Don't know if I'm a DS revision candidate? (currently sleeved)

  Need serious help, my lovelies.

I would like to know my revision options.
I had the VSG 2 years ago and am now at 50% regain and am gaining even more.

Am I a candidate for a revision to DS?
Should I just get re-sleeved? (kinda hesitant to go that route again)

Backstory:

Weighed 240 lbs. (my highest weight was about 2 years earlier, 280lbs)
Got a sleeve in the Summer of 2009.

My sleeve must be too big because basically, I had very little restriction to begin with (I mean, after the initial swelling went down), so basically did everything with willpower and heavy exercise.
And by heavy exercise I mean hardcore balls-out bootcamp-type activities 2-3 hours per day 6 days per week.

I kept up the heavy exercise up until 3 months ago when it became so painful i went to the doctor. Turns out I have osteoarthritis and my knees are pretty much not working without shooting pains anymore. The only exercise i can do is swimming now, which just doesn't really cut it at all for me since I am restricted to just straight-legged freestyle and backstroke. (plus... it's FREEZING COLD now. lol) 

I was initially a great candidate for the sleeve, because i did have the desire to exercise a lot and even though I've been obese most of my life, I thought I was someone who just needed just a little restriction and willpower and heavy exercise could do the rest.

With this new arthritis curve, I am now disabled (I went from jogging just 6 months ago, to now sometimes having to use a cane) so heavy exercise is out of the question and forbidden by my docs.
But I REFUSE to get back up to 280, and I do believe I might make it there soon.

To add a bit more scariness to this, I am able to eat a full plate... actually more than a full plate. Of pretty much ANYTHING (except for rice, i have a hard time with it). Any protein or fat or carb you can think of pretty much slides down with ease. lol.

Can anyone point me to my options? 
Am a revision - to - DS candidate?
What are some doctors that even do this? (I am full self-pay and have no problems going outside of the States for a competant doctor)
If not, are there any other solutions I can look to? (i'm hesitant to get resleeved then gain again. i would feel like a triple-failure)
I am now 190 lbs and rapidly regaining. (i am 5'3", 37, female, my only comorbidity is my severe arthritis in both knees, and doc says soon in the ankles. yikes. )
Or maybe options that I am overlooking?

I remember reading when I was researching DS a long time ago, that it was originally done in two stages, at two separate times... sleeve, then switch. So perhaps there is a doctor willing to revisit that method with me and just able to do the switch? Also I know there are some differences, like the DS sleeve is larger because the switch makes it possible to not have to rely on restriction alone. But right now, my sleeve is feelin' pretty large :/

Thanks in advanced, and I hope everyone's progress and weight loss and happiness are going well :)

Why did you choose to have the sleeve only instead of the full DS? It actually wouldn't be considered a revision, just the switch part.  Usually the only time a DS is done in two parts is when the patient is so SMO that the doctor isn't comfortable working on someone that large for that long. I was over 300 pounds (5'3") and had the DS done at one time.

I think every doctor is different as far as the size of the sleeve. I'm sure someone will correct me if I'm wrong but I think any vetted DS doctor can do the switch alone since you've already got the sleeve (and you might want to be resleeved while they're in there since it sounds like its definitely stretched).

Janet, you have eased my mind so much with this. wow!
I just wasn't thinking of it the correct way, i was really thinking of it as a revision. I was so afraid i would be severely limited in my doctor selection. wheew!
 
"Why did you choose to have the sleeve only instead of the full DS?"

At the time I was researching it, it just wasn't possible for me to get the sleeve. I had no insurance, and it just wasn't possible for me to pay at all. The sleeve's a pretty expensive procedure ("the cadallac ;>  ) and I also didn't have the necessary resources for keeping up with my labs, supplements, etc without the luxury of insurance.
Plus, I did research the sleeve at first and my first two docs contacted said I wasn't a candidate because at my curent weight (i think at the time i was 230... i was like... uh... "lightweight my ass! lol") and the fact that i didn't have comorbids, it might not be the right surgery for me. 

I really enjoyed what the switch had to offer, and it was a good choice for then since I was looking forward to being very active.

Unfortunately being hit with rapid osteoarthritis has changed the game so now the sleeve just... well, isn't an option because I am disabled and unable to exercise. Different set of cir****tances now, thus re-evaluation of my options .

thanks for the help!

 oops, typo. i meant at the time DS was the "cadillac" that i could not afford and VSG was sufficient.

Well, if they won't look at you for the switch now, the time is sure coming :-(. Bummer.

I would suggest consulting with an experienced revision surgeon. Names that we like to mention here: Keshishian and Rabkin in CA, Daryl Stewart in TX, Kemmeter in MI, Greenbaum in NJ (though some of us have gotten hesitant to mention him for RNY to DS revision). I'm forgetting a couple others, including one in NY meto area.

These docs could talk to you about what getting just the intestinal part might do for you compared to getting your stomach further reduced (which is the far riskier part of such a procedure than the intestinal part) as well.

Since you are, unfortunately, moving in a direction of increased physical disability, you are wise to consider that your days of power exercising could very well be behind you and that you might now need the metabolic boost and the malabsorption that the DS provides.

If the consensus you get is that you should be sufficiently served with just the switch, then really any competent DS surgeon can do that, so you might find one closer to home. What's important with the consultation, though, is to get with one or more surgeons who have seen a LOT of revisions and know what they've seen results wise.

I don't know about the other docs I've just listed, but Dr. Ara Keshishian does a lot of consultation work via distance. Try contacting him through his site www.dssurgery.com and see how you might work out some kind of consult via phone and email or Skype.

 your info, especially your pre-op links are a goldmine. 
thank you.

and so weird, i thought the intestinal portion would have been the more dangerous. I'm glad to know then that I have undergone the riskier portion already. No complications there.

Looking up the ones in Cali right now, contacted Dr. Kemmel, will see about Dr. Rabkin as well. 

thanks again!

I think getting the switch part done (no re-sleeving) should do the trick. Do let us know how you work out. Because you aren't really a "revision" that opens you up to about any vetted DS surgeon around.

 this is really good to know.

EN gave you most of the best revision names, I would just add Dr. Roslin in NY.

Actually, the full DS came along well before the sleeve as a stand alone. It was only done in 2 parts for the few patients who, for medical reasons, could not have the whole thing done all at once, and someone noticed that some of these patients did well with just the sleeve, so now it's being tried, as you had, by itself. No one knows what the longterm results will be for large groups of people, some are already failing, and I suspect many of the successful ones will be the people who are able to exercise like crazy (which as you have learned may not last for life) and able to limit calories, carbs and fat for life.
     Turning again to your situation, it sounds like, for whatever reason, you never did get much restriction, and I suspect your stomach may need to be re-sleeved along with the intestinal portion of the DS. But certainly that's something to discuss with the surgeon.
    Oh, and whatever you do, don't get RNY, as you are going to need NSAIDs for those joints, and you can't take them ever again with RNY.

Larra

 Thanks, Larra. 
Will contact a lot of docs on the list, I also have to go with an affordable one. I know the DS is pricey, but definately the one i want :D

Thanks for the RNY advice!
haha. but don't worry, you're preachin' to the choir about the evils of rny's. rny marketing was so rampant in my last hometown and I saw so many people with so many severe complications that there's just no way in hell... lol.