The ABC's of Revision A to Z

Hi Dr. Schlesinger... I need your opinion...I had lap RNY just 16 months ago and have been having such complications and problems.  As I was bypassed 150 cm and then had two strictures and an ulcer and then by 6 months post op, I had twisted intestines and had to have an additional 150 cm removed from my comman channel.  So I malabsorb more than the normal RNY person. I am 5'6" tall and weigh in ~ on a good day, at 105 lbs.  I can't seem to gain or maintain my weight.  My one year check up with my surgeon showed that my calcium and b-12 were very low and he also wrote FAILURE TO THRIVE on my records.  He wanted me to gain 30 lbs by my 16 month check up.  At my 16 month check up, I weighed in at 100lbs.  So he has given me two weeks to gain 15 lbs.  Well, that isn't happening.  I dump on sugar and fat.  I can't tolerate Whey or lactose and I still can't digest beef.  I believe my pouch is smaller than most because I can only eat 4-5 bites of food and I am stuffed.  I do eat every 2 hours and it is always a protein first. I feel like in your description of the ERNY, that is me...how can it be corrected?  I'm really scared of heart and kidney damage.  It's true that I haven't always been compliant with my vitamins...sometimes I just feel so kicked down on to the streets..how is vitiamins gonna help me now.... Any words of wisdom or suggestions you give me would be greatly appreciated.  I'm so scared and confused and being threatened with a feeding tube as soon as the 20th of this month.  I didn't get this surgery to be so sickly and be a FAILURE TO THRIVE!! Thank you, Dawn

HI DR. SCHLESINGER. I WOULD LIKE TO KNOW IF THE ROSE PROCEDURE IS BETTER THAN STOMAPHYLX. IS IT POSSIBLE TO STILL LOSE WEIGHT HAVING THE ROSE PROCEDURE DONE WITH AN UNDERACTIVE THYROID.          THANK YOU DANA

Dawn,
Although I do not have a comprehensive picture of your intestinal anatomy, it appears that you effectively have an ERny. Your inabilty to gain weight is NOT your fault. Based on the information available, it would appear that you need to have the malabsorptive component of your surgery reduced, i.e. your common channel requires lengthening. This should be done ASAP if your nutritional status will safely allow the operative procedure. The best way for you to address your nutritional status is with an elemental diet. This is a special type of liquid diet that is most easily absorbed by your body. It is not the most tasty or appealing of drinks but as a way to gain some weight, it's your best bet.
I believe that your current condition requires urgent treatment. In other words, you don't need to head to the Emergency Room, but definitive treatment should be initiated SOON.
GOOD LUCK!

Eric Schlesinger, MD, FACS
AZ Weight Loss Solutions

Oh my gosh Dawn!  You represent what I fear!  I am far from being in the danger zone yet but I take hands full of vitamins to help me get through my day and though I eat like a crazed pig; I continue to lose.  I think I've got a handle on mine for now but YOU worry me!  Please get help!  I was counciled my my nutritionist to suck in as many high calorie nutritional liquids as possible.  I dump on ice cream based stuff but have found that certain smoothies or slushies go in o.k.  I add a scoop of flavorless Any Whey so I boost my protein.  If you can't get in many bites then SUCK those calories in!!!! Get on the wagon with the vites and supplements and get that weight back on you girlfriend!  Keep us posted!  .....Gheesh!  Now I'll be stressing about you all weekend!  ...... Big fuzzy HOT hugs from Phoenix! Joyce

