Weight and Eating Report

I've been 213.5 the last couple of days.  Day before yesterday, that was depressing, because I'd done well.  Yesterday, not so good.

My body is stabilizing from the rapid weight loss, I guess.

I'm starving now, going to cook some beef.

Weight and Eating Report

I'm holding steady at 213.5.  Yesterday wasn't stellar.  I ran around and thus was unorganized with my food.  I ate out at Burger King--yep, the bun.  What else?  Just a few slips, a bite here, a bite there.  Hopefully, today will be better.

Why curcumin works for my RA

I was diagnosed with RA after an awful flare that hospitalized me back in April after my DS Feb 4 (and those hospitalizations for complications through March).  I take Curcumin (needs to have piperine in too to work) and Coramega.  It makes a noticeable difference and I have NO other flares close to the first one after nine months and my pain is under control without Motrin.


I knew the Curcumin worked, but I just learned WHY it works.

Interleukin-1 (IL1) is essential for systemic inflammatory bone loss

Objectives: Chronic inflammation is a major risk factor for systemic bone loss leading to osteoporotic fracture and substantial morbidity and mortality. Inflammatory cytokines, particularly tumour necrosis factor (TNF) and interleukin-1 (IL1), are thought to play a key role in the pathogenesis of inflammation-induced bone loss, but their exact roles are yet to be determined.

Methods: To determine whether TNF directly triggers bone loss or requires IL1, human TNFα mice (hTNFtg) were crossed with mice lacking IL1α and IL1β (IL1−/−hTNFtg). Systemic bone architecture was evaluated using CT scanning, static and dynamic bone histomorphometry and serum markers of bone metabolism.

Results: hTNFtg mice developed severe bone loss accompanied by a severe distortion of bone microarchitecture. Bone trabeculae were thinner and decreased in numbers, resulting in increased trabecular separation. Histomorphometric analyses revealed strongly increased bone resorption in hTNFtg mice compared with wild-type mice. In contrast, IL1−/−hTNFtg mice were fully protected from systemic bone loss despite still developing inflammation in their joints. Lack of IL1 completely reversed increased osteoclast formation and bone resorption in hTNFtg mice and the increased levels of RANKL in these mice. Structural parameters and osteoclast and osteoblast numbers were indistinguishable from wild-type mice.

Conclusions: These data indicate that IL1 is essential for TNF-mediated bone loss. Despite TNF-mediated inflammatory arthritis, systemic bone is fully protected by the absence of IL1, which suggests that IL1 is an essential mediator of inflammatory osteopenia. -- http://ard.bmj.com/content/69/01/284.abstract?etoc

 Curcumin blocks IL1

Curcumin is a dietary compound with diverse anti-inflammatory and anticarcinogenic effects in several experimental models. A mechanism by which curcumin exerts these actions might be the direct modification of protein thiols, thereby altering the activity of the affected proteins. An early event in inflammatory signaling cascades is the recruitment of the interleukin-1 (IL-1) receptor–associated kinase (IRAK) to the IL-1 receptor (IL-1RI) upon stimulation with IL-1. IRAK recruitment was shownrecently to be inhibited by agents that modify thiols of IRAK. We asked, therefore, whether IRAK is also a target for curcumin. Curcumin indeed blocked IRAK thiols in a murine T-cell line stably overexpressing IRAK (EL-4^IRAK), which resulted in the inhibition of IRAK recruitment to the IL-1RI and phosphorylation of IRAK and IL-1RI-associated proteins. Inhibitory effects were not reversible by thiol-reducing agents. Thus, modification by curcumin did not occur by oxidation but rather by alkylation, as is typical for electrophilic compounds reacting as Michael addition acceptors. The block in one of the earliest events in the IL-1 signaling cascade can explain the often observed inhibition of IL-1-mediated signaling steps by curcumin further downstream. Hence, thiol modification might be a crucial step in the anti-inflammatory functions of curcumin. -- http://jn.nutrition.org/cgi/content/abstract/135/8/1859 

We have previously demonstrated that anti-inflammatory and antioxidant compound curcumin (diferuloyl-methane) inhibits the expression of monocyte chemoattractant protein-1 (MCP-1/JE) in bone marrow stromal cells by suppressing the transcriptional activity of the MCP-1/JE gene. Since both AP-1 (TRE) and NF-kB (kB) binding motifs are present in the promoter of MCP-1/JE gene, we examined the effect of curcumin on IL1 alpha- and TNF-alpha-induced activation of ubiquitous transcription factors AP-1 and NF-kB by electrophoretic mobility shift assay and Western blotting. IL1 alpha and TNF-alpha rapidly induced both AP-1 and NF-kB DNA binding activities in +/+(-)1.LDA11 stromal cells. However, treatment of these cells with curcumin blocked the activation of AP-1 and NF-kB by both cytokines. These data suggest that inhibition of MCP-1/JE transcription by curcumin involves blocking of AP-1 and NF-kB activation by IL1 alpha or TNF-alpha.  -- http://www.ncbi.nlm.nih.gov/pubmed/9439980 

Weight and Eating Report

I lost another pound and a half!  My morning weight is 213.5.  My morning weight before my weight gain was 212.5 so I'm only a pound away from baseline.

This low carb eating is working as far as losing weight.  The protein drinks (I really only like it in hot beverages, usually coffee, caf or decaf, but low cal spiced apple cider packets will work too) make it easier to stick to lower carb eating.

I am eating some carbs in the evening without it stalling my weight loss.  I had chicken, green beans, dressing,  and cranberry sauce for dinner last night.  Got the cravings and dug out a protein bar.  Later realized that it wasn't a low carb one, but one of those Snickers Marathon bars.  Need to buy some Atkins bars.

I woke up starving.  I'm sipping my coffee with whey protein and have a low carb omelet in the oven (2 eggs with 1/2 c half and half and a T of French onion dip, 4 slices of bacon cut up and fried with 1/2 a small onion, and topped with grated sharp cheddar).  Have finally kicked my potato jones to the curb (none in the house except some potato flakes in the pantry).

Why did I have SUCH a hard time doing this--controlling my eating enough to take off the rest of the weight I want to lose?  I don't want to speak too soon, I've only been doing this for a few days--but if I could control my eating reliably, I'd not have needed the surgery.

My immediate goal is to make Onederland.  That would be wonderful.  It would be more wonderful if I could make by my year surgery date.

Weight and Eating Report

I lost a pound. 215 morning weight.

I'm doing good at avoiding sugar...but need tightening up on the carbs.  Slipped in a bit of bread.

