stormy D.
Useful DS Info
May 02, 2009
Flagyl W/O Rx- Per LeaAnn's Blog
I'm getting a lot of requests for the link on how to get Flagyl without a prescription, so I'll just post it here so no one misses it:
http://www.lambriarvetsupply.com/i_001TLZOL-100_Fish-Zole
These are the 250 mg. so you'll need to take TWO of these 3 x a week, OR there are also some 500 mg. available on that same site. The tablets taste gawdawful, so put them WAY back on your tongue to swallow them and swallow them with something strong tasting (lemonade) or milk....
Here is a portion of published medical text on the need for antibiotics because of bacterial overgrowth [in our bypassed loop of intestine] (supplied by our excellent resident Nurse Practitioner, Carolyn):
From: http://www.oley.org/lifeline/bacter.html
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EXCELLENT ANIMATION OF DS SURGERY |
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Not to be construed as medical advice, this list includes labs we have had performed as gastric bypass patients. The first group, every 3 to 6 months for life, as we are able. The second group, annually, as long as the results were comfortably within normal limits for more than 2 years in a row.
1st Group
*80053 Comprehensive Metabolic profile: (sodium, potassium, chloride, glucose,BUN, creatinine, calcium, total protein, albumin, total bilirubin, alkaline phosphatase, aspartate aminotransferase) (10231)
* 84134 Pre-albumin:
* 7600 Lipid profile: (cholesterol, HDL, LDL, triglycerides, chol/HDL ratio)
* 10256 Hep panel: includes ALT (SPGT) & GGT)
* 84100 Phosphorous – Inorganic: (718)
* 83735 Magnesium:
* 84550 Uric Acid: (905)
* 7444 Thyroid panel: (T3U, T4, FTI, TSH) (84437; 84443; 84479; 84480)
* 85025 Hemogram with platelets: (1759)
* 7573 Iron: TIBC, % sat
* 83550 Ferritin: (457)
* 84630 Zinc: (945)
* 84446 Vitamin A: (921)
* 82306 Vitamin D: (25-hydroxy) (680)
* 84052 Vitamin B-1: (Thiamin) (4052)
* 84207 Vitamin B-6: (Pyridoxine)
* 7065 Vitamin B-12 & Folate: (82607; 82746)
* 83970 Serum intact: PTH
* 83937 Osteocalcin:
* 84597 Vitamin K:
* 85610 PT:
* 85730 PTT:
* 86141 C Reactive Protein
2ND GROUP
* 593 LDH:
* 31789 Homocysteine, Cardio:
* 83921 MMA:
* 367 Cortisol:
* 84255 Selenium:
* 84590 Vitamin E:
* 82525 Copper:
For diabetics: *496 - HEMOGLOBIN A1C
POSSIBLE DIAGNOSIS CODES
269.2 Hypovitaminosis
269.8 Vitamin D deficiency
275.40 Calcium deficiency
266.2 Cyanocobalamin deficiency (B12)
281.1 other B12 deficiency anemia
281.0 Pernicious anemia
280.9 Iron-deficiency anemia
281.2 Folate deficiency anemia
285.9 Anemia, unspecified
269.3 Zinc deficiency
244.9 Hypothryoidism
250.0 Diabetes
401.9 Hypertension
276.9 Electrolyte and fluid disorders
272.0 Hypercholesterolemia
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
*579.3 Surgical malabsorption*
*579.8 Intestinal malabsorption *
* Bands or sleeves should not use these codes as they are not accurate.
*Some insurance companies will not pay for any procedure that uses these codes.
This is NOT medical advice, just my own targets for the main blood levels I watch.
Protein: 7's
Albumin: 4's
Pre-Albumin: 20-30's
Iron: 80-100
Ferritin: 200-300
HGB: 12+
HCT: 36+
Vit A: 60- 80
Vit D: 80-120
Calcium: 9.0-9.4
PTH: 20-40
Vit B1: Mid to top of range
Vit B6: Mid to top of range
Magnesium: Mid range (but also go by if we have leg/foot cramping)
Zinc: Mid range
Vit B12: 1000 +
Folate: Top of range
AST (sgot): Below 40
ALT (sgpt): Below 40
We usually want to "meet or beat" pre-op levels. In some cases, higher is better, and in other cases (Cholesterol, PTH for example), lower is better.
