Slower weight loss with revision from RNY to ERNY compared to full DS?

Hi All,

I went into my revision surgery almost five weeks ago, Sept. 13, intending to come out with a full DS. I had a lap RNY in 2009 and had a lot of problems with it, which is why I wanted to revise. I did go to a vetted DS surgeon, Dr. Henry Buchwald, but he informed me right before surgery, literally the afternoon before surgery, that he may not be able to give me a DS due to my pouch. It was made very tiny and too high up and close to my esophagus for him to be able to cut/sew and convert the pouch to a sleeve. He did tell me he would go in intending to do his best to give me the full DS, but I ended up coming out of surgery with an ERNY, or long limb RNY instead. They did perform an intraoperative endoscopy during surgery to measure the distance between the pouch and esophagus, so I think he really did try to make it work but couldn't due to my prior pouch construction. I was devastated, to say the least, because I wanted the full DS.
 
Dr. B. has been trying to reassure me that I will have just as much weight loss with the ERNY because the malabsorption is what does the work, not the anatomical structure of the stomach, he said. I have a 75 cm common channel, so I would think I'd be losing a lot of weight. What I want to know is how people with the revision from the RNY to ERNY have fared in terms of their weight loss? Is it slower than someone who has the full DS? I'm losing so little and so slowly and I'm concerned about that. I can't help but wonder if it's because of the type of surgery I received. I don't really have much restriction now but thankfully don't have problems with strictures anymore or dumping. My stoma though is still enlarged since he couldn't convert the pouch to a sleeve. I do have a DS intestinal configuration. I've only lost 18 pounds in the past 5 weeks and it's not from a lack of trying on my part. I'm so frustrated. I'm getting 80-100 grams of protein daily, about 80-90 oz of water, often more, and am taking all of my vitamins without a problem. I walk several times a day...short bursts of 10-15 minutes with my dog. I'm trying to severely limit carbs....under 40 a day, yet my weight loss has stalled for the past 2 weeks.
 
Is this normal with an ERNY? When I had my initial RNY, I'd lost 22 pounds my first two weeks and was down almost 50 pounds 2 months out. Granted, I was heavier then than I am now, but I still feel like this surgery isn't working and that I'll never lose my weight. I'd like to hear from others who've had the RNY to ERNY revision about your experiences. I'll admit, I'd a bit jealous when I hear of my friends who had the full DS losing so much their first couple of months. I thought I'd be down at least 30 pounds by now, so the 18 pound loss is disappointing, although it's better than nothing. Now it seems like I've stopped losing weight completely the past two weeks, and even go up and down within about a 3 pound weight range. Is this normal?  I don't know what else to do outside of going on some crazy liquid diet...which I won't do because I won't get my protein in then. I've heard some people say that revisions take longer to lose the weight and that if you're a lightweight to begin with that it will come off even slower.
 
Is it true that the ERNY will work just as successfully for me as the DS in terms of malabsorption and weight loss or was Dr. Buchwald just feeding me a line? I have to go back to see him in Dec. for my 3 month check up and right now I'm so mad and frustrated I'm afraid I may tell him off instead, which I really don't want to do because I really do like him and generally think he's a nice guy. I went to him because I trusted him and believed he was a man of integrity. I'm really hoping he told me the truth and wasn't just pulling a bait and switch maneuver on me. He knows I wanted the full DS and that was all we talked about and discussed at my consults up until the day before surgery when he discovered, after poring through my records, that the conversion on the top half may not work out. I'm really hoping he didn't just lie to me so he could get in a quicker operation and get more clients in the OR that day by shortening my procedure. I still can't help feeling like I've been cheated. I'd appreciate any input/advice about the slow weight loss I'm experiencing and if it's normal or not. And I'd like to hear how other ERNY'ers are doing long term. Also, when can you expect the abdominal swelling to go down. I'm always so bloated and swollen, no matter if I eat or not. The pain has diminished a lot but I still appear to be nine months pregnant. I'm wondering when that will subside. Right now I'm frustrated because I feel like all I've gotten from this surgery is a very small weight loss and chronic diarrhea.       Yikes! Hope it turns around soon! I'd appreciate any and all input. Thanks in advance!  Lisa

