well saw the doctor for a revision yesterday

Well I saw the surgeon yesterday and he will not even consider a revision for me. By BMI is only 34.6 and he would not even talk to me about it until I was well over 35. He told me that it was good and unusual for someone to maintain a hundred lb. weight loss with RNY and that I couldn’t have done that without the surgery so he considered me a success even if I had gained 80 lbs since I hit goal 5 years ago. I tried to explain to him that I had gained the whole 80 lbs in the past year and a half but it didn’t matter to him. He told me again that I was considered a success and I just needed to diet to stay where I was and not gain anymore weight. I told me I could go on a liquid diet and the nutritionist would talk to me about that. He did agree that I most likely have an ulcer so gave me basically Mylanta and Pepsid to take.  He said take that for 6 months then come back and “we" will see how I am doing.

I talked to the nutritionist, had all my Fitday food listed for her to go over with me, and she didn’t even do that. She said I needed to take in at least 1900 to 2000 calories to stay where I am and since it says I am taking in between 1200-1300 a day I obviously was not recording everything or there were “hidden" calories somewhere since I am not losing weight. She told me about the liquid diet but said that although I could try it- if I was going to continue to eat the way I was before doing it  I was just going to gain it back when I stopped it. My husband wants me to try the liquid diet and increase my workout to 2 hours day anyway.

So that is where I am. I agreed to do that but I don’t know how I am going to handle going from where I am – back to my old goal weight- then as soon as I go off the liquid only, regaining it back (probably with an additional pound or 10 since that is what my body does without the metabolism adjustment we get post RNY until it readjusts to the new change.

Oh I did forget to add, Shoen does not do the RNY to DS. He will do a BOB or ERNY which he says (haa haa)  is just like a DS. So even if he would have listened to me, I would not have had him to the revision.

Well off to the gym. I pray and pray again that your experience is better than what I had. It has been nothing but devastating for me. I cannot even go to another doctor since my insurance would not cover it and I definitely cannot be a self pay. I am so sad.

Why won't your insurance cover another doctor?

It is Tricare Prime so we can only see someone who will accept payment from Tricare based on their rates- which are at or lower than Medicare / Medicaid. Doctors cannot balance bill us if they accept the Tricare Prime insurance.  As a result, because the payment to the doctor are so low and the restrictions pretty strict (though I imagine most insurance is like that)  not many doctors will accept Tricare Prime - meaning we have little choice on whom we can see. We cannot see anyone outside of military providers if we are within a 30 miles of a military base and there are doctors that can treat us there. If not, the doctor has to be within a certain radius of us for us to see them at all. All of this, in the end, makes for very few choices for us regarding whom we can see for what. The saddest part is that the mental health area takes the biggest hit of all. There are virtually no therapists, or psychologists that will treat military retirees or family members and the few active duty doctors have their hands full with the active duty people involved in the war in Afghanistan and Iraq. As for WLS, while  Tricare will provide coverage if we can prove medical necessity- we do not get to choose who we will have to do it unless we want to self pay.

My soapbox…
The real kicker is  a lot of members in Congress say that it is not fair that we get the coverage as retirees, for a low premium (which is only low compared to most insurance companies- not really all that low)  and that our premiums need to be brought up to current health insurance premiums but with the same provided medical coverage that already exists. Eventually those who feel this way in congress, along with medical insurance lobbyist will get their way. None of the new healthcare reform bill apply to military insurance either.  The rules and guidelines are not very fair to military- active duty or retired. My husband served actively in 6 different wars during our 20 years active duty, then also did 3 years in Iraq on top of that. But in the end, at least we do have some coverage- and many people don’t. At least we can afford what coverage we have- and many can’t.  So I guess overall we are lucky. Two of our grown daughters are not insured at all and my husband and I have over $25,000 in medical bills for the grandchild we are raising because she was not in the military system (through no fault of ours) when she got very very ill. So there is no way in hades we could afford to go self pay

Unless we win the lottery, I am stuck with what I have.

 "Oh I did forget to add, Shoen does not do the RNY to DS. He will do a BOB or ERNY which he says (haa haa)  is just like a DS. So even if he would have listened to me, I would not have had him to the revision."

What did I tell ya!!   And, BTW, your doc sounds like a jerk!   The probable reason you have put on weight in the last year and a half is because the villi in your intestines have become more adept at absorbing nutrients (and calories) from the food you eat.   Also, the RNY is really only good for losing 1/2 of your excess weight.   (The never tell you that, now do they?)   So, if you needed to lose, say 150 lbs to get to goal, the surgery (including "bounce back") is only good for 75 lbs of that.

Also, that liquid diet your doc is recommending is a waste of time.   Sure, if you go on it and starve yourself, you'll lose weight and then (guess what?) you'll gain it all back as soon as you go back on your regular foods.   And, I'll just BET he stands to make more $$$ from you if you go on the diet.   Does he sell the special liquid you need to drink?   Or, maybe he gets a kickback from the nutritionist's fees from your office visits with her?

No he actually does not sell any supplements in his office. The liquid diet includes a variety of options-

Optifast products shakes or bars
Slim Fast low carb
Low Fat milk skim,1% or 2% ( can add No Sugar Nesquick if I want to)
Hood Dairy Brand carb countdown choc. Milk
No sugar added Caration instant breakfast
and the typical Sugar free Jello-Sugar Free Popsicles- Fat Free broth-and calorie and caffeine free beverage-dill pickles & celery.

