I am in hell and want to talk revision...

Last year at this time I was on the scale looking at 177 and this year I am pushing 220. Stress, family chaos and down right frustration and aggravation have been my constant companions this past year.  February 2006 I had surgery weighing in at 252, August 2006 I was 180 and stayed there for almost a year. Welcome crap and chaos and since last summer I have gained 43 pounds. I will be very honest, I have little patience or tolerance right now but I am having such a hard time even getting back into an exercise routine because of the pain associated with my weight gain. I look back at the pictures of the "thinner me" and want to go back there again... I need to get back there again. Every reason that I had bypass in the first place is starting to rear it's ugly head... Joint pain, diabetes, hypertension, gerd, etc.... UUURGH.... Help... Who has had a revision, what was it like, what did you have to do to get approval... I know that I have first to get my head back together and I am honestly trying. Today was the first step. Research and "admittance that I have a problem." Hmmm is there a 12 step program for those of us who have fallen off the RNY wagon ? 

have you check into this

StomaphyX

This revolutionary procedure is now available for individuals who have had previous gastric bypass surgery and who are regaining weight. This procedure involves no incisions and no recovery and involves placing an endoscope through the mouth into the stomach pouch. The connection between the stomach pouch and small intestines is then sutured resulting in slower emptying of the stomach and earlier satiety and more weight loss. The procedure also shrinks the stomach pouch and makes it small, similar to the outcome of the original gastric bypass procedure. Just a thought good luck to you and How is ulster county these days?

Hello, thank you for this topic and your honesty with all the challenges ....
Especially that you feel is it due to lifstyle changes (diet choices and exercise choices +/-?), and it is mostly driven by emotional factors.

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Here is info I have posted before! The risks are heavy with revision to weigh carefully! Stomaphyx may help if fullness is the ONLY issue, but it hasn't stood test of time yet so new....


Realistic expectations after WLS are imperative to defining success. Many want to lose it all or most and in reality most surgery is meant to assist in and maintain at 5-10-15 yrs a 50% of excess loss of that extra, so if you had 100# to lose that means you'd expect to lose 50# +/- and maintain and that is a success in surgeons minds...(more or less depending on tool chosen band, proxy or distal bypass or DS...)

Any tool can be defeated, (*I say they could connect my mouth to my butt and I could find a way to gain!) it is normal and expected to be able to eat a greater variety and quantity of food at a meal. Lifestyle habits developed in first 6 months the honeymoon are what helps us carry out the maintenance. Wt regain of 10% is typical so if you lost 100# a 10# bounce back is a expected/typical result of dipping a little lower. (OK I see you have more than that!)

Dietary choices in a consistent and self responsible way are necessary as is exercise in a consistent manner for life to be healthy (i.e. keep up muscle mass and reduce bond density loss etc). Avoiding grazing, drinking caloried beverages and the slipper slope of refined sugar (Dumping may or may not happen early in ~ 50% of rnyers and lessens over times ESPECIALLY if one tests the waters early and frequently...the body adapts!). The pouch can stretch as it is a muscle but if overstretched by overfilling is an issue, also sometimes stoma will relax, not always a surgeons or persons fault just does...for those unlucky ones!

Have you had an upper GI endoscopy scope to see what is up, stomahyx is for enlarged stomas/pouches but truthfully for ~ $10,000 self pay it is so new and no one has long-term results or will this need to be done again and again? I am not made of money as most aren't and insurance doesn't pay....mostly at this time...this may be changing...will it need to be done again and again???

Lapband over bypass may be possible but I'd caution the risks of a band are not to be taken lightly, the more we see of bands the more we have seen body reject, port flip, erosion and perforation of stomach, not all RNYS can have a band due to adhesions etc...the band may help fullness I suppose no more malabsorption though. If you are grazing, eating sweets, emotional eating, not exercising etc I wouldn't think stomaphyx and or band would help much as neither would address those concerns. *Not sure your specific concerns/issues...

