Duodenal Switch

Patient Info


Surgeon: Dr. Robert Rabkin, San Francisco, CA
Surgery date: October 19, 1999
Pre-op weight/BMI: 299/49.9
Current weight/BMI: 170/28.3 (as of October 19, 2005)

Latest update: Six years post-op: Long-term Perspective on DS


Left: Day before surgery (299lb.); Right: 2 years post-op (155lb.)

by Melanie M.:

As long as I can remember, I was overweight. In spite of having a happy personality as a preschooler, and a lot of love and affection from my family, it didn't take long, once I was in school, to feel the disapproval and shame that my weight brought to me. I remember being in third grade, standing in line with the rest of my class to be weighed. I felt very self-conscious, knowing that when I stepped on that scale, it would be confirmed to everyone that I wasn't like the other kids.

I lived with my grandparents during the years between fourth and sixth grade. During this time, I piled on about sixty pounds, reaching a weight of 200 pounds by age 12. I was separated from my mother and sisters, and I think I found solace in food. At my grandparent's house, there was an abundant supply of Mallo Cups, Fudgecicles, ice cream, macaroni and cheese -- anything my heart desired, I asked and I received. Despite the fact that my eating habits later normalized, the upward trend was set, and I continued the inevitable climb toward morbid obesity that had been exacerbated in these formative years.

My weight wasn't simply a result of environment or psychology. The paternal side of my family is highly populated with morbidly obese people. On the maternal side, there is also obesity. Genetics played a big part, and I think that they, along with a complex array of other factors, are responsible for my ultimately reaching a level of morbid obesity that required surgical intervention. I didn't simply eat my way there, and I don't believe that most MO people simply eat themselves there. Think about naturally skinny people who eat mass quantities and never gain weight. Why is it OK to believe that their thinness is a fact of nature, but not OK to believe that obesity can also be a natural condition? Must fatness always be "blameable"?

At age twelve, I began my first and most successful diet effort. One morning, I woke up and my mother said to me, "We're on Weight Watchers!" This was the first serious attempt to control my eating, and I stayed motivated by the successful weigh-ins each week. I started at around 200 pounds and reduced to 135 pounds by the end of that summer. For a brief moment in my life, I felt normal and even proud of my body. Unfortunately, that jubilation was short-lived, as the scale began its inevitable climb back to 170, 180, 200, and beyond.

I tried various diets, yo-yoing down and up, plus more, for nearly 25 years. I did Weight Watchers several times, calorie counting, fasting, fad diets, physician-prescribed diet pills, over-the-counter diet pills, Physician's Weight Loss Centers, Medifast, Weight Loss Subliminal tapes, Brainwashing weight loss seminar tapes, Deal-a-Meal, Hypnosis, Jenny Craig, and fat gram counting. Each attempt was less successful than the previous one, and each rebound ended in my reaching a weight higher than ever before.

In 1992, when I was married, I weighed in at around 240. When I got pregnant with my first daughter in 1994, my starting weight was 269. My starting weight for my second pregnancy, in 1996, was 279.

From 1994 until my surgery in 1999, I shunned diets and tried to adopt a "fat acceptance" mentality. I had reached the point where I was simply unwilling to try another diet, fearing that I would gain the weight back, plus more, as I always had. For the five years when I was actively non-dieting, I gained approximately 30 pounds, reaching my pre-op weight of 299. I stopped smoking in 1994, so how much of that 30-pound gain was due to that I do not know.

My journey to weight-loss surgery began when I saw the Roseanne show in early 1999 where she admitted having had WLS. That started my wheels turning. I got on the internet and began my research. I was astounded to find so many wonderful resources on the web. I began to realize that despite all of my "self-acceptance" talk, I really, really wanted to lose weight. I just simply did not know how to be successful at keeping it off!

I was not a binge-eater, and I did not routinely consume huge quantities of food. Like any normal person, I made bad choices at times: I ate high-fat foods, I drank soda pop, I ate a bowl of ice cream. But I honestly think it's the dieting that got me to where I was, and not a simple case of gluttony, as most of society would like to have us believe. I dieted myself to my high weight, and my "set point" was so high that it would have required a Herculean effort on a daily basis to lose my excess weight and maintain the loss without surgical intervention.

