High Risk Surgical Patient

Hi, I have diabetes (insulin dependent), high blood pressure, kidney stones, sleep apnea and need to lose about 150 pounds. I had a lap band placed about 3.5 years ago and only lost 50 pounds, regained 30, and am now thinking about a revision from the lap band to RNY.  Anyone else out there with a similar medical history that's gone through a revision?  What was your result?  Thank so much! 

Because I'm reading the boards this morning, and I noticed you hadn't had any response as yet. 

 I thought I would get on here and post to you, just so you know you can expect a lot of great quality information coming your way.

There are several people on this board who have gone from Lap Band to RNY. As well as from Lap Band to DS, Lap Band to Vertical Sleeve.  I wish I was a patient going from Lap Band to RNY or any of the many options out there, you have calling your name. You are considered a virgin revision at this point....Which is Great!, Great!, Great!....

You will find after much investigation that the odds of you finding a very successful surgery from Lap Band to whatever? are very much in your favor!!! I will refrain from going into it since my knowledge and study has been mostly about a different kind of revision.

Good Luck and I'm sure you'll the information will flow your way.

Janie

Thank you to everyone who took the time to reply to my post.  Your kindness speaks volumes. 

Hi,
I just wanted to say that I don't really think you're a higher risk than many of the rny patients. I didn't have high blood pressure, but I did have diabetes, high chloresterol, kidney stones, sleep apnea, and a lot of scar tissue from the many other abdominal surgeries that I had. I came out just fine and the surgery will help you get rid of some of these problems (hopefully all of them). My revision did take 8 hours, but I had a lot of scar tissue and adhesions. Don't worry you'll be fine and we'll be praying for you.

Have you looked into other surgeries as well? There is not just the RNY, many people revise a lapband to a VSG or to a DS. I assume that with 150 pounds to loose, your BMI is over 50, and for those with a BMI over 50, the RNY has a failure rate (= not loosing at least 50 % of your excess weight) of 40-60% !! Look here: 
http://www.obesityhelp.com/forums/revision/3886215/Everyone-should-read-this-Revision-Procedures-for-Failed/

For me personally, that would be an unacceptable high failure rate.
Statistically, you have a much better chance of loosing most weight and keeping it off with the DS. Check the DS message board for more information. The DS also has a 98% cure rate of diabetes, which is better then the RNY.

Several things. I have a lifetime history of kidney stones, as does most of my family, and finally found some things that help, and it's listed in the first part of my profile page.

Next, you need to look at all the surgeries, as it looks like the DS may be good for you. It not only has the best weight loss statistics, and maintenance of that loss, but has a 98% CURE rate for type 2 diabetes (unlike the band or RNY, when diabetes can only go into REMISSION, which means if you regain, you probably get the diabetes back).

Select the procedure that would work best for you via research (not just by what adamant posters on this site may say, although many can get you links to useful medical studies) , and only then select your surgeon. Many surgeons that only do RNY or band will only discourage you from other procedures like DS or sleeve.

I've had resolution of sleep apnea, insulin resistance, high blood pressure, PCOS, metabolic disorder, and high cholesterol since my DS, and would be happy to answer any question I can.

As a general principle, patients seem to be more metabolically stubborn following a failed weight loss procedure. I liken this to a patient on a yo-yo diet, where it becomes more difficult to lose weight at each recurrence of the cycle. Being a diabetic on insulin is another marker of statistically high failure from weight loss surgery, including RNY. Although there is a tendency to "blame the patient" among many surgeons when they fail, most of this failure is what I call "metabolic failure", meaning that the original procedure was not metabolically active enough for them to effect long-term weight loss. The best statistics for LapBand in the U.S. show a 25% failure rate; the typical statistics for standard RNY show a 20% failure rate. The "edge" may, therefore, be modest. The results with revisions are generally not as good as with successful, first-time procedures. Is this because the patients are inherently more metabolically stubborn, or is there something about their failure that has made them more so? The great philosophical question.

All this said, I have grown into the opinon tat those revisions that add a metabolic edge are the ones best worth a second procedure. I also have become a big advocate of vertical/sleeve gastrectomy, as it is a different kind of restriction and can be used as a springboard for revision to DS if necessary.

Lots to think about, I know. There is no such thing as taking too long to decide which riute is right for you.

John D Husted, MD

Just saying hi!

I had lapband first too, but I think we diabetics find it harder to lose weight, and it didn't really work for me - I lost about 20 pounds by the end of the two years.

I revised to DS because by then my diabetes was beginning to affect my eyesight, and I wanted so badly to be cured. I am now an ex-diabetic (my HbA1c is normal, no medication), have normal blood pressure again and no pain in my joints either. If I hadn't lost any weight at all I would still be happy with the result!

As it is I've lost 80% of my excess weight in a year so far, more than I've ever lost, and I hope to be at goal within the next 6 months. Keep researching, and come over to the DS board if you want more information.

I have HBP, high cholesterol, type 2 diabetes, sleep apnea, and the first two comorbs I was diagnosed with after being banded two years ago.  I'll be 49 soon too which doesn't help and a bmi of 40.  I didn't lose any weight while banded and gained.  I'm still hoping the revision to RNY will help and am waiting on approval.  Good luck to you, brandyII.

Have you ever been tested for Celiac Disease?  I urge you to get tested ASAP, as many seemingly unrelated health conditions (PCOS, Lupus, Fibromyalgia, Diabetes, acne, depression, arthritis, osteoporosis, asthma, sleep apnea, just to name a few) can be caused by undiagnosed/untreated CD (researchers have found a compelling link between Diabetes I and CD).  CD is a malabsorptive condition, and up to 40% of people who are diagnosed with CD are overweight, with 30% of that number being morbidly obese (this goes against what the medical community has been taught). 

