Reversal.......really?

I've been in and out of the hospital the past few weeks due to complications from an anastomotic ulcer.  Well, I'm home again and doing much much better thanks to TPN feedings and IV Protonix.  Before I went home from the hospital my surgeon said if this didn't work then a reversal was the next step.  I dind't respond to him because I was in shock.  It seems to me that revision would be the next logical step.  I felt like he was just aggravated I wasn't getting any better and that if I had a reversal he wouldn't have to deal with me anymore.  Do all surgeons not perform revisions?  With where my ulcer is (the stoma between my pouch and intestines) I wouldn't see how a reversal could be any easier than a revision.  My immeadiate reaction is to seek an opinion from a different surgeon if I don't get any better.  Fortunately, I think giving my stomach a break is exactly what I need.  I wasn't able to get in anywhere near enough protein before due to pain and vomiting.  Now I'm getting 90g a day with my TPN plus I feel well enough that I can get in an extra 20-30g daily with a shake.  I'll gradually increase my shakes, but I was warned not to exceed 300 calories a day with shakes because I'm already getting 1100 a day through my TPN.  I can go over 300 but my weight loss would likely stop.  The dietician has me on the lowest amount of TPN that she could put me on to get in adequate calories.  I think she did that to make me worry less about gaining.  I know if I gain it will come right off when I'm off TPN though.

Anyway, should I be concerned that reversal was his first suggestion if the TPN doesn't work?  I just feel like that is such a huge step and I'm not comfortable with it at all.  I did this to get my health back and one stupid complication isn't going to convince me that a reversal is necessary.

I have suffered from 3 ulcers in less than a year all of them located where yours is.  for me the trick was Carafate and Nexium when I was out of the hospital.  I take nexium twice daily and as long as I don't skip I am good.  When taking the nexium I open the capsule and empty it on my tongue and swallow it with  dose of carafate.

The Carafate creates a slimy coating on your stomach lining to protect it from the acids.  Nexium and Protonix do pretty much the same thing.  I would fight a reversal at all costs especially if this is your first.  Unfortunately these things do occur but if you push through they can be totally worth it.

Thanks Paul.  This is my first that is what boggles my mind.  I've had it for close to 3 months with no healing despite Carafate 6 times a day and Protonix 40mg twice daily.  They sent me home on Nexium and to continue the Carafate.  Plus they are giving me Protonix through my IV.  I think the issue was I couldn't stop throwing up which didn't allow most of the meds to get absorbed and kept irritating my pouch. 

I just don't see how a reversal could be the next step.  Granted I don't have a medical degree, but I'm not willing to have a reversal over a stupid ulcer.  I'll live with the ulcer pain first.

when you are able to do the nexium make sure you open the cap and empty it into your mouth. 

 I had issues and a hernia and carafate and protonix is what helped me. I was in the hospital so many times and my surgeon threatened me with a reversal. I think he was almost doing it because he thought I was failing on purpose or something. Anyway, in my opionion, I think a reversal is absolutely the last option and I've heard of surgeons threatening a reversal but not actually meaning it...like mine. I would say if he really is set on getting you a reversal then you should get a second opinion. A second opinion wouldn't hurt. I'm glad I didn't get a reversal. I was really really close to getting one.

That's such a ****ty scare tactic.  Why would anyone fail this on purpose?  It's not like I enjoy vomitting and being in so much pain I can't speak.  I guess they thought I'd rather be in the hospital than be home enjoying life with my children.  I feel like they wouldn't of sent me home on TPN unless I had *****ed about them doing nothing.  If there was another surgeon closer I would see about switching.  If I have to switch to another surgeon within the state I will, but I have a feeling that I would be hard pressed to find one willing to take on another surgeon's "problem".  

I'm so glad you're doing better.  For some reason my body just wasn't responding to the Protonix and Carafate.  From what I've read it's pretty rare for them not to heal, but not totally unheard of.  I'm praying that keeping me on the TPN for a few weeks is what I need.  

I would seek a second opinion before having a reversal, yeah.  I don't know enough about it to have an opinion about whether or not it might be warranted in your case (I know, I have opinions about almost everything, but not this) but if it was me, I'd only want a reversal if there really were no other good options.

"(I know, I have opinions about almost everything, but not this)"

I had to LOL at this.  Your opinions are all based in fact and if it weren't for you voicing them a lot of people would go without vitamins they need. 

I feel like a reversal is only okay when it is life and death.  My having an ulcer isn't a life and death situation.  Yeah it's a pain in the ass, but I can live with it.  I just scheduled an appointment with a local GI doctor for a second opinion.  I think a new set of eyes will probably do me some good.  Honestly had I of not *****ed I probably wouldn't be on TPN right now.  I felt like after being admitted 3 times they had to do something different.  What they were doing (nothing) wasn't doing crap and I just ended up rehospitalized with severe dehydration 4-5 days later.

MANY surgeons who do RNYs do NOT do reversals and some will not do revisions (depending on WHAT needs revised).  I can understand why they don't do reversals, since a reversal is actually much more complicated (and carries higher risks) than the original surgery (and probably more so than a revision), but I would think that any surgeon who is competent to do a RNY in the first place should be competent to do a revision of the stoma area.

Several of us suggested to Katie that her surgeon was using the threat of reversal as a scare tactic and I would say the same thing to you... that it is possible he is using it as you suggested (or is using it to get you to just quit "complaining" about the ulcers).  Yes, it is a crappy tactic, but -- sadly -- I have heard of several surgeons using it (mostly with people with vomiting that is not explained by any physical problem such as a stricture... I think those surgeons believe the patient is being overly dramatic or vomiting on purpose or just refusing to eat (thinking it will help them lose weight even faster) and that if they threaten them with taking away thier weight loss tool, they will "straighten up".

Definitely get a second opinion if you think he is serious about a reversal!  I'm so sorry you are havign to deal with the stress of all of this.

Lora

From what I understand from my surgeon...
both revisions and reversals are very complicated. My surgeon is talking about a revision for my ulcer. It's in the exact spot yours is. I've also been in and out of the hospital. Seems like the cool thing to do, right? LOL. I've been talking about the TPN with my dr's. So far they seem to not want to do that for me. I just want to get all of my nutrients and protein in that I'm lacking, but its not what they want to do yet. I don't know what to tell you because I'm in the same  boat. Noone seems to want to do anything bu****ch. It's terribly frustrating when you feel awful and just want some answers. I hope that they figure something out for you soon. I'll keep you in my prayers.