Revision Question....

Hey Everyone! So, I've heard the term 'revison' being used on the board, and I have questions as to what that really is. My surgeon says most people do not need revisions, they need to revise the way they are eating and going back to the basic rules. How does a surgeon determine who needs a 'revision' and who doesn't. And how many kinds of revisions are there? Doesn't there have to be some physical changes in your pouch/stoma documented (like in Reenie's case)? If someone is eating more due to stress or simply not changing their old habits, and they gain their weight back, yet there is nothing wrong with the original surgery, how does one qualify for a revision? I'd like to know what people's experiences are regarding revisions and their surgeons. Thanks everyone!! Joanie

Joanie, I don't really know what defines a revision, I haven't really researched it; guess I should. My understanding from the doctor that is performing my endoscopy suture is that this is not a 'revision' - which I think means going back in and shrinking the size of the pouch because it has stretch out due to overeating, a procedure that requires open or laproscopic surgery - what I'm getting done is "tightening" the stoma, which has dilated to 32 mil. when it should be at around 10 mil. I don't know why my stoma has dilated so much but my pouch remains quite small. If you recall through my many posts about this over the past few years, my bloodwork has always shown that I am not absorbing nutrients, particularly protein, well - even though I have always focused on taken in suffiicient amounts of protein, between 60-100 grams a day. According to this doctor, this is because the food that I eat - especially the protein shakes - dump immediately into my small intestine because my stoma is too large, so I am being hit with the calories but without the benefit of absorbing the nutients because the food doesn't stay in my pouch long enough to break it down. Hopefully, this procedure will remedy that. Hope this helps, sweetheart. I need to tell you, my husband read your posts to me about my fears about doing this and he said, "What a wonderful person she is!" You've been a very good friend to me, Joanie, thank you. Love, Reenie

I know that you're situation is different, I even discussed it with my surgeon. I know you are not getting a revision, rather a correction of something your doctor has physical evidence that isn't right with your stoma. You have always gone by the book with everything you were told, and this I know. And I also remember that your bloods weren't always quite right, and that did make me wonder. However, I do hear the term 'revision' thrown around quite a bit, for different reasons. I am thankful and grateful that I don't need any type of revisions done, but I am curious to know what they are and who needs them and how that is determined. Maybe I'll google it or something..... Again, you are going to be just fine with this little thing you need done. Don't listen to the nurse about the pain...everyone is different with that kind of thing. Love ya! Joanie

Hey Joanie, My problem is the same as Reenie's I'm just having a different outcome. My pouch is a good size but my stoma has opened up too wide. I'm looking into the stomaphyx. My blood work has been great but I have had some regain in spite of following the rules most of the time. I also had to have an endoscope to take a look to see what is going on. I've asked why the stoma has opened up like that and was told that it happens alot. I don't think they know why is does. Some doc's say that it is the body working to overcome the surgery. I have not heard of anyone being able to get this or other procudures like it done without having a scope done. Sadly overeating and non-compliance is not always the cause of problems such as I am having. That at least would be something I could work on. I will keeping working on it........I refuse to go back to where I came from!!!!! Take care..................Betsy

Thanks for the response, Betsy. You, like Reenie, had tests done to find a reason for your weight gain, and a physical reason was found....and I think that's a good thing because you know what it is and that it can be fixed. When I asked my surgeon about the enlarged opening of the stoma, he said he found it to be very rare, and judges his criteria on what the person is eating versus how fast the weight came on and how suddenly. Bloodwork results also play a big part in the picture. As we all know, WLS patients are regaining at an alarming rate for a variety of reasons. I think research needs to be done to examine these reasons and to find out why this is happening. For example, if it is due to poor eating habits in some patients, is it because they were not properly informed of the behavior modification needed to be successful, or were they not a good candidate for the surgery? Perhaps further psychological investigation needed to be done to make sure the patient had the ability to comply with the rules. Maybe food addictions need to be examined more closely before surgery is performed. If it is a physical reason, such as yours and Reenie's, can something be done during the surgical process to make sure the organs stay intact so the patient does not experience weight gain? How many people have issues with the stoma being too big because that was how the surgery was done initally? We know that many 'outsiders' (non WLS patients) feel the surgery is the magic bullet to weight loss and that once we get the surgery and lose the weight we never have to think about it again. WLS patients, especially people 4 years out like we are, know this is the furthest thing from the truth. What I find distressing is the amount of people who are ill prepared for this fact and end up in failure. And what further distresses me are the people who have had the surgery, gaining weight, and due to the emotional nature of the situation, are not getting themselves checked out physically and just feeling like they failed. Ok, guys, the ball is in your court. What do you think? Joanie

