Revision from RNY to DS

Hi. I had RNY almost 15 years ago and lost about 150 lbs but have regained about 80 of that. I've tried the various diet plans and can lose about 15 lbs before I stop losing again. I met with a surgeon yesterday to see what my options were for a revision. He said basically my only option is converting to a Dudoenal Switch. I was very surprised because I'd seen a non-surgical option on a video from his website, so thought that's what he was going to suggest.

Anyway, I'm starting the process whi*****ludes a GI study, endoscopy, meeting with an endocrinologist and dietician, getting updated bloodwork and starting a medical weight loss program for 6 months. Honestly, I'm hoping I can lose the weight without the revision.

The surgeon was pretty up front and said the revision from RNY to DS is a big surgery, has the highest 30 day risk out of all the bariatric surgery options and that the aftercare/malabsorption is twice as bad as RNY. He said I'll need to double-up on my multi-vitamin, plus add in Vits A, E and K. I'm already on prescription Vit D pills once a week and B-12 shots twice a month. I've also had two blood transfusions, several iron infusions and am monitored every 6 months by my hematologist.

I'm sure the surgeon was just trying to be thorough and not sugar-coat anything but I left the appointment feeling very discouraged. Is the RNY to DS revision as awful as he made it out to be? Do I have any chance of losing weight through a medical weight loss program? I actually had a consultation with their program 4 years ago and at the time, all they told me to do was eat low carb/high protein - and they tried to get me to buy their brand of supplements which were extremely expensive. The surgeon said they now have options to prescribe medication along with their program so that might change things. I'm just very discouraged and not sure what to do.

I would be very careful on who you pick to revise your rny pouch to a VSG, there are only a handful of surgeon in the world that can perform that surgery. The surgeon is for cutting not for follow up. If that is all he told you you would need, that is way off. First RX vit d is d2 which is oil based and is not absorbed in general but as DS is fat malabsorption, we need to take dry d3, that is all of the fat vitamins..ADEK and zinc. In general 50k vit d/week is nothing, add d2, you may as well throw that rx down the toilet, it is worthless. many dsers take 50-100K or more of dry vit d3/day. Dont know why you would take vitb12 injections 2xs a week, the sublingual work so much better, cheap and easy. you will need to take calcium citrate at least 1500 mg/day.

Like i said make sure your surgeon knows how to take down your rny pouch.

do you have a chance of losing weight, no one can answer that except you

Thanks for the insight. He's one of 3 surgeons in the practice. It's an "all-in-one facility" (my words, not theirs) so they have an endcrinologist, dietician, nutrition, medical weight loss advisors (non-surgical) and bariatric surgeons in the same office, which is affiliated with my local hospital. This was my very first meeting with him, and he specifically mentioned the vitamins because told him I had a lot of vitamin deficiencies from the RNY. He wasn't by any means saying those vitamins were all-inclusive or that there wasn't anything else I would need to take - he was just giving me a high-level answer to level-set that there's a lot more vitamin maintenance required than what I'm currently doing.

He has successfully performed this type of revision many times, and he showed me diagrams of what happens in the revision (what gets put back together, what gets removed, what gets switched....etc.). Again, this was my first visit so there's still lots more follow-up and lots to learn. Hopefully I can see results through their non-surgical program and avoid the revision but having PCOS makes it difficult to lose weight in the best of cir****tances.

As for the B12 shots vs. sublingual - I've never been able to absorb B12 sublingually for some reason. It's been a struggle for a lot of years, and the shots are the only things that seem to work. Similarly, I don't absorb iron or retain ferritin without iron infusions. My hematologist monitors my levels every 6 months and lets me know when my numbers start to trend downwards.

I didn't have a RNY but I do have a DS.

you may can lose the weight on a medical diet but css as n you keep the weight off?
you regained it the first time. What will stop you from gaining it back this time, without the DS?

What will stop me from gaining it back? Well, I don't know that there are any guarantees, but I know what contributed to my weight gain. Since my RNY, I went through several years of infertility treatment (multiple IUIs w/ injectable meds and IVF) which resulted in 3 wonderful children - a singleton and a set of twins. I retained a little baby weight in between pregnancies, but not that much. After my twins were born, I made the mistake of having an IUD inserted to help with some of the nasty post-twin birth issues. I say it was a mistake because while it helped in some areas, I didn't realize it didn't have any hormonal qualities that would keep my PCOS in check. Quite frankly, I have to be on some kind of estrogen otherwise the free testosterone in my body skyrockets causing all kinds of issues, including weight gain. I should have researched it more before I agreed to the IUD so that's on me. I was on the IUD for 2 years and that's when I gained most of my weight back. I had it removed, and went back on oral birth control pills, but the damage was done. I also spent a year dealing with the death of my father and making multiple trips out of state to make funeral arrangements, clean out his house...etc.

I don't plan on having any more children so there won't be any infertility treatments or pregnancies in my future. I'm never having another IUD put in. I'm working with an endocrinologist to help manage my PCOS and get the side effects under control, since unfortunately there's no cure for PCOS. I'll also have to be more diligent about my diet. I have a child with cerebral palsy so there are lots of doctor, specialist and physical therapy appointments, and I have a very demanding full-time job so I tend to skip meals and grab snacks on my way out the door. I need to start making myself and my health a priority rather than putting myself last. That's probably going to be my biggest challenge.