Once I began to see weight-loss surgery as a solution, I allowed myself to admit that my weight was a hindrance to me in many, many ways. I wanted to be able to rollerblade and go to amusement parks and sit in airline seats and run and play and generally enjoy life with my husband and my two young daughters. I didn't want my daughters, who have always seen me as beautiful, to ever feel the pain of being told that I am not. I wanted to lose the weight before my joints deteriorated completely, and before my bladder stopped working entirely, and before my heart one day just decided to seize up and stop carrying me around.

I wanted to live life like a normal person, and I didn't want my screwed-up metabolism to continue punishing me for eating normally. I wanted the DGB/DS surgery to work for me as it is intended: to first limit my intake so that I could lose the weight, then to absorb fewer calories so that I could maintain my low weight while enjoying a quality of life and eating just like any other normal, "never-been-fat", healthy individual.

June 19, 2000: At 8 months post-op, I'm feeling great, eating a wide variety of foods, and generally enjoying life! I've lost 96 pounds so far, and not a diet in sight. It's working!! :-) I was blessed to have a complication-free recovery, and I have not had any adverse side effects from the procedure. Despite what some alarmists would like to portray, this procedure has absolutely not caused me any uncontrollable gas or diarrhea. In addition, I have no problems eating or digesting any type of foods. My blood levels have stayed consistently good due to the fact that I am compliant in taking my daily multivitamin.

This procedure isn't for everyone. If you cannot follow your doctors orders and comply with taking your daily vitamin, I strongly advise you not to opt for any malabsorptive procedure. (However, even with a mostly restrictive procedure such as the RNY, your doc is most likely going to advise a daily vitamin.) I take a prenatal vitamin each day, and two calcium citrate tablets after each meal. Not a biggie! My blood levels are staying great, and best of all, I feel fantastic.

My need for sleep has decreased, my energy has increased, my bladder urgency and frequency problems are cured, my resting heart rate and blood pressure are down, and my self-esteem is getting better every day. I'm planning active family vacations that I would have quickly dismissed as too difficult before.

I'm so thankful for this procedure and the wonderfully normal quality of life that it has given me. I do my part by taking my vitamins, staying moderate on sugars, and trying to stay active -- but aside from that, the surgery has done all the work for me. What a miracle it has been for me!

My Post-op Eating Habits (the unvarnished truth)
I eat what I want, when I want, as much as I want. I don't think a day goes by that I don't indulge in a sweet treat -- in moderation! I don't eat a bag of cookies or a pint of Haagen dazs, but I do have a couple of cookies, or a scoop of ice cream. So, I'm not the model of avoiding sugars. I keep them in moderation though. I have lost 96 pounds in 8 months, and I have given myself this freedom from the very beginning. I am absolutely not dieting, and I am not denying myself anything that I want. I did stop drinking full-sugar sodas. I eat much less than I could before surgery, but am now, at 8-months post-op, able to consume a normal-sized meal. I went to the Macaroni Grill restaurant yesterday and ate the following:

- 5 or 6 bites of bread dipped in olive oil
- 6 or 8 bites of Caesar salad w/ croutons
- ~3 oz. of Veal Picatta with butter sauce over
- 1/2 c. angel hair pasta
- 1/2 a glass of iced tea
- 5 or 6 bites of sinful chocolate cake

I was well-satisfied with this meal, and this is typical of the quantity I am able to consume now. I am normal, normal, normal! I love food just as much now as I did pre-op, but I am blessed now to be able to EAT and not be punished by a screwed-up metabolism! Whoever said that enjoying food had to be a punishable offense?

The malabsorptive nature of the BPD/DS allows me the freedom to eat a higher-fat diet than I was able to allow myself pre-operatively. The distal bypass means that fats go through my system mostly unabsorbed. Some people want to know if the effect of this is similar to what people taking Xenical experience... this has been asked on the Duodenal Switch mailing list. The resounding answer is no. I have heard of a very few people who had this happen in the very early months, but it's not something that's ongoing or problematic for the vast majority of DS patients.

It's great now to be able to to unabashedly eat a steak dinner whenever I want one. I can enjoy the taste and texture of the food, and benefit from the high-protein value of red meats without having to worry much about fat grams. It took a little while for me to wrap my brain around the fact that bacon, for example, is a great choice for me now. It's got good protein, and the fat is essentially a non-issue. Another benefit of the BPD/DS procedure is that I never have to worry about any type of food getting stuck or blocking anything in my digestive tract.

