I have created this new page which makes available some template documents to assist individuals with the process.

Follow this link: Prior-Approval for OOC coverage

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A year ago to the day (in July 2004), I talked my family doctor into referring me to Dr. J. Joffe, a Toronto surgeon for bariatric surgery. When I hadn't heard from his office in 9 months, I called his office. They told me that they do not accept faxed referrals and so the referral my doctor faxed them ended up in the garbage rather than on their waiting list with over 4,000 names. When I asked if they could recommend the name of another bariatric surgeon, I was told that other bariatric surgeons had similar waiting lists. They were right!

So after confirming with majority of Ontario surgeons who do bariatric surgery that they indeed have waiting lists over 300 weeks long, I opted to apply to OHIP for prior approval for out of country coverage. The criteria is that individuals must have a BMI higher than 40 and that without the surgery in a timely fashion, individual could die and/or suffer irreversible tissue damage. It also helps your case if you live with co-morbidities such as hypertension, sleep apnea, and/or diabetes. I had the sleep apnea as it turned out.

Originally I decided to follow the majority of Canadians heading to Highland Hospital in Rochester New York to have the Roux-en-Y Gastric Bypass performed by Dr. William O'Malley (whose claim to fame among the Canadians is that he appeared on the Oprah Show). His waiting list was quickly approaching the likes of Ontario bariatric surgeons -- If I could wait a year for my surgery, I'd wait to have the surgery performed in Canada!

During my research, I came upon two Canadians who had opted to have a procedure called the Duodenal Switch (DS) instead of the RNY-GB. As soon as I heard that the DS did not bypass the pyloric valve and that the stomach was left fully functional, albeit smaller, it didn't take long to switch gears.

On June 2, 2005 I sent off my application to OHIP to have the DS surgery performed by Dr. Marek Lutrzykowski of Oakland Bariatrics in Bloomfield Hills, Michigan at Crittenton Hospital in Rochester Hills, Michigan. OHIP lost my application so I faxed them a copy on June 13th and 2 days later on June 15th, I was approved!

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BACKGROUNDER

20 years ago, in 1985, my weight ballooned up to 264 lbs, with 110 lbs of that weight gained over the 6 previous years living in a university residence. I accumulated the weight through these factors:

* no exercise … other than walking between classes & residence,
* sleep deprivation … studied to 3AM each night to maintain GPA & scholarships,
* poor eating habits (i.e. skipped breakfast & lunch, late night eating),
* no mother around to monitor & regulate my diet & exercise regime,
* drank excessive amounts of caffeine (espresso).

So here I was, fresh out of university armed with 2 degrees, and no life outside my work. It was easy to fast track up the corporate ladder ... With much success in the workplace, I came to define myself by my WORK. I knew that something was missing but I was so driven to succeed and be at the top of my game, I didn’t give much thought to building a life outside my work.

Then in late 1984, an appointment with my hair stylist changed my life. My hair stylist, CJ, had lost over 100 pounds from weight loss surgery. She encouraged me to contact her bariatric surgeon and inquire if I was a good candidate for weight loss surgery.

In the spring of 1985, I had weight loss surgery during my vacation -- a standard Mason VBG (vertical banded gastroplasty) partitioned and undivided. I went from a weight of 264 lbs to 143 lbs -- a loss of 121 lbs over 18 months.

I maintained that weight loss for 11 years by sticking to the strategies I knew would ensure success. The most I allowed my weight to fluctuate was a couple of pounds.

Three years post surgery, in August 1988 I got married, modeled my wedding gown (an Aldo Beltrami original design from Italy) in Wedding Bells Magazine (Summer 1988 issue), and within 2 months I was pregnant with my first child. I gained less than 14 lbs through the pregnancy and delivered a small but healthy baby boy on July 4, 1989 weighing 5.5 lbs.

During my pregnancy, and after Free Trade, my company was taken over by Americans (General Signal Corp). So when my pregnancy leave was over, I opted not to return to work or Toronto. Instead I remained in northern Ontario – about 200 miles from anywhere. One of the unfortunate impacts was that I no longer had easy access to my surgeon to continue the yearly follow up appointments.

Sadly, as it turned out, my phenomenal surgeon, Dr. MD was facing allegations of sexual misconduct brought forward by some former patients … much to my amazement my hair stylist -- the woman who referred me to her surgeon, was alleging that she was one of his victims. She contacted me several times asking me if he had ever acted inappropriately with me. The answer was NO I repeatedly told her, to which she kept asking me “are you sure?” as though if she asked enough times, I might respond differently. (Isn't that the definition of insane... repeating a behaviour and expecting a different result?)

