Revision from RNY to DS Blue Cross CA

Hello.  I'm planning to make an appt with the Surgeon that performed my RNY regarding a revision to a DS.  Has anyone gotten approved for a DS with Blue Cross of CA? I've gained 50 pounds and my knees are painful, again.  I want to get help now.   Thank you! Tonya

Hello Tonya, I live in MD but i have BCBS PPO and I was approved for my revision in 24 hours.  I could have had any of the NIH approved procedures (Lapband, RNY, DS).  I have chosen to be revised from proximal to distal rny (BPDS).  I just feel that for me the risks of revising my pouch out weigh the benefits.  I am having my revision on 12/26/07 and i am so excited. I don't know which procedure you are considering but I'm pretty sure you won't have any problems getting approval.  If you have additional question feel free to pm me. S

Hi Shawnta. Distal RNY and BPD/DS are two very different procedures. Are you having your RNY pouch revised to a subtotal sleeve gastrectomy? And what kind of changes are being made to your small intestine?  Call me a Nervous Nellie, but when I read you post I wanted to make sure that you're going into your procedure fully informed about what's going to be done. There's no such thing as being too well-informed as a patient :-). Good luck. What a Christmas present to yourself!!

Hello Elizabeth, I am having the BPD which I'm sure you know  is essentially the same as a distal  rny revision!  i am not having anything done to my pouch my surgeon is going to revise me to a 75 cm common channel.  I have researched ALL of my options and I feel that the BPD is not only the best but also the safest option for me. Thanks for your concern S

Ah okay, now I follow better :-). I was under the impression that in the BPD the lower portion of the stomach is removed, so that you have a somewhat different pouch than with the RNY and the remnant stomach is gone rather than resected. (In the DS, the stomach reduction is more or less vertical and leaves the pyloric valve intact and functioning.) But that's my very non-medical and very limited understanding of that part.  What's important is that YOU know, of course. Here's to a flawless procedure and smooth recovery!

Dr. Maguire is giving you a distal RNY and NOT a BPD or DS.  The only common thing is the length of the common channel, resulting in all the malabsorptive qualities of the DS without the ability to eat enough food to get proper nutrients from the pouch of the RNY.  It's like the worst of both worlds IMHO.  That means more and more supplements and struggling to get in your 100 g of protein each day.  You get the B vitamin issues because of the pouch along with all the ADEK issues from the fat malabsorption. I just don't understand why someone as skilled and experienced as Dr. Maguire won't do true DS revisions.  If you haven't already, check out a gal out here by the name of vitalady.  She has a distal RNY and can be of great assistance with getting you off to a good start with supplements.  She's helped many distals and DS'ers. 

If your original pouch is not going to be touched, it is still an RNY pouch. So dumping and such will still happen, if it happens now.

Revising the lower end to a 75cm common channe makes you a distal RNY, not a BPD. BPD had a huge stoma*****omparison to RNY, the 90's version being about 5 oz vs your 1/2 to 1 oz.

I have a distal rny, 100cm common channel, since 1994. When my staple line disrupted, I opted to have the useless part of my stomach removed when they repaired my staple line because of a history of ulcers (all my life). So, in some semantics, they might call it a BPD, because of the gastrectomy plus short common channel. But the dumping and hypoglycemia episodes define it as an RNY, distal, because of the short common channel.

I am healthier than most because even in the 90's our docs had us on large doses of iron, calcium (but the wrong kind) and dry forms of vites A, D, E. We also were taking protein supplement a decade before they were palatable. Ewww.

It would be important to get your definition really straight, cuz it's sorta like saying you have a sports car station wagon now, KWIM?

Since I do fine with my distal, I don't think it's a death sentence, but a 75cm common channel will take some VERY fancy footwork to stay way ahead of on the nutritional end.

http://medpolicy.bluecrossca.com/policies/SURG/severe_obesit y.html Here is the position statement for BSBSCA. Suz

Thank you.  I'll read it now. T

You are very fortunate to live in a state where there is excellent precedent for approval for both "virgin" and revision DS procedures. If your insurance balks, you can appeal the decision and will stand a great chance of getting it overturned.