In this episode, as I promised in my last episode, I bring back Dr Walter Medlin of the Bariatric Medicine Institute in Salt Lake City, Utah to talk about the bariatric surgery known generally as Duodenal Switch, but commonly called the “D.S.” Now for those of you new to the podcast, welcome, I’ve got over 90 past episodes for you to dive into! If you are not familiar with Dr Medlin, he has been a guest on this podcast a few different times. Here. Here. Here. And Here. He is a bariatric surgeon and he is also a bariatric surgery patient, having had Sleeve Gastrectomy, so he brings a unique dual perspective to the conversation.

This episode is both technical, because we have to get into the nitty-gritty of what is actually done to create the DS and, as always, it is conversation style because, well, that’s how we roll. Regarding the technical aspects of this conversation, if you find yourself lost in the verbal descriptions of the GI tract and how it is altered with the DS surgery, then I recommend you go to my website,, to look at the illustrations I have put there because, well, a picture really is worth a thousand words.

But before I cut to the episode, I want to give a shout-out to my new Patrons at These are listeners who have gone above and beyond in their appreciation of the podcast to offer financial backing. Huge shout out to Sandra R., Missy V., Michelle D., Bonnie B., and Marcia T.

If you, dear listener, want to become a supporting member of the podcast for as little as 1$ per month, head on over to and sign on up.

Discussed in this episode:

  • Is there a correct way to pronounce Duodenal? Dew-OH-DE-nahl or Du-WAH-den-nahl? Both are correct.
  • The GI tract from beginning to end. Mouth > Esophagus > Stomach > Pylorus > Duodenum > Jejunum > Ileum > Ileo-Cecal Valve > Ascending Colon > Transverse Colon > Descending Colon > Sigmoid Colon > Rectum > Anus.
  • DS and Roux-en-Y gastric Bypass both “short-circuit” the bowel.
  • DS: The Stomach is “sleeved.” Then the duodenum is divided in half approximately one inch below the Pylorus.
  • The Pylorus regulates the flow of food into the small intestines, which means the risk for Dumping Syndrome is less.
  • The long-term risk for gastric ulcers is much higher in Roux-en-Y Gastric Bypass (RYGB) than in either Sleeve Gastrectomy or Duodenal Switch.
  • The standard, aka “traditional” DS is called Biliopancreatic Duodenal Switch (BPDS) (see drawing below). It bypasses A LOT of small bowel, leaving approximately 1-2 feet of functional small bowel. The result is a higher risk of dehydration, diarrhea, malnutrition, and foul smelling gas. BPDS:
  • The newer Loop DS (see drawing below) bypasses less small intestine, leaving approximately 300cm or 9-10 feet of functioning small bowel. The result is a much lower risk of diarrhea. Loop DS:
  • In order to make the length of the functioning section of the DS, the surgeon begins measuring from the Ileo-Cecal valve.
  • Once the length is measured, the duodenum is divided in half approximately one inch below the pylorus and the Ileum is connected, sewn to, the duodenum just below the pylorus, thus creating a Duodeno-ileostomy. This creates the “Loop” part of the DS.
  • Before the Duodeno-ilestomy is created, the surgeon performs the sleeve gastrectomy.
  • The remaining Duodenum is not removed. Bile and Pancreatic enzymes still enter the Duodenum and flow down the duodenum, past the Duodeno-ileostomy and into the “common channel.”
  • One of the risks to a Loop DS is that bile and pancreatic enzymes can reflux up into the sleeve stomach but in order for this to happen, the enzymes would need to pass through the pylorus, which is possible but does not happen often because the pylorus is a very strong tubular muscle that is pushing stomach contents downstream.
  • Loop Duodenal Switch can also be correctly called Single Anastomosis Duodeno-ileostomy with Sleeve (SADI-S) or Stomach Intestinal Pylorus-Sparing Surgery (SIPS).
  • The “Classic” duodenal switch, BPDS, involves two anastomoses. Some would consider this a more complicated surgery to perform, with higher risks.
  • Why might a bariatric surgeon choose to NOT perform DS? The anatomy around the duodenum is complicated with higher risk for injury to surrounding tissue.
  • The benefits to the Loop DS is better weight loss, less risk of gastric ulcers, and less risk of internal hernia compared to Gastric Bypass.
  • Sometimes DS is a “staged” surgery, meaning the first operation is the Sleeve Gastrectomy and then months later the surgeon performs the duodeno-ileostomy part of the surgery.
  • The risks of Loop DS are few but do include diarrhea, gastric reflux, foul smelling gas (farts), vitamin deficiencies (especially fat soluble vitamins, A,D,E,K) if not taking vitamins regularly