Therapy can help fo course the emotional component and self sabotge nature we can find ourselves in, helping us be aware, present, accountable and responsible to selves in a consistent manner.

I am not saying any of this is you, just what I have seen online and in person. Many jump to a revision only to find it isn't the answer or is a challenging one..some it is perfect! Support is a huge factor in long-term success for folks we see that more and more in the research literature and I do in person!

Of course you can go to bariatric revisionist and get a consult..I would of recommended as first step after evaluating your self HONESTLY....

Once you give me more info on your stats and thoughts of regain I can probably give you more info as well!

Do you get full? What do you eat in a typical day? (amounts/type/calories etc), how much exercise do you do daily/type/intensity etc, fluid do you drink? Water, caffeine? What meds/vits do you take? When did you have last set of full labs with all vitamin levels (about 10 vials of blood?) when was your dexascan last? for bone denisty testing? Who is doing the follow up?

2 articles FYI
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


This is a great group
I also know OH has a different Revision Forum.
http://www.obesityhelp.com/forums/revision/

Dr. Garbers link on revisions (note some of the info on revision difficulty and increased complications came from this link!)
http://www.stopobesityforlife.com/revision.html


Be well in your journey whatever it may bring you as you decide on the next step!
http://www.stomaphyx.com/
http://www.stopobesityforlife.com/StomaphyX.html


It doesn't sound as if a revision or stomaphyx (tightening a pouch or stoma if indeed enlarged may be indicated but won't do a thing for what you are talking about I have met many who had this hoping it would fix things w/o any wt loss beyone the 1 wk liquid diet and now are out $10,000!) would do much other than put you at risks for complications as either of those can be defeated with a non supportive lifestyl of no exercise and emotional eating/grazing/not healthy choices (carb ladden)!!! The emotional work if ignored wil only lead to further unhappiness and possibly MORE regain. It is what the WLS tool can not do for us sadly but truthully.

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It is so common after 6 months for old habits to resurface, the honeymoon is slowly ending for most and it is a frightening time for many. Wt loss slows which is typical as by 6 mo we usually have lost 2/3 of what we will. The tool is slowing and out need to live a self-responsible and consistently healthy lifestyle increases if we wish to lose more and keep it off for life. Moving away from rapid to slower wt loss and into more of a maintenance phase is a challenge. For me no diet fixes those behaviors it only reinforces deprivation and self-sabotage. Looking beyond a week to life helps me. CAN I DO THIS FOREVER? If the answer is no its a diet and not going to be useful or helpful in the long run. Everyone has different opinions on this I am sure but dieting never worked preop and well after it doesn't either. It doesn't address the underlying issues such as emotional eating, stress, etc. That is what I believe makes us successful along with realistic expectations. It is not realistic to lose like we did at 3 4 5 6 months. We can still lose a few pounds a month may be typical the effort involved is greater, diligence with the principles of a healthy life and kicking exercise up is the key I believe (in a balanced non obsessive way). Sometimes we consume our lives with dieting/food, (*it is all we are familiar with*) thinking about what we can and can not have, when we can eat or should eat, how much, how often, how it should be cooked, when to buy it, how much, etc that we occupy so much time and do not even realize that we have no time left to feel (the point) in an addiction, it takes over us so we can forget us and what we are scared/fearful of feeling/being. Consider writing all the 'supports' of diet/exercise/lifestyle changes, coping skills etc for non-emotional eating (i.e through individual therapy, support groups) you have worked on, now where do you need to add reinforcements?

i have posted this before and it is sent to all members on my OSSG OFF TRACK yahoo support group: http://health.groups.yahoo.com/group/OSSG_Off_track
THIS IS ABOUT PERSONAL ACCOUNTABILITY NOT DIETING LOOK AT INTRODUCING ONE PRINCIPLE/GUIDELINE EVERY FEW DAYS!!!

