What made you decide to seek revision?

[mesa0102]

Hello, everyone!

I'm dealing with a sensitive situation. My boyfriend (soon-to-be-fiance) is a RNYer who is about 4 years out. He was massively successful, lost over 230 pounds, but has steadily regained a good amount, I'd guess somewhere between 60-80 pounds, in the past year and a half. This puts him back about 100 pounds above his ideal weight. He keeps saying he just needs to go back to his immediate post-op diet and he'll lose the weight, but it's not working. He keeps slowly and steadily regaining, and he's getting more and more frustrated.

I'm just being the supportive partner and wouldn't dream of suggesting revision to him yet at this point. I don't know how he would take it coming from me, and like the initial decision to have surgery, it would have to come from him and be a thing he himself actively pursues.

My question for you all who have gone that route is: What made you decide to seek revision? At what point did you realize that your first WLS failed you, and simply was not going to work for you anymore, if it ever did? I'm wanting to get a feel for the
mental and emotional journey that led people to pursue a revision. Also, any hints or ideas on what you might have found helpful or especially supportive in a partner at that time?

I really hope this post makes sense. I feel how frustrated he is at this point, and I just want him to feel healthy and be happy with himself. I'm struggling with this big time, because I'm a fixer and want to suggest revision SO badly, but I don't feel it would be my place to do it. Thanks in advance for any help or advice you can give me.

[clpeltz]

Hello! I am sorry to hear that your spouse is dealing with this. It is very frustrating and it is easy for us to blame ourselves.

I had RNY in May of 2008. I had complications over the entire summer. I dealt with stricture after stricture and basically didn't eat the entire summer. After finally getting the DR to order a scope, the stricture was diagnosed and the stretching began. Took three scopes to stretch is where I could eat comfortably. I lost over 100 and got down to 190lbs. I stayed there for about 5 minutes and started to regain. I was also dealing with reactive hypoglycemia which required my to eat frequently and food intolerances which made it hard for me to eat right. I was able to eat carbs, but any dense proteins or veggies always got stuck, no matter how much I chewed. I was throwing up almost daily because of food getting stuck. I was big on blaming myself. My original Dr didn't help things cause he was big on blaming the patient.

I finally decided to see Dr. Buchwald to get checked out. They did all the testing and my pouch was enlarged and the stoma was enlarged. We decided that a revision to DS would be best for me. I had regained 60 and knew I needed to do something or I was going to continue to go up. I love Dr. B and he has given me my life back! It was the best decision that I have ever made.

You are right that he is going to have to make the decision himself. Just be there for him. When he is ready, he knows that you have the info. He'll come to you!

[Ladytaz]

I never considered revision. I knew the surgery hadn't failed. When I did the things I was supposed to I lost weight and kept it off. I just accepted that I was a lost cause that even WLS wouldn't work for.
What got me the revision was when I decided I wanted a reversal. I was having issues that affected my quality of life and I got to where I had no benefits of WLS and all the negatives and just wanted to go back to where I was before I had surgery.
My surgeon was the one who suggested the revision, even though he told me I probably wouldn't lose weight. I really didn't want it but I was scared of gaining even more weight so I agreed.
The revision was successful in that my issues have been resolved. The only reason I have managed to lose weight is because I stopped eating the things that caused me to regain. The revision helps me with quantities and not being hungry but I am 100% responsible for what goes in my mouth. No WLS will work for me if I continue to eat the way I did.
To be honest, I wouldn't suggest a revision to someone unless they had mechanical failure or health issues. A revision is a very risky procedure and shouldn't be taken lightly.

[mesa0102]

Thanks for the replies! He's not having any distressing complications, but his pouch and stoma are definitely stretched. He can eat a little more than me, and I have a big ol' Dr. B sleeve. He also dumps pretty steadily, it doesn't take much sugar or fat to make him sick. He doesn't stay full for very long, either.

Christina, I'm hoping if/when he decides to seriously look into it, he'll go with Dr. B. Dr. B is local for him, and I doubt he'd travel for it. Also, I just freaking love Dr. B, and would trust my bf's life in his hands- after all, I trusted him with my own.

Ladytaz, it sounds like you're very much aware of your own issues and hold yourself accountable for your past difficulties, and I applaud you for that. I think there are some of us, myself included, who could benefit from being more honest with ourselves about our eating habits and how that's reflected in our weight. I don't think any of us, with any surgery, hasn't ever eaten anything we shouldn't, at least occasionally. I'm happy for you that your revision solved the issues you were having. I believe that his pouch and stoma are stretched, which would be a mechanical failure. Of course, there would need to be tests performed to see if this is indeed the case. I don't think any reputable surgeon would perform a revision if he didn't have a mechanical failure or other significant issue. I appreciate your concern regarding the seriousness of a revision, and I agree that it shouldn't be taken lightly.