So pretty much the normal pre op diet.  Regaining whatever I lose is exactly as you said- as soon as I lose it with the liquid diet I will just gain it back when I go off it! That was my argument to the nutritionist and Doctor as well as my husband.  In the end, I decided to do protein shakes during the day with a late snack of fruit then a small dinner- whatever I make for the family. What I am hoping is that if I can go back to getting used to eating only for nutrition it will make it easier to keep to the old post op diet. Kind of like resetting my brain.

When I originally lost weight post op I lost 178 lbs. but honestly, as much as I loved it at 138, I really was too small. I have regained 80lbs. and want to get back to 145lbs. so I currently need to drop 72 lbs.. A long and currently seems like, impossible mountain to climb. I am instead of looking at numbers working to just get myself back in good physical condition (I used to work out all the time and loved it). If I can get the weight off in the process well great- but if not I will just have to learn to live in a bigger body. It is really hearbreaking for me but since I cannot get the doctor to listen to me there isn’t a whole lot of choice unless I win the lottery or move to a different location thus be able to see a different doc.

TriCare Prime covers across state lines.  Find a surgeon who takes TriCare Prime and does Rny to DS revisions.  Fly or drive there.  Surgeon's who understand the DS as a revision generally recommend or approve it as a surgery even if you're an ounce or 2 away from 35 BMI!!!

I've had military friends who livei n AZ, fly to Texas, Nevada and CA for surgeries that they can't get taken care of locally.

Think outside the box.  A Bariatric surgeon *****commends a liquid diet as a good option for losing 75 pounds is playing into our original disease!  Did he give you a yo-yo with the prescription?  Seriously!!!! 

My hubby is retired AF and I feel your pain.  We aren't into the military insurance as we have benefits with our current employers but will see what's left of it in a few years (after the Gov messes around with iti) and probably be part of that system as well. 

I've learned that "NO" very often means try harder!  And, in the case of the military....sometimes it's who you know and not what is written in a handbook.  Tap into your old "General" sources if needed!

Good luck and hang in there!

I'm revising to a BOB in less then 3 weeks, but even I know it's NOTHING like the DS. Sounds to me like your doc doesn't want to lose money by referring you to another doctor that can actually perform a DS. Don't give up, I hope you find a way to get the revision you want! ~Kel

Isnt it AWFUL when they dont listen to you??? for me to maintain my weight the numbers say I must be eating close to 3000 calories a day. Ok, not even possible when I cant have solid food unless Im having 4 super milkshakes a day (which im not). I have days in my journal where I dont even reach 1000.

SO FUSTRATING!

 I'll bet if you go on fresh steamed or olive oil stir-fried non-starchy veges (in huge amounts) and some high quality grilled or baked protein (salmon, chicken breasts-no skin) with only berries for dessert, you'd lose the weight w/o doing that stupid liquid diet (which isn't real food at all and certainly isn't healthy!).  Use a tablespoon of any sauce you like to cook each serving of protein.  No bread, pasta, corn, potatoes, sweets , etc.   If you are still hungry after consuming, say -- an entire head of broccoli and a chicken breast - have another chicken breast!   Stay away from large amounts of salt.   No soups or chili.  Drink 4-5 16 oz bottles of water per day.   Do 6 days on and one day off (and on that day off, don't go crazy with carbs or fats).

You show that doctor and his nutritionist that YOU can do it WITHOUT them!

You go girl!   

Another tip:  Broccoli becomes a treat when you sprinkle on parmesan cheese and a tablespoon of olive oil, then toss in a big bowl!

Thanks for the suggestions.. A lot of that I already eat/ate. I only do salmon on occasion since fish is definitely not something I like. I do substitute with boiled shrimp instead. I don’t and really never had done fried foods. Not even eggs. I scramble them dry or with a non stick olive oil spray on the pan. Veggies I only did a bit of because I still fill my pouch pretty full (usually about a cup or cup and a half) when I am eating my chicken (my favorite) or the pork I gag down – don’t like that one, never have. I also avoid starches except occasional wheat or oat bran bread or potatoes. Pasta’s and the sort (especially rice) I am surprised even you can do as a post op! I had to give all of that up 8 years ago. If I have a small portion of spaghetti (thin or smaller) I can do about ¼ cup but that is it. My husband is the same way so that works out pretty well- though I do miss stuffed shells and lasagna J Never thought of broccoli with parmesan or cheese before. I will try that one. I have a lot of fresh veggies and fruit in the house for my 2 year old. Her (& mine) favorite is cucumber. Funny though I am not a fan at all of pickles!

I decided to do a combination of liquid protein drinks and a healthy dinner. With the occasional piece of fruit before dinner. If that does not work then I will change more. That is what is most frustrating and in addition with the pouch pain drove me to consider a revision. I don’t eat bad. Never really have except the occasional “mistake" like a bite or two of birthday cake. I am severely hypoglycemic so if I do sugar I really have a bad “dump" syndrome added to a drop to a blood sugar of about 25. Not cool.

 

Oh my goodness drinking!! I swear I spend more time peeing than anything else. I have a gallon pitcher that I fill every other day. My goal is to finish that with a day and the next morning. Usually I succeed no problem. The only variation to this is Diet Snapple Peach Tea first thing in the morning and , on days when my husband and I go on motorcycle trips I change to Diet soda because it contains so much sodium that it absorbs most of the liquid in your body- which results in two tings, a) you don’t need to pee as often ( a huge benefit on motorcycling in the mountains) and 2) I have to drink

2x the amount of water than I drink a soda!. Fortunately 8 years ago our NUT told us – no pounded into our heads- no calorie containing beverages’!

 

Ok off to be a mom.

Have a great weekend! The weather here in Colorado is rotten today, after a day which ended up with a total of 24 tornado warnings! I live in the foothills so normally don’t’ get tornado’s so it was very cool yesterday to get my first tornado .