The only things *I* don't mind being on the high end of out of range are Ferritin and B12. But that applies to ME.
My doctors don't show interest in any of these until I am out of range. *I* am interested when I begin heading that direction.
lab rat chart
http://www.epursimuove.com/ds/
ds procedure~~from Lori
A short and easy description of the DS procedure
Duodenal Switch
This procedure modestly restricts food intake while radically limiting the absorption of calories, especially the obesity causing calories from fat, complex carbohydrates, and starches. Approximately 3/4 of the stomach is removed, but the natural outlet of the stomach, the pylorus, is left in, allowing the stomach pouch to function more naturally. As the stomach pouch stretches out in the first year after surgery, patients are moderately limited in the amount of food they can eat, reduced to about 2/3 of what they could eat before surgery. However, patients are not limited in the types of food they are able to eat, tolerating meats and whole vegetables without difficulty.
The food is rerouted through a radically altered intestine, limiting the amount of food that is absorbed, which is what results in weight loss, despite the patient eating freely. The intestine is essentially reduced to less than half of its length and the digestive juices (the biliopancreatic secretions) mix with the food at only the last 10% of the intestine. This arrangement means that not only are the total amount of calories eaten not absorbed, but especially fats, complex carbohydrates, and starches - the things that contribute to obesity.
Patients undergoing duodenal switch eat normally and have bowel habit changes characterized by frequent (2-4 per day) soft stools and a propensity for gas. Both of which are generally malodorous unless a stool deodorant (such as Devrom) is taken.
| A | The stomach is trimmed to a 4-6 ounce volume, preserving its natural inlet and outlet ( the pylorus). Trimming the stomach results in a temporary restrictive effect on eating for several months, which then reverts to normal, and decreases the incidence of ulcer formation as well. |
| B | The small intestine that the stomach normally empties into (the duodenum) is "switched" to the downstream portion of the small intestine (the digestive limb-D). The outflow from the duodenum, carrying the digestive juices and enzymes (but no food) becomes the bilio-pancreatic limb (C) utilizing approximately 60% of the small intestines length. |
| D | The digestive limb takes up approximately 40% of the small bowel length, and most of this length is upstream from where the biliopancreatic limb deposits its juices to allow for the absorption of fats, starches, and complex carbohydrates. |
| E | The common limb, being the portion of intestine where both food and biliopancreatic outflow meet, is made up of the most downstream 100 cm of small intestine and is the only portion where absorption of dietary starches, fats, and complex carbohydrates occurs. The capacity for absorption reaches a maximum within several months after surgery and cannot be over eaten, resulting in long term sustained weight loss.. |
| F | The gallbladder and appendix are removed. |
rny vs. ds~~from hayley_hayley
RNY compared to the DS
RNY – expected weight loss
- 50-65% expected excess weight loss (percentage varies in opinion – this is the most commonly seen estimate)
- Results may vary
- Regain
- Possible regain: more prevalent after 5 years
- 50-100% regain of weight has been recorded
- Results may vary
- Must follow “pouch rules” in an attempt to not regain
DS – expected weight loss
- Results may vary
- Possible regain: more prevalent after 5 years
- 50-100% regain of weight has been recorded
- Results may vary
- Must follow “pouch rules” in an attempt to not regain
- 85% expected excess weight loss
- Results may vary
- Regain
- Studies show little to no regain (20 pounds recorded)
- Results may vary
- Highest success rate over 10 year study (78% avg. Excess Weight Loss – EWL)
- Size: 2 oz
- Stretch to average size of 6 oz in 2 years (possible to stretch up to 9-10 oz)
- You can eat more as time goes by
- Average after 1 year is 1-1.5 cups of food
- No Endoscopes on blind stomach/remnant stomach that is bypassed
- Doctor evaluation: cannot use an endoscope (to find ulcers and tumors)
- RYGBP construction makes the large bypassed distal stomach inaccessible to standard non-invasive diagnostic modalities. Neither x-ray contrast studies nor endoscopy can assess this potentially important but hidden area.
