Revision

HelloI just recently signed up for this forum because I needed a little help of advice from others who have had or is facing  the same situations. I had gastric bypass in September of 2012 and lost a total of 100 lbs ! Prior to that I weighed 351lbs. My surgery was a success but after I awhile I slipped into depression which led back to my old eating habitsI have not gained a significant portion back but I know if I keep this route I will be back at square one. I am considering a revision or the sleeve procedure reason because I want to get to that goal weight! I can admit it is my fault and not the Dr's he a very respectable doctor in the medical field. Any suggestions guys????

Most insurance companies have a "one WLS per lifetime" clause.  Unless you have some kind of mechanical failure from the first surgery they will likely not approve a revision.  You will have to contact your insurance company to find out.

Have you been to your surgeon to see if everything is still functioning properly?  If your pouch is still intact you can still lose weight.  It won't happen as quickly as when you first had surgery, but you can lose it.  You have admitted that the weight gain is your own fault for letting old habits creep back in.  Even if you get a revision, you still have to watch what you eat.  WLS  was never meant to do all the hard work.  The surgery is the easy part.  We have to be responsible for choosing the right foods and to watch our portion sizes. We can out eat ANY weight loss surgery if we don't get the "head stuff" figured out.  Many of us see a therapist to help with the process. 

If you get back to basics and eat dense protein first, then veggies, limit fruit to one serving per day, and eliminate all processed or simple carbs (like bread, pasta, crackers, sugar, rice, potatoes, etc.) you will begin to lose weight again.  Eating these carbs will cause you to have intense cravings and we can eat a ton of them without feeling restriction.  They are also the biggest cause of re-gain

Drink at least 64 ounce of fluid daily.  If you are drinking with your meals STOP!  Drinking with your meals allows you to eat more and you get hungry faster causing re-gain.  This rule must be followed for the rest of your life.

Weigh and measure your portions.  Obese people do not have a proper image of what a normal portion looks like.  I can not trust myself to eyeball a portion size.  I know I will over eat.  Don't eat until you feel full.  Many of us use that "full feeling" as an emotional crutch.  Measure your portion and eat only what you measure out.  We have to learn to be satisfied with small amounts of food.  Food is just fuel for the body.  It's not to be used to comfort you, relieve stress or to fight boredom.  We don't have to center celebrations around food.  We have to change the way we relate to food to be successful.

I eat 6 very small meals daily (200-300 calories).  That means I am eating every 3-4 hours.  Anyone can wait 3-4 hours until they eat again.  If you feel hungry , ignore it.  Hunger is not an emergency.  What's the worst that will happen to you if you feel a little hunger for a few hours?  I eat by the clock and if I feel hungry, I tell myself, "I can eat again in a few hours".  Then I go find something to do.

You still have a great tool if you use it the way it was designed to be used.

YOU CAN DO THIS!!!!!

Ladies thank you for your replies 😎I have an appointment with the surgeon next week to talk about my options , his office stated they would do a upper GI to see how much of my pouch has expanded. My problem is I got comfortable and once I realized I could tolerate certain foods I began to eat eat eat! My confidence is still good just I feel like I'm still a fat girl 😞

Rocky can you email some things to eat 

Don't drink your calories.  Zero calorie drinks only ( like Crystal Light, Mio Water Enhancers, herbal teas, water, Decaf coffee).  

Plain Greek yogurt is high in protein.  I sweeten it with a little MIO or sugar free instant pudding and throw a few strawberries or blueberries on top.  I eat cottage cheese the same way.  This would be a great breakfast instead of the usual, carb loaded breakfast foods.  String cheese wrapped in a thin slice of deli ham is my go to snack.

Meats are your best friend.  They will keep you feeling satisfied longer.  Chicken, fish, beef, lean hamburger or ground turkey, even pork as long as it's baked or grilled and not fried.  Instead of sandwiches, I will make chicken salad and eat it in a lettuce wrap like a burrito.  You can do chicken or beef taco fixings in a lettuce wrap too.

Veggies to avoid are potatoes, corn, and peas.  Green leafy veggies are the lowest in calories ( lettuce, spinach, kale, cabbage).  I eat a lot of broccoli and cauliflower, zucchini, and green beans too.  If you eat salads, be aware of the calories that you add to it with cheese, dressings, etc.  Sometimes a salad can have more calories than a 1/2 pound hamburger and fries!

Stay away from most fruits while you are losing.  The body reads fruit as sugar and it will slow or stop your weight loss.  If you must eat fruit, limit it to one serving per day and stick to berries (strawberries, blueberries, or raspberries)  and remember that a serving size is about 4 medium strawberries, not the whole pint.  You can carefully add fruit back into your diet after you reach goal.

