RE-DOING GASTRIC BYPASS

Well here i go posting again. I had the surgery almost two years ago and i have only lost less then 100lbs, i know thats alot BUT!!!!!!! I'm still FAT. I admit my eating habits were not all that great but they were not all that bad either. I know of people who ate the same way before surgery and they are skinny. Do ya'll think that i should see a surgeon again and are they able to re-due my surgery?????? I workout every day for at least 5x a week and i do watch what i eat(sometimes) I have hyp-thyroidism well so i think,last time i checked was border line hyperthyroidism,anyways i have tried to go on basics again and then start to lose a few lbs but stop when i start solids again. I have sciatica and that comes and goes,when i do have it i cant workout for about a week and then thats when i go on "lil" binges anyhoo,i am trying my best. Thanks for leting me vent. Rosie

Hi Rosie, how are you . I just tried to get some info on your profile but not much there. I have to say you look great in the pics you have posted. Can i ask, how much did you start at and how much you are now? What is your BMI? Do you have support around you? Support groups or therapy? ANother weight loss surgery buddy to help you out? You took off 100 pounds and have kept that off and that is a great acomplishment. Sometimes our bodies dont agree with surgeons goals and we can do everything right and the scale just feels comfy where it is. So with a little more info maybe we can help you figure this out. Just dont forget the positive in this, you lost 100 pounds!!!!!!!! Lets go fromt here.....Hope to hear more from you. LisaMarie

Hey Rose, I have to say that you look great in your pictures. Your face is thin and defined. I think that sometimes we see ourselves differently than other people do, you have lost 100 pounds in less than a year....that is awesome....I don't have any real advice, because I am pre-op myself, but I just wanted to let you know that you have made a great accomplishment. Take care and God Bless. NoraLynn

Do you realize the accomplishment of losing 100 lbs.???? OMG. That is so amazing. It sounds to me like you are in a kind of rut right now. I don't know how much more you have to lose (you are a very attractive women BTW ) but perhaps you need a support group or a WW type atmosphere where you have to be accountable for your eating. Personally...if I could do what you did...I would hold off on surgery and try to kick butt on the rest of the weight. You can do it. You already proved it. I know you can. Maybe everyday you can post here about your daily menu. I'll join you. Take Care and many {{{hugs}}}