I am not flawed because I enjoy eating, nor because I want to indulge in all variety of foods. This is normal! I thank God for giving us this pleasure in life, and I thank my surgeon and this magnificent surgical procedure for making it possible for me experience this pleasure sans suffering!

July 5, 2000: I did it! At 8.5 months post-op, I've now lost 100 pounds, and reached a weight of 199! :-) :-) The last time I was under 200lb. was in 1989!

The BPD/DS surgery has been the answer to my prayers. I am finally normal! At 8.5 months out, I'm able to eat and enjoy a normal-sized meal again. There are no feelings of deprivation here; if anything, I get the occasional flicker of guilt that I am losing this weight and not suffering for it. Do I deserve this? All I can say is thank God for leading me down this path!

Can I be happy living the rest of my life with this procedure? Wow, when I think of that in real terms, it's HUGE. If I'm lucky enough to live another 40 or so years, that's about fifteen thousand days that I am going to be affected by what my surgeon did to me. Another 15,000 multivitamins to take, and another 45,000 or more meals that are going to be directly affected by my modified anatomy. Am I glad I picked a surgery that would give me the fewest food limits? You betcha. :) That's a lotta days and a lotta meals, and I thank God I don't have to look upon them with the tiniest bit of regret or dismay about what is before me.

I'm feeling more energetic and more optimistic about the future than I ever have. I am looking forward to fun, active family times that would have only saddened me to ponder before. We're going to the lake this summer, renting a boat, swimming on the beach, going to a water park, and my kids are going to remember this as a fun adventure with mommy and daddy both participating 100%. Wow! And I will NOT hide behind the camera! :)

So, there's my thoughts for today -- I have reached the biggest milestone on my journey so far, and I'm so happy and grateful to be here!!!

September 7, 2000: I'm down to 187 pounds, for a total loss so far of 112 pounds! Vacation at the lake was wonderful, doing all the active things that I would never have even tried before: swimming, boating, racing grand prix cards, miniature golf, jacuzzi -- heck, just being SEEN in a swimsuit! :-) It was great to be able to fully participate in everything and not keep myself on the sidelines as I always have in the past!

January 2, 2001: At 14 months post-op, I'm down 130 pounds! I can't believe I'm actually at 169 pounds. There's not a lot new to tell at this stage; I'm feeling like a normal person in every way. I truly eat what I want, when I want it, and I am continuing to lose at a healthy rate of about 4-5 pounds per month. I'm only 9 pounds from my final goal of 160 pounds, but I can say that even if I never lost another pound, I'd be a happy camper!

March 15, 2001: I had my 17-month follow-up appointment with Dr. Rabkin yesterday, and got my body composition analyzed. According to this nifty device, I am pretty much at goal right now! My percent body fat was 23.4%, and to reach the ideal of 21% body fat, I only need to lose five more pounds! Is that bizarre or what? LOL. Me? Not having to lose anymore weight? Unfathomable!

To recap, in 17 months, my weight has gone from 299 to 159. My body fat down from who-knows-how much to 23.4%. Down from a size 3X and 26/28 to a size M/L and 12. My joint pain, asthma and urinary incontinence are history. My self-esteem and mobility are better than ever.

Needless to say, Dr. Rabkin got a huge hug from me when I left him yesterday. How do you repay a man who changed your life so dramatically? He will have my everlasting gratitude and respect.

October 19, 2001: Two years post-op! I had a surprise this morning: I got on the scale and found that I had dropped another pound. Six months after reaching my previous low weight of 156, I am still stable -- and even dipping lower than my previous low weight. This surgery is a wonder!

Since my weight stabilized about six months ago, I have been watching the scale and wondering if I would experience any regain of weight. I have seen my weight fluctuate between 15614px59, depending on the time of the month. I've been nervously waiting for the other shoe to drop -- my mind doesn't want to grasp that after a lifetime of obesity, morbid obesity, and being on the cusp of super-morbid obesity, that I could ever succeed at KEEPING weight off.

Well, I'm starting to believe that this is sticking.

  • I have lost 93% of my excess weight
  • I have had ZERO regain of weight
  • I'm wearing really, truly not-tight-at-all size 10 jeans
  • I eat whatever, whenever, however much I want. I enjoy liberal treats.
  • I still take my vitamins religiously
  • I feel better than I have ever felt in my life!

