Oh no! Thank you for your reply... I'm sorry you are having to have new surgery ?? I'm definitely going to look into my options especially because revision surgery probably won't be possible as I have medicaid insurance and I'm almost positive they only do one surgery per lifetime. Also id be really super bummed if I have to have another surgery and go through it all again when I could've prevented it in first place. Next appointment is Aug 14th and if he doesn't address this I'm getting a second opinion or speaking with the other woman doctor who also works there.

Hi, I had a hernia done as well I'm July 17 th. It's the 2nd week and it has just started to feel better. It will get better soon.

It certainly seems like you have some time to decide on things. Your GERD seems to be reasonably controlled with the medication, it's just when you skip it that you have problems, is that right? It sounds like there is still some room to play with medication, diet and lifestyle tweaks to improve things without going as far as surgery - some have GERD problems that don't respond to any of these things, and they are the prime candidates for the RNY revision.

Keep in mind that every time we go in there surgically, we back ourselves into a corner a little further as far as future options are concerned, so we want to make the most of it if we go for a revision. The RNY, even in its virgin form, imposes limits on future medical treatment options and is difficult to revise should weight problems persist or reoccur or if intransigent side effects crop up (typically the marginal ulcer problem.)

I had the opportunity a couple of years ago to revise, though GERD was more of a sideshow, and at the level that yours sounds to be at - minor level of medication needed to control things, but if I skipped a dose, I would feel it the next day. Recently, I have discovered that if I skip a dose, I don't notice it until I check my pill box the next day and see that I didn't take them yesterday - so symptomatically, things have improved - will have to check with the gastro about making adjustments and following up on that.

The problem that I see with your muscle issue (by your description, it sounds like the muscles controlling the lower esophageal sphincter - the pyloric valve's opposite number) is that it doesn't seem that the RNY revision really addresses that problem directly. It will usually improve the overproduction of acid that can reflux, and reduces pressure in the stomach that can cause some reflux so it can relieve your noticeable symptoms, but doesn't correct the fundamental problem of the sphincter not keeping the stomach contents down. The couple of rare cases of esophageal cancer after RNY that I have seen referenced were a result of the basic problem that you have - the esophagus becoming an overflow stomach - so this is something that you likely will still have to contend with after a revision. You should limit meal sizes (as you should now) and monitor things endoscopically periodically to make sure things aren't deteriorating in there. There are implantable devices and other surgical procedures that are sometimes done to address this problem specifically, and that would be another avenue of investigation for you, as there may be something there that is appropriate for your situation.

Another point is the medications that are needed. Some may be overly eager to revise in order to get away from the PPI medications that are used - there are lots of scary stories on the internet about them, and ideally it is best if we can avoid medication of any kind (but our world is far from ideal.) The problem with this is that many in our RNY community here are also on PPIs to control the RNY's acid related problems - what GERD is the the VSG, marginal ulcers are to the RNY; also, GERD is not unheard of with the RNY, so opting for surgery in preference to medication that works is questionable.

It sounds like some second opinions are in order, both from surgeons and non-surgeons alike. I had one surgeon who was pushing an RNY revision pretty strongly, but other doctors offered alternatives that were worth pursuing, putting off surgery until sometime in the future, if ever. At this point it remains an option, but once the trigger is pulled, it's hard to go back. I will take things slow and monitor things before exercising that option.

I am planning to have this procedure done next year & think I've narrowed down my search to the following prospects:

• Dr. Elias Ortiz - EOC
• Dr. Ariel Ortiz - OCC
• Dr. Juan Corvala - Angeles Health

If you or anyone you know personally has used any of these physicians/facilities, can you please tell me what your experience was like?

Thank you!

First off, do not have a surgeon who is willing to do a bilateral replacement. That's a red flag, high risk for infection, possible amputation if one knee gets infected, increases the risk of complications. I know that wasn't your primary question.

I had my surgeries 6 months apart. Had I known the 2nd would not go like the 1st, I would have waited 9 months.

The first 2 weeks were rough sleeping, thankfully I have a power recliner. It was a good 2 months before I could sleep in the bed due to the pain rolling over.

Make sure you do the post op flex exercises. After the 2nd surgery, the PT orders were geared towards strengthening whereas, the 1st surgery flexibility was stressed. My surgeon apologized because he did not emphasize the flex based on how well the 1st went. What happened? Scar tissue, some people are more prone to develop, moi. The scar tissue was the worst, it hit 4 weeks post op and I stood the risk of his putting me under to remove it. Apparently it's extremely painful. Anyhow I worked so hard, went through stretching exercises that I had to take the hydrocodone prior to.

My intent is not to discourage you, rather prepare yourself for the emotional piece and down days. Have a spinal and a block. I was so scared of the spinal, I didn't even feel it. When the block wears off 24 hours later, the pain sets in.

I want to stress, no 2 people have the same experience. Nor are our knees the same. The 1st was a better recovery than the 2nd.

While I have clicks, totally normal. I have no arthritic knee pain! No cartilage crunching!

My surgeon was very strict with the BMI, he started out that I had to lose 15 # in 6 weeks. No way, I'm on a med that messes with my metabolism plus sedentary due to pain. He gave me a break, I lost 8#, he knew I was doing my best.

Finally, research, research, research surgeons. I doubt you live in MN, my surgeon was awesome, part of the Allina System. When you go to your preop appointments strike up a conversation with a post op patient. If they have a negative story find out why, if it's the doctor run. Easier said than done.

Summary, of sorts:

1) Find a reputable surgeon; 2) do pre op knee / buttock / lower back strengthening exercises, the more strength you have going into surgery the easier the post op PT/ endurance. 3) One knee at a time, if you're able space them out, at least 6 months apart. I had little choice due to my work. 4) Take your pain meds, if you're at a 8-9 it's out of control, you will be miserable, and unable to do your PT. Use caution of course if you've been through treatment, could be an an issue. It wasn't for me because I'd go to hell before treatment again. However you can balance the pain, the meds, and PT is the key to success.

Sorry for the book, hopefully this is helpful. Like I tell people, take what you need, and leave the rest.

All the best to you. And no, I do not regret having replacements. I don't want to do it again, but I would if something were to happen.