Revision

Hi all. I had RNY in 2001.  Saved my life, I started at 315 and lost down to 170. Two years out I had breast reconstruct and tummy tuck. All went well, no complications.  Several years later I started gaining weight. Several things happened. First I found out that when you start gaining weight the fat will first start where there is more room, such as legs and butt. Second to get control of gaining weight is as hard as before. Know I am weighting 257 and right back where I was before. Looking for answers. It's like a run away freight train.  I am looking for a good Dr. To give me options on revision. I will go just about anywhere, but I want someone that has had success with this procedure. The Dallas area would be a great area for me. Love to hear from anyone else with this issue. God Bless all.

Hi Tubs2311,

May we suggest you post this on the Revision forum for more replies.

Revision Weight Loss Surgery Forum

Here are a couple of surgeons in the Dallas area that does revisions.

Todd McCarty (6.5 miles away)

Dallas (also in...) 
Phone: 469-547-6170

 

Nick Nicholson (16.1 miles away)

Plano 
Phone: 469-814-2548

 

Joseph Kuhn (1.4 miles away)

WLS Surgical Associates 
Dallas (also in...) 
Phone: 214 823 5000  

Please let us know if there is anything else we can do to assist you.  

Regards,

Member Services

Yes, losing regained weight after weight-loss surgery is almost as difficult as it was before surgery. You do, however, still have your couch which is smaller than your natural stomach to help you with portion control. You still have to do your part to control what your food choices are and how much you eat, however. Your surgery will not do it all.

You don't say why you believe you have regained, but for the vast majority of people it is simply a matter of eating too much or allowing too many carbs back into your diet.  A revision isn't going to fix those things. Very few people have a ouch or stoma that is truly enlarged beyond what one would expect for a "mature" pouch (my surgeon said less than 20% of the people who claimed they were still eating properly, and we're just SURE that their pouch or stoma were stretched actually had any physical issue).

Your best bet is to go back to basics, focusing on a protein forward, limited carb, portion controlled diet.  Measure your portions (it is REALLY easy to let the portion sizes creep up as the years pass) and track everything you eat for several weeks.  That will probably show you where you are going astray.

Lora

thank you Lora, I totally understand what you are saying. it has been 14 years and I did not gain this overnight. I don't eat much. I try and get in Proteins first. I will admit I do crave carbs and have to work on that. But I have tried doing all you have suggested and nothing happens. Everyone around me is confused to me gaining  because of my portion sizes is so small and food choices. I have had many heath issues in the last 1o years. such as, bleeding ulcers, GERD, Reflux, arthritis, depression,  back issues and have had knee replacement on both knees. I avoid NSAIDS, take my vitamins and have had so much testing done. However I am not very confident with my gastro dr. will be looking for someone else to review all of the testing. Where I have issues with is with drinking water and now exercise due to pain. I am trying to get back on track, but this continues to not get me anywhere.

Thanks,

Toni

Do you journal you food? If you don't, start. Don't change the way you eat until you've logged a week's worth, but log every single thing that goes in your mouth. Then look closely at not just how much you eat, but what you eat. It's very easy for carbs to sneak in, and carbs are what get most of us in trouble. You might get some good suggestions of how to change things up if you post a few days' meals here.

You also need to see your surgeon, and find out if you do have a mechanical problem, like an enlarged stoma or a fistula. However, if your portion sizes truly small, and if you're not eating several times a day, you probably don't have a physical problem---having the capacity to eat more doesn't affect your weight unless you do, in fact, eat more. (*grin*)

If your gain isn't due to the number of calories/carbs you're taking in, the only thing left is your metabolism. You can try burning more calories, but in truth it's almost impossible to lose weight through just exercise. This is especially true if you have a very thrifty metabolism.

It's normal for our metabolism to slow down as we age. You're 14 years older now than when you first had your RNY. Also, our bodies are very good at 'curing' the minor malabsorption of calories that the RNY causes, so at 14 years out you're probably only malabsorbing a very small per centage of fats, and of course certain vitamins and minerals.

There are only two revision options that will significantly change your metabolism. 14 years ago some surgeons were doing proximal RNYs, some medial RNYs,  and some distal RNYs. If yours is a proximal, meaning only a small amount of your small intestine is bypassed, you can convert it to a distal one. This will give you back some malabsorption of calories and boost your metabolism---but it can also cause some unpleasant side effects. Before going this route, talk to Michelle Curran, aka Vitalady. She and her husband are about 20 years out from distal RNYs, and they've learned a lot of the potential problems the hard way. (There's a reason they're in the vitamin business.) However, this is a fairly simple revision, and most surgeons are comfortable in doing it.

The second revision option to speed up your metabolism is to convert your RNY to a Duodenal Switch. This is the more complicated procedure, and far fewer surgeons perform it. It involves complete taking down your RNY, sewing your pouch back to your remnant stomach, and giving you a Sleeve. Then, your small intestine would be re-configured to the Switch, which would give you some major malabsorption, especially of fats. (DSers typically only absorb about half the protein we eat, about 60% of complex carbs, and only about 20% of fats. However, EVERYONE, no matter what form of WLS they have, absorbs nearly 100% of simple carbs, like sugars.)

Both of these options would demand that you take a LOT of vitamins and minerals faithfully every day, and get a complete blood workup at least annually. I am 11 years out from the DS, and I take a handful of pills four times a day. For ME, this is no big deal---it's a habit. Over the years, I have had to tweak my dosages from time to time, but nothing major. For some people, this is a major obstacle, and they should NOT get a distal RNY or a DS.

First I'd start tracking everything I was putting in my mouth with something like MyFitnessPal to see what was causing the problem and what I needed to modify about my diet.  Then I'd work on getting back to my basics.  Here's a list of mine, yours might be slightly different.  

1. Prioritize protein and water
2. Deprioritize carbs
3. Make the most of healthy fats
4. Eat three meals a day with no snacks
5. Avoid liquid calories (breakfast protein shake is the exception)
6. Weigh portions
7. Eat mindfully and with no distractions aside from real live people
8. Move as much as possible
9. Weigh myself daily
10. Be kind to myself

I'd also go to my surgeon and get my plumbing all checked out, just to make sure everything was still working properly.  

Thank you, I will look at this and my dr. is in California and I am in Texas. Will need to make plans for someone to review my situation.

Toni

Thankfully you can start doing all the other stuff while you seek a new bariatric specialist!

You might end up finding you don't actually need one.

If the weight gain is due to a failure in the original surgery then you can probably get your insurance to pay for a revision. If your weight gain is due to non compliance then you'll have to lose it on your own. The tool we had put in place during surgery is still there. Cut calories if that's your problem, eat better, exercise more and drink lots of water. If you're going back to bad habits cut them out. Carbs are NOT our friends, sweets and other non  compliant foods have to be cut way back or eliminated. Start journaling your food intake for every day and at the end of the week find out where you can make better choices. For many of us going back to basics is the key - protein forward or only meals, little fruits and veggies, lots of water, take your supplements as prescribed and move a lot. Exercise is the key to maintaining weight loss and keeping toned. If you have a failure in your surgery your doc can recommend a fix for you. If your pouch is no longer small enough, If there's problems with the stoma opening that can be repaired. He/she can tell you the next step after your tests are done. If you've been eating too much or the wrong thing,  not exercising and gaining on your own then a revision won't help you. this surgery is a tool - we have to make the right choices every day or this doesn't work. Get back on track and you'll be surprised how you can still take it off.

Jen 14 yrs  post op RNY