X Post from DS Board - Revision from RNY to DS - Please Chime in!
OK - here goes -- and my story -- I am looking for opinions and experiences -- the good, the bad and the ugly --
I am currently 54 yrs old. I had RNY June 2003 with a starting weight of 340 -- lost 180-187 lbs in 18 months by December 2004 -- no complications, no dumping -- thought I had finally beat this weight thing that had haunted me for years! Spent 2005 going through various recontructive plastic surgeries -- LBL, eyes and neck, boobs, arms, thighs (twice). I was able to get insurance coverage for my LBL, but paid out of pocket for the balance (approximately $30K) thru loans, etc. My weight seemed to stabilize at 160, and though my own goal lwas 150, I was happy at that weight.
I remarried in June 2006 -- managed to keep weight off with minimum bounceback thru the end of that year, but it was definately getting harder, being able to eat more and no longer having ANY restriction. By October of 2007, I knew something was wrong and I went for an endoscopy that showed that I had an enlarged stoma as well as an enlarged pouch - that the food was just moving right thru me. At that time, the 'devious' STOMOPHYX revison surgeon was widely being discussed, and despite insurance denial, I decided to have it done with Dr Shawn Garber. It was like taking $9,000 and throwing it in the trash. At the time of the Stomophyx I was up to 197 lbs. Now I am at 230 lbs!!!!! BMI is borderline 38-40......
Being fair, I have to say that during this time of weight gain, my exercise regime severely dropped off due to foot surgery, knee replacement and just plain old "lack of"! All the old head demons came back -- the ones that say -- I know I shouldn't have that, but I'm hungry -- of course much of that head hunger is emotions coming from various issues that life throws at us all -- add to that no restriction, never feeling full due to pouch and stoma enlargement and you all get the picture.
Currently, I recently saw Dr Roslin about a revison to DS -- having realized that it is my last shot at conquering this weight issue. He reviewed all my past surgical reports -- RNY and Stomophyx as well as the endoscopy. He confirms that I am a candidate for a revision to DS and that he would take me on as a patient. Relief!!!!! Whooo not so fast.
I now find out that my current medical insurance (Cigna) (with different employer than in 2003)has a WLS exclusion against all bariatric surgury including revisions or complications from bariatric surgery. No way around it.
Dr Roslin quotes me self-pay fees of approximately $33,000 for surgery -- ($10K for him, $18K for hospital, and various other misc of $5K). Now I don't have that kind of money floating around, but I did clear up all my old loans and credit card bills in the last two years, and could put those fees on various credit cards and then early next year, take a withdrawal from a retirement account that will be due for a rollover. I believe that I could avoid the 10% penalty in taxes due to medical bills creating a hardship that will qualify under tax rules, etc.
My question to you guys is:
1. How much weight could I plan on losing with the DS over the next year, with my current weight of 230, as a revision?
2. Is the $33,000 cost worth it -- realizing this is strictly a personal opinion question?
3. Due to WLS exclusion in current medical insurance any possible 'complications' from revion would also not be covered -- is the risk worth it?
4. I have a four hour commute to work each day with no toilet access -- two hours each way -- would the change in bowel movements and gas be horrific?
5. Lastly, how long would I have to take off from work for recovery -- my job does not continue salary during times of disability, etc.....except for minimum state mandated payout....
I need to make a decision fairly quickly -- any and all opinions, comments and experiences welcomed!
Thank you.
Nannette
I am currently 54 yrs old. I had RNY June 2003 with a starting weight of 340 -- lost 180-187 lbs in 18 months by December 2004 -- no complications, no dumping -- thought I had finally beat this weight thing that had haunted me for years! Spent 2005 going through various recontructive plastic surgeries -- LBL, eyes and neck, boobs, arms, thighs (twice). I was able to get insurance coverage for my LBL, but paid out of pocket for the balance (approximately $30K) thru loans, etc. My weight seemed to stabilize at 160, and though my own goal lwas 150, I was happy at that weight.