Dr. Schlesinger, I have a quick question about the prevalence of band problems.  I got my band over 3 years ago and I did really well with it.  I lost 145 pounds (75% of my excess body weight) in the first year.  I was doing great.  I was exercising, eating a good balance of protein and complex carbs, and was at my sweet spot and never hungry.  After getting diagnosed with a painful disease, I had to stop exercise (which should be only temporary... but for who knows how long).  I ended up gaining all my weight back, but not due to the lack of exercise.  I was not able to exercise for several months and I just maintained my loss.  I started to have band problems where I would vomit everything that wasn't liquids.  I would have horrific reflux that would make me aspirate at night (making my asthma worse).  I actually got salad stuck (with an empty band) and was admitted to a hospital for 2 days due to intractable vomiting.  My "then surgeon" studied my band under fluro and endoscopy.  No problems were visible other than gastritis/esophagitis on the scope.  Months of testing.  Months of me complaining and suffering.  After a the first few months of vomiting everything solid, I resorted to living on oatmeal, ice cream, and milk.  I couldn't have protein shakes since artificial sweeteners were off limits for a health reason.  So... because I added that crappy food back into my diet, I gained all my weight back over 1.5 years.  It kills me because I used to have such a healthy diet (eating vegetables, some meat, beans, nuts, etc), even before banding.  My band made my diet WORSE!  My surgeon even had me get a psych consult saying that my vomiting and reflux was all in  my head (it didn't help that his GI doctor didn't believe me either... saying that I "found a way to stay fat because I 'mentally' don't want to lose weight".  I was irate when I heard that).  So... I got to my breaking point and was going to revise to the sleeve with another surgeon that I didn't love, but who was skilled surgically.  My "then surgeon" hates the sleeve and put  me in contact with a "band expert".  The expert had me call him and we talked for a while.  He said, based on my symptoms, it was slip, hernia, or both.  He studied it under fluro and saw the hernia, "clear as day".  He repaired the hernia, but also found a significant slip during surgery (why it was not visible before then is beyond me).  Unfortunately, the reapir didn't work.  I still have horrific reflux and vomit on occasion when I eat meat/vegetables.  So, I found a surgeon that is highly recommended by many and he thinks RNY is best for me due to the severe reflux and with having a BMI over 50.  I was sold on it and will be having my revision soon.  I am thrilled to have found him. That is just a brief PMH.  I just wonder, is my story common?  Why is it so hard to diagnose complications like mine?  I mean, I suffered for 1.5 years and being told it was in my head!  So the result, I went to soft foods that are high calorie, low in nutrients just so I wouldn't vomit or reflux.  I started with just milk and cottage cheese, but like I said, it was a LONG process to get a diagnosis, and I ended up eating junk food just for variety. Do you see people like me succeed with other forms of surgery once the band is removed?  After having a band fail, I am afraid to gain weight back with another surgery.  I know I have the motivation and committment, and I pray that once my band is out, I will sleep better (without the GERD and pain... yes I have pain from the repair as well).  My other disease is getting more manageable and I will add swimming back soon.  So... I guess I just wonder why it took so long to get a diagnosis, if someone that had struggled like I did will succeed at another surgery (my current surgeon thinks I will), as well as if my story is fairly common in the failed band "camp".   Thank you (and sorry this was so long!  Hopefully you found my story interesting at least)!

Alyssa,
Although band complications are not common, the problem that you experienced is not uncommon among "Banders" with problems. The cause of your inability to tolerate solid foods with no obvious problem with the band is not well understood. As we see more patients like you, it has become clear that replacing or repositioning the band is not the answer. All too often, replacing the band will either be ineffective in remedying the problem or prove to be ineffective as a weight loss tool.
For others who may read this, please read carefully. Band problems are uncommon. My comments are specifically directed to the situation in which no mechanical problem with the band can be easily and clearly identified. "Subtle slippage" should be considered a suspect diagnosis.
Finally, I have every reason to believe that you will succeed with a Rny. Given that your BMI is greater than 50, you owe it to yourself to consider an ERny.

GOOD LUCK!
RECLAIM THE SUCCESS YOU DESERVE!

Eric Schlesinger, MD, FACS

Thanks Dr. Schlesinger!  While it appeared as there was no problem for over a year, they did determine that there was a moderate slip and hital hernia.  Reparing both didn't help.  It's such a shame.  When the band works, it is wonderful.  I am really looking forward to my revision!

Dear Dr. Schlesinger, I am in process of gettting an ERNY revision from you...going through the 'red tape' of insurance. I just saw Dr. Kruger here in Tucson for my Physc. Eval. and it went very well. He seemed really interested in any information he could get his hands on about revisions!  I told him that I learned the MOST about the types of revisions from your post here on O.H. called The ABC's of Revisions. I told him where he could go to read all about it.  I told him that I read it quite often because it's the most direct and honest and easy to understand information I have seen yet! So a quick thank you for posting this, it's perfect.  My first WLS I just jumped in.....didn't know near as much as I do this time, thanks to you!!   It makes me feel much safer and more comfortable the more I know. Keeping my fingers crossed that my turn to FINISH ME up will be approved soon!  Not giving up just yet! Jenn in your office is a complete GEM.  Jenn the GEM!  She is one hard working, CARING person and I'm glad she is on my side!   Thanks again, Gwynn in Tucson

Hi Dr. Schlesinger- I had my Lap RnY in Decemner 2002.  I initially had tremendous success - I lost 60 lbs in my first 30 days, 100 in 6 months, the last 55 over the next 9 months.  Then the trouble came -- I started having excrucinating pain that would not stop.  After 18 months of doctor and er visits, somone finally caught it - I had a leak in my pouch, which was leaking stomach acid into my peritoneal cavity.  They pulled 2 liters of pus from me; in addition, I had a perforated bowel.  I was in the hospital for 47 days.  I lived through that, and here I am -- 60 lbs heavier.  I was 150 lbs,  and I am now at 190 lbs., considering revision.  I have a 32.4 BMI.  Would this be considered high enough for a revision?  And would insurance cover it?  I understamd you can tell "for sure" but in your experience, what would your best educated guess be?  I feel like a failure, I just got married and don't even want my husband to look at me because I feel so hideous.  I have a consult on 7/16.  ANy inf you have would be so appreciated.

Hi Dr. Schlesinger, I have a question.  Those of us who have hypoglycemia, how does the ERNY help with this or will it not be resolved?  I am having a little problem wrapping my head around it and trying to explain it when I don't quite understand it especially with an enlarged stoma.  I am sure that I am not the only one here that has this kind of question.  You just took me off guard when I saw you in the office last month and I didn't get to ask you this question.  Is it a matter of diet that will control this? Hope to see you soon! Deanne