I'm revising the eating plan.  I'm going to include protein drinks and allow a serving of carb (such as one piece of bread or a bit of potato) with dinner.

Coffee with whey protein (20 g)  Take calcium, my extra D and anti inflammatories for RA (curcumin, Cormega) 

No carb sit down meal with protein--usually eggs Take the rest of my supplements and iron.  I'm taking KCl too.

Drink with whey protein   Take calcium

No cab sit down meal 

Drink with whey protein  Take calcium

One serving of carbs with a sit down meal 2nd omeprazole

So far, so good.  I made the best eggs, yum!  I fried bacon and onion then added frozen spinach. I mixed up eggs with heavy cream and French onion dip and poured the mixture into the cast iron skillet with the spinach and bacon and added this brie cheese that I found at the back of the fridge.  Diced it.  Then I baked it in the oven until the eggs were firm.  Almost better than sex!

Went to church this morning.  They had a pot luck afterwards, and I slipped up a bit on the carbs, but not badly.  Have gotten my protein drinks in, just have one more to go.  

Weight and Diet Report

Other than taking my supplements and trying to mind my health, I've been ignoring the weight.  It bothers me that I haven't lost the weight I wanted to lose as easily as I wanted to lose it.

I've been going hog wild on sweets over the holidays.  I got on the scale earlier this week and saw a five point weight gain.  Up to 217.5 from 212.5 early am weight.  That shook me.

I thought of an eating plan I believed I could stick to and so far, so good.   I'm down to 216  after one day.

Stop the sweets and sugar!  Just stop.  Eat meals.  Mandatory food.  Once I eat the mandatory food, the plan is that I'm satisfied and won't eat more crap.  NO sugared beverages.

Breakfast
Eggs...I like them baked.  I mix three with heavy cream and sourcream onion dip with a little Lawry's season salt and smokehouse pepper and bake in a small cast iron skillet with unlimited bacon
Coffee and half and half

Lunch
Lettuce and raw veggie salad with a cup of meat salad.  I love the chicken salad from Aldis.

Dinner
Meat
Veggies I like

Snacks
Cheese or peanut butter and Wasa Fiber Rye crackers (low carb)
Olives, nuts, cream cheese

More labs: Vits A&D

My D was up to 28 from 18 in just a few weeks with just a few thousand IUs supplemented.  A was 35 mcg, within normal limits.

In Western nations apparently toxicity from too much A is far more of a danger than deficiency.  From wikipedia...

Since vitamin A is fat-soluble, disposing of any excesses taken in through diet is much harder than with water-soluble vitamins B and C, thus vitamin A toxicity may result. This can lead to nausea, jaundice, irritability, anorexia (not to be confused with anorexia nervosa, the eating disorder), vomiting, blurry vision, headaches, hairloss, muscle and abdominal pain and weakness, drowsiness and altered mental status.

Acute toxicity generally occurs at doses of 25,000 IU/kg of body weight, with chronic toxicity occurring at 4,000 IU/kg of body weight daily for 6–15 months.^[25] However, liver toxicities can occur at levels as low as 15,000 IU per day to 1.4 million IU per day, with an average daily toxic dose of 120,000 IU per day. In people with renal failure 4000 IU can cause substantial damage. Additionally excessive alcohol intake can increase toxicity. Children can reach toxic levels at 1500IU/kg of body weight.^[26]

In chronic cases, hair loss, dry skin, drying of the mucous membranes, fever, insomnia, fatigue, weight loss, bone fractures, anemia, and diarrhea can all be evident on top of the symptoms associated with less serious toxicity.^[27]

It has been estimated that 75% of people may be ingesting more than the RDA for vitamin A on a regular basis in developed nations. Intake of twice the RDA of preformed vitamin A chronically may be associated with osteoporosis and hip fractures. This may be due to the fact that an excess of vitamin A can block the expression of certain proteins that are dependent on vitamin K. This could hypothetically reduce the efficacy of vitamin D, which has a proven role in the prevention of osteoporosis and also depends on vitamin K for proper utilization^[28].

High vitamin A intake has been associated with spontaneous bone fractures in animals. Cell culture studies have linked increased bone resorption and decreased bone formation with high vitamin A intakes. This interaction may occur because vitamins A and D may compete for the same receptor and then interact with parathyroid hormone which regulates calcium.^[26]Indeed, a study by Forsmo et al. shows a correlation between low bone mineral density and too high intake of vitamin A.^[29]

Toxic effects of vitamin A have been shown to significantly affect developing fetuses. Therapeutic doses used for acne treatment have been shown to disrupt cephalic neural cell activity. The fetus is particularly sensitive to vitamin A toxicity during the period of organogenesis.^[14]

These toxicities only occur with preformed (retinoid) vitamin A (such as from liver). The carotenoid forms (such as beta-carotene as found in carrots), give no such symptoms, but excessive dietary intake of beta-carotene can lead to carotenodermia, which causes orange-yellow discoloration of the skin.^[30][31][32]

Researchers have succeeded in creating water-soluble forms of vitamin A, which they believed could reduce the potential for toxicity.^[33] However, a 2003 study found that water-soluble vitamin A was approximately 10 times as toxic as fat-soluble vitamin.^[34] A 2006 study found that children given water-soluble vitamin A and D, which are typically fat-soluble, suffer from asthma twice as much as a control group supplemented with the fat-soluble vitamins.^[35]

Chronically high doses of Vitamin A can produce the syndrome of "pseudotumor cerebri".^[36] This syndrome includes headache, blurring of vision and confusion. It is associated with increased intracerebral pressure.^[37]

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Dina Teaches Me New Stuff About My Supplements

There's always something new to know.  I had no idea that DSers need to to have a higher B12 than normal.  Apparently because we malabsorb, optimal B12 levels are a good baseline to maintain.  I have a tendency toward anemia, even before the DS, so it won't hurt.

The danger in low calcium and the D that helps the calcium work is that your body will leach the calcium from your bones to function.  This will eventually cause bone loss--brittle bones, broken bones.  Hurt bones are a world of pain and disability.  I've never experienced it, but I've seen it. I want to keep my bones intact into my old age!

A couple of markers that your body is leaching calcium from your bones are the PTH and alkaline phosphate levels.  If these numbers are even borderline high and coupled with a borderline low Ca--that's what's starting to happen.  The solution, be religious with calcium/D supplements and get those levels in line.  I need to work on this one.