I remarried in June 2006 -- managed to keep weight off with minimum bounceback thru the end of that year, but it was definately getting harder, being able to eat more and no longer having ANY restriction. By October of 2007, I knew something was wrong and I went for an endoscopy that showed that I had an enlarged stoma as well as an enlarged pouch - that the food was just moving right thru me. At that time, the 'devious' STOMOPHYX revison surgeon was widely being discussed, and despite insurance denial, I decided to have it done with Dr Shawn Garber. It was like taking $9,000 and throwing it in the trash. At the time of the Stomophyx I was up to 197 lbs. Now I am at 230 lbs!!!!! BMI is borderline 38-40......
Being fair, I have to say that during this time of weight gain, my exercise regime severely dropped off due to foot surgery, knee replacement and just plain old "lack of"! All the old head demons came back -- the ones that say -- I know I shouldn't have that, but I'm hungry -- of course much of that head hunger is emotions coming from various issues that life throws at us all -- add to that no restriction, never feeling full due to pouch and stoma enlargement and you all get the picture.
Currently, I recently saw Dr Roslin about a revison to DS -- having realized that it is my last shot at conquering this weight issue. He reviewed all my past surgical reports -- RNY and Stomophyx as well as the endoscopy. He confirms that I am a candidate for a revision to DS and that he would take me on as a patient. Relief!!!!! Whooo not so fast.
I now find out that my current medical insurance (Cigna) (with different employer than in 2003)has a WLS exclusion against all bariatric surgury including revisions or complications from bariatric surgery. No way around it.
Dr Roslin quotes me self-pay fees of approximately $33,000 for surgery -- ($10K for him, $18K for hospital, and various other misc of $5K). Now I don't have that kind of money floating around, but I did clear up all my old loans and credit card bills in the last two years, and could put those fees on various credit cards and then early next year, take a withdrawal from a retirement account that will be due for a rollover. I believe that I could avoid the 10% penalty in taxes due to medical bills creating a hardship that will qualify under tax rules, etc.
My question to you guys is:
1. How much weight could I plan on losing with the DS over the next year, with my current weight of 230, as a revision?
2. Is the $33,000 cost worth it -- realizing this is strictly a personal opinion question?
3. Due to WLS exclusion in current medical insurance any possible 'complications' from revion would also not be covered -- is the risk worth it?
4. I have a four hour commute to work each day with no toilet access -- two hours each way -- would the change in bowel movements and gas be horrific?
5. Lastly, how long would I have to take off from work for recovery -- my job does not continue salary during times of disability, etc.....except for minimum state mandated payout....
I need to make a decision fairly quickly -- any and all opinions, comments and experiences welcomed!
Thank you.
Nannette
Nannette
Lap RNY 6/16/03
Revise to DS 8/15/11
Have you contacted Dr. Ungson's office in Mexico? (He trained under Dr. Baltzar from Spain to do RNY to DS revisions) I recently heard; if he is accepting RNY to DS revision patients that is..... He charges $16,000.00 all inclusive. This has been my paln "B" since the beginning in 2009, when I started my journey. Check out this link, this is where I got my info.
http://www.obesityhelp.com/forums/revision/4382488/i-am-now- a-self-pay-patient-where-the-h-do-I-go/
I copied & pasted this off of the dsfacs.com website:
Mexico
Dr. Gilberto UngsonEmail: [email protected]
Cell: 044 662 256 2357
The Clinic for Excellence in Surgery
Campodónico No. 31 Esq Emilio Beraud
Col. Centenario, C.P. 83260
Hermosillo, Sonora
Mexico
Phone: (662) 217 56 56 or (662) 217 46 02
Phone Mexico toll free: 1-800-670-3434
Fax: (662) 213 83 38
Hospital CIMA Hermosillo:
Paseo Río San Miguel # 35
Col. Proyecto Río Sonora
Hermosillo, Sonora
C.P. 83280
Mexico
Phone: (662) 259 09 65 or (662) 259 0900 ext 1100
Fax: (662) 259 09 67
RNY 2/26/2002 DS 12/29/2011
HW 317 SW 263 BMI 45.1
SW 298 CW 192 BMI 32.9~60% EWL
LW 151 in 2003
TT 4/9/2003
Normal BMI 24.8 is my GOAL!!!