JAMIE'S BACK ON TRACK TIPS
Your surgery hasn't failed; you are just not using your tool to its potential that is all. It is there still; you need to get back to basics though. Remember it isn't the surgery alone that makes us lose weight it is the lifelong lifestyle & behavioral changes we make that enable us to lose weight and keep it off. Dumping isn't guaranteed (~ 50% will dump early on only!) after surgery and may decrease the farther we get post-op....with that said:

You most likely know the principles of the tool & where you can focus.
So how to get back to basics? You have to just take one step at a time; it doesn't have to be all or nothing that is old thinking! What do you feel you can conquer first?

Write down your goal for the week, then work on it, once you have one goal under your belt start on another, be patient and kind to yourself, no one said this was easy! It is hard and no one is perfect! But you can change. The negative habits didn't happen overnight so neither will positive ones! But they wont happen if you don't start somewhere! Asking for help and admitting the problem is a great first step! Get to a local support group at least monthly if available, this keeps you focused on what you are doing and accountable to yourself...Life will always be busy but you need to reprioritize health as a higher priority and taking care of yourself has to be more important than anything else!

DO NOT RETURN TO DIETS! THEY DIDN'T WORK PREOP AND WON'T POSTOP!
MY 3 FAVORITE MANTRAS:

ü IF YOUR LIFE IS TOO BUSY TO EXERCISE OR TAKE CARE OF YOURSELF THAN YOUR LIFE HAS TO CHANGE! THIS IS NOT SELFISHNESS!

ü PROGRESS NOT PERFECTION!

ü IT IS WHAT WE DO 90% OF THE TIME THAT MATTERS, THINK CONSISTENCY!

What works for me is the PHILOSOPHY of the South Beach Diet (not dieting) I look to it to guide my LIFE....It is a good marriage between healthy lifestyle and postop WLS needs! I must stress it is not a diet but a way of life for me! I am carb sensitive, when I eat more refined carbs I am hungry sooner and crave more carbs, it is a vicious cycle, but when I eat better carbs, getter fats, healthy lean proteins the way the pouch rules dictate I do well and maintain
SAMPLE GOALS:

Fluid: Resolve to drink AT LEAST 64 ounces (This will keep you full longer and tension on the pouch) of NON-carbonated-NON-calorie fluid a day. (Water, Crystal Lite, diet Kool-Aid) In other words don't drink your calories! DO NOT DRINK WITH MEALS and WAIT 1-2 HOURS AFTER MEALS TO START DRINKING....(OR YOU WILL JUST MAKE YOURSELF HUNGRY AGAIN...SOONER!).
Vitamins: Resolve to take 1-2 multivitamin(s) a day, calcium as citrate form ~1,500mg a day (some may need more), & ~1,000mcg B12 liquid/tablets sublingually daily (some may need intramuscular shots). Other vitamins are based on labs/dexascans: some will need extra iron/vit C (pills/shots/infusions), vitamin A, D, E, K, Zinc, Magnesium, Thiamine (B1), Folate, B6, selenium....This is a reason we need to follow up for life with our healthcare providers, deficiencies can happen not just early postop but anytime postop!
Protein: Resolve to get in ~65 grams a day (this will vary due to age/ht/wt/medical comorbidities) either in the food you eat or by supplementing with shakes *this is controlversial do what is best for you. EAT PROTEIN FIRST!!! IT fills the pouch!(less room for carbs)
MEALS: Resolve to eat no more than 3-5 small meals a day, NO GRAZING! Take 15-20 minutes for a meal no less/more, pay attention to the food, not a TV, radio, newspaper! Composition of meals: ~50% protein leaving 25% of meal for veggies/fruit and 25% carbs (whole/multigrain/low glycemic index/.load).
Exercise: Resolve to exercise 30 min 3x a week, then increase to 60 min 3x a week or 30 min 6x a wee****il you are exercising 30 min MOST DAYS OF THE WEEK (or more)! It helps you cope with stress, so you don't turn to food, it will help the wt loss and also give you energy! You will feel better about yourself and be less apt to go for the carbs. NOTHING revs the metabolism better! START SOMEWHERE! VARIETY IS KEY!
SUPPORT: Resolve to either get involved in a local support group monthly (weekly would be better but at least 1x a month), online support is also helpful and/or get into therapy to deal with your food issues and look at why you are sabotaging your happiness. We all have food issues/demons and we all need to face them eventually the surgery is a great help but the brain is a hard organ to change and unfortunately they didn't operate it when they shrunk our tummy! Be around those whom can support and not sabotage your success, this may mean making new friends and giving up old/unhealthy ones!