Labs drawn today

I saw my surgeon.  I told him about my low vitamin D my rheumy found.  He redid it and ordered a full battery of tests.  I used to be an easy stick, but no more after my weeks and weeks in the hospital.  My veins are a mass of scar tissue.  I hate labs now because I'm usually stuck several times and often end up with a butterfly needle in the hand.  This hurts.  I figure it's poetic justice because I have drawn plenty of blood for other folks that way in my home health days.

My surgeon told me the usual about eating to further my weight loss.  Protein first, then the rest and watch caloric fluids and simple carbs.  I do need to tighten up on my habits.

Halloween has been sort of dicey with the candy.  I'm happy it's over and have gotten most of it out of my house except the candy corn.  Will take that to a friend tomorrow.

I was experimenting to see how my stomach can hold without upchucking.  It's only around 1/3 cup and I can't drink and eat at the same time.

I weigh 213.

Oh, I never mentioned my major DUH moment with my calcium/D supplement.  I was only taking one pill instead of two.  DUH, DUH, DUH.

And I have yet a new diagnosis...asthma.  It's sort of an auto immune thing too?  I have a new inhaler.

Sorry...

I hardly ever visit here.  I'm still depressed over my DS.  Looking at the bright side (and I realize there is one) isn't working right now.  Weight is still holding the same.  I'm not eating much...but life is rushing like a river and I'm not paying much attention or trying to diet.

I take my supplements and have an appt with the surgeon next week where I'll get more labs done.

The lady who had a bad time with the potato chowder recipe...I'm sincerely sorry if I left anything out.  I made it and it was good, but it is possible I screwed up with the recipe writing.  I'm new at this and will stick to real recipes from elsewhere that I've tried out and liked rather than attempting to transcribe my own concoctions.

Back in the saddle as far as food

Getting control of my food eluded me for months and it has been depressing the hell out of me.  But yesterday, I was finally able to do it--and today too, it seems.

I'm eating low carb.  My secret is to have low carb food that I like easy and on hand when cravings attack, deviled eggs, chicken salad, glazed sugar free cinnamon nuts (nuts fried in butter, splenda and cinnamon), hot wings, bacon, fiber rye wasa crackers, sharp cheese, diet soda...

My goal is to take off twenty pounds and leave the 200s behind forever. 

Low vitamin D

It's 18.  Normal is 30-80.  My rheumatologist checked it.  I don't see my surgeon for several weeks.  The rheumy told me to add 2000IU of D, but I added 4000...in addition to what I usually get, that's 5800IU a day.  I hope that's enough. 

On the good side, everything else was normal, including my iron which was up.   And my diabetes is apparently gone.  A1C was 5.5!  Three months ago it was 5.9, so it's on a downward trend. 

Depression worsens

I'm considering joining OA for help in becoming abstinent in sugar and white flour.

Indeed, after a horrendous surgery, I have proved I'm pretty powerless.

Still the same

I think I'm getting a little depressed.  The weight loss is stalled, has been stalled for months and here it is...I have to be satisfied or diet.

I can't get into the diet mindset.  I don't know why.  I drift through gray days, feeling a bit desperate.

I eat what I eat.  Not a lot and not overtly bad stuff, but comfort food such as chicken and corn bread dressing with peas on the side.  Lots of carbs.  Then the next day I make a ratatouille with cheese for dinner and feel better, but I know I haven't done enough.  I haven't dieted.  I didn't eat chicken breast and salad or steak and green beans...because I didn't want it.  I've slipped into the familiar robes of soft, slippery comfort.   Food has become the enemy again.

I'm a bad person because I can't diet. I don't want to diet--I hate it, the constant alertness and monitoring, the privation and denial of what you really want to eat.  Why eat stuff you don't want?  My mother says this is my problem, that I refuse to eat nasty food.  "Food is simply nutrients for the body--you should eat what's good for you, not what tastes good."  Not what feels good either.

I grew up with broiled chicken, tuna, uninspired salads and weight watcher's food.  Nasty food. Remember when they sold frozen fish in those rectagular packages, like the once ubiquitous frozen vegetable squares?  There was never carbs in the house, no bread and god forbid, no cereal.  No mashed potatoes, no macaroni, no sweets, ever.  Peanut butter and jelly sandwiches were a novelty, something eaten away from home.  Home was dry frozen white fleshed fish, vegetable boxes of string beans and broccoli, always broccoli, along with chicken.

So I know what to do.

 I have to diet to get what I want--an attractive, healthy body.  No way around it.  My birthday is this week.  I'm getting old and before I die, I want to have it.  So, somehow, I have to do it.  Everything depends on my dieting.  Do I want success?  Do I want a life?  Diet, diet, diet.  And exercise, of course.  But one can exercise oneself silly without losing weight (I know).  Dieting is the key.  Food is my enemy while being the only friend.

I think this over and over and the days pass by with no diet.

Misery of the usual kind.  The kind I'm lifetime familiar with, a despised companion.  My DS was half a success, but half a failure.  I'm halfway to the goal I really want, and don't know if I can make it the rest of the way.

Why tell me the obvious?  I know, I'm worthless because I can't diet.  Sigh.  

I have a DS sister

She was also a 90's VBG revision to a DS.

We had the same docs, Dunshee and Stewart...they work in pairs.  Stewart worked on me--Dunshee was my primary.  Dunshee worked on her and Stewart was her primary.  They were both trained by Anthone.

I don't know if they do them separately now that they've racked up more experience.  They had done fifty DS's jointly when I had my surgery.  They did the procedure in teams of two surgeons without an extra charge.  They did it lap on DS virgins and would try on revisions, but always cautioned it could be quickly converted to open, especially on a revision.   My DS sister and I both ended up being done open.

She had her surgery a week before me and we were in the same hospital together.  She was 50-75 pounds heavier than me at our surgeries, I don't remember exactly.  She left a few days after I had my surgery.  I was hospitalized for weeks, much longer than her.  

She's lost a lot more weight than I have (100 pounds when I last heard) without my nasty complications at the outset even though we were both revisions.  She's not moaning about dieting either, but seems to eat what she wants within reason.  She had a lot more taste issues than me, but then again, I couldn't eat jack for months and subsisted on tube feedings.  I was so happy to eat once I could finally chow down, taste was the least of my worries.   Getting and keeping it down was my issue.

I write this to let folk know mileage does vary.

More from Kathleen and the DS Dieting Dilemma

Kathleen gave me permission to reproduce her post...it was in response to a woman who was worried about her weight loss post op the DS. She got the usual prompts to restrict her carbs.

As I am one of those where the DS kind of "didn't work" I feel I must reply to this post and put in my 2 cents. I lost 45 lbs and stopped. I started at 285 and was very dismayed at my weight loss stopping before I'd lost at least 100 lbs.