Joanie, I know that after we had surgery, they came out with some sort of ring that was implanted. I'm not sure why or where it went, but I'm wondering if that was to address the stoma issues. A local woman had what she and her doctor called a revision. It involved going from a proximal rny to a distal rny. Essentially just bypassing more of the small intestine. My understanding is that the body becomes adept at absorbing calories again and the malabsorption benefits that we had in the beginning are no longer present so a revision to distal jump starts the malabsorption again. This particular woman was going to have the stomaphyx procedure, but because she had a partial intestinal blockage and had to have an open procedure to address that anyway, decided to go ahead with the "revision." I've always felt that we have no idea what we are doing to our bodies long-term when we decide to have surgery. Frankly, I just don't think enough is known about the long-term effects, the causes of obesity nor do we have any real solutions. It bothers me that we are an obese nation and we become unhealthier by the day. On my television right now is chunky Emeril Lagasse who is cooking a very rich Bernaise sauce. Before him was Paula Dean who was cooking everything drenched in butter. FoodTv is Pudge Porn and cooking shows that show healthy recipes just don't sell. The McLean sandwich didn't do well at McDonald's. What is missing in our lives that we are nourishing our souls with fat and grease? My weight loss surgeon was on TV the other morning. This woman saved my life four years ago and I haven't seen her since. She's heavy and I wouldn't have recognized her if I met her on the street. This is a woman who has a staff that includes therapists that specialize in eating disorders, nutritionists, exercise physiologists and she has still gained a good amount of weight over the last 4 years. My first selfish thought was "If she can't keep weight off, what chance do I have?" After I felt guilty about that selfish thought and pulled my head out of my butt, I thought "What must be going on in her life that even with all the resources available to her, she's found comfort in food?" I think we are an emotionally broken society. We can surgically alter our bodies to counteract the ravages of obesity that we have inflicted upon ourselves, but as long as we are self-medicating with food and using calories to soothe what ails us, we will continue to eat through one medical procedure after another. I'm an intelligent person and I realize that what I put in my mouth will impact my health and weight. My surgeon provided me with more than adequate education on after surgery eating behaviors to make me successful. I even had to pass a written test before she would operate. The long and short of it is that food is my drug of choice. It has been there for me through thick and thin - literally. It has soothed my aching heart and calmed my rattled nerves. Food has been my abusive lover and understanding therapist for most of my life and until I finally figure out how to redefine the relationship I have with food, I will be a potential candidate for a revision. Hugs, Connie

I know I could have drafted this precisely the way you have, you have sung my anthem in this post. It takes courage, Connie, to say this outloud and with such conviction. My question to you is why have you not seen your surgeon since your surgery? Have you not had any followup care from her or her staff? Not that mine is involved at all - I have my 4 year post-op appt. scheduled and he'll breeze in, take a look at my bloodwork results, tell me I'm doing fine and see you in a year. He will not be interested in hearing about my struggles, to which he would only refer me to his nutritionist - after all I'm not addressing my problems unless I'm working with HIS staff - they have to be paid after all. I am somewhat cynical these days but mostly I just want to do whatever I can to keep the weight off, stay fit and strong, and be helpful whenever and wherever I can. You are completely and absolutely right on with everything you say here. We are up against it, that's all there is to it. The only weapon I know of that will keep the weight off is to find your passions and live them - channel that energy that we give so easily to food - redirect it to living the hell out of life. It's a choice. It's not easy. Choosing food is easy. Getting up in the morning and walking hard for 4 miles because I CAN, well that's not the easy choice but it sure feels better than eating crap food. Getting on my horse and riding through her issues until my legs are aching and shaking from the effort, that sure isn't the easy choice but it is my passion these days. And every day I find myself thinking what the hell is a 51 year old woman doing with a horse who spooks when you say "boo" anyway, I think because I CAN - 4 years ago I couldn't stand next to a horse for too long because I was so fat. Passionate living is not easy but it's what I always go back to when I'm in trouble with the food. I've missed you very much and the tone of your posts make me wonder if you're ok - how is your back? How is the Man? How are you? Love, Reenie

Hey Reenie, Six months after my surgery, my surgeon stopped accepting my insurance, but she was willing to see me for the screaming discounted price of 120.00 a visit. Her policy was to see you for one pre-op visit, your surgery and then again at your one year check up. Other than that, her staff handled all visits. I guess there are two ways to look at that 1) It's efficient, staff are capable of handling most things and she can save more lives. 2) It's efficient, staff are capable of handling most things and she can make more money. I really do feel that she is a gifted surgeon and she has an excellent program, I just think I was left in a lurch when she no longer accepted my insurance. It turned out OK because my pcp has been awesome about keeping up with my blood work and he's very thorough. I need to get back in and see him because when I was hospitalized in November, my protein, blood calcium and pretty much everything else was in the toilet, but he didn't know if that was because I was sooooo sick and dehydrated or because there was something else going on. I was supposed to pump up the protein and vitamins and get back to him for more blood work in January. I spaced it because my focus has been the back so thanks for reminding me. I'll make an appointment tomorrow. I'm really doing OK. The back is miserable and I'm having trouble coming to grips with not being able to do all I want to do. For cripes sake, it hurts to fart. Every time I fart, I get a shooting pain down my left leg. Never take farting for granted. I hold everything in for as long as I can and when the stomach hates me, I brace for the pain and let loose. Don't even get me started on a bowel movement. I know, TMI. Tired of living on medications that make me gain weight and swell up like a toad. I think part of what bothers me is that I really thought all these back issues would go away when the weight did, but there was just too much damage. Somehow, I'll find a way to work through this. Just had another MRI so we'll see what that shows and where we go from here. The Man is great and a huge help to me and my back woes. He's good for me because he monitors my craziness and I know I'm going to get an earful if I overdo it. His mother (really his grandmother who adopted him) turned 102 last week. We had a huge party for her here at the house and I think she had a great time. This week, my own grandmother who is 92 fell and broke her hip. We all emotionally prepared for her death because the doctor gave her zero chance of surviving the surgery. So far, not only did she survive the surgery, but she is doing better than someone half her age. Knowing that I come from that stock is somehow comforting. My father is starting home dialysis and I'm taking classes to help with that. Before I'm done, I'll know more about kidneys and blood than I ever wanted to know. So that is pretty much my world these days... bad back, good man, old ladies and cleaning blood. How is Devin? I think of you two often. Love ya, Connie