Connecting with Dr Medlin
Twitter: @bonuslife
Bariatric Practice: Bariatric Medicine Institute

Connecting with Reeger

I believe in you



Dr Medlin Goes to ObesityWeek2017

by reeger on December 4, 2017


In this episode we have a special guest-host, Dr Walter Medlin. Dr Medlin takes us along with him has a experiences ObesityWeek2017. ObesityWeek is an annual conference hosted by the American Society for Metabolic and Bariatric Surgery (ASMBS) and The Obesity Society (TOS).  If you are not familiar with Dr Medlin, he is a bariatric surgeon in practice in Salt Lake City, Utah. Additionally, he is a bariatric surgery patient, having had sleeve gastrectomy. From this dual vantage point he has interesting perspectives and knowledge to share.

Reeger’s Preamble: Dr Medlin and I will co-host a Q&A podcast in the near future. Email your questions to me at Sorry this episode is late- I have been very busy. Thank you to my new patrons at Patreon!!

Dr Medlin discusses in this episode:

  • If you should and how you might to talk to people you do not know about their obesity.
  • The importance of self-care, even, or especially when you are really busy.
  • ASMBS committees Dr Medlin is involved with.
  • Challenges to get new information out in the world using social media and why many practices are reluctant to do so.
  • The importance of delivering value in medicine.
  • The truth that even though surgeons can seem stuffy or intimidating, really they are genuine in their desire to make the world a better place.
  • The future of mathematical modeling to help make predictions of outcomes and response to surgery.
  • The ongoing role of expectation management.
  • Fear of Missing Out (FOMO) and how conferences can sometimes feel like being back in high school and trying to figure out where you fit in.
  • Dr Manoel Galvao Neto – the “everywhere guy” for all things endoscopy-related for the treatment of obesity.
  • Dr Medlin shares a story caused by eating too much meatloaf.
  • The importance of sometimes letting experiences come to you rather than feeling like you have to always chase them down. But at the same time, be willing to take risks and step out of your comfort zone.
  • The future of bariatric surgery might not include as many Roux-en-Y gastric bypasses.
  • The future will include more sleeve gastrectomies.
  • Duodenal Switch has become a much safer operation than in the past and we will probably be seeing it used more in the future.
  • The change in language from “failure” to “non-responders” or “regainers” speaks to the important evolution of both patient-centered care and our understanding of obesity as a complicated, chronic disease.
  • Medicine should move slow in a careful way, but not slow in a “reluctant to change” way.
  • The frustration surgeons feel regarding insurance companies role in dictating what can be offered to patients.
  • A new therapy to help treat sleeve gastrectomy leaks: Endoluminal Vacuum Therapy.
  • The growing trend of looking at second-line therapies, which may or may not include surgery, in recognition that obesity is a complicated chronic disease and that one surgery might not be the only treatment a person needs.
  • Dr Medlin’s analogy between car engines and trying to understand what causes of obesity.
  • The predicted role of Loop Duodenal Switch in the future for sleeve gastrectomy non-responders or regainers.
  • In the era of patient-centered care, we don’t define what a patient needs. We define what is reasonable to offer.
  • Reeger’s concluding thoughts.

WLSP Facebook

Dr Walt Medlin on Twitter





Why Follow-Up Matters

by reeger on October 22, 2017


Why Follow-upMatters

Welcome to the WLSP where we talk about obesity and BS one episode at a time. I’m your host, family nurse practitioner, Reeger Cortell. In this episode I am going to give you the breakdown on why follow-up matters after bariatric surgery in 11 reasons. When I started crafting this episode I knew I wanted to list the reasons why follow-up matters but I didn’t know how many reasons I would come up. Well the number is 11, go figure.