If I had to do it over again I think I would have been watching my carbs more carefully from the early months but right after surgery I was 1. not used to dieting, 2. not used to actually believing that diets worked for me, in fact, convinced they did not! and 3. wasn't able to eat very much so it didn't seem important that I ate carbs as long as I got in protein first.

I still can't each much. Heck, I just started to be able to eat at all a few months ago. My doc told me to eat whatever, since I could eat so little. I was on a tube feeding for months. I never have gone hog wild and eaten sweets wholesale--I'm diabetic. Eating whatever meant to me was eating the few carbs that I could tolerate without distress. So far that's not much, mainly potatoes and brown rice--but I don't like brown rice much. Eating whatever is eating a piece of Ezekiel bread (sprouted whole grains and beans--high protein) and rejoicing I kept it down.

You might say I had to learn the hard way that for some of us (what do you think, maybe 50% or more?) this is a tool that helps people lose a bunch, eat less after that, and get determined to stick to a sensible eating plan, (I am not bothered by the word diet, which to me means eating plan) and the DS does not automatically achieve the ideal weight loss by itself. It was a learning curve for me, and in the first year I did get down to a 65 lb loss by dieting, and later down to a 120 lb loss with more dieting, and this was indeed a "weight loss diet", one I liked and could stick to. I didn't stay at the 120 lb loss (165 lbs) and am now at 185 to 195 range and working on it, adding more exercise and sticking to my preferred eating plan (except when I don't).

Oh shit. Eating plan means D I.E. T. to me and diets have always been my nemesis.

I just wanted to say a word here about honestly looking at ourselves, how new people sometimes talk before DS about "diets don't work for me" and after DS many of us talk just like people on a pretty darn strict diet. ...Also called watching your carbs.

Thank Gawd, I'm not the only one who feels like that. I was boggling when I started to look into archives about my slowed to nonexistent weight loss. Everybody was telling me to diet! If I could diet, I wouldn't have needed the frickin' surgery, I thought.

 I never have gone hog wild on carbs, had to limit them because of my diabetes. Eating the minimal carbs always kept my ass fat. So am I back to square one!?  But I kept my mouth shut.

Whatever term you are comfortable with, it is a much stricter way of eating than we were doing before DS. I don't want to be telling Worried to "be afraid, be very afraid", just to recognize, as many have to sooner or later, that a change of eating is indeed part of the "work" and the "success" of the DS. We just can't eat like we did before surgery, for many reasons. Not trying to suggest that Worried is doing so, just commenting on the subject of life post DS and how it was for me, and that sometimes it does seem the DS didn't work.

Heresy!  The words seem to be verboten in the public forums.  Did I really damn near die for something that won't work all the way? Maybe I did...but I do know I wouldn't have lost the 70 pounds without it. Time will tell if it was worth it. Life is usually a gamble, and with no risk, comes no rewards. No regrets.

Yeah, yeah, I know you lucky ones who don't diet, never had to, the DS worked beautifully for you and I am happy for you and desperately wanted to be one of you myself, but get over yourselves, you were damn lucky!! Appreciate your good fortune, it didn't happen that way for quite a few of us, including, I suspect, many who just read, am I right?

Smug be-yotches. Okay, I admit it, my 215 pound ass is jealous. But why do people have to transform into born and bred Skinny Bitches once they lose the weight? Seriously.

I have often considered a revision, and while I have never really completely given up on that idea, I know that a little discipline and a good eating plan and exercise would do me just as good and cost a lot less. I don't regret my surgery (6 years ago) but I wish I had had a shorter common channel and developed better eating habits sooner. Better late than never tho! I am trying to be encouraging and informative with this post, and mean no criticism for anybody, just talking about my own experience and wanting to share with others who can relate.

Thank you! I SO related to you. But I'm not considering more surgery. I've had enough and more might just kill me. Where I'm at right now is either to accept my 215 poundedness or deal with low carb dieting. Maybe I can set my sights lower. I can lose thirty more pounds, can't I? I'd be more satisfied at 185.

Bear with me. I'm working through it. This is a big deal.

Dieting and the DS

Nope, I didn't do well yesterday. I was fine until the evening when that certain restlessness/dissatisfaction hit me. And damn, there were ice cream bars in the refrigerator. Yes, ice cream bars. Well, they're gone now.

Today is a new day. But I do need to finish the food I have on hand. I don't have the money to throw away food. I have too many carbs in the house. When they're gone, they won't be replaced.

One thing about carbs, a little will make you crave more. And they are the foods that fill that restless, dissatisfied emotional void I mentioned earlier. Carbs are the Devil. White flour is just a lesser demon in comparison.

Anyhoo...I was looking over at Obesity Help, a site full of folks and info. The duodenal switch forum is positively positive on the DS. It is a wonderful surgery in comparison with the others, but there are drawbacks that it seems verboten to talk about much. Are the ones having trouble with weight loss afraid to speak up? I know I was, even at the decision stage in the beginning. It was an invaluable source of info, but I kept my questions to myself and just read the archives and lurked.

Whine about dieting and carb restriction on the open DS forums too much and you run the risk of serious flames. Where did these once morbidly obese women get their steely carb-resistant willpower?

Dieting seems to be the reality of more than a few DSers, especially us revisions. Sure, there are some who have lost the weight without a hitch. There are others who have serious nutritional problems and bathroom issues.

Is there a safe place where us DSers who will have to diet to lose all our weight can speak out and seek support?

Effin' dieting. I really like Kathleen on the lists and boards. Ever time I read her, she has something of substance to say.

I feel that an important part of this process is really swept under the rug, the part where we all say (or most anyway, some claim then NEVER overate and those hundred or more pounds just "appeared") that dieting doesn't work.

I hear ya. My theory is that we really fat folk are genetically skewed toward getting fat in the midst of plenty. Some people couldn't gain up to 300 pounds if they tried and tried hard. But we do eat and love doing it. It's not as if somebody else was stuffing our mouths.

I think there could be a lot more honesty that we are all somewhat food addicted. I don't think that is shameful, everyone has some addictive behavior or coping or control behavior, whatever term floats your boat, and for some it is food. I love food, I am a "foodie" in the best sense of the term, I am a good cook, a connoisseur of good eats and love the food channel.

I not a great cook or a foodie that much, but I sure love to eat. And I adore my potatoes. I compare quitting them is about the same as quitting cigarettes felt to me twenty-odd years ago. Quitting cigarettes was a hell of a lot easier than the whole effin' dieting thing. Potatoes are just one thing.

