Remember my friend who eats crap and wanted a revision...?

... and the first surgeon turned her down because after looking at her food logs he believes her eating habits are the problem not the RNY?  As predicted, she went to see another surgeon (I also figured she would lie on the food log this time).  This surgeon did not ask her to keep any written food logs.  He just asked her some questions...  what she ate yesterday, where and what she ate one of the last times she went out to dinner, how many times a day she eats, how many calories, etc.  She is upset because she claims he refused to even try to get a revision approved because she had trouble remembering what she ate yesterday and the last time she went out to dinner, and because she couldn;t tell him how many calories she eats per day.  She thinks he is being completely unreasonable and does not understand why he said that if she couldn't even tell him how many calories she consumes on an average day, she hasn't put forth an effort to make sure that she is eating properly and that her weigth gain is not because of what she is eating (how true!). 

I, on the other hand, am glad to find yet a second surgeon who is NOT anxious to just do a revision willy nilly to make money off of someone who may very well fail even after a revision.  I'm pretty sure that when she hesitated (and probably stumbled all over herself the same way she has when her friends have tried to talk to her about what she eats) on the questions about yesterday's meals and her last dinner out, he knew she was hesitating because she was trying to modify it on the fly.

She is understandably very upset, but she did say a couple of things that make me think that she MIGHT now take some of us up on our offers to help her get back to a healthy diet and try to get some of the regain back off.

Lora

I'm sure she is upset but I'm glad to hear there are actually some surgeons out there doing a good job.

I don't know if she's open to suggestions but perhaps she'd be willing to keep a food log for a while and stuff so she could demonstrate to a surgeon that she did try to eat right and still  needs a revision.  Of course, if she does that, it may turn out she doesn't need the revision after all.

Kelly

It would be GREAT if she would because then she would see that she is gaining because she is eating WAY too many high-fat, high-calorie, high-simple-carb foods.  She gives another RNY friend and I a hard time about us being so "strict" about what we eat...  which is funny (sad funny, not "ha ha" funny) because ANYONE who knows me (or has even been out to eat with me more than once) knows that I truly DO believe in "all things in moderation"!

She probably should have had the DS to begin with where at least the increased calories and fat would not have been such a  problem, but getting approval (and a willing surgeon) for a revision when she isn't even honestly trying to control what she eats is problematic.  (As, IMO, it should be.)

Lora

I agree with you.  For one thing, insurance should not pay for a revision unless it's medically necessary.  And it's not medically necessary to eat tons of high fat high calorie starchy carb foods.  I think an ethical surgeon should not do a revision that's not medically necessary either.  Cosmetic nose jobs and stuff is one thing but this is a very serious, risky surgery.

I am reading these posts and shaking my head up and down in agreement.  In our program, we do not even consider a revision without the patient going through at least 2 months of nutrition counseling.  It also MUST be medically necessary (gastrogastric fistula, etc.)  More often, we find that patients gain their weight back because of behaving as your friend has.  It does astonish me that people are given this precious tool to aid in long-term weight loss and they ABUSE it!

While I agree a DS may be good for her, the idea that she should revise to a surgery type that allows her to eat increased calories/fat is not such a good idea....I agree with you when you say that her inabililty or unwillingness to control what she eats is a problem.

I have an aunt who had DS almost 4 years ago.  She has gained back 102 pounds.  She NEVER really changed her diet and was extremely noncompliant.  Her original surgeon should have delved deeper.  Her psych eval was done by the same lady who did mine...umm...she fell ASLEEP during mine!!! 

I think the issues that challenge her compliance must be addressed first before ANYTHING can be sucessful in the long-term for her.

Revisions are tricky, RISKY, and affect the stats of the surgeon (in so many ways....successful revision.... number of patients LIVING through it, etc) and I think that any surgeon who cares about his reputation would want to make sure that a revision patient is there for the right reasons.

This may be unpopular opinion, but I get sometimes frustrated on the main board when folks go there and talk about having trouble with keeping the weight off, and certain individuals always rush to encourage them to seek a revision. If you have a working weight loss surgery, no medical issues, and can't follow the rules well enough to be successful with that.... then you are NOT likely to be a good candidate for ANOTHER surgery. Why not use the one you've already got installed rather than have risky dangerous surgery and another set of rules to ignore!

I have that same (yes, probably unpopular) frustration and the same opinion about diligently working the tool you already have.

Lora