Reluctant Reviser with VSG>RNY Questions

I had VSG on 11/30/2012 and have kept off about 110# in the 6.75 years since then. I am ~ 25# overweight but right about at goal, 5'11" (male), 195#, 34" waist, very fit and active, etc. I was down to 175# when I ran marathons but have had a few hip issues that are now resolved and had a minor regain. I actually really like how I look / feel at this weight as I looked a lot older at the lower end.

I'm pretty happy with my weight loss. But since about 2 weeks out I've had ridiculously bad GERD. I get an annual endoscopy (familial cancer syndrome) and ever since VSG, I have had erosions show up from the reflux. This last time it was diagnosed as Barrett's Esophagus, which is a pre-cancerous syndrome.

I cannot control it fully with meds. I either take 5-6 PPI (200-240mg esomeprazole magnesium) or 6-8 extra strength Zantact (900-1200mg ranitidine). These are of course way above the recommended limits and in the case of the PPI there are long-term risks associated with it.

The bariatric surgeon (University of Wisconsin) has recommended I convert to RNY and after the Barrett's Esophagus diagnosis, my PCP and the genetic cancer team both strongly recommended it as well. So I'm going to do it despite not really wanting to. I have been approved by my insurer and have an early November surgery date.

I have several concerns, most notably that I don't really have more than 25# to lose or I drop in the < 18 BMI range and I don't want to be there. The surgeon says he will make a larger pouch and a smaller bypass portion but it's still there and I work out all the time so I already know I will lose more than I want in the beginning. I guess I have a bunch of questions. Feel free to answer any and all if you've had this type of revision:

1. How long did you take off work? I'm told 2 weeks. I usually work from home at a computer. Was there much pain?

2. How long before you could work out again?

3. Did you lose more weight than you wanted?

4. Did it resolve your acid reflux (if that was the reason)?

5. Were you able to enjoy good food at special meals (holidays, etc.) with RNY? I'm terrified of losing ability to have a nice meal with family.

6. Are bowel movements normal at some point?

7. Could you drink alcohol again? I'm fine going months without but at some point would like to enjoy a glass of champagne again. I can't right now as carbonation is brutal.

I'm just reluctant even though I know I have to do this. Any re-assurances would be helpful.

1. How long did you take off work? I'm told 2 weeks. I usually work from home at a computer. Was there much pain? - I had RNY on a Tuesday and went back to work the following Monday. I was on a pain pump for a day in the hospital and took one pain pill at home. I could have gone back to work by Friday.

2. How long before you could work out again? - I was told six weeks before lifting weights, but walked every day.

3. Did you lose more weight than you wanted? - No and the average loss with a revision is 20 pounds.

4. Did it resolve your acid reflux (if that was the reason)? - N/A

5. Were you able to enjoy good food at special meals (holidays, etc.) with RNY? I'm terrified of losing ability to have a nice meal with family. -The only food I will never be able to enjoy again is absolutely nothing. I can eat or drink anything I want. I do restrict sugar and keep to healthy choices. Dense protein, green leafy veggies, and fruit.

6. Are bowel movements normal at some point? - Constipation can often be a problem. Some people might have to take Miramax, some might have to take Imodium. It has a lot to do with their food choices. Many have no issues at all, but it is individual.

7. Could you drink alcohol again? I'm fine going months without but at some point would like to enjoy a glass of champagne again. I can't right now as carbonation is brutal. - I gave up alcohol because it hits me really hard now and I am drunk on a small glass of wine. Carbonation does not bother me and I drink Diet Coke and lots of water and Crystal Light. If you have a glass of champagne, try it at home first of make sure you have a driver if you do it out of the house.

I recently converted from VSG to RNY due to GERD, about a month ago.

1. I was off work for 2 weeks, but ended up calling out 3 days in my first week back because I was exhausted and feeling generally miserable. The pain was only bad for the first week, I took a little Tylenol during week 2 but it was much better by that point.
   
   
2. I was cleared to do walking, nothing strenuous, right as soon as I got home, though honestly I didn't have the energy to do much. 20 minutes on the exercise bike and I was ready to pass out. At 4 weeks out I was cleared for "everything," I did a 45 minute bike ride this weekend and it was kind of miserable but i pulled it off.
   
   
3. Can't speak to this as I'm currently working to lose weight (regained some after VSG). However, you should be able to prevent yourself from losing too much weight as long as you keep your calories at the maintenance level-- totally possible after RNY.
   
   
4. My GERD is completely resolved. I'm still on Prilosec for 6 months as a precaution, but I haven't had any acid trouble since the day I cam home from the hospital.
   
   
5. Your eating habits will honestly not be that much more different from after VSG, with the exception of the (possible) exclusion of refined sugar. So you can definitely do a fancy meal.
   
   
6. I don't know how to define "normal," but I'm not dealing with constipation or diaherrea right now. Stool quality is a little different because of the malabsorption, but it hasn't caused any trouble.
   
   
7. Alcohol is generally best avoided after ANY surgery. Transfer addiction is a dangerous possibility, plus the alcohol will hit you harder after having your digestive system altered. The empty calories don't help, either.

My lifelong severe GERD ( due to a birth defect of a huge hiatal hernia ) was totally resolved after RNY .

Talk seriously with the surgeon about the prospect of shorter limbs to minimize weight loss. When I was looking into this a few years ago (cancer scare), one of the things that I noted from others who have undergone these surgeries for non WLS purposes was the relatively common incidence of bile reflux. Discussing this with the surgeon, he stated that he hasn't had any problems with it if he keeps the limb a minimum of (IIRC) 80cm (though it may have been 60). That seems to be a critical factor in keeping things balanced, even if it might result in you going a bit overboard on weight loss initially.

Diet wise, high fat, low carb is the way to go to maximize caloric density and minimize weight loss (Paleo or Keto in the popular diet world.) Longer term, diet with the RNY will not be significantly different than with the VSG, though some may be more inclined than others toward dumping and/or reactive hypoglycemia and need to make appropriate adjustments.

Please stop taking Zantac, it was just found it can cause cancer.

FDA Announcement - Sandoz Inc Issues Voluntary Recall of Ranitidine Hydrochloride (Zantac) Capsules 150mg and 300mg

https://www.fda.gov/safety/recalls-market-withdrawals-safety -alerts/sandoz-inc-issues-voluntary-recall-ranitidine-hydroc hloride-capsules-150mg-and-300mg-due-elevated