Before I get to that, I want to give a shout-out to my new patrons over at These are listeners who have gone above and beyond in their appreciation of the podcast to offer financial backing. Huge shout-out to Teresa Silbert, Christine Hepburn, Lane, and Marianne Baxter.

You folks are the best. Thank you so much.

If you, dear listener, want to become a supporting member of the podcast for as little as 1$ per month, head on over to Patreon and sign on up. There is also a link on my website,

Discussed in this episode:

  • A tribute to some of the hardships people have faced in the past month.
  • Why I love getting emails from listeners.
  • Christine’s email question regarding set-point after bariatric surgery.
  • Another listeners request that I dedicate an episode to why follow-up matters.
  • Tying these two questions together.
  • Why bariatric surgery is not like other surgeries.
  • The importance of education and commitment.
  • If weight gain is going to start after surgery when is the most common time of year (for Americans) I see it starting.
  • How your metabolism is like the heating system in your home and fat mass is the temperature that gets regulated.
  • How my office visits begin at Southern Oregon Bariatric Center.
  • Our Inbody BIA Scale.
  • The 11 Reasons Why Follow-up Matters- We go over: 1) Nutrition 2) Vitamins 3) Hydration 4) Physical Activtiy 5) Weight 6) Labs 7) Emotional Health 8) Co-disease monitoring 9) Subjective: How do you feel/what else is going on 10) Physical Exam 11) Coming up with a Plan.
  • Concluding thoughts.
  • Halloween jokes told by my husband, Adam.

Resources Mentioned
InBody BIA Scale
Geisinger Get 2 Goal App
Dr Connie Stapleton, PhD free weekly Facebook Live event
Dr Michelle May, “Am I Hungry”
Brene Brown PhD
Indirect Calorimetry

Connecting with me:


I believe in you.


087 Mary Rogers of “Experience 50 – The Podcast” Interviews Reeger Cortell FNP

September 24, 2017

In this episode I talk with fellow podcaster Mary Rogers of the “Experience 50, The Podcast.” Mary’s podcast explores life from the perspective of people in their 50’s. She asked me to be a guest on her podcast because many of her listeners have concerns about their health and if weight is one of those […]

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086 It’s Never Too Late with Zoe Belle

August 26, 2017

In this episode I have a conversation with Zoe Belle, author of “Queen of Crop“ which is a book version of the weekly blog she kept for the first 14 months after her bariatric surgery. After a life-long struggle with her weight and a consideration of bariatric surgery for all of one month, Zoe, who was […]

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085 Elizabeth Anderson RD- Healing Your Relationship with Food

July 23, 2017

In this episode I talk with Elizabeth Anderson MA, RD, LD. Elizabeth has been a Registered Dietitian for more than 16 years and has worked in community nutrition, industry, and clinical settings. She began her own counseling practice, lovingly called CrackerJack Nutrition in 2013 as a way to work exclusively with people on a bariatric surgery […]

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084 Obesity, Metabolic Disorders, and Bariatric Surgery as a Friend: A Conversation with Bariatric Surgeon Dr Samer Mattar

June 25, 2017

In this episode I have a conversation with Dr Samer Mattar. Dr Mattar is a bariatric surgeon and director of bariatric surgery at Swedish Medical Center in Seattle, Washington. Additionally, he is the president-elect of the American Society for Metabolic and Bariatric Surgery. In this episode Dr Mattar shares thoughts on: Why he chose to […]

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083 Reeger Rambles

May 21, 2017

This episode is unique in that I follow a free-form monologue method. I had some thoughts I wanted to share with you and so I decided to simply open the mic and start talking to you. Let me know what you think. Discussed in this episode: Gratitude to my new Patreon Super Fans Happenings over […]

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082 Understanding Post-Bariatric Surgery Reactive Hypoglycemia

April 16, 2017

In this episode I talk with Jerry Ross about his experiences with post-bariatric surgery reactive hypoglycemia. Jerry had Roux-en-Y gastric bypass in 2002 when he was in his early thirties. Although the fact that Jerry had RYGB is central to this story, gastric bypass alone is not the reason Jerry and I recorded this conversation. […]