I am glad you are looking at the issues and wanting to deal with them! Be proud of yourself for that and you can do it. Now is a great time to start, holidays and parties are always going to happen, we can always find an excuse to wait or a reason why we can't, search within yourself and find a reason why you can and do it (nothing tastes as good as health and thin feel!)

__________________________________
Or another way I have put this:
MY recipe for success: (I GUESS SOME SEE THIS AS A DIET I SEE IT AS A PRESCRIPTION TO GET ON THE LIFELONG LIFESTYLE WE NEED TO BE HEALTHY AND SUCCESSFUL MAINTAINERS!)

1) FIRST YOU IDENTIFY THE PROBLEM

2) SECOND YOU FORMULATE A PLAN OF ACTION!

3) THIRD you post it here so we can support you (Being accountable to someone outside of self helps!)
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NOW MY PLAN was it takes about 3 days to overcome the HORRID/VICIOUS carb addiction cycle for MeE/MOST (the physical aspect that is)...

SO STEP ONE:
I detoxed my house of all foreseeable triggers/carbs (*Yes some will say this is deprivation) well should we have all that crap all the time? Most likely not!

STEP TWO:
I loaded my home with things allowable such as cheese sticks, pepperoni, jerky, eggs (hardboiled a few ahead), sandwich meats, stocked up on shakes so I had variety for the 3-5 a day I could use, low carb veggies etc.....I actually come to enjoy them over time as I feel satisfied and happier and healthier

STEP THREE: I was following the south beach phase 1 plan (adding shakes as above), so I had the book and there is a document explaining the reason it works/the plan in the files under http://health.groups.yahoo.com/group/OSSG_Off_track/files/ first folder back on track tips and plans.. Karen B's timer plan is there and many find that SO helpful!
I KEPT IT HANDY TO READ/REREAD in times of crisis. I believe in a daily shake if not 2 one in eve to stave off hunger.

STEP FOUR: Place motivational sayings all over, on computer on fridge (like nothing tastes as good as healthy & thin feels), you can do this, its only a craving and will pass in a few minutes!

STEP FIVE: List a bunch of things to do to pass time when a craving happens (it will happen and it will pass!) take a walk, drink a cup of water, have a shake, call a friend, email a friend, email the group, brush your teeth, listen to music, pet an animal (walk the dog), journal your feelings, give self a mani/pedicure, deep breathing/relaxation, go for a ride (bike or car) etc chew gum, have a sf hard candy. HAVE IT HANDY, as when we are impulsive it's hard to think so go to the list not everything will work all the time but it helps delay!

STEP SIX: MUST PLAN, plan meal, prepare take fluid and food with you, if you fail to plan you plan to fail as we say here on off track. THIS is about progress, NOT perfection so don't beat self up, know that things improve with each passing day u get the refined carbs outta your body. It really gets easier cause if you don't put the junk in the hunger really decreases it is amazing!>>>>Again south beach worked for me...took me 1 mo to lose my 10# regain following this it was the hardest week 1, after that hunger was minimal and my willpower could handle the HEAD cravings (it couldn't handle the physically driven ones from how I was eating...bread=hunger kinda thing)...

