xpost: question re Upper GI - RNY 7 yrs out

I had a RNY in 4/02.  I never got closer than #45 to my goal weight (started #120 from it).  I have had 2 upper GIs - one 4 mos out, and another 16 mos out and both showed "rapid emptying" of my pouch.

Today I had another one in preparation for a revision to a DS as I have gained ALL the weight back, and again, there was rapid emptying.  This doc took the time to tallk with me and said my pouch was appropriate for this far out (about 1/4 - 1/3 the size of a normal stomach) and the rapid emptying was also normal.  I tried to explain that my concern is everything (including food) just flows right out of the pouch making it so that even if I eat appropriately an hour later I can eat another meal -- I have no feeling of being full since everything just flows right through.

Am I totally wacked out or does it sound like my tool may be "broken" and it isn't just my head?

I never had a problem with nutritional deficits and dont take any vits - always figured if my labs were good, why waste the money.  Bottom line is I think I need some malabsorption as well as some restriction here....


EDIT:  The part I forgot to put is that I am asking because insurance will pay for the revision (or I can argue it) if the original surgery is defective.  If it is not working as it should - which I feel it is not (but I a bit biased), then it should be revised.

Comments?? 

If you're getting a revision to DS, you will have the rapid emptying resolved, because the pyloric valve which controls emptying of your stomach, will be restored with the DS. And the DS stomach is very small early after surgery. So you will have restriction. As time goes on, there will be less restriction.
The intestinal part will increase the malabsorbtion and will help too.
So the DS will take care of both issues you are asking about.

Your situation is exactly what my situation was except that it took me 20 + years to look into a revision...I had no clue all those years that something could have been done.  I was too ashamed to go back to my surgeon (just a general surgeon as this was done in 1982) and I thought it was my fault that I had gained all this weight back.   My endoscopy, UGI all pointed to the same thing as yours.  I had rapid emptying and found that I could literally eat all day. Then I found OH and started to research a revison.  I chose to have a lap band placed over the old stapling, which was a good choice so far for me.  When I had my surgery, my surgeon said that my pouch was actually larger than he thought.

There are many choices now for us and that fact alone is a miracle!  Do your reaearch and find the surgery that fits best into your life.

I wish you the best...feel free to PM me anytime for support!

if you are not bothering to take any vitamins with your RNY there is no way in hell you should get a DS

you may not think you have deficiencies but you are most likely using up what stores your body had.

please rethink your commitment to your health before you go for more malabsorption

Judi,

I appreciate your concern, however....

First off I am an RN and do get labs quite a few times a year do to other issues.  IF and WHEN I EVER thought there was any reason to believe that ANY of my values were out of normal (I have copies of labs faxed directly to me) I talk with my doctor as to what she wants me to do.  Your comment that "...may not think you have deficiencies but you are most likely using up what stores your body had"...if I was newly out, perhaps... but 7 years AND a pregnancy, baby and nursing for a year...... no, sorry.... I don't buy it.

To that extent, my zinc did go low a few years ago and was on a suppliment for it at the time.  Also with all the infertility stuff we went thru for the past 5 years I was taking a multi vit and extra folic acid (for the baby).

As I see from many DSers, they self monitor labs as well -- changing vits as needed to remain in normal ranges.

As for "no way in hell I should get a DS"...... I suppose you are one of those of the opinon that I "didn't follow pouch rules" or some such nonsense which caused my gain....  If I had appropriate malabsoroption AT ALL throughout my RNY venture, I don't think I would be here at this point now.

Thank you for your reply.

I would never blame a surgery malfunction on a person. I have just read so many horror stories of people with brittle bones and other problems your vitamin comment just made me worry.

glad you are up on your labs and maybe your surgery is so broken that you are absorbing all your nutrients from food.

it just sounded from your post that you were a little blase about the vitamins and i found that scary.

glad i was wrong and i hope this all works out for you

Again, I do apprecaite your concern.  My mother had RNY (altho a distal) about 6 mos after I did and she DOES have malabsorption issues. 

I always felt that if my labs did not show anything was dipping or low, why literally pee the money away (some of the suppliments can be quite costly!).

With DS I do realize that it is a different animal and will be watching to see what suppliments will be needed.  As my signature says... I have an almost 2 year old and I need to be around many more years for him -- malnurished and/or dead from not paying attention to those sorts of things just wouldn't be a good thing :).

 Be sure your doc actually performs the DS surgery and is not a "bait & not switch" surgeon, who gets you into his office and then convinces you that some other surgery would really be best.   Read the two Journal articles I just posted on the revisions board - they talk about the failure rate of the RNY (much higher than anyone ever thought), and about the results to be expected from each type of revision.  The DS has the best success rate, but only a handful of docs in the U.S. do it.  

What has happened to your pouch is normal.  Pouches stretch - it's one of the reasons for the high failure rate of the RNY surgery in the long term.   And, sometimes they are not made small enough initially.  With your original RNY, there should have been some malabsorption built into the operation.  It sounds like you don't think there was?   If you don't supplement and still have good labs, there is a good chance that you hardly have any malabsorption.   If you had malabsorption, you would need to take vits and protein.    And, if you want the DS, you will have to supplement for your lifetime if you want to be healthy.

The inherent nature of the operation is why it failed you.   It is working like it should, but it was a "cookie-cutter" procedure which was never tailored for your particular weight loss issues in the first place.   Your pouch may have been made too big and you may not have been bypassed enough.    Unless you can get a doctor to find some issues, it is doubtful that insurance will pay for your revision.  There are options for self-pay, but many of them are out of the country.   Some people who post on here have gone to Mexico and had great success.   I think that may be the most reasonable.   There are also doctors in Italy and Spain who do the DS.  

You can also try a lapband over your pouch (a less invasive and cost-effective alternative), which has been successful for those who can tolerate the restriction of the band.   A couple of people on here have had that done.   If you put up a post about "lapband over RNY experiences", you will get some answers.   

Good luck

Thanks SMom....

Yes, I am not going to a "bait and not switch" doctor... in fact, I have an appointment with Dr. Greenbaum in NJ on Thursday.

From my UGI results in 2002, 2004 and last week it looks like the pouch is an appropriate size -- I am still convinced it is the outlet that has no restriction and again, the malabsorption seems to be non-existant (always did seem that way actually).  I don't think a band would help since I can get anorexic on my own (see my profile) just restricting isn't going to do it at this point.

I went to a general surgeon last time around -- figuring it was just the pipes that needed to be re-routed -- and had he bypassed more than 100cm, perhaps it would have remained ok.

Thanks for your concern and rest assurred I am not going into this blind and am fairly confident I have chosen an appropriate, capable surgeon to do my revision. I do hope his office staff is also creative with insurance companies and able to state my case appropriately.