The part that we ignore in the forum is that bit where the DS magically changes us into people who can "control our carbs". Just when and how does that happen for most people? I have tried to discuss it but have gotten little interest.

Kathleen is braver than I am. I don't dare try to discuss it in front of DS strangers. I'm an inveterate cowardly lurker. But I'm really struggling over controlling the carbs, as much as I ever did? Where is my DS magic? Does it exist? Dear Lawd, I'll never buy ice cream bars again, no matter how much the kid begs.

If anybody wants to talk about the DS and dieting, I'm here. It's my turf and I'm brave here.

Miserable About Dieting

Today, I vow to diet. It's the same as what I did thousands of days before my WLS. Low carb has always worked best for me--but I had to be very strict to lose weight before. No diary whatsoever, not every many veggies.

I'm going to just restrict my carbs (starches). Maybe I can still lose weight with some dairy (not carb laden milk-I'm talking cheese and cream). I'm going to have half and half in my coffee with whey this am. Make a note to buy cream instead.

Then I'll make a couple eggs with sour cream--maybe some bacon for brunch.

Later for dinner, I have left over pork chops. I can have that with cabbage. Sigh. Yes, I'm missing my potato already. Since it's just me and my daughter, if I make potatoes, the temptation to eat more than a bite or two is great. I'll make her mac and cheese to go with her pork chops and cabbage.

Basic vitamin regime on the cheap

I'm on Medicare due to disability.  I'm poor.  Another women in my boat wrote in at the duodenal switch lists asking for advice on how to pay for her vitamin supplements since Medicare doesn't pick up this cost.

I wrote her back privately...this is what I do

I can get the basics shipped to my door for approx $20 a month.

I ordered the multivitamins with ADEK from Baratric Advantage at first, but they are too expensive and unnecessary.  I bought cheaper multivitamins from Vitalady 180 caps (her private label) for around $35 which will last me three months.  I'm going to go with the cheapest generic ones when I run out.

I don't take the ADEKs my doctor's office showed me.  They are too expensive at $40 a bottle for 60, not even a month's supply at 3 a day.  The doc said they weren't necessary either.  It's best to add what you need based on your lab tests.  If you need extra vitamins, your lab tests will show it.

You can order what you need at Amazon, cheap, and utilize their free shipping for orders over $25.  I always buy enough at once to get their free shipping.

Ferro sequels from Amazon.  100 tablets at 1 a day will last appros 3 months. I love these because they are good to my tummy and non constipating. $7/mo

Citracal calcium citrate with D 180 tablets at three a day will last two months. I do like the chewable and lozenges, but these are cheaper. They have no taste, like chalk. I just chew 'em and chase it with a beverage. $7.50/mo



Centrum multivitamin You get 250 which at 2/day will last approx 4 months. Big pills, I break them into half. $5/mo


(Don't always go with the best price. If it's just a dollar or so more, the ones that qualify for free shipping are worth it)

The Diet Dilemma

A member of the duodenalswitch list at yahoogroups.com wrote something I related to deeply. She did not give permission to reproduce it verbatim on my blog when I asked, so I'll just say she was exactly my weight (285) when she had her surgery and she only lost 45 pounds and stopped. She had to diet to lose additional weight, losing 120 pounds and stabilizing at around 90-100 pounds lost.

I'm a little luckier, despite being on tube feedings for months after my surgery...I stopped at a 70 pound weight loss. It's been several months and my weight has stabilized at 213 (nekkid and hungry) 215 (clothed and fed), neither losing or gaining.

It's a fact that some DSers lose only a certain amount and stop short of their goal. I'm apparently one of them.

The seventy pound weight loss is a blessing though. Most of my obesity related maladies are gone. I look somewhat normal now, although I wish I were thinner. I'd be happy to lose down to 185, 100 pounds down from my surgery weight. I need to lose thirty more pounds to reach that goal.

Hell, if I could diet successfully, I wouldn't have needed the DS! But, maybe now I can. Before Atkins never worked for me unless I stayed on it in the strictest sense...no cheese, no eggs, no dairy at all, and limiting my veggies in addition to no other carbs whatsoever. It was undoable.

Now, maybe I can do Atkins with low carb dairy and low carb veggies. That would be workable. I'm loving my potatoes now, a starch I can tolerate well. They will have to go...

DS eating to lose to optimal weight needs to be low carb because we malabsorb fat and need our protein to function well.

It's back to the diet struggle unless I can decide I'm happy at the weight I'm at now.

Yummy beef and potato chowder

Fall is stew and soup time for me! I made a great soup yesterday and need to finish the leftovers

Beef (cheap cuts), chopped into fine chunks, about a pound. You can use ground beef too if you prefer
A medium onion, chopped
5 large potatoes, grated
1/2 cup corn
1/2 cup peas
1/2 cup carrots
1 can cream of mushroom soup
1 cup sour cream
1 cup half and half
2 cups water
Garlic
Worcestershire sauce
dried parsley

Cook the beef until brown the onions until translucent, add garlic, dried parsley and a dash of Worcestershire sauce. Add the water, carrots, potatoes, and mushroom soup, and cook until done. Then I add the other veggies and the half and half and sour cream. Salt and pepper to taste.

Progress

I fell off the wagon big time as far as recording my food. I don't know quite what happened, I got busy and sidetracked.

It seemed as if I had a couple pounds weight loss, could be water fluctuation...but now I'm back right where I was, 215 pounds.

I think my free weight loss is over, and it was worth it. My sleep apnea, diabetes and hypertension are gone. I want to take off at least 50 more pounds though...I'm going to have to do this on my own.

White flour and sugar have to be completely out of my life. The sugar has been gone, but the white flour sneaks in.

White flour is the Devil

I admit it, I've done badly at recording and charting my food. But I have been trying to watch what I eat the past few days.

I discovered white flour does not work for me at all. I get gas and abdominal trouble big time.

I'll ban flour from my diet also and see how it works.

Healthy at any size?

Being fat in this culture is frickin' miserable.

But I don't doubt some can be healthy and fat...200, 250 pounds for the average female may not be a big problem as far as health. I see ladies weighing 230 or so who get around great, have none of the diseases of obesity and look and feel fabulous. Weight loss surgery isn't for them and an ethical surgeon wouldn't consider it, nor would insurance pay for it.

Those are the people who should preach and teach healthy at any size. The problem is when fat moves into morbid obesity...when you're hurting from the effects of obesity...then defining yourself as healthy moves into the realm of denial.

