Possibly need revision, have MVP insurance

Is there anyone out there with MVP insurance that had insurance pay for a revision.   I had my surgery in July 2002 in Iowa.  I moved here in 2003.  I have gained weight back and had an Upper GI today and my stoma is stretched to the point that food just goes right through to my intestines.  Hence I don't ever feel full.   I may be jumping ahead but from what I have read may need a revision.  I don't have a surgeon yet, but wanted to know if anyone out there has MVP and had a revision.   Thanks so much.

Few things:
May want to seek support on Revion boards as well.
http://groups.yahoo.com/group/WLSrevisionsupport/
http://www.obesityhelp.com/forums/revision/


Ther may not be any revision that may help, depends on your individual situation, surgically may be too risky for the low benefit of fixing a stretched stoma (if scar tissue etc), a lap band over bypass may or may not be a possibility, the newer endoscopic procedures are NEW and longterm results are not in, some have small success some nothing....(I am talking stomaphyx http://www.stopobesityforlife.com/StomaphyX.html or http://www.endogastricsolutions.com or ROSE procedurehttp://www.incisionlesssurgery.com/default/go-to-location ), many insurances are NOT paying and they are ranging around $10,000 but this may be changing. Your MVP is different than my MVP plan so only way to know is ask your plan what their revision policy is, SOME require same thing as if an initial surgery (BMI 35 w/ 2 comorbidities or BMI of 40 and no comorbidities) some exclude revisions no matter what....
You are entitled to a copy of your policy when you call customer services! Sclerotherapy where they inject an irritating substance into stoma has also been low on positive results even those who get 3-6 injections.

I recommend much research on choices, options, insurance as well as finding a VERY VERY expereinced REVISION BARIATRIC SURGEON! There are not many, and a general bariatric surgeon maynot even see you or if they do have limited or no experience with what to do.
So I ask those considering to remember that revision operations are more technically challenging and carry a higher complication risk. Patients need to seek out very experienced bariatric surgeons that perform revision surgeries.


Dr. Garber in NYC is expereinced, Dr. Gagner was also but moved to FL. Many travel a few states to find a experienced revisionist! YOU ARE WORTH lowering your risks this way! http://www.stopobesityforlife.com/revision.html

Articles:
http://www.wlshelp.com/bariatric-revision-surgery.html

http://www.bariatrictimes.com/displayArticle.cfm?articleID=article207
Revisional Surgery Article:
Bariatric Revisional Surgery
- by Rodrigo Gonzalez, MD; Scott F. Gallagher, MD; and Michel M. Murr, MD, FACS
EVALUATION FOR WEIGHT LOSS FAILURE
http://home.comcast.net/~muzicluvr777/Eval.htm

I WISH YOU WELL!

Provided your remnant stomach is still viable, you may be a candidate for revision to the DS... unfortunately, there are no DS surgeons in the capital area, let alone one skilled or experienced enough to perform an RNY to DS revision. For that, your choices (in state anyway) would be Dr Pomp at Weill/Cornell (was partner with Gagner before Gagner moved to Florida), or Dr Inabnet at NY Pres.... both in NYC, both great surgeons. a little further away, yet also pretty well versed in RNY -> DS revisions, is Dr Greenbaum in NJ. I'm also in Sch'dy, and had the DS (not a revision though) down in NYC... it's not really all as bad as it may sound (the distance thing, that is) if you want some more info, come on over to the DS board... there are a few of Inabnet's and Greenbaum's revisional post-ops over there (possibly Pomp too, not sure) If you'd like some more personal insight on the DS, feel free to PM me.  If you're not familiar with the procedure, I'd be glad to go over it with you if you'd like.  Whether it be via PM, on the phone, or at the Starbucks on Watt St., or at the Barnes & Noble Cafe (also a Starbucks) in Mohawk Commons. Whatever you do, good luck

Would you share more info with us in relation to the regain, making recommendations that could be helpful really count on this. Your OH profile is a few years old but I see you got pregnant after WLS (and had regain prior to that due to fertility drugs); many regain during pregnancy and beyond simply as they return to a less healthy and wt maintenance supportive lifestyle (eating more, grazing, quicker eating on the run, emotional eating is a big one and lack of exercise).

