I had RNY but have gained back weight.

I had RNY Gastric Bypass 8 years ago. I weighed 363lbs. at the beginning and never lost below 250 lbs. This year I have gained 35 lbs. Will Medicare pay for a revision or a lap band? I heard they require 18 moths of supervised dieting and documentation. I don't have that. I reallly have no documentation for the pass 4 years. I can't afford to to pay anything up front. I have osteoarthritis, Fibromyalgia, degenerative disc disease, stress incontinency, severe depression and anxiety attacks. Any and all advice would be appreciated. The only insurance that I have is Medicare, Part A & B Thanks!

Hi Dorothy, First, a 100+ lbs loss is somthing wonderful - celebrate it! Yes, you have gained back 35 lbs, but at least you have recognized what is happening and are looking to change the situation. Many people don't until it is too late. So don't beat yourself up over it. Have you discussed with your PCP how your meds interact? Can any of them be contributing to weight gain? Do you still see the surgeon who did your original weight loss surgery? Is there a local WLS support group you can attend? Call 800-Medicare for a list of bariatric surgeons in your area. What you can do right now is to visit your PCP and start a physician-supervised diet and exercise program. This is not only for your health, but also so when a surgeon tells you that you need a documented weight loss history you are on your way. Also, to make sure that you do not have a mechanical failure you will need to bring an upper GI report/CD to your new surgeon. There is a chance that you don't even need surgery again. As far as your surgery goes; assuming that you do not have a mechanical issue, I would suggest returning to your pouch rules as if you just had surgery yesterday. You still have the tool, try to work it by getting in the required protein, water, vitamins and exercise. Try to use a tracking program like http://www.fitday.com to track everything that goes in to your mouth. If you don't have access to a nutritionist or local support group, Weight Loss Surgery for Dummies has some great information that can help you along your renewed path. HTH, Kristen

Kristen, I don't mean to sound stupid or offensive, but I'm concerned about how it is possible to gain back weight, when as you said, we "still have the tool". Is it because the pouch stretches? Or eating the wrong foods? I guess I want to try to be preventative in avoiding these pitfalls instead of having to figure out how to deal with them when they happen. I really like reading your postings. You have great perspective and advice. Thanks so much! Karyn

Hi Karyn, Thank you, I am happy that my posts have been useful or interesting to some. I can tell you from my own experience that I have strayed from the pouch rules in the past and started to gain. I gained back a whopping 9 pounds early last month before I realized and put a stop to it. I started down the path to "soft calorie syndrome," which is when one will eat soft or even crunchy foods that aren't as nutritionally sound, just because they are easy to find and easy, even quick going down (things that would just slide by my pouch's silastic ring). I was completely complacent, not getting in my protein, water, even missed a few rounds of supplements. I still have no idea why I did this, except maybe in some way I was feeling, well, *invincible* since I had just celebrated my two-year re-birthday. I am not sure. What I do know is that once you start picking away at the formula for weight loss surgery success, like picking away at pieces of a puzzle, things will start to fall apart. That being said, some people do suffer mechanical failure of their pouch. Maybe it is something like a staple line disruption from an older surgery or even a gastro gastric fistula. Or frequently eating beyond the capacity of the pouch (which can cause things like vomiting, etc) which will in turn, morph into a mechanical failure. Even if someone can eat more than a 1/2 a cup of food, it is still a long way away from the 4+ cups we could eat pre-op. That is where the pouch rules come in. Sorry, I didn't mean to be so verbose. The best advice I can give anyone is to decide right now (assuming one hasn't already) how much weight you are willing to regain before taking action (i.e., better diet/pouch rules, exercise, consult with your surgeon or nut, etc.) For me, approaching 10 lbs gained sent me into panic mode, and now I am back down to where I was in early November before my slips. I hope this helps. Kristen

Thank you Kristin for your input. I have gone on liquid diets for over a month to try to shrink the pouch but it doesn't work. I am hungery within an hour of eating a small meal and then have to eat again. I am constantly hungery. I am talking real hunger pangs! Yes my meds work against the wt. loss but they are necessary. I am unable to exercise due to my knees and pain in hips and back. Medicare insists that you have surgery at a Center of Excellence before they will pay for any of it. My surgeon, in Gainsville, is now a Radiologist and does not do surgeries. I am seriously thinking about going to Mexico to have the Lap Band. The prices are excellent and the physicians are highly qualified. I had a friend who had a RNY Gastric Bypass there and she did beautifully. I have since spoken to others who have also gone there and they raved about their care. The all inclusive fee (flight, hotel, surgery, fees,food, everything) covered everything. For the lap band it was around $8500.00. The facilities were very modern and the staff spoke English. One girl just had plastic surgery there and she did beautifully. I just want to get this done. I can't stand always being hungery and I don't want to gain all of my weight back! Dorothy

Hi Dorothy, Our office does bands over bypass. If you have Medicare, it is $4895 for the surgeon's fee, surgeon's consultation and program fee (whi*****ludes all of your pre-op education plus the first year of doctors office visits and adjustments to the band). Medicare will cover 80% of the usual and customary for hospital and anesthesia. We are a Center of Excellence. If that is the way you want to go, look around and make the most informed choice that you possibly can. Take care, Kristen

Hello Kristen, Thank you for your prompt response. Where is your office located?Can I have the lap band done now or do I have to "weight" (pardon the pun) for 18 months. Do you do the procedure outpatient? I can get letters from my psychiatrist and psychologist stating it is necessary to have it done now. My Rehab specialist is my acting PCP but she hasn't been following me on any type of diet. She would write a letter stating it is was a necessary surgery though. I do not eat junk food or overly soft foods. I stop when I feel full. Unfortunately it takes more that it should to fill me up. I can easily eat a salad and an 8oz steak and about 1/2 of a baked potato to make me feel full. I always stop at the first sign of feeling full and always have. Medicare told me that it would depend on the diagnosis code and the procedure code as to whether or not they would pay for it. It seems no doctor wants to operate on another doctors surgery or you have to pay all of the money up front because they are afraid that Medicare will not pay. My doctor ordered a CT of the abdomen which was clear, however it didn't address the pouch.I have been having muscle spasms under my left rib cage that has gotten worse over the past few years. I picked up a 40 box of cat litter 4 weeks ago and it felt like something ripped or pulled, in that very same area. It was a sharp, stinging pain and the pain comes and goes. I guess I would need an upper GI series to determine mechanical failure or to see what is going on. Would a different test be better? Thank you for your advice and all of your knowledge. I didn't know that Medicare even covered the lap band. I thought it was only for gastric bypass or revisions. Any advice would help. I just can't wait for 18 months feeling like this. I am on disability and want to go back to work. I can't with the pain I am in. My knees are killing me as is my back! Thanks again! Regards, Dorothy

Hi Again Kristen, Is the $4895.00 my cost or what Medicare will pay? Will medicare pay for the hospital or is it done out patient? Where is your office and how soon can I get it done? I am having an Upper GI sometime next week. BTW your picture is beautiful. Maybe someday I won't be afraid to have my picture taken. Please answer ASAP. Dorothy

Hi Dorothy, I work at US Bariatric Orlando. If you want to call me this week, we can discuss the particulars. Definitely get an UGI done, though. My office number is 407-303-4506. Take care, Kristen

Dorothy- Have you considered having a revision to the DS? There are several people on the DS board who have had revisions from RNY. You can find the DS board at the link below -- why not post a message and hear from some of the folks that have had revisions. The DS is an approved Medicare procedure. Red http://obesityhelp.com/forums/ds/a,messageboard/board_id,5357/