Tuesday, July 15, 2008

More on Reactive Hypoglycemia and Duodenal Switch Weight Loss Surgery

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Bobblehead, the day before his weight loss surgery: Weight 383 pounds.


Bobblehead last month, weight 180 pounds.

I have been following Jane's blog on her journey after Duodenal Switch 6 years ago. As a matter of fact, she was the first in the UK to have duodenal switch gastric bypass surgery. As I was writing my post on connections between WLS and reactive hypoglycemia Jane posted an article about gastric bypass as a possible cure for diabetes, even more than a sample group who just lost weight. Her blog, Dances with DS, is here: http://satorijane.com/blog/

I emailed Jane and mentioned some of what I was going through. I asked her to consider referring back to Atomic City. She wrote me back, and yes, she reads my blog on a regular basis as I do hers.

Jane is 6 years out, I am 5 1/2 years out. It is uncommon to see a weight loss patient continue to blog about WLS that far out. Being "thin" is "normal" for me, now (though I still see a 400 pound man in the mirror, not one at 180 pounds). Jane and I both want to give accurate pictures of weight loss surgery. It is not a magic bullet nor an easy way out. If you are considering WLS, you should be exposed to all of the information: The good, the bad, and the ugly.

Jane asked me some specific questions. I think it is in everyone's best interest to answer them via a blog. I have nothing to hide. Besides, she is asking good questions.

Jane: I was wondering not long ago on my blog about this very condition when I heard of several RNYers (Roux-en-Y Gastric Bypass) struggling to deal with it. I wonder how many of us DSers are out there suffering from it. Do you know of any others?

Bobblehead: The literature I read only mentions RnY specifically or generic "gastric bypass." The connection is that DS patients have a RnY. Basically, that is a reshaping the small intestine into a "Y" shape where actual digestion only takes place in a "common channel" right before the large intestine. In my case, the common channel is 100 cm long. Earlier patients had the length set arbitrarily. Later surgeries based it on a ratio compared back to the total length of the small intestine. As far as I can tell, I am the only DS patient I know about with this reactive hypoglycemia but I do not believe it. I would bet money that the ratio of RnY patients to DS patients on this is about 1.0. That portion of anatomy change is consistent.Reactive Hypoglycemia is similar to dumping, though, at least in reactions. Dumping occurs when food passes out of the "pouch" of an RnY patient quickly into the duodenum. The body responds by "dumping" a large amount of insulin into the blood. RnY patients usually only experience this with simple carbohydrates (especially alcohol) and can often balance this effect off with protein. Not me. Even a low carb high protein bar will cause my insulin levels to rise and my sugar to plummet. DS patients do not traditionally dump as the anatomy of the stomach entrance into the duodenum is unaltered where it is altered in RnY.
Jane: You say you had headaches - ouch - they sound really painful ... did you have any other 'leading up symptoms?'
Bobblehead: My headaches usually do not hurt my head...ah, the joys of basilar migraines. I see other clear triggers such as drops in air pressure and spinning motions (probably due to my inner ear problems). Flashing lights and other visual stimulation can bring on an attack. So can fatigue. But so far, with my glucose in check, it is clear to me that the main culprit is my hypoglycemia.
Jane: Where you diabetic pre-op? Do you need a special diet of any kind?
Bobblehead: I was not diabetic, although I had Metabolic Syndrome. I figured out that I cannot control this via nutrition. I cut out all raw sugars, went to only whole foods, high protein...Bobbleheadilicous no matter what.
Jane: Did you tell Dr Hess about this?
Bobblehead: I emailed Hess (my surgeon) via his web page. He is retired. He never wrote back. HELP: If anyone has contact information for Hess, please email it to me. You can reach me via the sidebar on the right side of this blog or leave a comment.
And, of course, we shared information on dogs. I have four. A Labrador, a Siberian Husky, a Pug, and a Chihuahua. And three cats, four...wait five birds as Mrs. Bobblehead text messaged me to tell me she bought a baby green-cheeked conure (now our second) in Texas on Sunday...Yes, it is a zoo.
Hope this helps.

[posted by ♠ Bobblehead ♠]