STEP SEVEN: WRITE IT DOWN if it goes in your mouth, at least week one...then tell us how u r doing, many use www.fitday.com and I also recommend exercise of some way shape or form for the body soul and mind! TOGETHER WE CAN DO THIS! IT is hard, but you just gotta do it....READY SET GO!!!!!!!!!!!!!!!

Another saying we have is its WHAT U DO 90% of the time that matters, this strict carb reduction isn't forever, you can reintroduce things at a later date, for now it is no carbs like bread & crackers cause they aren't your friend, they give lots of calories and little nutritional value and well they make u hungry sooner with NO satiety (full feeling) I agree a burger or a pork chop sits with me for hours!!!!!!!!!!!!!!!!

Be well.


________________
Here is more info if helpful some may be repeated!
Bariatric Surgery: A "Tool" in the Treatment of the Disease of Obesity
http://www.beyondchange-obesity.com/obesityResearch/bariatricSurgATool.html

Life After Weight Loss Surgery
http://my.webmd.com/content/article/101/106105.htm?printing=true

(SNIPPED) Regained Weight May Be an Issue
And that's why as time goes on, not all former weight loss surgery patients remain as pleased with the surgery as Kochman does right now, says Jacqueline Odom, PhD, the psychological director of the Beaumont Weight Control Center in Royal Oak, Mich.
"A year or two years out, patients are reporting struggling with weight regain because they are struggling with their old eating habits and may have not incorporated portion control and exercise," she says. During the immediate aftermath of the surgery, people can only tolerate small amounts of food, she explains, but after a while they can eat more because the pouch opening gets stretched out. "Food cravings start coming back and medical problems can follow suit," she says. "Surgery is not a cure for obesity, it's only a tool," she says. "One has to have the mindset or resolve that lifestyle changes are inevitable. A lot of people have been disappointed in surgery long term because they really thought it would cure obesity and it hasn't." Odom runs a monthly support group for patients considering the surgery as well as those who have undergone it. (SNIPPED)

First anyone with ANY bariatric operation can regain weight, it is not the operation typically that causes this but a variety of other factors/forces. Bariatric surgery is meant to be a tool a person can utilize to lose/maintain a significant amount of weight long-term if the tool remains intact and the person chooses to use it.

With RNY bypass one can defeat the tool in many ways, do not exercise, not change your relationship emotionally with food and do not choose to eat in a healthy manner.

Here are a few common ones I am sure there are others!

Grazing all day on small amounts food perhaps calorie dense and non filling (sliders/carbs) can easily do it..It is still about calories in and out. No fullness=more eating=more carbs=more hunger=wt regain after typical 6-12 month honeymoon.

Drinking with meals=no fullness and ability to eat more calories which can lead to no fullness and regain (more eating)

Drinking caloried beverage also can lead to wt regain still as before calories in matter and drinking your calories=no satiety and regain for many.

Continuing to emotionally eat to avoid and numb, not taking opportunity to develop other coping that are less damaging can set one up for regain. Perhaps the most important thing is to deal with WHY we are eating, I have said this before I believe we all have food issues and just because we have had surgery on our stomach it did nothing to our heads! The proper use of psychology may help us utilize our tool with all its defects the best!

So we know WLS is a tool, if we choose to eat the certain foods (carbs/sugar that we NEVER EVER malabsorb, digestion/absorbtion of these substances happens starting in the MOUTH!), overfill pouch, graze all day, don't exercise, drink calories, eat and drink together then we can/will regain wt. IT IS still about calories and you can regain wt. WLS is the tool to help us lose wt, PSYCHOLOGY is the tool to help us maintain that loss! In this delicate time (after 6-12 months) many things happen: dumping may decrease or sto if it happened at all, you are able to eat a larger variety of foods, you can eat larger quantities of food expected!, you get over the newness of surgery and may let some habits slide, the malabsorbtion*See below n intestinal adaptation (your intestines grow longer and adapt to have more surface area by having more folds as well as more villi so this is why wt regain can happen even w/o increase in calories although a minimal increase of 100 cal a day more will yield a 10# regain in a year!) may decrease as the body tries to normalize! Basically life happens.