Rosie: I would need more info to respond to your post.... But even w/o this info consider this as a tool, the honeymoon is over and any wt loss/maintenance is up to you based on your lifestyle choices that are self responsible and consistent! Can yu provide us w/ this info so we can guide you? ALso consider realistic expectations, many feel they should be thin, but WLS is not meant to make people thin, only less obese, and healthier, some get thin but that is not the expectation..Sometimes a revision is necessary but if wt loss that is insufficenent (less than 50% excess) is due to habits such as grazing, drinking calories, not being active and less than optimal food choices then a revision is not usuallyindicated Any tool can be defeated! I believe un treated emotional issues at 2-3 yr postop are the root of a lot of regain, addressing them can be a help! Sadly we find this isnt the magic we thought it may be and realize the tremendous effort we must expend daily to be consistent, self aware and self responsible for it to last! WLS can afterall be a failed diet attempt and many have regained large amountsyes even all the wt. Stats show at 5, 10, 15 yrs most still have >50% excess gone, no diet can give close to that! So our vision and the acceptance of realistic goals is an issue to look at as well. Ok tell us more! SUCH AS: Age: Surgery type: Starting Wt/Ht: Current WT: Medications you take: Vitamins you take (timing, with others etc, doses): Medical diseases treated now? Exercise amount, intensity & times a week? Type? What r u eating in an average day (Go to www.fiitday.com and log it in! EYE OPENOR!~ need calories total, carbs/fats/protein percents. Do for 3 days at least for average... How much fluid do u drink?Carbonated?caffeinated? Calories in beverages? Do u drink protein shakes? Type, name, howmany? Mixed with? Last set of labs done when? What was done? last time u saw surgeon? Do u get full? Do you graze all day or eat 3 meals and one snack? What menu do u follow? (Lo carb?) Do u eat and drink together ever? Do u dump on fats/sugar? ~~~~~~~~~~~~~~~~~~~~~~` REALISTIC EXPECTATIONS; WHERE IT ALL STARTS! The surgical community considers anyone a success when they have lost 50% of their excess weight. Right here we have a problem. MANY approach this surgery expecting to lose 100% of thier excess weight. And if we don't, then we consider ourselves failures even though our surgeon is adding our name to their success column.The first month or two after the surgery makes matters worse. You are losing 20 pounds +/- a month and believing that this will go on forever. I know I had my calculator out and was trying to figure out how long it would be before I hit my goal (excess pounds divided by 20). But life isn't like that for most of us. We hit plateaus. We come to the end of our widow of opportunity before we reach our goal and we stop losing. Or we stop losing and regain some of our weight. Why do surgeons consider 50% as a success? It is because there is no other method that you could use that would result in that much weight loss on a permanent basis (think 5, 10, 15 years). Remember back to your old diet days? Yes, you lost weight, but regained it plus additional weight. The best you can attain with dieting is a 5% weight loss.Before surgery, have your eyes wide open. Although most people lose 70% to 80% of their excess weight, you may lose only 50%. Figure out what 50% is, and be sure to rejoice when you hit that mark. ANYTHING ELSE IS A BONUS! WT LOSS DIFFERENCES There are so many factors to consider, heights, starting weights, men vs. women, individual metabolisms, age, and most importantly if you have any other medical conditions or are on medications!!! Remember the heavier people are the more they will lose (but the farther away one will be from an ideal bodywt..) and the lighter one is the closer to an ideal bodywt you will get, but the less they will loose overall! ~~~~~~~~~~~ DO I NEED A REVISION? What are your issues/ideas/thoughts on why insufficient wt loss or regain? Solution/recommendations may be different depending on answers.... Three things may be happening independent or together: ü Broken Surgery (tool) ü Behavioral issues (not using tool ü Wrong tool/surgery 1. BROKEN SURGERY: a. WERE YOU Open or Lap? b. Were you transected (pouch and distal unused stomach severed by staples and cut by space?) IF not maybe the issue is a staple line disruption/failure (AKA SLD)...food is going into the old tummy and no malabsorption is happening. Or a fistula ("A gastro-gastric fistula is simply a communication between the new "pouch" and the "old" stomach.)