RNY revised to... an RNY!!!!
Some bells ringing.......
So, you never really had a distal, as in distal.
Just a long limb proximal.
My revision was in 2000. Pretty much all our 90's buddies were revised within 2 yrs. Mine lasted 5 yrs. My mentor's lasted 2 yrs. Don is still intact. Freak. lol
I think Dr W was the last non-transecting doc in the state, and by about 5 yrs. Everyone else was using the newer equipment.
So, how did you do? Any fractures? Teeth breaking? Any spasms or cramping?
So, you never really had a distal, as in distal.
Just a long limb proximal.
My revision was in 2000. Pretty much all our 90's buddies were revised within 2 yrs. Mine lasted 5 yrs. My mentor's lasted 2 yrs. Don is still intact. Freak. lol
I think Dr W was the last non-transecting doc in the state, and by about 5 yrs. Everyone else was using the newer equipment.
So, how did you do? Any fractures? Teeth breaking? Any spasms or cramping?
Michelle
RNY, distal, 10/5/94
P.S. My year + long absence has NOTHING to do with my WLS, or my type of WLS. See my profile.
Yeah, I asked him to consider transecting but he convinced me it wasn't necessary. I think I was about 150 - 170 cm and HE said that was distal. I don't remember all the particulars now, it was so long ago. Outside of getting pnuemonia 10 weeks out, I had no side effects at all. Got down to about a size 10 at 180 pounds or so. Couldn't believe it. I remember buying protien powder from you, tried several different types. Never could find one I really liked. Do you still sell those? Do you still use them?
T
T
He didn't believe in a true distal, as measured by common channel. Last one I know of that he did was 2006, and she was SLD by 2007!
I have more like 12 FEET bypassed.
I do. And I have about 100 here to try. I still do 180g per day in drinks, 6 x 30g. I had a 4 month lag time waiting for my insurance to go thru for my revision. I only gained 12#, because I was drinking protein almost every hour to keep the reflux down and to be sure I would still only eat tiny amounts.
I'm still a believer, yep.
I have more like 12 FEET bypassed.
I do. And I have about 100 here to try. I still do 180g per day in drinks, 6 x 30g. I had a 4 month lag time waiting for my insurance to go thru for my revision. I only gained 12#, because I was drinking protein almost every hour to keep the reflux down and to be sure I would still only eat tiny amounts.
I'm still a believer, yep.
Michelle
RNY, distal, 10/5/94
P.S. My year + long absence has NOTHING to do with my WLS, or my type of WLS. See my profile.
Why would you minimize protein drinks. Unjury is low carb, as are all mine. But we make with water, not milk or juice.
I took 180g either side of my revision, which is when I decided I preferred how I feel on that much, KWIM?
I took 180g either side of my revision, which is when I decided I preferred how I feel on that much, KWIM?
Michelle
RNY, distal, 10/5/94
P.S. My year + long absence has NOTHING to do with my WLS, or my type of WLS. See my profile.
Ah, I can't stand ANY of them with water. I have to have them with milk. There's my issue. Unjury is better with water than the others I guess, but skim milk is the best. I've actually been really good with keeping the carbs down so I could very well do one or two a day and that should be fine considering that I'm getting plenty of protein in with my foods anyway. I'll be more concerned about it closer to surgery time (still 6 mos out).
T
T
Tammy Lee 
Hi Michelle, help me out with all of this info - I just don't easily wrap my head around it. All I know for certain is that I had open RNY in 2004. I don't understand the differences you're discussing here - e.g., distal vs. SLD, etc., etc. In "laymans" terms, did you revise from one RNY to another type of the RNY? I'm pretty certain a revision is in my future - can't put a plug in this weight gain and I'm pretty certain it's the stoma that's the issue, not the pouch. I don't believe the endoscopic procedures work but i am trying to understand my options. I really am not attracted to the BOB because I don't want a port to deal with - it's the main reason I didn't want a band originally. Help me out here - what ARE my options? Is there a viable redoing of the original RNY - with another version of it? Is this what you had done? And why? Thanks! Maureen
Dream as if you'll live forever, live as if you'll die today.
I've written a coupla things re: transection vs SLD. And distal vs proximal. They are vbery, very simplified for my groups, but you said elemental erms:
****
You know about the partitioning of the stomach to create a small pouch, right? The older procedures just ran a row of staples across to create the division. Of course, by "a row", I mean whatever the doc does, 3 rows, 4 rows, 6 rows, 8 rows, and most docs also oversew. Then intestine is attached to pouch, etc, but we're only talking pouch here, right?