GBP (RNY) 2/26/02 298 lbs, TT 4/9/03 151 lbs, DS 12/29/11
HW 317 SW 263 BMI 45.1/CW 192 BMI 32.9/GW 145 ~ Normal BMI 24.8
**Revision Journey started 3/2009 Approved 12/12/11**
I'm researching DS on the web as I can't accept RNY due to the problems you've encountered. I've spoken to Vivek N. Prachand who performs laparoscopic DS at the University of Chicago, and so far, he's not accepting me as a candidate to have DS. He says that my BMI of 40, 245 lbs, I'm not super-obese and subject to severe malabsorption. Being Type II and taking Metformin, I lost 20 lbs and then Byetta, I lost 12 lbs within the last month, so I'm now 213 and having a BMI < 38. Unfortunately, Byetta caused vascular inflamation and I'm now to take Actos and that will likely cause weight gain. I'm searching the web to find those who are not super-obese that had or will have DS and found your comments.
Perhaps some of my research will answer some of your questions, but the answers pertain to standard biliopancreatic diversion/duodenal switch results for the super-obease and may be different than a revision.:
1. How much weight could I plan on losing with the DS over the next year, with my current weight of 230, as a revision?
I've only found loss data given as a percentage: Mean percent excess weight loss at 6, 18, and 24 months was 51%, 89%, and 91%, respectively.
2. Is the $33,000 cost worth it -- realizing this is strictly a personal opinion question?
Consider your future, your earning power, need for savings, changing jobs/insurance, and having the surgery performed out of the U.S. You'll need a U.S. specialist for follow-ups ~ perhaps lifetime. I found some hospitals provide employee insurance that covers both the surgery and the skin reconstructions.
3. Due to WLS exclusion in current medical insurance any possible 'complications' from revion would also not be covered -- is the risk worth it?
I'm on medicare, and Dr Pranchand informed me if complications prevented him from completing the surgery, medicare will not pay for the surgery. I don't know if this also means they will not pay for the related hospital, etc. We know that insurance has a negotiated price and so pays only a fraction of the full billing, so I'd want an agreement that should the insurance not pay, I'd only need to pay what would be the insurance negotiated cost.
4. I have a four hour commute to work each day with no toilet access -- two hours each way -- would the change in bowel movements and gas be horrific?
4 hour commute !!! That helps to put the weight back on. Another reason to consider if a job change is possible?
Mean 3 bowel movements per day: many patients experience excess gas if they eat too many carbohydrates or specific kinds of carbohydrates. Many will also experience diarrhea if they eat too many fats. In most cases patients have control over when and if this occurs because it can be controlled through diet.
81.3% of Duodenal Switch patients experience normal gastric emptying
Study ~ reported the average number of bowel movements per day for 43 pre-op patients was 1.9, 421 patients six months post-op was 2.7, 316 patients twelve months post-op was 2.6 and 113 patients > thirty six months post-op was 2.8.
To control gas and bathroom odors, many found success with Digestive Advantage, yogurt with pro-biotics, Devrom, Flagyl, Trader Joe's Air Therapy, Mediaire biological odor eliminator.
5. Lastly, how long would I have to take off from work for recovery -- my job does not continue salary during times of disability, etc.....except for minimum state mandated payout....
Duodenal Switch Yahoo Groups - poll results show that almost 50% of the patients were able to return to work within 4 weeks after the surgery, and within 6 months all patients had returned to work.