NO BREAD, NO PASTA, NO CRACKERS, NO RICE, NO SUGAR!!!  If it is made with flour or is very starchy DON'T EAT IT!  These foods are notorious for making you gain weight and cause wicked bad cravings.  The more you eat them the more you want.  It will be tough for the first week or two, but then you really stop wanting them.  DON'T GIVE IN TO THE CRAVINGS!

This "zoodle" maker is really great when you are missing pasta.  Just make a yummy meat sauce.  It's my favorite utensil in the kitchen.

Nuts are good for crunch as long as you just eat a few.  They are high in calories and we can eat a lot of them.  If you eat too many, you will gain weight.

If you eat clean, you will do well.  Shop the outside isles in the store (meat, dairy, produce) and stay away from the center isle where all the canned, boxed, processed foods are.

This site has a lot of recipes that are WLS friendly and some great tips on how to eat.  

Hope this helps!

You have made a good first step in taking responsibility for not reaching your goal and recognizing your eating issues.

The first thing to do is go back to your surgeon.  Don't be embarrassed.  You won't be his first patient who didn't reach goal and you won't be the last.

Get things tested and checked out and see if there has been any mechanical failures that need to be addressed.

If not then the first step is to address the eating issues.  How you do that is individual to you.  Support group, self help books, counseling, eating disorder treatment.  There is a lot out there and whatever helps you is good.

Then you have the advantage of already having a functioning WLS to help you with you eating issues.  Another piece of advice is to work with a nutritionalist for a year, one who is experienced with WLS and can help you learn how to eat the best way for health and in making healthy choices for your emotional issues revolving around food.

Insurance may not pay for it.  Mine didn't but it was the best money spent.  I had no clue to how to eat even without an altered anatomy.  I needed to learn what to eat, when to eat and how much to eat.  And I had to take the information I got from her and see if any of it is affected by my eating issues.  For instance my nutritionalist said bread was okay.  My eating issues knew better.  I knew what my trigger foods were (and are) and avoided them whether they were approved or not.

Good luck to you.  Keep hanging around there.  People who have support are far more likely to succeed.  I have seen this first hand in my own life.  Support and accountability is huge in making your WLS work for you.

Hmm I don't get it ??? How in the world would a revision get you to goal. You have your tool , use it. Behavioral therapy is the way I suggest you go

Sometimes, there is a mechanical failure---a stretched stoma, and enlarged pouch, a fistula, etc. And sometimes a person simply chooses the wrong form of WLS for their individual needs. Behavioural therapy can only do so much if your real problem is that your metabolism is super-efficient and can run your body on a very tiny number of calories, or if you're super-efficient at extracting calories from food. (Recent studies have found that some of us really can extract more calories from a given food than the 'average' person can. This means that someone with this sort of metabolism can eat what *should* be a 100-calories portion of food, but extract, say, 120 calories from it.)

Unless you have a mechanical failure, the first thing you must address is your diet. Do you journal your food? How many grams each do you eat daily of protein, fat, and carbs? You know you're gone back to bad habits, and no revision surgery in the world is going to change that---that is ALL something that has to happen in your head.

If you do have a mechanical failure, then by all means, get it fixed. If it's not a mechanical failure, and if getting your eating back on track doesn't fix the problem, then it's time to start thinking seriously about your surgery TYPE.

I cannot recommend revising an RNY/gastric bypass to a Sleeve, unless you're having some sort of RNY-specific problems. The Sleeve relies solely on restriction; the RNY relies *mostly* on restriction, but during the first 18-24 months, it *also* causes you to malabsorb a small per centage of the calories you eat. (Since you had your surgery in 2012, you probably no longer malabsorb any calories---just certain vitamins and minerals. Vitamins and supplements are forever!) Essentially, revising your RNY to a Sleeve will give you, at best, temporarily more restriction, but no malabsorption. You will still have to get rid of those bad habits.

If your problem truly lies with your metabolism, then you should look into revising to the Duodenal Switch. The DS has both a Sleeved stomach, plus an intestinal bypass similar to what your current RNY has---but it's much more aggressive. The DS causes permanent malabsorption of a significant per centage of the calories you eat. It also makes a dramatic, permanent change in the way your body metabolizes food. BUT---revising an RNY to a DS is the most complicated revision surgery out there, and there are not a lot of surgeons who perform it. Odds are good you'd have to travel to find an experienced RNY-to-DS surgeon, and this is NOT a procedure you should let anyone do on your unless they are highly experienced.

Thank you very much for your input 😀since I last wrote I lost lbs😋😋😋😋I know it's not a failure its me ! I allowed myself to go back to old ways....... My surgeon is one of the best in the state , I am still going to discuss my options thought just to see where I am at . Most importantly I'm back in the gym