[Ladytaz]

If he is dumping constantly that is definitely an issue that affects his quality of life. I hope he does consider a revision. He shouldn't have to live that way.
You would be surprised but there are surgeons who will do revisions on people who have no complications, they just never reached the goal they wanted and some have had revisions with only a smaller amount of weight to lose, like 30 lbs. Most insurance companies won't pay for revisions unless medically necessary but if you are self paying you can find a surgeon that will give you a revision. It is a very dangerous surgery. I wouldn't have subjected myself to it if I didn't have hope that my quality of life would be worth the risk.

[Girlrocker]

It's true, revisions are definitely a big decision, and we have to first look to ourselves for personal accountability. It's GI surgery, not brain surgery. I relate to the weight gain, not staying full, dumping...I also had food get stuck all the time. I had the RNY in 2002, and had a bad time - complication, back in the hospital 2 weeks, later, 2nd surgery after 4 weeks in the hospital, developed a wound infection, that put me out for 3 months. While I was recovering, I got into the post-op way of life - lean protein, low/complex carbs, water, exercise. I've been working out for years now, as soon as I could go back full on I did. Stuck to the eating regimen, and by December I had lost 78 lbs, hit 200. And then my weight loss stopped. At first thought it was a stall, I knew they happened, so I kept up with everything.

Months went by, weight wouldn't budge. My PCP asked me if I could be happy at 200 lbs, if this was it...!! I'm like, hello, 200 lbs when I started at 278, I work my a$$ off, to remain obese? Um no, NOT happy. During this, I of course developed a hernia, had another surgery and got some PS/skin removal at the same time. After that I hit 185- which I held for about 5 minutes. Working out, eating right, the 'ok in moderation' lapses, and I struggled to stay at 200, get under. I'd go to 195, bounce back up. I found myself leading a life very similar to my pre-op life, yo-yoing. I lost a lot of hair, I dumped, had troublesome bowel movements, and no more weight loss. When my mom got sick, I packed on 40 lbs and freaked out.

I signed up for a bootcamp program to get myself back on track. The teacher was amazing, and I wound up doing it for over a year. I lost the weight I gained, and after a bout of pneumonia, got down to 185 again...for the same five minutes. I was devastated. 6x a week workouts, clean eating, and I STILL couldn't get under 200 lbs. I got more and more depressed, and slowly started giving up. I could not possibly maintain that workout regimen as a lifestyle, and it just seemed hopeless. By the end of the summer, went back up to 240. In September I started thinking about a revision, ran it by a couple of friends. Next I had tests done to see if there might be mechanical failure. There wasn't, but some stretching. I started researching the DS, because at this point, I was pretty sure that what I didn't want was the RNY plumbing, it wasn't working for me. I checked to see what surgeons were in my insurance network, scheduled consults.

Dr. Keshishian was my first consult, and I knew he was the right surgeon for me. For the first time I didn't feel like a failure; he helped me understand being obese wasn't my fault, that I didn't have the surgery that would help my particular problems and issues. Everything he said made sense to me and I felt this enormous weight lifted off my shoulders, validated. But I was, truly, scared of having surgery again, and he encouraged me to continue with the other consults, learn for myself as much as I could. So I did - I saw the surgeon my PCP wanted me to see; he wanted to do a band over bypass, and I had definitely thought about it. Then he wanted me to go through a 6-month medically supervised diet; I wanted to scream, "you're not listening to me, MY story, my problems And really, I never wanted a band, and I still didn't, couldn't imagine a foreign object around surgery plumbing I thought was questionable. The other surgeon I saw wanted to do an ERNY (distal) and I thought to myself, what will this do? I'll have more of the same problems, probably go bald, and maybe get to 190 instead? I went back to Dr. K and said I wanted to move forward.

My paperwork was submitted in mid October- 2 weeks later I was approved, and I couldn't believe it. Scheduled for Dec 15, because it fit best with work, etc. I was in shock, even when being wheeled into surgery, that it was actually truly happening, I was convinced I would be denied.

I'm now 6 weeks post op as of tomorrow. It's not an easy recovery, it was a big surgery, but I've had a completely uneventful one, and I'm so grateful. I can't believe the difference in how I feel already having a real stomach again, no more pouch. I'm excited that finally, I will, really, have the tool I set out to get to do the work, see my goal of 150. Yes, 150 - no desire to be a skinny bitch, just healthy, to match my curvy, muscular frame.