OK, when it's transected, they again do 2 pairs of rows of staples (most of the guns fire 2 rows simultaneously). They cut between the two pairs, so 2 rows hold the pouch side together, 2 rows hold the stomach side together. There is a space between the two stomachs now. My doc sends that hunk between to pathology, but other docs do different things with it.
When it is not transected, it's much like stapling your lips together, slimy fabric to slimy fabric. They never grow together or seal. The staples are holding them together and keeping the partition intact. Staple line disruption can occur at any time (some within 2 weeks, some by 18 months, mine was at 5 yrs) or never. It's a risk.
When it IS transected, you have two adjacent raw edges held together, so they heal to each other and bond. (That applies to both the pouch segment & the stomach segment, of course). If you cut your finger, it is definitely open, but it heals back together invisibly, you know? Raw edge to raw edge. The risk of leak is in the first few days, but then, we are at risk of leak from any of the attachings. And if lea****urs, it will most likely be at one of the intestinal connections. However, once you are past the immediate post-op period, that risk is past.
So, the main benefit of transecting is that you will likely only have ONE surgery. Personally, I still had acid & discomfort before revision, and not much after, but then, I'd guess my staple line was compromised just slightly early on. My doc starred transecting all of them in 96, but I was a 94, my husband a 95, so we were not.
If there is a choice, I'd always recommend transecting. It can be a disaster to have a staple line disruption. It can be painful, as well as the inevitable weight gain, and that general sensation of failure. And what if you do not have the right insurance to fix it?
But that is my very biased opinion.
*****
Let's assume that we all start with 300" of (small) intestine. We don't, but we need to have a figure, so that's it. From the pix you've seen of RNY/gastric bypass, you know there is a left side, right side and tail of the Y. The "junction" of the sides is the determiner if a procedure is proximal or distal.
The original intestine comes out of the old stomach and carries the digestive juices that are manufactured in the old stomach. This piece is called the bileo-pancreatic limb because it carries bile from the gallbladder and pancreatic juice from the pancreas. There is no food here.
This is the LEFT side of the Y. This is the portion that is bypassed.
The alimentary limb connects to the pouch and only carries food, but cannot digest or absorb. This is the RIGHT side of the Y.
The tail of the Y is where both elements mix together and where digestion (if any) and whatever absorption will occur. This is the part that is still in use and is also referred to as the common channel.
If the junction of the Y occurs in near proximity to the stomach, it is said to be proximal. If the junction occurs as a far distance from the stomach, it is said to be distal. That said, neither word describes any actual measurements of anything, so the meaning is in the mind of the person speaking of the procedure. What is proximal to my doctor is considered distal by another.
Generally speaking, ALL RNY people will have to supplement at least the basic 8 elements*, though in varying doses. We are all missing the stomach and its normal digestive function.
Truly distal (with a lot bypassed, and a short common channel) people need to supplement in larger volume, but will achieve and maintain the better weight loss over time. Proximal (less bypassed, longer common channel) people still need to supplement the basics and can reach a reasonable weight, but after 2 years may have to work a little harder to maintain their goal weight.
My doctor measures what is in use, not what is not. So, in my case, I have a 40" common channel, then 60" was used to reach the pouch. The bypassed portion is then ABOUT 200".
Most procedures performed are measured backwards from that. The doctor will bypass 12 to 72", use 60-80" for the right side of the Y, and the common channel will be 100-200".
* the basic 8
protein
iron
calcium
A
D
E
zinc
B12
These need to be supplemented in specific ways to help absorption.
We also malabsorb SOME fats/oils and complex carbs.
We never, ever malabsorb sugar.
Some will have to supplement potassium or magnesium, but not everyone.
****
You know about the partitioning of the stomach to create a small pouch, right? The older procedures just ran a row of staples across to create the division. Of course, by "a row", I mean whatever the doc does, 3 rows, 4 rows, 6 rows, 8 rows, and most docs also oversew. Then intestine is attached to pouch, etc, but we're only talking pouch here, right?
OK, when it's transected, they again do 2 pairs of rows of staples (most of the guns fire 2 rows simultaneously). They cut between the two pairs, so 2 rows hold the pouch side together, 2 rows hold the stomach side together. There is a space between the two stomachs now. My doc sends that hunk between to pathology, but other docs do different things with it.
When it is not transected, it's much like stapling your lips together, slimy fabric to slimy fabric. They never grow together or seal. The staples are holding them together and keeping the partition intact. Staple line disruption can occur at any time (some within 2 weeks, some by 18 months, mine was at 5 yrs) or never. It's a risk.
