Revision from sleeve to RNY

Hi everyone, I was sleeved in 2011 and now I'm in the process of getting revision to RNY. I've never was able to make goal before with the sleeve but I was always scared of RNY because of never being able to have a glass of wine periodically nor take NSAIDs, so my question is, what do RNY patient take for pain. And are you never ever able to have a glass of wine AGAIN? The reason for me not getting RNY before was because of not being able to have NSAIDS again and I do have fibroids causing extreme pain and ibuprofen is the only thing that work for me. I have GERD really bad-now. This is new for me because I didn't have it before I was sleeved.

Hi,

The opioides are alternatives? Is a dificult decision. Talk with your doctor.

We can't have wine but VSGers can??? That's a new one!

If that's your worry, let me tell you that the "rules" for RNY are pretty much the same as for VSG.

NSAIDS are not recommended, so you'll have to decide what is important to you before you get a revision. Maybe your GYN can point you in the right direction. Honestly, it's a rare woman who doesnt have fibroids. I know I had 3 last time i was scanned.

Taking NSAIDs isn'a good idea for RNYers but my clinic, in discussing NSAIDs, said it wasn't good for sleevers to take NSAIDs either. I take tylenol which doesn't do well for me as NSAIDs did which doesn't mean it won't do well for you. (Edited to add this) I also sometimes take tramadol which is a low level synthetic narcotic medicine but I take that for arthritis when it acts up. Opiods can be taken for severe pain but historically,(long story short, my arthritis in my back flared up severely), at least for me, gets in my system faster and has a much stronger sedative affect.

I've never heard that alcohol was forbidden for RNY, mostly, it's recommended that you don't drink for 6 months (I think, veterans probably know more) after surgery and that it will probably affect you differently after WLS because it goes though your system faster. It isn't an issue for me. I have no moral issues against drinking alcohol however there is a history of alcoholism in my family (my father) and because there appears to be a familial tendency for alcoholism, I choose not to drink except very occasionally and it has probably been 3 or 4 years since I last had a beverage with alcohol of any kind. (That was pre bypass. Anecdotally, you get drunk faster because it gets in your system faster but you sober up quicker for the same reason.

I miss ibuprofen but I really don't miss the weight. I can't take most narcotic pain meds, they cause nausea and vomiting. The best thing I've found is CBD oil, the one I use is made from hemp and has no THC in it. There is also CBD cream for muscle pain, it works really well too.

Alcohol should be pretty much off-limits for ALL WLS patients, regardless of surgery type. It's empty calories and carbs, it's much easier to get buzzed, and there is a very real potential for transfer addiction.

While the normal admonition about alcohol and WLS hold - not great for weight loss or control, concerns about transfer addiction and liver health issues during rapid weight loss - I've never seen any reference to there being any significant difference in tolerance between the RNY and VSG.

On your pain relief concerns, that is where there is a conflict in contraindications between the RNY and VSG. My suggestion is to get a second (and third!) opinion before any revision owing to the inherently more complex situation that accompanies them. In your particular case, being an early sleever (I am also a 2011 model) there is a greater chance that there may be shaping or technique issues that may play into your problem. At that time, most bariatric surgeons were fairly low on the learning curve in doing the VSG, so they often were not as well done as they would later do (this is why I traveled to have mine done as even in a major metropolitan area such as LA there wasn't anyone there at the time who had adequate experience in them.) The DS guys had much more experience as they had been doing them 10-20 years or more as part of the DS, and they are still a good proxy for in depth experience in doing them, and most particularly in your case, evaluating problems with them and offering solutions. Diagnosing and fixing a problem is often much more complicated than doing a virgin procedure.

There may be some shaping issues - minor strictures or bulges - that may be causing or exacerbating your reflux problem that can be resolved by correcting the sleeve rather than throwing it out. And, there may not be and it is just intrinsic to you and there is no real option than to revise to a bypass, but this is what second opinions are all about - to see if there is another way of solving the problem, particularly when the "normal" solution of a bypass revision is contraindicated by your NSAID needs. Medical care is all about compromises and trade offs, and you want to get the best trade off that you can for your needs.

My suggestion is to find a DS surgeon for a second opinion, as it has been my experience that, while they generally have no problem recommending an RNY when it is that appropriate approach to a problem, they tend to have a broader and deeper "toolbox" with which to solve problems. In VA there is Dr. Hazem Elariny, who has a good reputation, and there may be others in the area - check with the DS board to see who is (semi-) local. You may find a better approach to your problem, or at least gain confidence that the revision is indeed that best way to go and work with your doctors on the next best pain medication regimen (there are some limited situations where meds such as ibuprofin are used successfully, but it is done under close medical supervision).

Good luck...

My center told me to avoid alcohol for one year. When I had some after a year, I was so embarrassed because I was at a work dinner and I slurred my words. I could hear it. The alcohol hits you right away, so I think transfer addictions become an issue. Then again, last month I had 2 glasses of wine at a dinner and again, I had to shut my mouth because the slurring began again and the buzz hit hard and fast. I can see why people get the addiction because God damn it felt nice. But note to self: avoid.

That's too funny!

Before I was sleeved I loved wine...just like I loved my iced coffees sweetened with zero calorie sweetener. After wls I have not had either. My brother brought a very nice 2001 wine over for Easter and I didn't have a sip.