You move through life huffing and puffing, sweat pouring out of your pores as you negotiate a flight of stairs. You often have sleep apnea or diabetes or painful joints. If you don't have them yet, as the years go by into middle-age, you're primed to get these problems. Running is an impossibility, swimming mostly an embarrassment and biking simply doesn't work.

No fool, you know your job and romantic opportunities are more limited by your morbid obesity. Your quality of life undeniably suffers no matter how much confidence you manage to muster up.

You desperately try diet after diet. Your body wars with you. You try and try but it is as necessary and natural as drinking enough water to eat enough to maintain your weight. The prattle about healthy at any size is reduced to bullshit for the morbidly obese. Your life is undeniably cut short by your bulk.

Most small-sized people couldn't get up to 300 pounds plus if they tried. Their bodies simply won't allow them to carry that much weight. If we have the genotype where we can get that fat--it's damn near impossible to lose unless there is an actual famine, hunter gatherer style. Nowhere in the first world supports that sort of lifestyle. We are throwbacks, anachronisms that will die sooner because of the complications of our inherent metabolic disorders. Check out the Pima Indians.

Studies after studies along with boatloads of statistics tell us the only solid way to take weight off and keep it off if you're morbidly obese is weight loss surgery. Other methods work about as well as playing the lottery if you want to get rich.

So merely fat (such as Joy Nash and the like) can indeed be fine and healthy, but the line drawn between health and suffering complications of obesity is a gray one of varying widths. It's not for anyone else to tell anybody when and where it should be drawn.

Not losing weight

I've been stalled at around 213 pounds for at least a month.

It's time to get real. The first thing to do is to record every morsel I put in my mouth. I'll use fitday.com. Not that anybody visits, but I'll also write my food diary here to keep it honest.

With the DS, I can eat fat since I only digest 20% of it. I have to keep my protein intake high, as it's crucial and I only digest 50% of it. carbohydrates are the nutrients to watch. I hear whole grains and whole vegetable starches such as potatoes aren't bad, but refined and simple carbs such as white flour and sugar are the killers. I digest 60-80% of carbs, 90-100% of sugars.

I haven't been eating candy or cookies, but sandwiches and crackers have snuck into my diet, in what I thought were moderate amounts. They'll have to go. I'll keep modest amounts of potato in and maybe a little whole grain and monitor how it affects me.

I haven't had a lot of gas, but I notice it's increasing. Not enough to bother me terribly...but I see if cutting back on the carb makes any difference.

Here goes.

Fat people on television

I'm down a few pounds...I think my weight ups and downs are simply natural fluctuations. I think I should weigh only once a month. This will take some discipline, but is worth it I think. The first is good.

I looked at that show...can't recall the name. It's like the bachelorette with fat girls. More to Love, that's it. A lot of the women really weren't that fat. They were tall, 5'8" or 5'9" weighing in at around 190.

I'm 5'5". If I go with the five pounds per inch rule, their 190 would be my 170-175. I didn't really consider myself fat at that weight and wouldn't again.

I'm between 212 and 215 now and feel I've lost most of my fat mojo down to pleasingly plump. Those chicks who are miserable and said they felt as if they could never be loved or wanted because of their fat? Sheesh, how unrealistic is that?

Speaking of unrealistic. The kid got the Paul Blart: Mall Cop DVD and I watched alongside her. The movie was predictably terrible, but what struck me is it was basically a running joke on the dim witted fat guy.

Worst, the woman he fell for was more than skinny. She was a twig, a size 0 at most. This is what Americans consider normal. The fat guy got the prize when he got the skinny e.g. beautiful girl. They showed him married previously to a fat woman and she was all things bad and ugly. so even the fat guy won't consider a normal sized girl.

We hardly ever see images of normal sized people in the media unless they are characterized as zaftig or plump. The average normal size in America is size 12 or 14 and the fashion industry considers that plus sized. Something is wrong with this picture.

The skinny women on television irritate me. But the show where they have the fat people dancing is degrading. I can't watch it. The Diva show on Lifetime is good. That is one show with a fat heroine that I recommend.

Weight Gain Blues

I'm five and a half months out. I've lost 70 pounds. Recently, I've put back a few more, around five.

I don't quite know what to make of this. I'm leaning toward water weight gain. My joints are mildly swollen.

I am eating more, not a whole lot of carbs though. I'm eating more because my stomach is finally able to take in real food such as meat with sauces and other textured foods.

I don't think I'll panic at this point. I really want to lose at least at least another 25 pounds and more like 75. I'll up the protein and chalk it up to water weight due to RA inflammation. I'll keep weighing to keep track of it.

If the weight doesn't swing downwards again, I'll need to modify my diet. First thing would be to keep track of what I eat. Fitday.com is good for this, I hear. I'll keep you posted.

My old time eighties stomach staple

I had this in 1982. I was around 22. What I remember most is how abusive my surgeon was. They served me a soft diet, bland meal and I nibbled on it. When he came to see me, he threw a tantrum. he left me in tears.

In nursing school, I was working the OR and the same asshole threw a piece of bloody, cancerous colon at a nurse for not being fast enough with the bowl. He needed his butt whipped in a big way.

I was young, I tolerated the surgery well and healed quickly.

I'd battled weight my entire life, since childhood. It was the one thing out of my control. I had weight loss surgery because it seemed to be the only answer for me. But it was a fail.

The stomach staple simply never worked. When my surgeon went in for a VBG in the mid nineties, they say they saw little evidence that staple lines were ever there.

Rich Curried Chicken

This is my first attempt at one of my own recipes. I generally am not a measure sort of cook, so amounts are estimated.

Chop up 4 potatoes,

2 onions and

2 or 3 apples, depending on size. Cook these until almost soft in a stick of real butter.

(This recipes is NOT low fat. But we DSers can snarf all the fat we want).

I added about eight boneless, skinless chicken thighs cut into strips. You can use breasts if you like. Skinless is best.

Then I added

3T curry powder

2T flour

Stir everything around, brown the chicken to take the pink off and

Pour in 1 can, 14 oz, of coconut milk

Add 1/2 cup raisins (optional) for that yummy unexpected sweetness

and about 1 tsp of red pepper flakes, less if you don't like spicy.

I add a 1/2 cup sour cream

and about a cup of water

and simmer for a while to meld all the flavors together, at least half an hour...

Add 1/2 cup green peas or garbanzo peas to finish.

Yum!

Curcumin

I've been taking this the last month, just one rather large capsule a day, 900mg, because I wanted a protectant against the toxins in the appreciable amounts of fat I'm releasing in my blood. since I now have rheumatoid arthritis, I also like it for its anit inflammatory properties. It's also supposed to do a lot of other stuff, but who knows. It doesn't hurt to try it though.

