11yrs RNY, journey for a revision-amazing what Dr's will find when they do tests

This is not a question, but more of a statement about the complex journey to a revision. First and foremost, insurance companies are for-profit and you have to prove that they should pay for any medical need. If you are looking for a revision - please don't just say your initial surgery failed -PLEASE go get the tests to see why you are having issues or why you aren't losing weight. It could be lack of will-power or a stretched pouch, but it can also be another medical issue. Hormones cause issues, thyroid, tumors, pancreas - go find out! The worst you could learn is that you ARE overeating, the best case is that you will catch a problem before it gets life-threatening or if you need a revision you will have the back up documentation required.

I had a successful LAP-RNY in 2003.  2 years ago I started putting on weight. I was one of the early RNY patients who had to fight with the insurance company to get them to cover my surgery. The weight gain caused me to immediately think that my RNY failed me. I knew that if I want a revision I needed to PROVE it was MEDICALLY necessary. Dr's automatically think you are over-eating so "call them" on it. 

Over 18 months I put on 30lbs., I don't eat sugary or refined foods but I can sit and eat too much of a good thing (veggies, meat) in one sitting. In addition to the weight gain, I had bizarre blood sugar drops. The first thing my Dr and two specialists said was - you are dumping, be honest with yourself, you aren't eating right. How? I wasn't eating anything I shouldn't.

Last July I was in the ER after passing out and slamming my head on a marble floor. The ER Dr said - you aren't dumping, something is wrong, see an endocrinologist, it might be your pancreas. Note that I already had my thyroid removed 7 years ago after several rapidly growing complex tumors were found, I know other things can cause problems. I also had severe acid reflux for 18mos. Off I went to the endo and gastroenterologist. 

My former bariatric physician moved 8 years ago; my family physician begrudgingly referred me to a new bariatric surgeon. He coordinated medical tests with my family Dr to ensure that there were no underlying reasons for my weight gain and severe recent onset of acid reflux. I had a MRI with contrast which triggered an MRI without contrast and a CT scan, barium swallow, cortisol tests, EDG, colonoscopy, lots of blood work, EKG and quite a bit of discussion. All of this over the last 8 weeks. All I really wanted to do was to build my case for a revision so I could fight the insurance company if I had to.

In 8 weeks they found a sizeable tumor in one adrenal gland, a "giant' paraesophageal hernia, ulcer at the anastomosis - and amazingly - my "pouch" is a full size stomach and it is trapped. The entire stomach is the giant hernia.  They also found other issues which are being corrected with non-surgical care. The RNY staples are still there, right at the hiatus. My stomach is apparently so unusual the nuclear medicine Dr, gastroenterologist, general surgeon, my PCP and the bariatric surgeon all had to watch the test videos themselves because they thought the radiology report must have been incorrect.  

I have urgent surgery scheduled for next week to put my stomach back where it belongs and they will put a mesh where the hiatus is to keep it from moving again. I was advised by two of the surgeons and the nuclear med Dr that I should not wait to get revision approval and to get the hernia repaired ASAP. The bariatric surgeon is working with me on eating right now and I have lost 6lbs in a week. After next weeks surgery the bariatric physician will work with me to try to get qualified for the revision based on the comorbids, most of which would go away with a revision. 

I am not scared, frustrated or worried, I just wanted to say that if you really think your pouch isn't working, and your Dr thinks you are just over-eating - take control of your health and seek out other possibilities. While you gather the recorded medical proof that you need for a revision, you may also learn that something else is causing you to gain weight.

:-) M

First let me say I am sorry for your issues. I wish you good health. I revised from RNY to DS. according to my Dr. my RNY did fail and the road to revision was not complex nor lenghty. I first met Dr. Keshshian in September and had surgery in December of 2013. My revisions was also medically necessary. 

I consider myself very fortunate.

Take good care

Whit

I am having a revision this Tuesday. Had an EGD with original surgeon last fall. He said everything was normal. Repeated EGD with a different Dr in May. I have a hiatal hernia, enlarged pouch and outlet. Since it is a hernia repair, I didn't need insurance authorization.

My pouch was also enlarged, I had a hernia, and marginal ulcers.  I hope you have a successful surgery. I have been very happy with my DS. 

I have severe hypoglycemia and grand mal seizures.  I am looking to have a revision from rny to DS.  I don't expect it to be a problem but most of my medical records are in Israel so I may have to have some of the testing redone although I failed the GTT here and my hypo is well documented so maybe not.

Bridget