In need of informed, constructive words -- Puttin' It ALL out there

Hello,

I am CLB...happily married, no kids (by choice) 2 awesome dogs and now living in Cali.

I come from a family that dies in their 50's.  And while their early deaths may have come from overindugence in food, they also smoked and drank -- and didn't exercise.  My eating is a "bit" off (no pun intended), I don't smoke or drink and I LOVE to exercise.

Nine yrs ago, I weighed 274.5.  Like many of you, I tried EVERYTHING.  Just before surgery, I was on 1,000 calorie diet a day and going on 4 mile hikes with my husband.  I literally gained weight.  I had multiple tests done and nothing was keeping my weight on except bad genes -- and big jeans.  Kidding.  Anyway.

I got gastric bypass in Cali by Dr. Steven McColgan.  Went pretty well.  But to my surprise, within weeks of my surgery, I got transferred to Las Vegas and within months to N. VA.  We then got shipped back to Vegas and after 6 yrs, back to SoCal.  (Sorry for being so detailed, but I realize some of this DOES matter regarding where I find myself now).

For years I was down to a size 10 (from a max size 24), then almost 3 years ago, while running my daily 5 miles, I snapped my PCL.  It required multiple surgeries.  Even with small meals, I gained weight and I am now up to around 238.

I still eat smaller meals, but have slipped into some bad habits and thx to osteoarthritis, I cannot be the athlete I was.  I now take Lipitor and lots of Motrin.  I am not diabetic and don't have high blood pressure or heart disease.

I know I need some kind of revision or something because I get a lot of heartburn.  I just don't feel right.  I went to see Dr. M. O. (I am being kind by not mentioning his name) and he was horrible to me.  His biggest problem was I gained wait back so I must be stupid (I am an MBA and JD and from NYC......We're all ignorant on some things, but I am pretty sure I'm not a dumbazz).  He said He couldn't do another bypass or a sleeve and that I would only lose 25 lbs if he did the band.  Huh?

My insurance?  Tricare Prime.  I am considering buying some of my own just to get this all over with and start over.  My understanding from another member on the site is that Tricare doesn't cover DS.

My questions:  Are there any group policies where I could buy into if I join a certain group (Some Chambers of Commerce do this)?  What are my surgical options?  Who do you know that would take my insurance?

I thank you in advance for your kindness, input and new friendship.  I'm not afraid.  Every day I become more informed.  But YOU have been there.

Please pvt message me if you would like to know more.  I have been berated at other sites and don't think that accomplishes anything.  I guess I belong to that "Do Unto Others" group.

M 

Unfortunately, the 25 lbs for band over bypass is probably pretty realistic. Some folks do better, but the odds are against you.

I have a sleeve and I love it, but I'm not sure about it as an option for RNY revision. Also, it does sound like you might do better with a malabsorptive procedure. So that leaves two options:

Distal RNY - which would increase your malabsorption. However, that still keeps the downsides of the RNY, including the loss of your pyloric valve.

DS - IMO this is likely the best option for you, BUT it's a complex surgery that not a lot of surgeons are qualified to do (the DS board folks would have a list...I know it has been posted a bunch of times, so you could probably do a search for RNY to DS revision and find it).

Unfortuntely, though the DS is the better of the two options, the distal RNY is likely to be the most affordable and the once insurance is most likely to cover.

As for insurance options, there aren't a lot of options for individual coverage. What there are often exclude WLS and tend to reject obese folks out of hand for coverage. I am in the "US health care availability sux" camp, so best to not get me started here.

I would definitely say the DS is a better option for you.  With the Motrin that you need to take, you should have a DS.  You really shouldn't be taking Motrin with an RNY.  The chances of getting ulcers is just too high.  If your insurance will cover another WLS, chances are good that you can get it to cover DS.  You will most likely have to appeal, but there are a couple of wonderful women on here that will help you with that.  Like the previous poster said, it is a complicated surgery and there are only a handful of surgeons in the US that are qualified to do it.  For a RNY to DS revision, you are in the best part of the country.  There are two highly qualified surgeons in CA.  Keshisian and one other...I am sure that someone will chime in with the name.  Go and see them and get their opinion on it. 

I am a RNY to DS revision.  I had my original RNY in May of 2008 and had my revision to DS in April of this year.  I couldn't be happier.  I had a lot of problems with the RNY.  Visit my profile if you like, I have some of the stuff listed there. 

Good luck on your journey and keep us posted.  If you have questions that come up, don't be afraid to post them. 

 My first advice is get a new surgeon.  If this M.O. is blaming you, he is not the right surgeon for you.

As the above poster already mentioned, you have 2 of the best surgeons in California who have done all the weight loss surgeries and will best be able to consult with you.

With all of the research that I have done and with all that everyone has shared on these boards, for the vast majority of us, the DS seems to be the one surgery that has the best chance of long-term success.  I had a RNY 11 years ago and regained almost all of my weight back.  I had no restriction due to a dilated anastamosis and severe reactive hypoglycemia.  Dr. Roslin in NYC did my revision  DS almost 6 weeks ago.  I'm in the early stages of recovery, but I'm very optimistic and feeling better every day.  