I am not saying this is you by all means. A broken tool is a factor but there are many other factors one can influence. HOW MUCH wt have you regained? That in and of itself is a helpful piece of info as if its 20# that may be typical bounceback, it is 50, 80 or more then different revisions may be considered. Many surgeons would not even consider a revision (other than endoscopic pouch/stoma repair perhaps) for a small regain, or if someone has lower BMI and no medical comorbidities. A more radical revision to correcting surgically your stoma (if possible); going more distal RNY or as Sean kindly mentioned a RNY to BPD/DS may not even be warranted if smaller regain and or if other factors in line to be addressed first. And yes need to travel to find a surgeon who would consider this and be skilled at it! I have some articles on RNY to BPD/DS if interested in PDF form email me off list, I did not mention them prior as your issue seemed to be an enlarged stoma merely and only was thinking at that time of ways to fix that if at all possible....you are not alone with stoma!

The body adapts well and revisionalry bariatric surgery is not always as helpful as we would like, the small intestines seem to have elongated, grown more folds and more villi to absorb so cutting more down and making a smaller common channel for absorbtion such as with distal RNY or BPD/DS may still not get one to goal. Especially when a surgeon bypasses a mere 50 -100cm more it typically in my research of literature and online with folks having this produces NO or very little sustained wt loss further.

Those who have had a stomaphyx and really had emotional eating/food addiction issues/lifestyle factors needing to be i.d. and addressed who did not found again proceudre was a waste as trullly it never could of corrected the underlying issue. A smaller stoma can be defeated with drinking/eating together, eating high carb meals, hig calorie dense foods, not exercising and grazing even if you feel full u will be able to eat again.

Distal RNyers and even BPD/DSers can regain or not lose optimally if they defy the rules of their particualr tool (this involves sugar usually as not malabsorbed and withBPD/DS no repercussions of that like dumping ~a good and bad thing so to speak)

I started at 350 in 2002, got down to 213 which was still overweight but because I am 6 feet tall I was not at all unhappy with.  As my profile says I gaines some weight with fertility drugs.  I only gained 18 pounds while pregnant and lost it all plus more by my two weeks post partum chech up.  At this time I was 255.  I then started gaining weight back fairly quickly to the point I am not at 290.  My daughter is 2 years old so it happened within that time.   I had my surgery in Iowa where I was living and then moved to New York 10 months after my surgery.  No surgeon would see me here because they did not do my surgery.  I did find out from teh hospital where I had my upper GI that they should take me at the program there.  This was at Ellis in Schenectady.   I read that people may not follow the pouch rules, I was very good about this after my surgery.  I was very into this and even started the support group in my area in Iowa.  It seems that it was after I moved and had not support.  Ireally didn't feel I needed it and then when I started to gain the weight back I didn't want to go to any groups and admit that I had gained weight.  I have been blaming myself all along.  I have read that it is possible for the patient to stretch out the pouch or stoma, but I feel that there is some mechanical failure in this.  I was only the 10th patient that my surgeon performed the surgery on.  I have spoken with Dr. Garber and he said that frequently patients who had a surgeon who was not yet experienced in the surgery, especially the laparoscopic kind, have the same problem I am having.  They are not experienced enough yet with the tools and cannot get things small enough.  Now I am not trying to put all of the responsibility off of me, because I am willing to admit my part in this, but I think if the tool had worked properly I may not have gained as much weigh back. 

Thanks for some clarification. I am glad you have been in contact w/ an experienced bariatric revisionary surgeon such as Dr. Garber. He is correct the learning curve w/ WLS increased complications and perhaps reduced outcomes.

I am glad you are looking at this thoughtfully and in total, many do not. This is not to say blame lies anywhere or is even relevant, judgment is shaming and not usually all that helpful. Noticing instead all the pieces and parts to make a comprehensive treatment plan is a good goal.

One other thing that comes up is has anyone done a full set of labs on you ever? I would be quite concenred about my nutritional status and overall health! Have you had a dexascan o check for me? these labs with a clinical nutrition doctor? typically every 3-6-12 months for life!!!

COMPREHENSIVE METABOLIC PROFILE
LIPID PROFILE
GGT, LDH, Prealbumin
PHOSPHORUS - INORGANIC, URIC ACID
CBC w/ diff
B-12 & FOLATE, B-6 & Thiamine (B-1)
IRON, TIBC, % SAT, FERRITIN
VITAMIN A, E & D (25-hydroxy)
THYROID PANEL (T3, T4, TSH)*only initially unless suspect.
ZINC, MAGNESIUM, Selenium, Copper
SERUM INTACT PTH
Homocystine, MMA
HGB A1C (only if diabetic or suspected)
DEXA SCAN every 1-2 years depends on results!
Diagnosis:
579.3 post-surgical malabsorption
268 vitamin D deficiency
269.2 hypovitaminosis
268.2 metabolic bone disease

What supplements are you taking? Vitamins & supplements go on labs
You will probably hear MANY different responses because each bariatric program has different guidelines, as well vit/minerals postop are individual based on a persons response to surgery and their pre-existing needs as well. This is why follow-up and labs are crucial...

