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Different DS surgeons have different theories about what is most important in a DS. Some go for more restriction (i.e. a narrower sleeve) and less malabsorption, others think a larger sleeve is ok as long as you have really good malabsorption.
It's certainly possible that the initial sleeve was not done as well as possible, but also possible that the original surgeon was being careful not to make too narrow a sleeve, which can cause serious problems with reflux. The size of the bougie doesn't tell the whole story, as it also depends on how tightly the surgeon stapled against the bougie.
So, given that none of the above options sounds great, I would recommend a second opinion with another DS surgeon, and the one I would recommend is Dr. Ara Keshishian in Pasadena, CA (near Los Angeles). He does a lot of revision surgery, and his philosophy goes more to the larger sleeve, more malabsorption end, which might be just what your sister needs. Though of course, if the sleeve is truly malformed, she may need a re-sleeve, but this is something to discuss with him. Given that your sister is going to be self-pay, she may as well pick the surgeon that suits her best.
Larra
If he wanted to do anything on top, I'd ask for a tighter sleeve.
HW: 398.8 SW:356 GW: 175 CW:147
Hi Guys,
Posted the other day about my sister's dilemma. Went to see Dr. Gary Anthone (always a pleasure to hear him talk) great human being. Rehash she was 425 down to 315-325 after 1 year with sleeve (200) would be great, just stopped losing weight after 6-7 months. Has some hormone and autoimmune disease issues and has certainly made poor food choices as well, but felt the surgery should have worked better for her year one.
Talked about everything going on, he said adding the DS to the sleeve in place at this point, she wouldn't see a big loss of weight and would probably be disappointed. He said she would need to add some restriction along with the DS. But he's not a fan of re-sleeving and thinks the Dr. that did the first sleeve didn't (hug) the bougie along the staple line and left to much stomach. The original Dr. used a 40 bougie, I had a 32 and she could out eat me at 7-8 months, I'm 10 years out and still have good restriction. She can still eat half of what she used to BTW. So he felt converting the sleeve to a pouch would be better.
So he gave her three options.
1: Get a Panniculectomy, $8-10K?he estimated 35-40 lbs. Her original Bariatric surgeon thought 40-45 lbs. Get some relief and more mobility from a plastic surgeon, then add a bypass with new restriction later.
2: Get a Laparoscopic Roux-en-y with one of the other surgeons he works with, about $24K convert sleeve to a pouch. We know the Roux-en-y will lose it's bypass effect overtime so there is a downside and Get plastics later.
3: Get the DS with him (open procedure) $32-35K and convert sleeve to pouch but do a DS hybrid of sorts would be most effective he mentioned, resolve the diabetes altogether hopefully. Probably help keep the weight off the most long term. Get Plastics later.
She's self pay for all of this and the last option would be a doozee financially, current employer doesn't pay for WLS. Time off not a problem can work from home. But even self pay for WLS hospital said 3-6 months supervised weight loss. Don't really wanna weight that long.
She has a couple appointments with plastic surgeons and another Bariatric surgeon. Anybody been through something similar and what did you do or how would go about it. She needs both knees replaced and mobility is really becoming an issue. Any thoughts are welcome.
Thanks,
Bubba
I wouldn't get a hybrid anything. I would get a straight up ds, even with a larger sleeve the malabsorption helps to lose weight.
I'll admit to getting lost in the terminology he used. He wanted to create a roux-en-y pouch out of the sleeve but do the intestines as a DS. That's how I understood it hence me calling it a hybrid of sorts.
DS Hybrid? I wouldn't want that. A stanard DS, yes!
HW: 398.8 SW:356 GW: 175 CW:147
Hi Guys,
Posted the other day about my sister's dilemma. Went to see Dr. Gary Anthone (always a pleasure to hear him talk) great human being. Rehash she was 425 down to 315-325 after 1 year with sleeve (200) would be great, just stopped losing weight after 6-7 months. Has some hormone and autoimmune disease issues and has certainly made poor food choices as well, but felt the surgery should have worked better for her year one.
Talked about everything going on, he said adding the DS to the sleeve in place at this point, she wouldn't see a big loss of weight and would probably be disappointed. He said she would need to add some restriction along with the DS. But he's not a fan of re-sleeving and thinks the Dr. that did the first sleeve didn't (hug) the bougie along the staple line and left to much stomach. The original Dr. used a 40 bougie, I had a 32 and she could out eat me at 7-8 months, I'm 10 years out and still have good restriction. She can still eat half of what she used to BTW. So he felt converting the sleeve to a pouch would be better.
So he gave her three options.
1: Get a Panniculectomy, $8-10K?he estimated 35-40 lbs. Her original Bariatric surgeon thought 40-45 lbs. Get some relief and more mobility from a plastic surgeon, then add a bypass with new restriction later.
2: Get a Laparoscopic Roux-en-y with one of the other surgeons he works with, about $24K convert sleeve to a pouch. We know the Roux-en-y will lose it's bypass effect overtime so there is a downside and Get plastics later.
3: Get the DS with him (open procedure) $32-35K and convert sleeve to pouch but do a DS hybrid of sorts would be most effective he mentioned, resolve the diabetes altogether hopefully. Probably help keep the weight off the most long term. Get Plastics later.
She's self pay for all of this and the last option would be a doozee financially, current employer doesn't pay for WLS. Time off not a problem can work from home. But even self pay for WLS hospital said 3-6 months supervised weight loss. Don't really wanna weight that long.
She has a couple appointments with plastic surgeons and another Bariatric surgeon. Anybody been through something similar and what did you do or how would go about it. She needs both knees replaced and mobility is really becoming an issue. Any thoughts are welcome.
Thanks,
Bubba
Thanks Pete. I did have normal ****il this year. My E is normal. I have heard back from my surgeon's office. They reassured me that we will follow and add or detract from what is working.
I think I am going to go to every other day with Prilosec. If I don't have heartburn, I can go to less. If I need it, then I'll go back to everyday.
I try to be proactive. Thanks to both of you for your responses.
RNY revision to Lap DS Feb, 2016, Dr. Ayoola.
HW 235/SW 184/CW 127
High B6 is bad
high B12 is no biggie
Are you taking dry D3? I need to take 100k daily to keep my D around 100, you may need to add another.
With the research I've done, high B's don't have any negative problems. I'd worry more about your low D.
Liz
HW: 398.8 SW:356 GW: 175 CW:147
My multi does have some but I wouldn't expect it to be enough to cause it to spike that high. I'm more over curious if anyone has heard of symptoms of high Bs.
B12 = >2000pg/mL (Standard is 211-911pg/mL)
Folate = >20ng/mL (this is in range)
Vitamin B1/Whole Blood = 255 nmol/L (Standard range is 70-180nmol/L)
My nutritionist said that my gut bacteria could be producing Bs somehow so she has me taking a probiotic to try to normalize it. Just looking at Bs as a contributor because the symptoms I've been trying to track down seem to be coming up empty on the causes.
You'd think that since vitamin B is water soluble it would have normalized with as much as I pee...