Feel free to message me if you have any specific questions.  I wish you the best of luck.  I cannot stress enough to please first find a surgeon who is capable of doing all the weight loss surgeries; my recommendation is Dr. Keshishian or Dr. Rabkin if you are in California.  

Sandy

I can totally empathize with you,

I had a RNY in 1989 and had a revision to a DS with Dr, Keshishian last December. I had about 6-7 years of success with the RNY before I started struggling and dieting and struggling....you know the cycle. Meanwhile my diabetes and hypertension returned and worsened with the new problem os severe reactive hypoglycemia.

I am excited to report that my diabetes. Hypoglycemia and hypertension are gone along with all my prescription medications including insulin. With a revision, the weight loss is much slower, but it's happening.

As a previous poster said, you really should not be on NSAIDS (Motrin), although this was not something I was ever told after my RNY. If you could somehow swing it, the DS is the way to go.

This revision is extremely complex and there are only a handful of surgeons in the US who do them

Good luck.

Email me offline bc this board, the revision one especially, pushes DS like a drug dealer feeding your crack cocaine. I had a RNY in 2002, went from 305 to 175. I was. Good till 2008 when I hurt my back running, bulging discs, and gained back to 246.6. I had the band over bypass on June 23rd and I am doing great. I have restriction again for the first time in years and I'm not hungry. I've just about 30lbs. I go in for my 2nd fill on Monday. The surgery is safe, was easy, and recovery was quick.

HEATHER (mba too)
[email protected]

Do yourself a favor. When researching weight loss surgeries for revision,  take a look at the long-term statistics. Also, take a look at old postings on this board. The most successful people, 2+ years out, are DSers. Most of the band over bypass people lose for a bit, stop losing, and most never come back. There's only been one person that I've seen on here who has been vocal about her long-term success.

The reason that the DS works better is because it offers continued malabsorption. If you could do it on restriction alone, you wouldn't be regaining. My RNY surgeon was very up front about the fact that malabsorption from RNY is gone after 2 years, and if anything, people have to work even harder because the intestinal villi hold on to even more of the food we eat. My DS surgeon agreed and even showed me journal articles about people whose intestines had grown back post-RNY.

The DS revision is a  tricky surgery, to be sure, and it's the sleeve that's the trickiest part. They have to take down the pouch, reattach the stomach, and then perform the conversion to a sleeve. There are very definite risks involved, including leaks. I had the added misery of having a permanent ring on my stoma (a combination RNY with VBG) so that had to be excised. Gee - since I had that permanent restriction, you think I wouldn't have had any regain, right? Doesnt' work that way. I stayed at 221 for the a year prior to my revision, even while following the 6 month 1200 calorie a day diet. My revision wasn't due to weight, it was due to the damage I had from constantly vomiting from the permanent band.

The lap-band is the least effective surgery for virgin wls patients, and there's very little data supporting long-term weight loss for band over bypass patients. The last person on the revision forum who used to brag about her weight loss and post studies, posted studies that didn't have the greatest results, they had a very small sample, and none off the data was long-term. She hasn't posted lately,  which is what happens when the revision starts to fail. There's a failed lap band forum on here, there's long-term data showing that lap-bands ultimately have the most problems combined with the least amount of weight loss, and the fine print from the manufacturer states it needs to be removed after 10 years. It's a foreign object!

I'm a research librarian, I knew the risks, and I still chose the DS because I knew it would offer me the best possible outcome.

If you have heartburn, the lap-band would cause more. If you need to take motrin and other nsaids, your choice is the sleeve or the DS, and if the sleeve is the tricky part, I'd go for the DS.

I truly feel like I got my life back. I can follow a lower-carb diet and feel phenomenally healthy. My labs are also better than they were after RNY. By the 5-6 year mark I was so severely anemic I couldn't do anything.

I had my revision in Dec. 09, and I'm still doing really well. I'm grateful every day that I have my life back. No more throwing up, no more esophageal erosion, no more dumping, no more reactive hypoglycemia, no more avoiding eating out with friends because I was afraid I'd gag and spit up.

 Do all you DS people realize that an open RNY to a DS is virtually impossible?

Um, where did you get that information?  That is news to me.  I had an open RNY to DS revision on April 26th and have had a boring, effortless recovery.  Everything has gone just fine for me and I am loving the DS.  I lived with the RNY for 3 years and it had its good points, but my body just didn't like it.  It is good for lots of people, just not for me.  But, please don't spread misinformation.  Yes, there are only a handful of surgeons that can perform the revision from RNY, but it most certainly CAN be done and IS done.  I was lucky to have one of those fabulous surgeons locally and the OP lives in the state with two of the best revisionists in the country. 

Odd statement, Heather, considering I had one on Dec. 21, 2009.

There are many RNY to DS revisions, and there are even some who have had it done lap, not that I'd recommend it. I think the surgeon has more control when the surgery is open.

I know you're trying to defend your choice but don't make statements that aren't true.