Researching

Well, from the moment I had my RNY I had wished I had a different surgery. I didn't research well enough, and I can 100% admit that. It's two years later and through severe dumping, multiple ulcers, a hernia, an early out pregnancy, and stalled weight loss well above "success" range...oh yeah and severe anemia....My GI mentioned the only "fix" may be to revise.

Now, he didn't mention what we would revise to. And I don't even know if a revision would be covered despite meeting the three standard criteria (Lack of weight loss, unresolved comorbidities, and medical conditions) because I am currently under the state's insurance, and they cut off a lot of Bariatric services...Doc insists he can get it covered due to medical need. I cannot afford to self pay, and here in AZ revision specialists are non-existant, or I just haven't found one yet.

This is all in starting phase, and I don't even know how far this GI is going to push the issue, but I wanted to get a start on research ASAP. I have the DS website, and I know the DS basics. Is this my only option? I really cannot afford to go out of state, and due to health concerns Doc doesn't really want me to spend years with the appeal game.

So.... advice, comments, help of any kind?

Thanks everyone!

This is just my opinion, and I am not a physician.

Given the problems you mention, the DS would be the ONLY surgery I'd revise to in your place. It's the only WLS that's likely to resolve dumping, ulcers, anemia, and poor weight loss. Your only other option would be a reversal/complete take-down to having no WLS, and we know that's not going to fix the weight-loss problem.

But you would have to go out of state, because there are NO surgeons in AZ who are qualified to do an RNY-to-DS revision. Given your very real medical issues, your GI is probably correct that he can get it covered, and it's also possible he can get your insurance to allow you to go to an out-of-network doctor for it.

Try, anyway---doing nothing isn't working.

Had a feeling that was going to be the case. I am seeing my primary doctor tomorrow, and he is suggesting revision as well. He wants it done at the same time as my hernia repair, however if I am going to have to look out of state for a surgeon, thats not very soon or likely. Being covered by the state a revision will have to be fought for, and I am sure to go out of state will be a second battle. Does the GI handle that, do I start making phone calls to the surgeons in CA now? SO lost and admittedly scared with all of this!

I'd start choosing a surgeon, and I'd recommnd talking with either Rabkin or Keshishian in CA. You can find their contact info at www.dsfacts.com

I'd also check out the link in my signature and talk with Diana Cox there---she's an attorney in CA who's helped a LOT of people with insurance issues, and her surgeon was Rabkin.

Just went over there! I also filled out the request for info with Keshishian. Thanks so much for your help!

 Here is a current list of surgeons who do the RNY to DS revisions.

**just so you are aware, Keshishian has a program fee of $4,000.00**  Rabkin also has someting of a fee, but it is not the "flat" fee.  I would ask Diana Cox, or anyone who has used Rabkin.  


Dr. Keshishian, located in California

Dr. Rabkin, located in California

Dr. Elariny, located in Virginia

Dr. Roslin, located in New York

Dr. Buchwald, located in Minnesota


Of course, the above doctors are in the United States 


Dr. Gagner, located in Canada

Dr. Baltasar, located in Spain

Dr. Marchesini, located  in Brazil




I just wanted you to be aware
-Jamie in Alaska

Hey hun!

How is your baby girl?

Sorry you are having troubles. You should definately shoot Vitalady Michelle an email with your latest lab findings.  If I recall right, you had deficiency issues pre-pregnancy and were a fairly early out post-op.  So pregancy did nothing but deplete you further.  Build your labs back up!  You'll need to be at your best possible physical health for healing if you do need a revision.

Hernias seem to be not uncommon post-op and you've had a baby too stretching out the stomach further before complete healing.  Good time for tummy tuck if you ever desired one  - but again you want to be pumped up nutritionally - your best right now. 

Dumping - are you eating the best diet to control this?  protein, protein, protein FIRST and forget the simple carbs.

Would a PPI help with stomach ulcers?  Look into that!

And have you had iron infusions?  If you are still iron deficient  you must feel lousy mentally, physcially, emotionally.  Communicate with Vitalady - she is so wonderful.  Sundown makes a very cheap elemental iron that does work (I have life long issues with low iron - well since I was a young lady)  don't forget the C for better absorbtion!  A nice B12 or B-Complex with B12

Just sayin' try these things first and until revision - if needed.  You need your body to feel okay with some energy before having to make such a huge decision.

(((BIG HUGS)))

I wish you the very best!  How is the little one - I know you have more but I am curious how things turned out with her.  Hopefully all turned out well health wise.

xo

HI :D   Jaelyn is doing really well! She has therapy twice a week, and its night and say how much it has helped her. They still believe she will get the cerebral palsy diagnosis, because she has some left sided weakness and rigidity. Overall, she is perfect. She didn't need the shunt, and her G-tube is removed!

As for me I have been deficient since surgery it seems, yes. My GI believes that I am actually unable to absorb any iron, no matter the form, and that I will need IV infusions from now until forever. He said this will be the case no matter if I revise or not. I am on Nexium and Carafate right now. Our first steps will be to get my labs in good shape, and try to heal the ulcers. The GI feels that once an RNY gets ulcers, they will just keep coming back and he prefers to revise if the person still had weight to lose in addition to ulcer problems. As far as dumping, I didn't dump at all until my pregnancy, now even some simple proteins make me very sick to my stomach. Any fat content at all makes me want to hurt, and even low sugar/carb items give me the shakes. Add in RH now as well, and its a constant battle. And I don't even get to be close to goal!

I am definitely going to try all options before I revise, but I don't want to jump through all those hoops, then have to wait another 6 months to get revision underway, if that makes sense

Glad to hear about Jaelyn's progress :).  Know that I asked with well wishes in mind for your entire family.

Wowzer, sounds like you do need a revision to duodenal switch the full one with a sleeve not a pouch!   You will have to travel for the best RNY to DS revision specialist.  A good revision is worth the wait.  You have the rest of your lifetime to live and a beautiful family that needs a healthy mom.

Yep some RNYers are unable to absorb any iron at all . . . don't give up!  If you are getting infusions keep up with them they can make such a difference in the way you feel.   In the last 5-7 years, I used a few rounds of Venofer.  I think I had a strange reaction that my low iron kept under wraps (you know how people with low iron DID NOT get malaria when there were outbreaks???),  but all and all it helped me to stop dragging around.  Being exausted all the time is no joke!

Take good care!  You will be in my prayers.

P.S.  I love my doc - had him almost 7 years . . . he does select cases of RNY to DS revisions.  You don't have a micropouch or anything and you are smart about your WLS and you are having "issues" might be the type of case he'd take on.  He's does the full RNY to DS and he's been doing something called a "LOOP" DS.  It  takes less time under and less reconnections.  Not sure if this is ideal or not but the handful on the DS forum seem to be doing well.  Some are critical of this not being "the real deal exact ds"-  I don't know enough to say.  What I do know is that my doc takes deep care of me.

 Leila