Revising to RNY- Why would it fail for me???
My insurance only approved RNY NOT DS. But have been getting lots of negative talk of RNY failing. Why would it fail? I currently have a sleeve and revising to RNY due to huge complications and weight gain and my BMI still very high after some weight. Loss
The first second step was to do a DS but my insurance won't pay for it and I have been through all the appeals.
Any feedback.
I am confused.
The first second step was to do a DS but my insurance won't pay for it and I have been through all the appeals.
Any feedback.
I am confused.
He who can't be Named
on 6/11/12 2:59 pm
on 6/11/12 2:59 pm
I can hardly abstain from saying what a BAD idea it is to mutilate a sleeve into a RNY pouch, but I suspect you may have been told?? (or maybe not, as I can't see that anyone who understood the ramifications of what a bad idea that is would do that).
Sigh. RNYs of any sort can and do fail for various reasons, but the main issue is that the malabsorbtion of calories is temporary with RNY. The villi regrow, and you regain the ability to absorb the calories again, but NOT THE VITAMINS, so you get stuck still supplementing for life, even after you've lost the caloric benefit. You supposedly absorb all the calories again in one to 3 years (with RNY, not DS), but people are individual.
Another common reason is that your RNY stoma (the man made opening you will have after they replace your own pyloric valve) stretches, and just dumps food into the intestines too soon, leaving the stomach immediately empty, and then hungry. This stoma thing is what contributes to the dumping, and reactive hypoglycemia that RNYers get as well. There is NO effective way to fix a stretched stoma.
One thing that is also often mentioned, is that the severed part of the stomach with RNY is left hanging inside, unable to be scoped for ulcers (which will be a worry with any NSAID usage with RNY) or stomach cancer, and also producing grehlin, the hunger hormone.
The only people I know that have effectively resolved the stretched stoma problems, and the mystery gaining with RNY that they never really pin down, is by revising to DS, but since you will have had your stomach cut twice already, there will be little chance you can revise back to anything, and will be stuck with the pouch no matter what. Considering the pouch is at the root of so many, and the WORST of the RNY problems, I really recommend seeing a surgeon that is actually capable of doing a DS revision. If you go to a RNY surgeon, that's all they sell, even if it's not what is best for you.
The way I see most dealing with the stoma issue is by revising to DS, and having their pouch patched back into a stomach, and then made into a sleeve, reintroducing the pylorus,
You have half of the DS. The remaining surgery would be much easier on your body to upgrade to a DS, and that actually would be an upgrade, unlike the RNY. With the DS, you don't have any of the worries about dumping, reactive hypoglycemia (read up on this, if you don't know how awful it is) marginal ulcers and the inability to take NSAIDs, on top of it being the best at getting rid of the excess weight and co-morbs. You DS still have to take vitamins with the DS, but you keep the benefit of mal-absorbing calories for life, especially fat calories, which is like a magic bullet for keeping the weight off.
Gosh, I guess I DIDN'T refrain from saying what a bad idea cutting up that sleeve into a pouch, but I can't in good conscience do that knowing what I know. It's just such a bad idea in every way except to line some surgeons pockets. If it were me, and I couldn't get my insurance to pay for the best surgery for me, I'd self pay for the final part of the DS. I wouldn't allow an inferior surgery just because it''s what they want to pay for.
Sorry if this isn't encouraging, but I believe the RNY can be a mistake, and you'll likely have NO chance for a do-over next time. I hope you receive this in the spirit is it is written, as I'm a bad typist, and only take the time to type this much because I'm concerned about the advice your are getting, and if you were a loved one of mine, these are things I'd want them to know.
Sigh. RNYs of any sort can and do fail for various reasons, but the main issue is that the malabsorbtion of calories is temporary with RNY. The villi regrow, and you regain the ability to absorb the calories again, but NOT THE VITAMINS, so you get stuck still supplementing for life, even after you've lost the caloric benefit. You supposedly absorb all the calories again in one to 3 years (with RNY, not DS), but people are individual.