From Wikipedia

In vitro and animal studies have suggested the curcumin may have antitumor, antioxidant, antiarthritic, anti-amyloid, anti-ischemic, and anti-inflammatory properties. Anti-inflammatory properties may be due to inhibition of eicosanoid biosynthesis. In addition it may be effective in treating malaria, prevention of cervical cancer, and may interfere with the replication of the HIV virus. In HIV, it appears to act by interfering with P300/CREB-binding protein (CBP). It is also hepatoprotective. A 2008 study at Michigan State University showed that low concentrations of curcumin interfere with Herpes simplex virus-1 (HSV-1) replication. The same study showed that curcumin inhibited the recruitment of RNA polymerase II to viral DNA, thus inhibiting the transcription of the viral DNA. This effect was shown to be independent of effect on histone acetyltransferase activities of p300/CBP.A previous (1999) study performed at University of Cincinnati indicated that curcumin is significantly associated with protection from infection by HSV-2 in animal models of intravaginal infections.
Curcumin acts as a free radical scavenger and antioxidant, inhibiting lipid peroxidation and oxidative DNA damage. Curcuminoids induce glutathione S-transferase and are potent inhibitors of cytochrome P450.

Dangers of taking too much of the stuff

Kawanishi et al. (2005) remarked that curcumin, like many antioxidants, can be a "double-edged sword" where in the test tube, anti-cancer and antioxidant effects may be seen in addition to pro-oxidant effects. Carcinogenic effects are inferred from interference with the p53 tumor suppressor pathway, an important factor in human colon cancer. Carcinogenic and LD50 tests in mice and rats, however, have failed to establish a relationship between tumorogenesis and administration of curcumin in turmeric oleoresin at >98% concentrations.
In animal studies, hair loss (alopecia) and lowering of blood pressure have been reported.
Clinical studies in humans with high doses (2–12 grams) of curcumin have shown few side effects, with some subjects reporting mild nausea or diarrhea. More recently, curcumin was found to alter iron metabolism by chelating iron and suppressing the protein hepcidin, potentially causing iron deficiency in susceptible patients.

I might go up to two capsules a day though (around 2 grams). This RA is kicking my butt. Fat and an element of black pepper, piperine, helps with its absorption. The LA Times had a great article on it, citing that despite all the test tube studies, there's little hard evidence as far as human studies that it helps. But it doesn't hurt. At least if you don't take craploads of the stuff

Cole agrees that there's little downside to trying curcumin. Because the compound is so poorly absorbed, he sees little potential for harm. Studies have found that people can take 7 grams a day without side effects, although it’s possible that larger doses, or use over longer periods of time, can upset the stomach and perhaps increase the risk of bleeding.

LA Times

Hmm. I think I'll go make some chicken curry now :-)

Vitamin regimen

I take the basics to start

I'm supposed to take a separate ADEK and was referred to sourcecf.com to get the chewables (children, bubblegum flavor). My doc said the bariatric advantage multis high in ADEK were fine though. I just finished my first bottle.

Those damn things are high priced and taste nasty though. They ring in at about $40 a bottle for a two month supply. I just ordered the multivitmin caps from vitalady.com that don't seem that different as far as nutrients. They run almost $40 (throwing in shipping expense) for a three month supply...a bit better.

I'm swallowing pills better now. I also got six bags of chewable chocolate calcium citrate with D, ten bucks a bag, but I bought five and got one free. Once these are done, I think I'm going to the Calcium Citrate pills at Wal-mart. They run $15 for a twenty day supply (120 pills). They have more D and now I'm swallowing pills now, I'm not crazy about chewables. Or I might keep these bottles as a back up and order some suckable lozenges through vitalady. I have about three bags of chewables left. They're going fast.

Wal-Mart has stand alone dry D now. It's pretty cheap. I'm upping my D even though I don't have those labs yet. can't hurt. I bought the 400IU and the 2000IU. I'm taking an extra 400 with my citrate chews.

As far as iron, I take a Ferro-Sequels (ferrous fumarate) from Wal-greens. It's $22 for a three month supply and I'm pleased with it. It doesn't jack with my stomach or cause me constipation problems like iron has in the past and it seems to be holding my labs fairly steady. 11.9 hgb is great for me.

As far as other supplements, I try to get extra protein, one scoop (18 grams) in my coffee every morning, but I'm working at being more consistent at this. I take 20mg of generic prilosec twice a day.

I don't need my diabetic stuff, insulin and pills, or my high blood pressure meds anymore!

I ordered Omega 3 from cormega from vitalady because of my RA because of its anti inflammatory properties. Hope it helps. I also take curcumin with piperine once a day because it might have a protective effect because of my fat loss which releases toxins and its anti inflammatory properties.

Got my first labs

My surgery was February 4th, 2009. I was in the hospital intermittently for three months post op because of complications.

I've just been diagnosed with rheumatoid arthritis and was told that anemia often goes with. I'm newly menopausal (last period was Dec. 2008) and that stems some blood loss.

CBC

WBC 6.9

RBC 4.84

Hgb 11.9 low (normal is 12.0-16.0, so I'm almost normal. This is great for me. I was eight point something in the hospital and needed transfusions)

Hct 37.4

MCV 77.2 (normal 80-96)

MCH 24.5 (normal 28-34)

MCHC 31.7 (normal 32-360

RDW 18.8 (normal 11.5-14.8)

All the white blood cells are normal and

Platelets 232

Vitamin B12 637 normal

Folate 25.3 high (normal is 2-20)

TIBC/Iron tests pending

A1C was 5.9! Goodbye diabetes!

BUN 6 low (normal 9-23)

Potassium 3.1 low (normal 3.3-5.5)

Everything else on the panel was normal including calcium, protein and albumin.

I get more tests in three months.

New Medical Diagnosis

Apparently, I have rheumatoid arthritis.  I had terrible pain, joint swelling, fever of 101 back in April/May.  I could barely walk and had to be assisted to the bathroom.  My surgeon was jumpy because of all  my prior problems post-op and promptly admitted me when my mother called him.

I was referred to a rhematologist by my surgeon and the rheumy gave me medrol (a steroid) IV.  It was like magic.  The swelling went down and boom, I was fixed.  It took this long to see him at his office.  He said I had RA (verified by bloodwork too) and said if I didn't take RA meds for treatment, there was an 85% chance for joint damage with severe disability in the future.