I don't know if I can help but I have the DS configuration with a RNY pouch.  I had a DS in 2002 and had a lot of problems and regained 100lbs.  I went back to my surgeon (first mistake) and asked for a reversal because of the problems.  I figured I had all the negatives and none of the benefits so I would rather not have anything.  I was informed that I could not be reversed, only revised.
I read my op report and saw that my common channel was lengthened from 100cc to 200cc and my stomach (which was a sleeve that was left way too large) was made into a RNY pouch.
That was about 15 months ago and since then I have lost all my excess weight and then some.  I am trying to regain some now.  Fortunately I don't have any of the side effects that I had before but now I have the side effects from the RNY such as dumping.  Because my pouch is so small it is hard for me to get in all the food I need to, not to mention the fact that I dump on too much fat or carbs.
I guess what I am trying to say is that while it isn't perfect it is what it is.  You will lose weight.  Since you don't have as much restriction you may have to work harder at it but you will lose weight and be able to keep it off with the malabsorption.  It may not be as fast as you'd like but you will get there.  While losing weight is important it is keeping it off that really matters and I think you will have a good chance of doing that if you just make sure you get in all your protein and vitamins so that you will stay healthy.
You may want to hide the scale for a while until you feel better about things.  Focus on eating right and doing the right things and there is no way you won't take off the weight.

Thanks for the feedback, Ladytazz! You're right in that I probably need to give it more time. I was just accustomed to a much larger, quicker weight loss after my first surgery. It makes me think this surgery is failing, even though I know I'm doing what I'm supposed to be doing on my part. I hear from some other DS'ers, newly out who are eating things like cookies and still losing an enormous amount and I'm trying to eat so perfectly and the scale isn't even budging. How long did it take you to lose the excess weight? I'm not sure if I should give myself a year or more or less and how much I should be aiming for in terms of pounds lost per month. Has anyone ever really failed with the DS or ERNY when it wasn't diet related? I was wondering if it's possible to lose that malabsorption, similar to what happens to some RNY'ers. Thanks again for your insightful feedback and I will try to remember to look at this journey as a marathon, not a sprint. I think that's part of my problem, that I'm perhaps expecting too much too soon.

Don't worry about eating perfectly with your surgery.  The only thing you have to be perfect with is the vitamins.  The malabsorption will compensate for any inperfections you may experience.  Don't skimp on the protein or fat.  The only thing you really need to watch are the carbs, especially the simple carbs since they are absorbed 100%.  
I lost pretty slow with my first WLS.  This time I really lost fast, which surprised me.  I reached my first goal (a normal BMI) at about 7 months and my final goal, 120lbs, at about 11 months.  And kept going.
You can't put a number on how much you can expect to lose a month.  You body will do what it wants to do.
I have never heard of anyone failing the DS that wasn't related to poor choices and even then I wouldn't call it failure but maybe disappointment at the amount of weight lost or amount of regain.  You had a very good surgeon.  I am positive he knows what he is doing and he did a good job on your surgery.  It won't fail.  When I was in a stall they used to tell me to up my fat and it seemed to work.  Maybe you can try that.
Don't forget, it is very common to experience a stall around 3 weeks out and for it to last 2 weeks or so, so you are right on schedule.
I wish I could tell you how much you can expect to lose.  I expected to be a slow loser.  My surgeon even told me that I may not lose any weight.  So I was surprised with just about every pound.  I kept expecting it to stop any time.
Don't compare yourself to anyone else.  Everyone has a different body and just about everyone loses weight at different rates.  I have rarely heard of anyone complaining that they lost weight too fast.  There was a guy that lost something like 50lbs in 2 months and he was complaining that he was a slow loser.

I think that's part of my problem...that I'm comparing myself too much to others with a full DS and also comparing myself to my past WLS when I lost a lot more faster. Last night I was up 4 pounds and about had a heart attack. I weighed myself because I felt so miserably bloated and backed up that it felt like something was wrong. Well, this morning I was down 4.2 pounds after using the bathroom several times, so even those day to day fluctuations can be maddening.