Another common reason is that your RNY stoma (the man made opening you will have after they replace your own pyloric valve) stretches, and just dumps food into the intestines too soon, leaving the stomach immediately empty, and then hungry. This stoma thing is what contributes to the dumping, and reactive hypoglycemia that RNYers get as well. There is NO effective way to fix a stretched stoma.
One thing that is also often mentioned, is that the severed part of the stomach with RNY is left hanging inside, unable to be scoped for ulcers (which will be a worry with any NSAID usage with RNY) or stomach cancer, and also producing grehlin, the hunger hormone.
The only people I know that have effectively resolved the stretched stoma problems, and the mystery gaining with RNY that they never really pin down, is by revising to DS, but since you will have had your stomach cut twice already, there will be little chance you can revise back to anything, and will be stuck with the pouch no matter what. Considering the pouch is at the root of so many, and the WORST of the RNY problems, I really recommend seeing a surgeon that is actually capable of doing a DS revision. If you go to a RNY surgeon, that's all they sell, even if it's not what is best for you.
The way I see most dealing with the stoma issue is by revising to DS, and having their pouch patched back into a stomach, and then made into a sleeve, reintroducing the pylorus,
You have half of the DS. The remaining surgery would be much easier on your body to upgrade to a DS, and that actually would be an upgrade, unlike the RNY. With the DS, you don't have any of the worries about dumping, reactive hypoglycemia (read up on this, if you don't know how awful it is) marginal ulcers and the inability to take NSAIDs, on top of it being the best at getting rid of the excess weight and co-morbs. You DS still have to take vitamins with the DS, but you keep the benefit of mal-absorbing calories for life, especially fat calories, which is like a magic bullet for keeping the weight off.
Gosh, I guess I DIDN'T refrain from saying what a bad idea cutting up that sleeve into a pouch, but I can't in good conscience do that knowing what I know. It's just such a bad idea in every way except to line some surgeons pockets. If it were me, and I couldn't get my insurance to pay for the best surgery for me, I'd self pay for the final part of the DS. I wouldn't allow an inferior surgery just because it''s what they want to pay for.
Sorry if this isn't encouraging, but I believe the RNY can be a mistake, and you'll likely have NO chance for a do-over next time. I hope you receive this in the spirit is it is written, as I'm a bad typist, and only take the time to type this much because I'm concerned about the advice your are getting, and if you were a loved one of mine, these are things I'd want them to know.
Some times dingle berries are the lowest hanging fruit.
The DS retains the pylorus, and thus all normal stomach function. It also has a rather long inttestinal bypass, which causes dramatic, permanent metabolic change and permanent malabsorption of CALORIES---the only form of WLS to do so. This is most likely the reason that the DS has the very best long-term, maintained weight-loss stats, and the best stata for resolving or preventing co-morbs like diabetes and high cholesterol.
The RNY can be a bad choice because it bypasses much of the stoma*****luding the pylorus. Food exits the pouch via a 'stoma'---basically a man-made, always-open hole. If this stretches, there goes your restriction. And since you also lose malabsorption around the 2-year mark, you're left with nothing but diet and exercise---and we all know how well THAT works. (*grin*)
The stoma/pouch combo has some other problems, too. Dumping syndrome can be AWFUL. So can reactive hypoglycemia. Then there's marginal ulcers, strictures, and getting food 'stuck'. And frankly, I simply could not live without NSAIDs.
Think twice, cut once. Research ALL your options. Check out www.dsfacts.com, and visit other WLS forums as well.
The RNY can be a bad choice because it bypasses much of the stoma*****luding the pylorus. Food exits the pouch via a 'stoma'---basically a man-made, always-open hole. If this stretches, there goes your restriction. And since you also lose malabsorption around the 2-year mark, you're left with nothing but diet and exercise---and we all know how well THAT works. (*grin*)
The stoma/pouch combo has some other problems, too. Dumping syndrome can be AWFUL. So can reactive hypoglycemia. Then there's marginal ulcers, strictures, and getting food 'stuck'. And frankly, I simply could not live without NSAIDs.