Most need at least a Centrum type complete multivitamin, Calcium in the form of citrate for Rnyers to best absorb amount depends on labs/dexascan/comorbid conditions, and Sublingual B12. With that said some need more supplements like;
VIT A, D, E, K, ZINC, SELENIUM, COPPER, IRON *USUALLY FEROUS GLUCONATE OR FERROUS FUMARATE OR POLYSACCHARIDE IRON, IRON CHELTE OR CARBONYL IRON, KEEP FROM FERROUS SULFATE IT CAN BE MOST HARSH ON POUCH AND NOT AS READILY ABSORBED. (oops sorry cap loc****xtra magnesium, thiamin (B1), B6, folate, potassium etc.
Preop have your levels been drawn? They are finding many Morbidly obese deficient preop now interestingly in things like Vit D especially.
_____
Yes Ellis has a good program as does Albany Med
Consider hooking up with a clinical nutrition MD/Bariatrician as well: here are some references for those I recommend my Clinical Nutrition Group in Albany (or the others listed below): (they do all sorts of nutrition issues, up to and including bariatric surgery.....all are great providers I see Dr Denning)...

Albany Clinical Nutrition
1240 New Scotland Road
Slingerlands, NY 12159

(518) 475-7000 X4

Vanessa Denning, MD
Ann V. Michelek, MD
Barbara Kapuscinska, MD
Carol R. Santoro, MD
Ellen Goke NP


Dr Sharon Alger 262-5299 http://academic.amc.edu/physicians/index.cfm?event=showPhysicianDetail&med_prof_rec_no=3
& Dr. Jennifer Lindstrom http://academic.amc.edu/physicians/index.cfm?event=showPhysicianDetail&med_prof_rec_no=4759
262-5623
AMC Bariatrics Center
47 New Scotland Avenue, MC 61
Section of Bariatrics/Div. Gen. Sur
Albany, NY 12208
http://www.amc.edu/Patient/services/Surgery/Bariatric/index.html
Kathleen Callahan RD

Jill Braverman-Panza, MD.
1375 Washington Avenue, Suite 202.
Albany, New York 12206
518.482.0007
I do not know if Jill is taking new pts have to call to find out! She is more a PCP with subspecialty in bariatrics the other 2 groups are more specialist types.


As for support groups the literature shows that those who attend longterm have better outcomeat attend reguarly long-term have better outcomes...I appreciate the shame you discussed w/ regain consider any of these local groups or especially the AMC 1 yr+ group we are dealing with regain, emotional issues etc and its not all the newbie glory there! But also more and more the local support groups are talking about issues such as regain, lifestyels, emotional eating, the psychological compenent, changing addictions from food to other things. I'd love tosee you in Albany or Saratoga! I also know Ellis has groups. Heres the info on all the groups locally I know of!

These are the online/in-person groups I know of...updated 6/13/08
I have facilitated a Bariatric Support Group in Saratoga Springs since mid-2003
(at the time Dr.'s Yeaton/Anderson were performing RNY at that hospital).
1st Monday of the Month at Saratoga Hospital in the Board Room
211 Church Street Saratoga Springs NY 12866 http://www.saratogacare.org/index.cfm?contentID=25&facilityID=3&itemType=3
this is Saratoga's website the board room is downstairs floor, if you are in front of hospital look to right of main entrance, says same day surgery go in first door on left!
My contact info [email protected] or (office) 518 583-3035 x 212 *can call and by 3pm if I cancel due to weather it will reflect that on my VM message, or hospital operator 587-3222 would know or on our website:
http://health.groups.yahoo.com/group/SaratogaSprings-NY-WLS-support/
I usually present a topic (realistic expectations, WLS lifestyle, protein
sampling, trimming the psychological fat, regain issues, body image/self
esteem...are some) and from time to time we also have some guest speakers.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Glens Falls (please call to confirm as it has tendency to change w/o my
awareness/dates time place etc.!) Karen Hogan @ (518) 926-2615 or email her @ [email protected] Meets every other month (EVEN NUMBERED MONTHS 2/13/08, 4/9/08, 6/11/08, SKIPPING AUGUST,10/8/08, 12/10/08) on the second WEDNESDAY of EVEN NUMBERED months, at 6:00-7:30 p.m. GF Hospital Learning Center side B- in Glens Falls, NY. It doesn't matter which hospital, surgeon, type of surgery, or nutritionist you are using. It is open to anyone who would like more information. http://www.glensfallshospital.org/
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
In Albany Med has 4 support groups all meeting in same room:
1) A general preop/postop support groups EVERY OTHER Thursday 5:30-7:30pm(open to anyone) but mainly Dr. Singh/Dr. Rosati patients attend. New Scotland Ave. entrance (white pillars) go in first LEFT (before the info desk) down the hall, in the waiting area it meets. I am currently facilitating these groups. I am a psych NP and 5+ yeasr post RNY patient. [email protected]
http://health.groups.yahoo.com/group/upstatenywlssupport/ next group 6/26/08