- Stoma: pouch
- Should not take Nonsteroidal Anti-Inflammatory drugs (NSAID).
- NSAIDs are: Advil, Alka Seltzer, Aleve, Anacin, Ascription, Aspirin, Bufferin, Coricidin, Cortisone, Dolobid, Empirin, Excedrin, Feldene, Fiorinol, Ibuprofen, Meclomen, Motrin, Nalfon, Naprosyn, Norgesic, Tolectin, Vanquish
- NSAIDs are used for arthritis, bursitis, tendonitis, back pain, headaches, and general aches and pains.
- Taking NSAIDs could develop into a bleeding ulcer and interfere with kidney function.
- Possible Problems
- Ulcers (Some doctors recommend taking prilosec for 6 months to 1/2 years in an attempt to prevent the ulcers)
- Possibility of a staple line failure
- Noncompliance: simply do not lose enough (even with following the rules)
- Vitamin Deficiencies
- Narrowing/blockage of the stoma
- Vomiting if food is not properly chewed or if food is eaten to quickly
- Dumping syndrome, NIPHS, Hypoglycemia
- No Valve (pyloric valve that opens and closes to let food enter intestines is bypassed) which means food empties directly into the small intestines and causes dumping and/or can cause NIPHS or Hypoglycemia
- Dumping: food (most commonly sugar but not necessarily “just” sugar) enters/dumps directly into small intestines and causes physical pain (some people believe this pain enforces good eating habits)
- Dumping varies in degree of occurrence and discomfort
- Dumping symptoms:
- Nausea
- Vomiting
- Bloated stomach
- Diarrhea
- Excessive sweating
- Increased bowel sounds
- Dizziness
- “Emotional” reactions
- NIPHS (insulin over production): “the body overproduces insulin in response to food entering the intestines at a point where food would normally be more digested already - this part of the intestine is not used to coping with metabolizing glucose in the condition it arrives after RNY, and it is suspected that the intestine signals the pancreas for more insulin to aid digestion, causing a MASSIVE overproduction. The change occurs on a cellular level, hard to diagnose. Treatment: Removal of half the pancreas.”
- RNY stoma that is created allows food to go straight through the stomach into the small intestine unrestricted so it does not control the flow. Because of that the body reads that it needs more insulin because the food is moving through so quickly and it thinks there's going to be a lot more food. With the DS, the normal peristalsis works because the pyloric valve is in place and can control the movement of food into the small intestines.
- NIPHS, Hypoglycemia is deadly if not corrected
- “Whole working stomach” - meaning the stomach’s outer curvature is removed as opposed to making a pouch/stoma.
- Part of the stomach removed is where most of the hormone called Grehlin is produced.
- Grehlin gives the sensation of hunger so by removing most of that section of the stomach a DSer is not as hungry as before.
- Whole working stomach: no blind stomach. Endoscope can be used.
- Can take NSAIDs
- Do not need to take Prilosec to prevent ulcers.
- Valves are in tack: no Dumping Syndrome or NIPHS
- Eat protein first
- 60g of protein a day
- Recommended to chew food to liquid consistency (pureed, soft, thoroughly chewed)
- This is more important for people early out (new pouch stomach will stretch out with time).
- Food is thoroughly chewed to prevent blockage (the hole/path leaving the stomach and into the intestine is roughly the size of a dime).
- To get food unstuck, patients drink meat tenderizer mixed with water.