Think twice, cut once. Research ALL your options. Check out www.dsfacts.com, and visit other WLS forums as well.
He who can't be Named
on 6/13/12 1:11 pm
on 6/13/12 1:11 pm
I can tell you that if you go to a RNY surgeon, they will convince you that is the best surgery for you. MANY of us have been told half truths about other types of surgery, because if we went to a band surgeon and asked for a sleeve, for example, we are discouraged from going to any other surgeon and told the band would work for us. That is why there are so many of us on this board that have failed the band or RNY. The DS and sleeve are two of the top surgeries, but if your surgeon doesn't do them (and I mean actually perform them, not just say they do "all surgeries", but when it comes down to it, they don't really) then they won't send away a paying customer.
I highly recommend looking at all the different surgeries, and comparing the two restriction only, being the band vs the sleeve, and the two with restriction combined with malabsorbtion which are the DS and RNY. The DS is the top dog as far weight loss, weight maintenance, resolution of co-morbidities, and most normal post op eating. Like RNY, you have to take vitamins for life, but you don't risk things like dumping, reactive hypoglycemia, and the inability to take NSAIDs, which matters to me with cramps, headaches, and a future w/ arthritis.
I have links to medical studies, and am happy to answer anything I can. I think there are more benefits to the sleeve and DS, and am happy gab about WLS.
Some times dingle berries are the lowest hanging fruit.
On June 11, 2012 at 8:16 PM Pacific Time, Carmen C. wrote:
My insurance only approved RNY NOT DS. But have been getting lots of negative talk of RNY failing. Why would it fail? I currently have a sleeve and revising to RNY due to huge complications and weight gain and my BMI still very high after some weight. Loss The first second step was to do a DS but my insurance won't pay for it and I have been through all the appeals.
Any feedback.
I am confused.
RNY to DS Revision 4/29/2011
Dr. Henry Buchwald
"Think twice.....Cut ONCE"
Please, appeal. I had to fight for nearly 3 years to get approved for my revision. BUT I WON!!!!!!!!!!!!
Diana Cox and Larra helped me with my appeals. Check out ProBoards for the vets who have moved over there.
FIGHT FOR WHAT YOU WANT~DO NOT SETTLE!!!!!
-Jamie
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**
(deactivated member)
on 6/12/12 6:44 am - WA
on 6/12/12 6:44 am - WA
You could fail your RNY by not following the rules for the rest of your life. It is that "just this once"
that will get you everytime. It is a slippery slope and if you stand at the top of it you will fail the surgery.
that will get you everytime. It is a slippery slope and if you stand at the top of it you will fail the surgery.
On June 11, 2012 at 8:16 PM Pacific Time, Carmen C. wrote:
My insurance only approved RNY NOT DS. But have been getting lots of negative talk of RNY failing. Why would it fail? I currently have a sleeve and revising to RNY due to huge complications and weight gain and my BMI still very high after some weight. Loss The first second step was to do a DS but my insurance won't pay for it and I have been through all the appeals.
Any feedback.
I am confused.
The Sleeve is considered a restriction-only procedure, although there is some evidence that the removal of most of the stomach causes some metabolic effects. If you revise your Sleeve to an RNY, in about 18-24 months, you'll be back to a restriction-only procedure---just like what's already failed you once. And you'll be stuck with it for life.
If you go the far less complicated route and get the Switch added to your exsisting Sleeve, you'll have LIFE-LONG malabsorption of calories. Get yourself a lawyer and keep on appealing---I'm betting you CAN win this fight, if you tri hard enough.
But ultimately, if you simply can't force your insurance company to pay---save up some money, out outside the US, like to Dr. Ungson in Mexico, and buy yourself the best possible surgery for your situation.
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