WLS is a tool that should lead us to a LIFESTYLE CHANGE...

~How we see & use food. FUEL or SELF SOOTHING
~How we keep our bodies active. EXERCISE or INACTIVITY Exercise In The Promotion And Maintenance Of Surgical Weight Loss http://www.beyondchange-obesity.com/exerciseHabit/exerciseInPromotion.html
~How we use our brain. EATING TO LIVE VS. LIVING TO EAT

WLS IS NOT MAGIC, IT IS NOT A GET OUT OF MORBID OBESITY JAIL FREE CARD...NO MATTER WHAT THE HONEYMOON HAD US FOOLED INTO BELIEVING! IT IS HARD WORK! PERIOD. We can either diet/exercise w/o WLS or with, we do not get to just have surgery and think that is the end..sadly many do and then the failed diet attempt/regain starts for some before 1 yr out!



FROM "UPDATE: Surgery for the Morbidly Obese Patient" by Dr. Mervyn Deitel MD CRCSC FICS FACN DABS INTERNAL FEDERATION for the Surgery of Obesity Editor in chief OBESITY SURGERY & Dr.George S.M. Cowan JR, MD FACN Professor of Surgery, U of Tennesseee College of Medicine. 2000 ISBN 0-9684426-1-7
CH 25 limb Lengths (oh how they can grow!)
Pg 271.As general surgeons we know that mid-gut volvulus resulting in the loss of as much as 50% of middle small intestine does not result in permanent nutritional harm. Patients usually adapt to the loss and are able to maintain adequate nutrition while experiencing only one or two extra, soft bowel movements daily. Thus like the Kidneys and Lungs, the average small intestine possesses approximately ONE-HALF of its length as BACK-UP or redundancy, if the remaining length is normal and an ileocecal valve and intact stomach are in place. The small intestine has the ability to more slowly adapt to even shorter lengths of intestines if necessary. This explains why Brolin's & Cowan's series of extended alimentary limb lengths each filed to increase long-term weight loss. Their patient's common limbs were too long, after intestinal ADAPTATIONS of ELONGATION, DILATION, ENLARGED FOLDS (Valvulae conniventes) and LONG HYPERPLASTIC VILLI occurred.

CH 23 BPD 2 decades of experience
pg 229 During the first postop months all patients due to food stimulation in the ileum, have reduced appetite, and they have early satiety, occasionally in association with epigastric pain & or vomiting. These symptoms characterize the postcibial syndrome that is caused by rapid gastric emptying with subsequent distention of the post anastomic loop. All of these symptoms, the more intense and lasting the smaller the gastric volume, rapidly regress with time, most likely due to intestinal adaptation. ONE YR after an operation the appetite and eating capacity are fully restored and the patients mean reported food intake is one and a half times as much as preop, independent of gastric volume,
NOW I know that's a lot of medical jargon, I know the 2nd message is re BPD (without DS) but the intestines adapt no way around that, HOW MUCH no one knows for sure...We know some get mineral and vitamin deficiencies while others don't. We know some get protein deficiencies and others don't. Who will u be? Dunno, labs are important, as is life long follow up. Other research I have states if common channel more than 200cm then risk of protein malnutrition is less than 1%. proxy RNYs have a common channel greater than 200cm. More like 400cm....

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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
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Then there is the broken tool, meaning a enlarged stoma, staple line disruption so no satiety and food goes into unused tummy, gastro-gastro fistula (connection between pouch and unused stomach) that bypasses bypass and all food absorbed!
EVALUATION FOR WEIGHT LOSS FAILURE
http://home.comcast.net/~muzicluvr777/Eval.htm

http://www.stopobesityforlife.com/revision.html

Revisional Surgery Article:Bariatric Revisional Surgery- by Rodrigo Gonzalez, MD; Scott F. Gallagher, MD; and Michel M. Murr, MD, FACS
http://www.bariatrictimes.com/displayArticle.cfm?articleID=article207

Or someone got not the best tool for themselves (many get lapband go to RNY, some get RNY go to Duodenal Switch, or many variations not mentioned).