2) A general preop/postop support groups EVERY OTHER Monday 2-4pm (call for location (518) 262-2195) next group 6/16/06, 6/30/08....run by dietician.

2) Lap Band Support group at Albany Med SECOND Monday of the Month 5pm-6:30pm same waiting area as above. I facilitate

3) LONGTERM WEIGHT LOSS SURGERY SUPPORT (those over 1 year out) SECOND MONDAY AT AMC 6:30pm-8pm same waiting area as above
I runs Lap Band & 1 yr out groups. [email protected]
I believe they have an answering machine system to call in case of
cancellations/inclimate weather (518) 262-2195 or it may be on the site
(although not too active lately)
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
***NOTE AS OF MAY 2008 ACN's are on HOLD!!!!!******call for more info
Albany Clinical Nutrition 1240 New Scotland Road Slingerlands, NY 12159
(518) 475-7000 X4 WAS Run by:
Kathleen Callahan RD [email protected] (she has recently taken position at AMC )EVERY TUESDAY 5-7pm in their waiting room. She usually does a topic w/ handouts. http://health.groups.yahoo.com/group/ACN_Bariatric_Surgery_EducationGroup/
THIRD Tuesday of the month is dedicated to 1 year plus issues!
~~~~~~~~~~~~~~~~~~
A newer group, I have little info on and have never attended is in Gloversville NY
(run by a patient OH chapter leader trained)
http://upstatenybariatricsupportlbravehost.com/
Meeting every Second and Forth Sunday of the Month Place: Nathan Littauer Hospital 99 E. State St Gloversville, NY in the Auditorium Time: 6pm to 8pm Please Email Staci White with any Questions at:
[email protected]
http://www.obesityhelp.com/morbidobesity/members/profile.php?N=W1144872146 is her OH profile
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Here is all the info on Ellis I have
http://www.ellishospital.org/bariatrics.cfm
http://www.ellishospital.org/bariatricsseminars.cfm
Bariatric Support Groups give weight loss patients and potential patients an
intimate forum to discuss personal and medical issues. The group meets the first
Monday and the third Wednesday of each month at 7 p.m. in Ellis Hospital's
George Wm. Graham Auditorium. Support groups are supervised by a medical
professional and feature a guest speaker such as a nutritionist, a psychologist,
an endocrinologist, or a surgeon.
Parking for both the seminar and support group is available, free of charge, in
the Ellis Hospital parking garage, which is accessible from Nott Street. Please
note that attendees may be dropped off directly outside the auditorium door,
which is accessible from Parking Lot # 1 off of Rosa Road.
Ellis Hospital Bariatric Care Center
1405 Fulton Avenue
Schenectady, NY 12308
Phone: 518.243.1313
Fax: 518.831.7007
Email: [email protected]

The group meets the first Monday and the third Wednesday of each month at 7 p.m. in Ellis Hospital's George Wm. Graham Auditorium. Support groups are supervised by a medical professional and feature a guest speaker such as a nutritionist, a psychologist, an endocrinologist, or a surgeon.
Posted by: [email protected] Tue Oct 30, 2007 5:10 am (PST)
Please do not forget that all bariatric patients - regardless of surgeon chosen, are welcome to attend the Ellis Bariatric Support Group meetings. We have always been an open meeting and do provide documentation of attendance for compliance with different surgical program pre-requisites. The meetings are run by Pamela Spicer and topics vary (based on the "Success Habits of Weight Loss Surgery Patients" and certified by Bariatric Support Centers, International ) and time is provided for small group discussion or networking time at the end of each meeting.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Dr Braverman-Panza's PATIENTS ONLY meet the first Monday of the month at 1375 Washington Ave Ext Suite 202 Albany, NY in Dr Braverman-Panza's reception room. Office# (518) 482-0007 facilitated by Janet Folkman Social Worker and seasoned Veteran RNY postop [email protected]