I *ran* the other day in the park, playing with my daughter -- just because I can! And I didn't get winded at all, nor did I or feel (as Sharon S. says) like "an ambulating spectacle". Nobody gave me a second glance.

To the pre-ops, hang in there! Two years of my life has zoomed by like nothing, and this has been easier than I ever dreamed. Easy way out? Not the decision -- that was tough. The recovery wasn't a bed of roses, but it wasn't too bad. But, beyond that -- yes, losing this weight this way has been the easiest and smartest thing I have ever done. Yay for smart, yay for easy! Whoo hoo!

December 2002:
My weight has stabilized and remained at around 158 pounds (give or take 5 pounds for time of the month) for two solid years now! I just had my belated three-year follow-up with Dr. Rabkin, and at my weigh-in there, I was a half-pound lighter than I had been at my previous follow-up eighteen months before.

It's hard for my brain to accept that this is sticking -- that I could lose weight, and then find myself two years later with no regain of weight. I have become a normal-weight person. There is no diet here, nor is there any gluttony. I'm just living and eating and being me. There is no willpower that I have magically achieved. I am exactly the same person inside as I was 160 pounds ago. The difference is that now I am supremely blessed to no longer be punished by food.

Feel free to email me if I can answer any questions or help in any way.

October 2003:

This day four years ago, I was in the capable hands of Dr. Rabkin as one of his very first Lap DS patients. Woo! I can't believe that so much time has passed!

It took 18 months to reach my lowest stable weight. Since then, another 2.5 years has passed. I'm still within ten pounds of my low weight! Miracle!!!

I think of where I would be today if this weight been shed due to some diet or another -- aside from the fact that I would never have stuck to any diet long enough to lose 140 pounds, I certainly would never have kept the weight off this long. I made the right choice getting my DS!

My mantra has become: Dr. Rabkin deserves all the credit for my weight loss. I don't accept any congrats on that score. However, I'll take all the kudos in the world for living up to the solemn vow that I took before I ever had this surgery: aftercare and follow-up.

My continued good health is not a twist of fate or good fortune; it is because I do what I need to do each and every day to care for myself. Words cannot express how much I wish to get this message across to pre-ops, post-ops or anyone considering WLS: Take your vitamins! Get your regular labs! Deficiencies are insidious because they oftentimes don't become symptomatic until damage has already been done, and it can be a very difficult struggle to get back into the normal range. Take your vitamins each and every day, even when you're on top of the world, and you will stay on top of the world. :)

Don't wait around for your PCP or surgeon to remind you that it's time. Know your surgery anniversary, and be pro-active in seeking out your annual labwork. You make the effort to ensure that copies of everything are sent to your PCP and to your surgeon. You make the effort to call and call again if necessary to get your labs interpreted and subsequent recommendations. Follow-up and follow-through, and don't wait for anyone to hand-hold you through this process. Take the reins!

As for my lifestyle these days, all I can say is that I feel normal now. Eat with me, and you would never in a million years guess that I'd had any WLS. Live with me, and the only hint you'd have of my past surgery would be the ever-present pill minder from which I dispense my daily vitamins. Walk with me, and you would never suspect that just a few short years ago, I could barely pull myself out of a chair.

Thank you, Dr. Robert Rabkin! And, to the wonderful friends that I have made along the way, you are a blessing to me.

November 6, 2003:
Someone recently emailed to congratulate me on my four-year surgery anniversary. They asked me if my perspective has changed over the years, and how I feel today about the DS surgery.

My feeling is that DS has leveled the playing field, so that I can eat and live like a normal, never-been-fat person. This wasn't possible for me as a morbidly obese person. The long-term statistics on this procedure show DS post-ops up to ten years and beyond maintaining their weight, with a regain from their lowest weight of 10-20 pounds at most. So far, I am stable at around 90% of excess weight lost and kept off. This is in sharp contrast to the significant number of post-ops of other procedures who find themselves regaining a lot of weight over the years. If I ever do find myself up 10 or 20 pounds, I will do what my mother and every other normal-weight, never-operated, living, breathing, aging human being does: watch what I eat, cut back on sweets -- and I feel like that will work. I'm not immune to putting on a few pounds, but by the same token, it is possible now for me to merely "cut back" and get those pounds off if they do hit me. That was never possible when I was suffering from the disease of morbid obesity. So, I don't see the DS as a license to overeat; I see it as the thing that has made me as normal as anyone else.