I didn't and still don't take this lightly. I know plenty of RNY, lapband success stories. But I'm in the 50% the RNY doesn't work for; I was a lightweight, in obesity terms, and I couldn't lose 100 lbs. I didn't have mechanical failure, but my BMI qualified for insurance coverage. In the end, as I was wheeled into surgery and for a split second thought about bolting :-) I knew I had made the right decision, that whatever happened, I was worth fighting for, nothing could compare to the pain, misery and suffering from obesity I had lived for over half my life.

[Ladytaz]

Obviously your surgery was medically necessary. It sounds like you have metabolic issues that nothing would address short of malabsorption. I am glad you have the right surgery for you.
I think I was the opposite. In hindsight I think I would done well from the beginning with good restriction. I don't think my metabolism was that screwed up. I could always lose weight when I cut back on food. The problem was cutting back. I was always hungry, even after my surgery.
Now I supposedly have little malabsorption. My op report says I have a 200 cc common channel. But I have lost too much weight and I am maintaining 100 lbs with over 2100 calories a day. And because I have good restriction I can't eat much more then I already am. I am confident that my eating capacity will continue to grow and I eventually will get to a healthy weight. I just hope it doesn't grow to my pre op levels or I am screwed.
It looks like your surgery is already working and soon your should be well under the 200 lb mark. No doubt you will reach your goal and probably exceed it. My original goal was 140 lbs.

[MsVee]

I am currently seeking a revision from RNY to DS. Initially when I started to regain the weight I felt like a colossal failure. I was going to the gym 7 days a week working out with a personal trainer 3x a week and my weight continued to climb.

I became depressed went back to my surgeon, joined weight watchers, and still continued to gain (the rate was slower but the regain continued). I could not figure out how to exercise more or how to restrict my food more long term.

I started to lurk more frequently on the OtHer site and I realized I was not the only one with a RNY this was happening to so I started looking for options. I read a post from someone that had the RNY to DS revision and they were losing again. That post restored my hope.

I had heard of the DS before I had my initial surgery but so many people were successful with the RNY that even though the DS was my first choice I settled. I joined OH in 1999 so I researched and tried many "one last diets' before I took the drastic step of having weight loss surgery. At that time RNY was touted as the gold standard. People were reporting good results with the DS but I was assured that I could be just as successful with the RNY. I was told with the RNY I could expect a post surgery weight around 170 lbs and with the DS my post surgery weight would be around 160. I thought the 10 lbs was negligible considering my highest weight was over 435 lbs.

The research then looked like the DS would be best for me given my high starting weight. I have learned a valuable lesson, when presented with the facts believe them. I am sorry this is so long I guess I am a bit wordy today.

MsVee

[Band to DS]

I got a lap band in 2008, lost 38 pounds during the first 6 months, and then gained it all back. I also developed food intolerances & swallowing problems. I was really ashamed & blamed myself. It took me 3 years to realize that I needed help.

If you want to approach your boyfriend about the subject, I would tell him that you've seen him work really hard to lose weight and you're concerned that something might be wrong with his RNY that's preventing him from being successful. Try to help him get out of the mindset that it's his fault. You can also tell him that you've read about people who were having the same problems & that they felt better after they revised to a DS. If someone had done that for me, I wouldn't have suffered for 3 years.

Best wishes,
Shelli

[zoetrope]

I hated my RNY. I don't think that the stoma was ever the right size. Ended up with years of never being full, ever and awful bowel problems I don't even want to remember. I was ready just to have the whole thing reversed. It was a nightmare for me. The decision was easy. Insurance was another story. They wouldn't pay and played a big "blame the patient" game from the get go.

[Girlrocker]

I think we're all trying to share our thought process about approaching a revision on all fronts - our physical challenges, our emotional/psychological beings, not small stuff :-) I appreciate what everyone shared here hope Mesa finds this helpful. Also thought Shelli had a very kind suggestion in how to possibly broach the subject. Sorry my post was a freakin' novel, I'm still so new post op and can't seem to stem the flow right now ;-)

[mesa0102]

Thank you all very much for your helpful and insightful responses! And Shelli, thanks for the idea about how to approach him- that's the way to do it for sure, but I'm scared he'll think it means I don't love him as he is. I just want him healthy and feeling good about himself.

[Band to DS]

I know that you're scared, but I'm sure you can figure out how to reassure him of your unconditional love. Like I said in my earlier post, I really wish someone had done this for me.