If you have CD (or Non-Celiac Gluten Sensitivity) and you go on a Gluten-Free (GF) diet, you will more than likely find that the pounds start to fall off without you doing anything other than eliminating gluten from your diet. Incidentally, a GF diet is MUCH easier to follow than Atkins, as it is much less restrictive on carbs - the gluten-containing carbs seem to be the ones that give people the most trouble.

I know about CD because our youngest daughter was diagnosed with it last April (she had NO symptoms, it was picked up on a routine blood screening for kids with Down syndrome).  Since then, I have been on a GF diet and have dropped from 275 lbs. to 237 lbs. while eating all of the foods that I love.  It is, without a doubt, the EASIEST "diet" that I have ever been on!  The other benefit that I have found - quite unexpectedly - is that ALL of my bloodwork numbers have improved, the arthritis in my knee disappeared within 24 hours of going GF, and I have more energy than I did when I was a teenager.  The reason that all of this wonderful stuff happened is that for the first time in a long time my body was absorbing ALL of the nutrients that I ingested - it's that simple.

You may want to try a gluten-free diet for a while and see what happens.  I have been amazed at our family's results over the past 10 months.  Best of all, it doesn't "feel" like a diet at all!  Some people who have excess weight have Celiac Disease and don't know it.  There is a blood test that can be run, but if you don't have any other health issues, it is possible that you are just gluten sensitive.

The reality is that SO many more people are Gluten-Sensitive than have actual CD, but a person has to have a CD screen run first to determine if they do, indeed, have it.  Only 3% of people who have CD actually know that they have it, yet almost 1% of the general population is believed to have it.  That's a LOT of undiagnosed Celiacs!

If you go to www.celiac.com , there is a link there which lists all of the health conditions which are known and suspected to be associated with untreated Celiac Disease.  If you have 2 or more of those conditions, you are more likely to have CD.  Many people have their blood tests come back negative for CD, yet they still have problems, so they try a Gluten-Free diet.  If their symptoms clear up, they can safely assume that they are gluten sensitive.

The best thing about the GF diet is that we have been able to eat ALL of the foods that we love - REAL ranch dressing, baked potatoes with butter, sour cream, and cheese, Snickers bars, ice cream, chicken-fried steak with gravy, etc. - the only difference is that the flours that we use when cooking are gluten free (you can find these in many different stores or online).  We have been eating "full" fat foods (real butter, sour cream, cheese, etc.) and have actually lost weight and seen our bloodwork numbers come down significantly.  My doctor (PCP) was skeptical, but the results don't lie, and now she is looking into the GF lifestyle as "the way to go" for all of her patients!

I don't know where you live, but chances are that you have a Gluten Intolerance Group (GIG) chapter nearby.  They can be a wonderful source of information, and most GIG's offer a Restaurant Guide that tells you what is "safe" at various restaurants.  Now, be aware that if you want to have the same results as we have, you CANNOT eat any gluten whatsoever - there is no such thing as "gluten lite"......

My suggestion would be to request your doctor to run a Celiac Screen for you, and then do a "trial" GF diet.  You will want to do it for at least a couple of weeks, preferably for a month.  Don't be discouraged if your weight "yo-yos", because what will be happening is that your body will be converting fat cells into muscle, and muscle mass weighs more.  The weight loss will be slow, but it will be steady over time.  I have "lost" 5 pounds, then "regained" a couple of pounds back over and over due to this process, but the net result has been a 37 pound loss over a period of 10 months.  I would probably have lost more, but I like to drink Cokes, and I don't like to exercise.......

My husband told me that if I DID quit the Cokes and started exercising, I could probably lose weight faster, but I told him that I am "conducting a scientific experiment", and I can only have one variable.  Nobody believes me when I tell them that I am losing weight simply by eliminating gluten, so I am going to see how far this takes me.  So far, so good!  I am confident that I will be able to lose most, if not all, of my excess weight - it may take 3 or 4 years (maybe 5 or 6), but I figure it took me a while to put it on, so I can be patient.

Also, my skin isn't sagging like you see in so many people who lose weight so quickly on WLS.  Since I am eating so much dietary fat, my skin is actually kind of glowing now, and my face is nice and soft.  Plus, some of the complications that I have read about several years after surgery sound EXACTLY like the conditions that are seen in people with untreated CD - it can't be a coincidence that both situations involve malabsorption.  The main difference is that one of them (CD) is very treatable.  Even with a reversal, someone who has had WLS will NEVER get all of their intestinal tract back, so there will always be some form of malabsorption - not something I want to do at all......

One other website that you may want to check out is www.junkfoodscience.blogspot.com - a whole lot of food myths are debunked there, including the one about dietary fat causing heart disease.  There are LOTS of interesting articles on that site that you may find very interesting; I know I did!

CD is a genetically linked condition, and first-degree relatives are at a significantly higher risk of developing CD.  If you do, indeed, have CD, the LAST thing that you want to do is have further Weight Loss Surgery!  You would be piling a treatable form of malabsorption (CD) on top of a surgically-induced form of malabsorption (WLS).  Good luck, and please keep me updated!  I am always available to answer questions.  PM me, and I will send you my contact information –

 

Links to Obesity/CD Related Articles: 

Obesity, Overweight & Celiac Disease

 

Link to Essay about Gluten Sensitivity: (This is EXTREMELY informative!)

http://www.baumancollege.org/pdfs/articles/Gluten_Sensitivit y.pdf

 

Link to Celiac Disease / Gluten Sensitivity Symptoms:

http://www.celiac.com/articles/1106/1/Celiac-Disease-Symptom s/Page1.html

Teresa Koch
Fort Worth, Texas