Six years post-op: Long-term Perspective on DS


January 2005: I'm a Pacific Laparoscopy calendar girl!

This surgery does soooo much for us. But it doesn't make us 100% immune to putting a few pounds back on after the initial weight loss. I honestly don't believe that I will ever see 300 pounds again, or anything close to it. However, these darn bodies of ours are amazingly adaptable, and the sad truth is that even with 60% of our guts out of the food path, our bodies can eventually find a way to gain weight again.

It's a bummer. All of us who have undergone WLS of any sort are very brave souls. We deserve to have this weight come off and stay off!

RNY folks can perhaps accurately call their tiny stomach pouch a "tool", since they must follow for the rest of their lives a list of rules to keep it working for them. If their tool breaks (eg. staple line failure or excess stoma dilation), their weight can come back with a vengeance.

But no similar logic applies to us DSers. I bristle when I see it written that the DS is a "tool". I do not agree. Rather, I believe that Duodenal Switch procedure changes our metabolism in a fundamental way, effectively lowering our body's "set point". There is nothing that we can "break".

We can certainly test our limits though, and lord knows that I have! It isn't limitless -- we can put on a few pounds. But it's a whole different ball game than when we were morbidly obese. Unlike before, we can make a few simple changes and see a happy result. Before my DS, I had to go into such utter deprivation to lose any weight that I would eventually throw up my hands and say "I give". Now, I can cut out sugars for a week, and the scale drops. It's just a different playing field now. A fairer one. And fair goes both ways -- we can't throw moderation out the window and expect to blissfully maintain the status quo. By the same token, if we do the right things, we are rewarded more than ever before our DS. Our margin for error is much better now, and we can get away with more than before the DS -- but even freedom has limits.

As DS "lifers", we have the same "tool" that any never-operated person has within them: we have the ability (not always the willingness, however) to self-impose dietary limits. If we do a good job with that, we will be rewarded with some weight loss. We have the ability (not always the willingness, however) to self-impose some daily physical exertion. If we do a good job with that, we will be rewarded with a body that is more toned, a healthier heart and lungs and bones, and perhaps a bit of weight loss. Those are the extent of our tools.

I'm basically a lazy person, so I hate using those tools. As DSers, the most potent thing we can do to reduce our weight is to eliminate simple sugars. My surgeon's clinical coordinator, Barb Metcalf, who has followed some 1500 DS post-ops over the past 11 years, says that "sugar is the control for our weight". She has related stories of long-term DSers who dropped a 10-20 or more pounds very fast, simply by cutting out all sugars for a month or so.

I love sugar! When I get on a roll, I can easily find myself enjoying dessert after every meal of the day. It's a hard habit to break. But it can be done. I find that if I can tough it out for 3 days or so without grabbing the sweet stuff, it then becomes much less difficult to maintain the sugar avoidance. And the weight drops.

Bottom line: I'm just like my mom now. She never had any WLS, but she has battled the same 20 pounds for her entire adult life. She diets down to 160 or so, then gradually regains to 180 or so, then goes into diet mode for awhile, and around and around we go. It isn't fun. I think that's the boat I am in now, but I remain grateful to be grappling with 10 pounds and not 130!

So, no, the DS isn't an immunity shield against any and all weight gain. I think it simply makes us like any other shlub out there who has to diet once or twice a year to keep things on an even keel. I can't quite bring myself to think that this is a horrible fate. It's a helluva long way from where I came from, at 299 pounds and climbing. So I'm keeping it all in perspective, and determined NOT to pout about it. At least not too much. :-)

Lest I be misunderstood, let me state emphatically that the DS is the best option currently available in weight loss surgery. Dr. Hess has compiled results of patients all the way out to ten years and beyond, keeping upwards of 75% of their weight off. That is astonishingly good! Paclap's DS results are unparalleled as well. No other WLS comes close to the DS, not only in results but in quality of life.

I feel certain that if I had chosen any other procedure, I'd be sitting here today with a bunch of regain and a ton of regrets. I don't do well with pain or deprivation, and the DS has spared me all of that.

Send email to Melanie M.

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