Best wishes,
Shelli


PS - Your posts are always interesting & informative, Sharyl. No need to apologize!

[mesa0102]

Thanks, Shelli! Ooh, look at you, getting awfully close to that 100 post mark!

[Girlrocker]

Jan 21, 2012 15:05:24 GMT -5 Band to DS said:

I know that you're scared, but I'm sure you can figure out how to reassure him of your unconditional love. Like I said in my earlier post, I really wish someone had done this for me.

Best wishes,
Shelli


PS - Your posts are always interesting & informative, Sharyl. No need to apologize!

Well thanks Shelli, that's sweet of you (sugar free sweet of course!)

I feel the same way about wishing someone had been able to tell me sooner - like Dr. K did when I met him in person - that I didn't have to be suffering like this, it wasn't my fault. I've lost so many years to all of this, and I've actually had a good cry about it in the past few days. I think it's possible you can let him know it's because you love him and want him to be happy, want him to be off the hook about how awful he must be feeling about a surgery that hasn't worked so great for him. You know your guy best, I know this is an emotional topic for men and women both. Let us know how things are going.

[formerlyfluffy]

I am hoping to revise at some point. I got the Lap-Band and it has never worked. I have had 17 fills and no restriction. I knew by about the 8th fill that it wasn't going to work. Every month I would go get a fill thinking "maybe this one".....but it never happened. Unfortunately I don't have insurance and can not afford to revise at this time or I would have already done it!

[Joanne]

Please have him watch this video. It's Dr Roslin's presentation at the ASMBS titled "Did the Patient Fail the Procedure or Did the Procedure Fail the Patient". He goes into detail on why some WLS dont work for some people. It is quite eye-opening.

[Band to DS]

I'm glad that you posted a link to Dr. Roslin's video, Joanne. I wish more MDs felt this way.

Shelli

[omeaga7]

Nausea, dumping, not reaching goal, and weight gain. Argh.

[omeaga7]

Jan 21, 2012 20:02:28 GMT -5 Joanne said:

Please have him watch this video. It's Dr Roslin's presentation at the ASMBS titled "Did the Patient Fail the Procedure or Did the Procedure Fail the Patient". He goes into detail on why some WLS dont work for some people. It is quite eye-opening.

Good information Joanne, thanks for posting.

[mesa0102]

More great posts and info! Thanks, everyone!

[baileymouse]

Late to the party, but here's my story:

I had my RNY in 2003. The doctor also used a permanent silastic ring on the stoma, which creates a combination VBG with RNY. His reasoning was that stoma stretching is the reason for most regain, and this would prevent it.

Wrong.

Many people have regain because the rny offers malabsorption for about 2 years, and then the body adapts. There have been cases of the intestine growing back, and my surgeon even said that the villi in the intestine get even more aggressive about absorbing and holding on to food.

Anyway, my reasons for revision:

1. the ring around my stoma caused constant vomiting. I couldn't eat solid food. No chicken, no beef, no pork. I even had trouble with ground beef. I hated it. I always did better with a low-carb diet, and here I couldn't eat protein sources.

2. I had severe dumping syndrome and wound up with reactive hypoglycemia, which was exacerbated by the inability to eat certain foods.

3. I developed severe anemia. In Nov. 2008 I went to the doctor, afraid I was having a heart attack, because of pain shooting down my arm. My joints were painfully swollen, too. The doc ruled out a heart attack immediately, ran a blood test (thinking I'd developed arthritis) and when he got the results back he told me I was anemic across the board. It was pretty bad, and I had misshapen, large red blood cells that were causing the joint pain.

He immediately thought there was something wrong with my RNY, so he sent me for an endoscopy & colonoscopy, which led to:

4. Severe esophageal erosion. My anemia wasn't being caused by any tears or bleeding, but simply from the bypassed intestine. This becomes very common for RNYers about 5 years out. They did, however, find that all of the vomiting was causing the esophageal erosion.

5. Some minor weight gain. I would have lived with that, it wasn't enough to send me screaming for a revision. I'd gone from 328 to 175, but after 5 years wound up at 221. Couldn't lose for trying.

My surgeon had stopped practicing and had sent out a list of about 3 docs he trusted. One of them was Dr. Greenbaum, and I'd heard good things about him, so I emailed him. He talked to me about converting to the DS. I was just interested in having the ring removed, but he said I'd regain weight (maybe) and that converting to the DS would solve the other problems. He was right. I had my revision in Dec. 2009, and I've been happy ever since.

No more dumping, no more puking, the extra weight came off, and with the right vitamins, I'm fine. Life is good!