Perhaps some of my research will answer some of your questions, but the answers pertain to standard biliopancreatic diversion/duodenal switch results for the super-obease and may be different than a revision.:
1. How much weight could I plan on losing with the DS over the next year, with my current weight of 230, as a revision?
I've only found loss data given as a percentage: Mean percent excess weight loss at 6, 18, and 24 months was 51%, 89%, and 91%, respectively.
2. Is the $33,000 cost worth it -- realizing this is strictly a personal opinion question?
Consider your future, your earning power, need for savings, changing jobs/insurance, and having the surgery performed out of the U.S. You'll need a U.S. specialist for follow-ups ~ perhaps lifetime. I found some hospitals provide employee insurance that covers both the surgery and the skin reconstructions.
3. Due to WLS exclusion in current medical insurance any possible 'complications' from revion would also not be covered -- is the risk worth it?
I'm on medicare, and Dr Pranchand informed me if complications prevented him from completing the surgery, medicare will not pay for the surgery. I don't know if this also means they will not pay for the related hospital, etc. We know that insurance has a negotiated price and so pays only a fraction of the full billing, so I'd want an agreement that should the insurance not pay, I'd only need to pay what would be the insurance negotiated cost.
4. I have a four hour commute to work each day with no toilet access -- two hours each way -- would the change in bowel movements and gas be horrific?
4 hour commute !!! That helps to put the weight back on. Another reason to consider if a job change is possible?
Mean 3 bowel movements per day: many patients experience excess gas if they eat too many carbohydrates or specific kinds of carbohydrates. Many will also experience diarrhea if they eat too many fats. In most cases patients have control over when and if this occurs because it can be controlled through diet.
81.3% of Duodenal Switch patients experience normal gastric emptying
Study ~ reported the average number of bowel movements per day for 43 pre-op patients was 1.9, 421 patients six months post-op was 2.7, 316 patients twelve months post-op was 2.6 and 113 patients > thirty six months post-op was 2.8.
To control gas and bathroom odors, many found success with Digestive Advantage, yogurt with pro-biotics, Devrom, Flagyl, Trader Joe's Air Therapy, Mediaire biological odor eliminator.
5. Lastly, how long would I have to take off from work for recovery -- my job does not continue salary during times of disability, etc.....except for minimum state mandated payout....
Duodenal Switch Yahoo Groups - poll results show that almost 50% of the patients were able to return to work within 4 weeks after the surgery, and within 6 months all patients had returned to work.
Sounds to me like you have a ****ty job, with a ****tier commute, and ****ty benefits - CHANGE JOBS!
The other point is you will lose what you will lose - NOBODY can tell you how it will go. Some is up to you, some is up to your body. You've already put it through a metabolically damaging WLS, so you are almost certainly going to lose more slowly than with a virgin surgery.
I rarely have to poop outside of the first hour or so in the morning. But, when I gotta go, I gotta go.
Shaking my head again - how can you tolerate losing FOUR HOURS of your day - of your LIFE -to commuting???
The other point is you will lose what you will lose - NOBODY can tell you how it will go. Some is up to you, some is up to your body. You've already put it through a metabolically damaging WLS, so you are almost certainly going to lose more slowly than with a virgin surgery.
I rarely have to poop outside of the first hour or so in the morning. But, when I gotta go, I gotta go.
Shaking my head again - how can you tolerate losing FOUR HOURS of your day - of your LIFE -to commuting???
Commuting -- been doing it since I moved to Jersey Shore when my kids were in grade school -- trade off is living in a nice area, but working in NYC for a decent salary. Unfortunately, my very well paying job ended three years ago due to the economy, and I am making 50% less than back then -- however, I'm still making more than double than I could make working locally where I live!
Bottom line -- I do it for the money!
Bottom line -- I do it for the money!
Nannette
Lap RNY 6/16/03
Revise to DS 8/15/11
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