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
OR LOOK AT IT THIS WAY!!!!!!!!!!!!!! (*MEANT TO BE HUMOROUS*)
You can beat this or any weight loss surgery. If you want to regain weight then I would suggest you do the following:

(a) Eat a diet rich in high carbohydrates with a high glycemic index--
such as donuts, cookies, cakes, ice cream

(b) Do not start an exercise program, instead spend more time watching
television and increase time in front of the computer

(c) Eat your food rapidly so that you don't get that full feeling. Remember, feeling full
-- or satiety -- takes a while to register, so if you eat rapidly you can stuff a lot more
in then if you eat a bit slower and feel full with less

(d) When you feel full, eat just a bit more-- this will help stretch that pouch out to a
normal sized stomach

(e) Graze throughout the day, especially those calorie dense foods -- eat a little bit all the time and you will find that no matter what operation, even a duodenal switch -- you can gain weight.

(f) Gulp down liquids before/during/after you eat, don't sip-- but gulp them down -- it will force the food out of a pouch (for RNY, lap band, VBG) and you can eat more.

(g) Drink alcohol, soda or any caloried/carbonated beverage you will absorb lll the calories, not feel full, hungry sooner and the bubbles may help stretch that stoma/pouch!.

I am certain there are other ways to beat the system, but these are some of the more popular ones.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
'Outeating' Weight-Loss Surgery:
High-Calorie Grazing Negates Results
The Wall Street Journal February 24, 2004
HEALTH JOURNAL By TARA PARKER-POPE
http://online.wsj.com/article/0,,SB107757061706636894,00.html

This link has 4 EXCELLENT articles written by: Teri Kai Holtzclaw, Ph.D (she had WLS in 1996), check them out!!! All about the emotional side of WLS, success, sabotage, regain etc!!!
http://www.beyondchange-obesity.com/psySpk.html
Getting To The Core of Obesity
Swapping Recipes for Success
Bariatric Bombshells
A Personal Message To The Ones Who Are Silent Among Us
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Now onto switching addictions or addiction transfer....

Causes for Food Addiction By Cynthia K. Buffington, Ph.D.
http://www.usbariatric.com/Silhouette_articles/articles_research.html#Causes_for_Food_Addiction

Do you agree there is such a thing as food addiction?
Food Addiction
http://www.beyondchange-obesity.com/obesityResearch/foodAddiction.html

Here is a website I found that some people have said got them back on track.  Basically it is starting like a fresh post op.  Liquid diet, progressing to pureed, soft etc.  According to the site many people have found that getting a fresh start has helped them relearn how to utilize the full potential of their pouch.  I guess it partially works by getting you used to having your pouch not completely full.  I don't know if pre-WLS if when you cut back for a while that your stomach would shrink or if that was a myth, but maybe the same thing happens with a pouch.  It is something you can try right away and it is much cheaper than the copays for surgery.

 www.5daypouchtest.com/index.html

Good Luck

Jim

I have decided that I am going to do some research and learn all that I can and then do some major thinking about the next steps. I have been trying to get back into the good habits of not eating and drinking at the same time and not 'grazing' but the real problem is that if I had been able to follow a diet before, lose weight and keep it off,  I would have never gotten to the point where I needed to have RNY surgery. 

Thanks for all the help and info !

Surgery requires diet and exercise for life and adherence tohealthy guidelines for longterm success, as you know any tol can be dfeated, that goes for revisions as well, sometimes I feel it is the behaviroal/emotional work we need to do that the surgery never touches that we must work on for success. be well