- Low carbohydrates
- Carbohydrates can slow weight loss and lead to possible regain
- Avoid sugars in particular (to prevent dumping syndrome)
- Low fat
- Foods high in fat may cause Dumping Syndrome
- Fatty foods can lead to slow weight loss or possible regain
- 64 oz of water
- Stop drinking within 15-30 minutes of a meal
- Do not begin drinking after a meal for 1-1.5 hours
- Some doctors do not encourage the use of a straw (pushes food too quickly through the stomach and can cause gas/discomfort)
- Water Loading
- 15 minutes before the next meal, drink as much as possible as fast as possible.
- Water loading will not work if you haven’t been drinking over the last few hours.
- You can water load at any time 2-3 hours before your next meal if you get hungry, which will cause a strong feeling of fullness.
- Disclaimer: this is a practice some people use to feel “full” and lose weight. Not a requirement.
DS – Eating
- Eat protein first
- 80-100g of protein
- DS patients can on average eat more food than any other type of weight loss surgery.
- Low carbohydrates
- Carbohydrates can slow the weight loss and lead to possible regain
- No dumping syndrome from eating sugar (or fat)
- Eat high in fat
- DS only absorb 20% of fat (do not need to eat low fat)
- If a taco has 20g of fat, a DSer only absorbs 4g while a person without surgery or RNY absorbs ALL 20g. (this is just an example, measuring absorption is not an exact science)
- When experiencing a “stall” (slowed weight loss/plateau) a DS patient commonly increases fat consumption to resolve
- DS only absorb 20% of fat (do not need to eat low fat)
- 64 oz of water
- Can drink with meals
- Can use a straw
RNY – Possible Issues
- Vitamin deficiencies: Must follow a vitamin regime for the rest of your life
- Common vitamin deficiencies found in vitamins B12, iron, and zinc
- Calcium must be supplemented for the rest of your life
- Bathroom issues
Antibiotics
If the dietary therapy is insufficient to control symptoms, it should be continued with the addition of antibiotics. Broad spectrum antibiotics, such as Bactrim and Flagyl, used continuously, at half the usual antibiotic dose, are often very effective. Trials of different antibiotics may be needed to find the right combination. In addition to Bactrim and Flagyl, we have found Augmentum and Keflex to be beneficial. Our most severe case of small bowel bacterial overgrowth was a child with short bowel syndrome who suffered severe d-lactic acidosis with seizures. He went through several treatment regimes before we identified oral Vancomycin, a potent antibiotic, as an effective measure to control his overgrowth. After the acute overgrowth has been controlled, antibiotic therapy may be required only for a few days out of every month or may be so severe as to require prolonged continuous therapy. If symptoms reappear after a few months, switching antibiotics is often necessary. We have seen no development of antibiotic resistant complications utilizing this therapy over prolonged periods of time, probably because of the lower doses utilized.
I also asked Carolyn about neuropathy and resistance concerns with the long-term use of Flagyl and she had this to say:
"The acute lethal dose of metronidazole in humans is not known. Neurotoxic effects, including seizures and peripheral neuropathy, have occurred in individuals who received 6–10.4 g of metronidazole orally every other day for 5–7 days for the treatment of malignant tumors. Nausea, vomiting, and ataxia without serious resultant toxicity have been reported in individuals who ingested up to 19.5 g of metronidazole in a single dose. The oral LD50 of metronidazole exceeds 5 g/kg in albino rats.
If acute overdosage of metronidazole occurs, symptomatic and supportive treatment should be initiated.
Above quoted from Medscape.
Please note neurotoxic dose is more than 12 times the usual prophylactic DS dose (250-500mg 3X a week). Your body processes it so that it is unlikely to "build up" to a toxic dose, unless you are in liver failure, in which case you would have other, more pressing concerns.
Intestinal flora that become resistant due to regular use of Flagyl is possible but not likely. Even if you were to develop a resistant strain of c. diff from regular routine use of Flagyl, for example, it would still be susceptible to and treatable with vancomycin.
Currently the only known resistance to Flagyl is some strains of trichomoniasis, an STD. It may reassure those of you who may be exposed to STD's that resistant strains of that bug can be treated with Tinadazol.
My advice is to use whatever means of gas amelioration works for you, that you are comfortable with, and that you can afford. Flagyl is not