I'm trying to avoid carbs like the plague, but it still is difficult to avoid them completely. Even my protein shakes, which have 42 grams of protein per serving contain 19 grams (only 2 grams of sugar though). I have two of those a day just to try to get enough protein in, and that puts me about at my carb quota for the day. I try to eat meat, fish, eggs, cheese, sometimes Greek yogurt too.

I have a question for you in terms of your vitamins. I'm taking most of what Vitalady recommends for DS'ers. I've had to order KI and K2 though and will be adding that in later this week when I receive it. I've been taking 2 of her tender iron capsules with an additional 1500 mg of Vitamin C to aid in absorbtion. I used to take the C alone and never had problems with it. Now, with the Tender iron, I notice I get rather nauseated afterward and get these "iron burps" from the capsules. What type of iron do you take and any suggestions of how to get it in without the nausea? I was instructed not to take it with food or other supplements, so I typically wait a couple of hours after my first round of vitamins, and between meals to make sure it's not competing with any other supplements/food. I used to just take two of the 65mcg ferrous sulfate tablets with the vitamin C and those went down ok, but I've heard they're pretty much useless for DS'er and ERNY'ers. It'll be interesting to see how my 3 month labs pan out. I've always been very good about taking my supplements and never had any deficiencies post RNY, so hopefully that will continue. I had reduced my fat intake somewhat...was mainly getting it from meat sources or cheese anyway, because Dr. B. advised me to cut back on it due to chronic diarrhea. I've done that, and added calcium and Benefiber in as he's requested, but I'm still struggling with chronic diarrhea 5 weeks out...going 5-9 times daily. Is this normal? I know we're expected to have major changes to our bowel habits post surgery, but I don't know if what I'm experiencing is the norm for a newbie post op or if it's something else.

Thanks again for all of your valuable input and advice! It helps hearing from someone else who shares a similar anatomy and understands the issues that may arise from that. I sincerely appreciate your words of wisdom!

Lisa

I can't help you with the iron because I take the tender iron with no problem.  I take it alone just before bed.  The tender iron has C in it so maybe you don't need the extra C.  You can always send Vitalady an email and ask her.  She is great about answering questions and since she has a distal RNY, too, she understands it very well.
I forget you had the problem with diarrhea.  I had it pretty bad, too, but I think it was because I had chronic bacterial overgrowth.  The only thing that helped was Flagyl and after a while my doctors refused to prescribe it because they were afraid I would become resistant to antibiotics.  Also, refined carbs make it worse because the bacteria thrive on the sugar.  Are you taking a probiotic?  Even a yogurt with active cultures will help.
Can you find a protein without so many carbs?  I use whey protein isolate and my powder only has 3 carbs per scoop (29 grams of protein).  Most whey isolate is low carb.
I wouldn't worry too much about the carbs in dairy and vegetables as much as the refined carbs.  I forgot you don't have a lot of restriction, though, so you may be able to get more in just because you can eat more, but that is good because you have more malabsorption so you want to be able to get in more food.  
I have always weighed myself daily but I had to make a deal with myself not to freak out over the normal fluctuations.  I knew if I was up 3 or 4 pounds that there was no way I could have eaten enough to gain that much so it must be water or being backed up.  I usually only count my weekly weight.
Have you posted on the Lightweights board?  They are very helpful there.  There are a lot of DSers there and they post their daily menu on there, which helps me see how I should be eating.

I am taking a daily probiotic, sometimes two a day since I came home from surgery. I also ordered a 5 pound tub of the chocolate Champion Pure Stack Whey Protein and a 2.5 pound tub of their vanilla protein powder. I hope it will work out ok for me or I'll have a lot to get through! I don't think the carb count is as high on the powders as the ready to drink shakes. I am trying to avoid refined carbs as much as possible and hidden sugars. I'll have to check out the lightweights board, although I don't know that I'd consider myself a "lightweight" just yet! Hopefully, it time I will be! Thanks for all of the tips!

Hello!  I know this is an old posting, but I would love to hear from you as I am set to have this very same procedure with Dr. Buchwald.  I am hoping you will check this account. 

Marcy