*Same as SLD your getting food into distal stomach and it avoids the bypass. c. Have you had an upper GI endoscopy? (Scope down throat) to see if pouch is intact and how large your stoma is (connection of pouch and intestines). Many have an enlarged stoma allowing them to eat larger quantities w/o feeling full, kind of like a chute. This is usually not patients or surgeons fault but many patients stomas relax on them...Some possible fixes:A lap band may help,or a surgical revision of stoma or a fixed silastic ring, but it isn't always possible. Also many are using sclerotherapy http://www.ingentaconnect.com/content/fd/os/2003/00000013/00000002/art00006 or http://www.drsimpson.com/chattranscript-08-13-2004.php for info. They say for this (inject substance thru upper GI scope into tissue to produce scarring) and there is a new procedure in Boston being done called: Endoscopic pouch repair. http://community.nursingspectrum.com/MagazineArticles/article.cfm?AID=14602 d. Do you get full? How much food? Have you done the cottage cheese test? http://www.digitalhorsewoman.com/pouchrules.htm 2. BEHAVIORAL (not using tool to potential):I am not saying it is behavioral just asking a few questions: a. What do you eat in a given day? Calories track on www.fitday.com % fat/protein/carbs. b. Do you drink with meals? c. Drink calories? d. Soda? e. Do you do protein shakes? (type/number) f. Do you do vitamins? Which ones? Types/amounts/when do you take them? g. When were your last full set of labs/Dexascan? h. Do you exercise? How often? Amount? Type? i. What other meds are you on? Medcial conditions? j. Age, Height? Starting BMI Current BMI. (Basically looking for % of excess you lost) k. Do you follow pouch rules? http://www.digitalhorsewoman.com/pouchrules.htm We can eat more at ~6 months out (quantity/variety), it is also time malabsorbtion of calories decreases for many as body adapts. (intestines can elongate/grow more villi/folds to increase absorbtion) OKAY the above questions are just to help us figure out some potential behavioral issues. Again I am NOT saying the failure of you or anyone is strictly behavioral. It is just one thing. Any surgery can be defeated if the tool isn't used, BUT if the tool is used reasonably it may be broke or may of been the wrong tool (surgery) for you! IF YOU DID NOT CHANGE YOUR LIFESTYLE THER IS NO TOOL THAT WILL WORK! 3 WRONG SURGERY: We do not always know this until after. Some surgeons realize the higher the BMI of the patient the more distal bypassed they should be. Or the type of eater someone is may lend itself to one surgery over another. Some fail to lose wt with a VBG or lap band only to lose well with a RNY or many with a proximal RNY fail to lose wt and do great with a distal RNY or others don't do well with RNY and do fantastic with a BPD/DS...you get my point. One surgeon had this to say about choosing your surgery type for you. (*I am not sure there is any real one size fits all though on deciding!) http://www.alagsa.com/Bariatric_Surgery.htm Some surgeons do a very short 40CM bypass (not near long enough for most of us MO)! Get a copy of your surgical report from the hospital medical records so you KNOW what you have! It is yours according to law! They say 50% of excess wt lost is a 'successful surgery'. I agree *but why accept this? when others lose 75, 80, 90, 100%? I know everyone is different but if there are means to allow most to lost 80+ % why shouldn't everyone have the opportunity? We all have to weigh the pros and cons. Going BPD/DS or more distal has risks, a lap band has risks etc. Many lose 80%+ and regain after 1, 2, 3,5 yrs. Not always behavioral or mechanical,,,,so their body is real good at adapting and hence they probably had wrong surgery.... I hope this helps some and doesn't really confuse you. I have to add, I haven't had a revision. I am here learning with everyone "IN CASE" (I think education is key to success and all I can arm myself with!). It (regain) scares me too! I see/read/hear about wt regain more and more online and read more about revisions. WLS has come a long way, but maybe just maybe some day we'll get the right surgery the first time! One that we can behaviorally adapt to and use and that won't break! ONE CAN DREAM! I think a good revision surgeon is key to lower risks, I wouldn't go to just anyone! And I know many on the group could help u with someone good! Dr Fox and Oh in Washington State. http://www.aboutmso.com/pp/prospectivepatients.cfm http://www.ohtobethin.com/ Dr. Gagner in NYC: http://www.cornellweightlosssurgery.org/ This is a great group http://groups.yahoo.com/group/WLSrevisionsupport/ of people who can definately lead u in the right direction! I also know OH has 2 different Revision Forum. http://www.obesityhelp.com/morbidobesity/amosforums/failed_wls_second_time_around http://www.obesityhelp.com/morbidobesity/surgtype-forums/Revision/ [email protected] email me privately if ??? OK! Take Care, Jamie Ellis RN MS NPP 100cm proximal Lap RNY 10/9/02 Dr. Singh Albany, NY 320(preop)/163 (lowest)/174 (current) 5'9'' (lost 45# before surgery) Plastics 6/9/04 & 11/11/2005 Dr. King www.albanyplasticsurgeons.com http://www.obesityhelp.com/member/jamiecatlady5/ "Being happy doesn't mean everything's perfect, it just means you've decided to see beyond the imperfections!"

Boy am I glad I logged on today! Thanks for your posts! I'm 6 years post op and although lost an intial amount of 120+ pounds (325-188ish) I reverted to my old eating habits (and also consuming alcohol) slowly I crept back up to about 265. Although I'm still about -70 lbs six years out, there are times when I do feel like a failure as well. I made the decision to cut out booze and go back to my original post-op eating plan. But first, I tested my pouch by eating small portions and "listening" to my body. Was I full? Was I satisfied? Then I didn't need to eat anymore and my pouch was still intact. I'm now down to 255 and although I still have a ways to go to my goal, I remembered that this surgery is a tool and if I want to get to my goal (whenever that may be) I have to use my tool diligently, even when I don't want to - which I admit, is alot of the time! Good luck to you, and God bless us all! N