I found my surgeon (Dr. MD) to be very professional at all times and I had, and continue to have, a profound respect and admiration for this highly skilled surgeon, one of Canada’s pioneers in bariatric surgery. The College of Physicians and Surgeons revoked Dr. MD's registration in 1997. I found that news incredibly depressing.

I will never believe that what happened with Dr. MD and his alleged 'victim' was anything but consensual and I am a feminist! I base my belief on my personal knowledge of the morally and financially bankrupt hairstylist who had no ethics -- the woman was a con artist and habitually ripped off the system and everyone she came into contact with.

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1996 - ELEVEN YEARS POST-OP

10 years post surgery, my partner fell three stories off a roof and didn't break any bones nor did he appear to sustain any permanent damage. At around the same time he was complaining of chronic pain in his side which his doctor attributed to the fall.

I believe that coming so close to his mortality prompted my partner to insist on having another baby and he needed my help in that process although I was reluctant and intimidated by the prospect of another child. In the end, although not thrilled with the idea, I knew it would be good for our other son to have a sibling.

Then in 1999, 3 years after our second child was born, my partner discovered he had HCV and cirrhosis of the liver. And within a few weeks, my beautiful 3 year old son was diagnosed with autism spectrum disorder (he's high functioning and is in a mainstream classroom with minimal accommodations.)

So that was the setting that I suddenly found myself in. Perhaps it was the old Catholic guilt for being healthy and well while my partner and son were not, that made me embrace the opportunity to become "martyr, caretaker and saviour" (now there's a Trinity of losers!) ... Perhaps I also used this to rationalize the fact I was about to drop all the strategies and changes in behaviour I had in place that were responsible for the maintenance of my weight loss.

Or perhaps I was just itching to find ANY excuse whatsoever to relinquish ownership, responsibility or accountability for my behaviour while acting the role of St. Barbara.

Those were miserable and lonely times for me and I think I knew that food could provide some instant gratification without the kind of damage that drugs could cause ... And since I could never stand the taste of booze and would never do drugs, all that was left was food to indulge in since extramarital sex is never an option when you've been raised in an Italian, Catholic family and you marry another Italian ... not unless you want to end up at the bottom of Lake Nipissing.

It's pretty sad to realize now how little I valued myself in those days that I truly felt guilty for my good health. My partner started a clinical trial on a new type of interferon combo and would sleep around the clock. His working and earning days were clearly over.

So I made some big changes in my life in 1999 ... I started taking on LOTS of contract work that would permit me to work from home. And I used the excuse that I could better manage my household and the needs of my family members including the disabled partner unable to work, and a child with autism spectrum disorder who had no access to early interventions because of immensely long waiting lists.

It doesn't take a psychic to foresee where this would lead... *** Workaholics should never work out of their home. *** I buried myself in my work and hated to stop even to go pee let alone eat throughout the day. Imagine! Perhaps it was because it was the only thing other than my youngest son that gave me any satisfaction! I was good at my work and it helped redefine me.

Since 1999, my partner has undergone 3 treatment protocols on alpha-b interferon and pegylated interferon. The first time it was for 6 months. The second protocol again lasted 6 months. And the third protocol lasted for 11 months (48 weeks) at double the dosage of previous protocols. He pretty much slept 18 hours a day for the last 6 years. And while he slept and got better, I worked and worked and my state of health and wellness diminished greatly.

I have gained and I have lost a significant amount of weight, a total of 5 times over that period. It must have really freaked him out to watch the little woman he married turn into a big, unhealthy blob. How very sad that my partner inferred my reluctance to be intimate as a fear of contracting HCV rather than as my shame and discomfort with my weight.

He was thrilled recently when Roche Canada, the pharmaceutical company that produces the interferon that cured him of HCV and saved his life, invited him to speak to their Pegasys team. He's proud of his accomplishment and well he should be. Only three people completed the protocol and my partner was one of them. I swear he is the most disciplined person I know and I wouldn’t doubt he could walk on water if he set his mind to it.

Back to me -- I am responsible for abandoning my needs and placing myself last. I am not trying to make excuses as I take complete responsibility for the poor choices and decisions I've made ... just want to clarify or rather lay the ground work for --->

How I fell into the same old patterns/habits I did during my years in university (residence) which resulted in huge weight gain:

* working around the clock,
* extreme sleep deprivation,
* poor eating habits (no meals in day, eating late in evening),
* drinking triple espresso's all day/night long,
* snacking/grazing late into the night,
* not taking vitamins and supplements, and
* no exercise! (heck if I wasn't having sex, I wasn't going to make time for exercise)

Therefore, it comes as NO surprise to me that I now find myself morbidly obese for the second time in my life after several years of ignoring the successful habits that afforded me the privilege of maintaining my weight loss for 11 years.