When it IS transected, you have two adjacent raw edges held together, so they heal to each other and bond. (That applies to both the pouch segment & the stomach segment, of course). If you cut your finger, it is definitely open, but it heals back together invisibly, you know? Raw edge to raw edge. The risk of leak is in the first few days, but then, we are at risk of leak from any of the attachings. And if lea****urs, it will most likely be at one of the intestinal connections. However, once you are past the immediate post-op period, that risk is past.
So, the main benefit of transecting is that you will likely only have ONE surgery. Personally, I still had acid & discomfort before revision, and not much after, but then, I'd guess my staple line was compromised just slightly early on. My doc starred transecting all of them in 96, but I was a 94, my husband a 95, so we were not.
If there is a choice, I'd always recommend transecting. It can be a disaster to have a staple line disruption. It can be painful, as well as the inevitable weight gain, and that general sensation of failure. And what if you do not have the right insurance to fix it?
But that is my very biased opinion.
*****
Let's assume that we all start with 300" of (small) intestine. We don't, but we need to have a figure, so that's it. From the pix you've seen of RNY/gastric bypass, you know there is a left side, right side and tail of the Y. The "junction" of the sides is the determiner if a procedure is proximal or distal.
The original intestine comes out of the old stomach and carries the digestive juices that are manufactured in the old stomach. This piece is called the bileo-pancreatic limb because it carries bile from the gallbladder and pancreatic juice from the pancreas. There is no food here.
This is the LEFT side of the Y. This is the portion that is bypassed.
The alimentary limb connects to the pouch and only carries food, but cannot digest or absorb. This is the RIGHT side of the Y.
The tail of the Y is where both elements mix together and where digestion (if any) and whatever absorption will occur. This is the part that is still in use and is also referred to as the common channel.
If the junction of the Y occurs in near proximity to the stomach, it is said to be proximal. If the junction occurs as a far distance from the stomach, it is said to be distal. That said, neither word describes any actual measurements of anything, so the meaning is in the mind of the person speaking of the procedure. What is proximal to my doctor is considered distal by another.
Generally speaking, ALL RNY people will have to supplement at least the basic 8 elements*, though in varying doses. We are all missing the stomach and its normal digestive function.
Truly distal (with a lot bypassed, and a short common channel) people need to supplement in larger volume, but will achieve and maintain the better weight loss over time. Proximal (less bypassed, longer common channel) people still need to supplement the basics and can reach a reasonable weight, but after 2 years may have to work a little harder to maintain their goal weight.
My doctor measures what is in use, not what is not. So, in my case, I have a 40" common channel, then 60" was used to reach the pouch. The bypassed portion is then ABOUT 200".
Most procedures performed are measured backwards from that. The doctor will bypass 12 to 72", use 60-80" for the right side of the Y, and the common channel will be 100-200".
* the basic 8
protein
iron
calcium
A
D
E
zinc
B12
These need to be supplemented in specific ways to help absorption.
We also malabsorb SOME fats/oils and complex carbs.
We never, ever malabsorb sugar.
Some will have to supplement potassium or magnesium, but not everyone.
Michelle
RNY, distal, 10/5/94
P.S. My year + long absence has NOTHING to do with my WLS, or my type of WLS. See my profile.
Thank you, Michelle! I am in complete awe and am so humbled by how thorough you were in this response to my question - and the effort you put into this response. I didn't know all of this! Now I need to go back to my surgeon and find out what type of surgery I had - distal or proximal and learn about the length of my channel - I just didn't know all of this and like so many others, all I could think about at the time of surgery was getting the weight off that was killing me. What is your link to purchase supplements from you? Thanks again, so much! Maureen
Dream as if you'll live forever, live as if you'll die today.
There were only a few actual distal surgeons in the whole country. And now, only 2-3. So, you can be sure you're proximal.
When will you be here? I can show flip charts, so then the images will be firmly planted in your head.
I don't pay for advertising here, so I am very careful not to do so. Since you're asking me outright, I spose I can say it? vitalady.com
I've had a good working relationship with OH since 1998, so ever remaining respectful of that.
When will you be here? I can show flip charts, so then the images will be firmly planted in your head.
I don't pay for advertising here, so I am very careful not to do so. Since you're asking me outright, I spose I can say it? vitalady.com
I've had a good working relationship with OH since 1998, so ever remaining respectful of that.
Michelle
RNY, distal, 10/5/94
P.S. My year + long absence has NOTHING to do with my WLS, or my type of WLS. See my profile.
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