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081 Moving Forward with Laura Van Tuyl

March 19, 2017

In this episode I have a conversation with Laura Van Tuyl. April, 2017 is Laura’s 14th Barisurgaversary for having Roux-en-Y Gastric Bypass. We talk about many aspects of her journey but some of the highlights include her thoughts of how being a very picky eater as a child contributed in part to her eating habits as […]

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080 They Didn’t Staple My Brain- A conversation with Dr Janine Kyrillos

February 13, 2017

In this episode I have a conversation with Dr Janine Kyrillos. Dr Kyrillos is Clinical Assistant Professor of Medicine at Jefferson Medical College in Philadelphia, Pennsylvania and she is Director of Jefferson Comprehensive Weight Management Program at Bala Cynwyd, Pennsylvania. She is also someone who herself is affected by obesity and has undergone Roux-en-Y Gastric […]

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079 Bariatric Surgery Seminar as a Podcast

January 9, 2017

Happy New Year everyone! In this episode I bring you a podcast version of the bariatric surgery seminar I give twice monthly at Southern Oregon Bariatric Center. This version is more generic to bariatric surgery in general because my intent is not to tell you specifics about SOBC, but rather introduce you to important concepts […]

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078 Gathering Knowledge with Amy Swayzee

December 11, 2016

In this episode I talk with Amy Swayzee who had gastric sleeve in May of 2015. We talk about her life before bariatric surgery, how she came to the realization that bariatric surgery was not cheating or the easy way, and that if she was finally going to bring her weight under control perhaps she […]

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076 What to Eat with Sarah Muntel, RD

October 16, 2016

In this episode I bring you my conversation with registered dietician, Sarah Muntel. Sarah has been a registered dietician in bariatric surgery for over 17 years. She brings a wealth of information and education to you in this episode. Covered in this episode: Sarah’s role as a registered dietician and program coordinator Pre-surgery nutrition plans […]

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075 Bariatric Surgery Rules? A talk with Dr Walter Medlin

September 11, 2016

In this episode I have a conversation with Dr. Walter Medlin about bariatric surgery rules. You may remember Dr. Medlin from episode 53. He is a bariatric surgeon at the Bariatric Medicine Institute in Salt Lake City, Utah. He is also a bariatric surgery patient having had sleeve gastrectomy. During this conversation Dr Medlin and I […]

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074 (Unedited) Set Point, Biology, Environment & Obesity: An Interview with Dr Randy Seeley

August 8, 2016

What you are about to hear is the unedited version of my most popular episode to date: Episode 34, titled “Set Point, Biology, Environment & Obesity: An Interview with Dr Randy Seeley.” I first published the edited version of this conversation on August 17th 2014. Over the past two years that episode has had the […]

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073 How to Choose a Bariatric Surgery Program with John Bukenas

July 12, 2016

In this episode I welcome back John Bukenas. We explore how to choose a bariatric surgery program. If you are new to the podcast, John and I have talked about his obesity and the possibility of bariatric surgery in episodes 26 and 45. Topics discussed in the episode John’s struggles and declining health First Step: […]

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072 “Hey Reeger..,” A Letter from a Listener

June 17, 2016

Welcome to the weight loss surgery podcast where we talk about obesity and bariatric surgery one episode at a time. I’m your host, family nurse practitioner, Reeger Cortell. This episode is brought to you by you, my listeners. I am so touched by the love you show me, whether that is iTunes rates, sharing the […]

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071 Jeff Newell: On Gaining a New Life

May 31, 2016

In this episode Jeff Newell returns to the podcast to catch us up on his life since having Roux-en-Y Gastric Bypass on 12/1/2014. Jeff has been on the podcast before on episodes 055, 049, 043, and 042. He is now 18 month out from his surgery and 300 pounds down from his pre-surgery weight of […]

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070 Reeger Cortell FNP: An Interview by Rob Portinga

May 9, 2016

Presenting Your Host, Reeger Cortell, FNP Over the last 18 months or so, I, Rob Portinga, have had the pleasure of going from being a guest, to being a contributing host on the Weight Loss Surgery Podcast (WLSP). It was started by Reeger Cortel, FNP nearly three years ago now. One of the driving themes, and […]

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