I screwed up in a major way TWICE but now I clearly understand WHY and HOW and hope that I can share this with others so they do not repeat my stupid mistakes. The WHY doesn't matter as much as the HOW. We face the "why" crap on a daily basis that can bring us down if we let it. If we're looking for excuses to justify whatever it is we want to do, there will always be readily available excuses.

When I had my surgery 20 years ago, there wasn’t the level of public education/awareness, access to information, and/or knowledge sharing that is available today via technology … not to mention the availability of online SUPPORT forums like AMOS, ObesityHelp, and the OSSG groups in Canada, which are quite simply, INVALUABLE!

The very first thing I am going to do when I rejoin the corporate jungle and am again earning bug bucks is to donate a healthy chunk of money to help keep ObesityHelp in operation!

I am happy that the world has changed a lot in 20 years and I urge anyone going through WLS now to:

* get informed (don't just follow the herd)
* find support
* commit to lifelong process of successful and proven strategies to maintain weight loss which requires a lifelong CHANGE in BAHAVIOUR, through good times and through hard times.

I had actually shared this with Mike in NY about to have WLS on May 26/05. I thought it might be worthwhile to amend the text to use in my profile... whether you read it or not is not an issue for me ... this is a cathartic experience for me and has helped to clarify for me how I ended up back to where I started 20 years ago.

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MOVING FORWARD

I am waiting for OHIP approval to go to the USA for surgery. I’ve resolved that I am proceeding with this either with or without OHIP’s help and if they don’t help me, when I return to Canada after my WLS I will make it my life’s mission to launch a legal challenge of the denial to fund my request for out of country medical considering the wait time for surgery in Canada is from 6 - 8 years.

The prospect of going to the USA for WLS scares the stuff right out of me ... But I've decided to focus on moving forward with my life and think of what is best for me. I can't function as a morbidly obese person and certainly would not live and would continue to suffer irreversible tissue damage if I had to wait on the Ontario waiting list for 8 years.

All I need is a qualified and skilled surgeon to get me through the surgery and I will work the strategies for successful weight loss maintenance with the same level of passion, energy and commitment that I use in other areas of my life -- to ensure permanent weight loss.

I better sign off before this turns into the book you never wanted to read ;-)

Take what you like and ditch the rest.

Barbara

STRATEGIES FOR LONG TERM SUCCESS

1. Eating
* Eat three well-balanced meals and snacks maximum twice daily. Daily servings for each of the food groups include:
* three servings of protein,
* three servings of vegetables,
* one serving of fruit,
* two servings of bread/starches, and

2. Drinking
* drink water - 40-64 oz of water per day,
* do NOT drink carbonated beverages including sugar-free carbonated beverages,
* do not drink sweetened juices or beverages,
* reduce consumption to 12 times a year or eliminate caffeinated beverages,
* reduce consumption to 12 times a year or eliminate alcoholic beverages.

Why Carbonated drinks are an issue:
- when a cold beverage is consumed, it warms and releases gases, distending the stomach... stretching of the stomach then creates undue stress
- carbonated drinks are high in calories, low in nutritional value, and contain simple sugars ...they're absorbed quickly into blood stream, causing rapid rise in blood sugar, elevated insulin levels, & increased hunger.
- carbonated drinks contain caffeine which acts as an appetite stimulant
- eliminate diet sodas

3. Vitamins and Supplements
* take daily a daily multiple vitamin, supplemental calcium citrate, & take supplemental iron such as Trinsicon or Chromagen and whatever else your doctor advises.

4. Exercising
* exercise regularly to maintain weight... recommend an average of four times per week for at least 40 min.

5. Sleeping
* sleep 7 hours per night

6. Take Ownership for Staying in Control
* weigh yourself weekly - by weighing weekly and allowing yourself only a few pounds / kilograms of leeway, you can maintain control. I regained all my weight following 11 years of maintaining my weight loss because I stopped taking ownership for staying in control.

I blamed my circumstances that resulted in the following BAD habits -- no exercise, poorly balanced meals, constant grazing and snacking, drinking excessive amounts of caffeine and carbonated diet drinks.

These bad habits resulted in me gaining 100 pounds over 6 years -- twice in my life.

CONCLUSION:

Changes in old behaviour and forming new, lifelong habits are required for SUCCESSFUL weight loss and MAINTENANCE!

To be successful after WLS, you must:

• eat 3 well-balanced meals & maximum of 2 snacks daily,
• drink a minimum of 64oz of water & avoid carbonated beverages of any kind,
• take your multiple vitamins & calcium citrate regularly,
• sleep at least 7 hours per night,
• regular exercise is imperative,
• weight control is YOUR own personal responsibility.

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Introduction

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Introduction

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