Well, dang.  Then I looked over at the RA meds and checked my insurance.  The ones on TV, the biologics (Humira, Orencia, Embrel) are incredibly expensive...as in around $1500 a month.  They don't come in pill format and must be injected.  My insurance would only pay 70% of these types of drugs.  Remicade you get IV in the hospital every couple of months and it costs $1200-$1800 a pop.  I can't afford several hundred dollars a month for one med.  The biologics zap your immune system, leaving you open for infections and at higher risk for lymphoma.  Just dandy.

Then there's the DMARDS such as methotrexate and arava, nasty drugs too, but my insurance pays for most of these.  Lots of side effects.

In the meantime there are NSAIDS and corticosteroids.  I was on prednisone a month or so ago and it dampened my looming flareup right down.


The rheumy told me to take 1600 mg of ibuprofen a day without fail.  Prednisone is hell on the tummy too.  Even with 20mg of Prilosec twice a day, what is that going to do to my poor stomach?

Ah, hell.  I think the RA was triggered either by the trauma of surgery or some med I had during my extensive hospitalization.

Menopause was also triggered.  My last period was the month before my surgery in January and it's July now.  With everything else going on, I'm not noticing any menopausal grief such as hot flashes or mood swings.  I guess being period-free is good for my tendency to low iron.

And sob!  My hair is coming out by the handfuls for the past couple of months.  I have male pattern baldness like all the men in my family!   It's too hot outside to contemplate a wig, a weave or even a headwrap.  At least my receding hairline is cool.

I suppose this is enough moaning for now.  On the bright side, I lost another pound, 71 pounds total.  Just got labs drawn, I'll call Monday for the results.  My tube has been pulled too and that's much better.  My diabetes is resolved, my sleep apnea gone and my high blood pressure much better.

What happened after my DS

Here it is...I replied to a lady who's going in for a DS with the same surgeon.  Last February Dunshee and Stewart (who has since moved) said they've done around fifty DS.  I'm sure it's more now.

Dr. Dunshee is very good.  Dr. Anthone trained him.  I have faith in him...but I had two WLS before and was a very complicated revision.  He said I was the most difficult surgery he ever did, period, and he's done lots.  Dr. Stewart (he just relocated and is no longer with the practice) assisted him with the surgery and also follow up procedures (EGDS, stent placement).  Also an excellent doctor.

I had complications...they basically had to reconstruct my stomach, which was a mass of scar tissue... I was on the table six hours, the longest time they've ever taken doing a DS.  My blood pressure dropped dangerously after surgery and I had to have blood transfusions...was admitted to ICU.  Dr. Dunshee came and inserted a central line and I was put on Dopamine to stabilize.

I was in the hospital in and out over three months, ICU twice.  Dr. Dunshee pulled me through.  I know I would have died with a lesser surgeon.  He was attentive, caring and pro-active along with being technically adept, but most importantly, did not try to rush in with multiple dangerous surgeries as some would have done and killed me.  (I'm a RN, I know the drill).

At the time it was hellacious though.  I couldn't eat or drink for months.  Did tube feedings.  I still have my tube in.  Revisions are the toughest surgeries.

But now I'm back on track and eating!  Doing good.  Lost 70 pounds so far!  Struggling to get protein in...drinking shakes.  I can eat all the soft stuff with small amounts of soft meats and recently salads.  I missed salad terribly.  Will probably get the tube out soon, but i use it to take big pills (I crush them) and anything nasty.

It's a big surgery, not a light and breezy thing like some make it out to be...but for me it was worth it.  I think I made the right decision with sticking with Dunshee and going through with the surgery.  My sleep apnea and diabetes are gone and my high BP is lower.

P.S.  My common channel is 100 cm.  

Marriage and WLS

A quote

The more interesting mental-health discovery he and his colleagues made, Pories says, were the effects the surgery had on people’s marriages. “If the woman married when she was thin, had kids, became obese, and then had the surgery, the marriage almost always got a lot better,” he explains. (An estimated 75 percent of all bariatric patients are female.) “But if the woman married someone while she was obese and then became pretty . . . well, then she found a job. Got her colors done. Felt better about herself. And almost every one of those marriages ended in divorce.”

When I'm thin, or normal, men are easy. I got married too fast when I became normal weight. I should have waited and been more picky. I could have. But I chose the first man who would take me, my biological clock clicking loudly. I wanted a child.
I can't escape the knowledge that to most men, I'm nothing but a body. Fat, I've always been unacceptable. Only if the outer package is acceptable will they bother to examine the contents. It doesn't make me value men very much. If women are judged by their sexual attractiveness, women need to judge men of the size of their wallets or their penises, or whatever else they have to offer us.
So what does the above quote say about the fat women who are married? That their men are insecure enough that when they become attractive/desired, their sorry men will leave them. Or do they leave their sorry men? It doesn't say. Maybe both. Men who married thin women are happy with the changes. Woe to the woman who gets fat while married. He may stay if he feel he has too--but the love is gone. Again there are no stats about how often women are abandoned because of physical deterioration. Often, I'm sure.

Rich person's surgery?

I'm sorta frustrated since I'm on a limited income. I want the DS, but it seems it's a surgery tailored to only people with lots of money.

Some could say this about obesity surgery in general though, with the hassle of getting insurnace to cover it.

The good thing is now Medicare and many Medicaid programs do cover it.

But that doesn't mean a person of limited means can have the DS. First, you usually have to travel to find an experienced surgeon. Some of these won't take Medicare or Medicaid so your pool is further limited.

The ONLY way I can afford to have mine is to have it in Topeka where my mother lives--the DS surgeons in Colorado are particularly greedy and don't take poorer people's insurance--only insurances that pay them at a premium. The Topeka surgeons seem to be just starting to do the DS, although they are experienced in other surgeries and revisions with good stats--the DS experience simply isn't there yet. It's a scary situation for me. But I don't have the money to buy experience. Medical care shouldn't depend onone's amount of money--but this is America and it's all about the money.

There is controversy about the Medicare Advantage programs. I'm enrolled in one. More providers take it because it pays at the higher Blue Cross Blue shield rate than the lower Medicare rate. This is a freebie giveaway to the health providers from the government because the care isn't any different despite the increased cost. But Bush and his cronies are all about government welfare and handouts for rich corporations and the wealthy. Hopefully, Obama will cut this waste out and mandate that providers take care of sick people for reasonable payment as other civilized countries do.

We should start calling it what it is--greed. Medical professionals should be able to make a good living, but not to be greedy. Greed doesn't go well with caring for patients.

As it is now the DS is an operation for people with the resources to afford it...hopefully one day it will be an operation for those who need it, regardless of their resources.