Revision after Fobi Procedure
I had the Fobi RNY with the silastic ring in 1991 and regained the weight I lost. I was approved for a revision by Kaiser in 12/2010 and finally completed the six month program. It took me longer than six months mostly due to my (former) employer who did not want me taking any time off for my appointments. All I have left is to select the protein drink of choice and submit it to the nutritionist and attend my consult with the surgeon which is scheduled for 10/10/2011.
I have worked hard in resolving the emotional issues that resulted in my regaining the weight; faced them, admitted them, and dealt with them - beginning with getting rid of the abusive spouse and learning to live on my own, free of drama, free of bad relationships for the past nine years. This may be TMI but it becomes important a bit later in my post.
Yesterday, I attended the required class at GBMC given by one of the surgeons (the partner of the surgeon with whom I had made the appointment). I went into the class feeling successful and confident. I have faced my demons, learned to eat right, lost 31 pounds. At first, I thought that perhaps I could do this on my own but the nutritionist pointed out that that without a revision, I may not be able to keep it off. From my own perspective nine months down the road, I really do want the revision to help me get the rest off and keep it off.
It appears that I was the only person in the class seeking a revision. I waited until the end of the question and answer session to ask about the revision procedure. Dr. Moe (the nickname the others on this board use for this surgeon), who had actually said that he tells patients that they might lose too much weight to qualify to go out and eat a hamburger, alluded to my own pre-op weight loss as proof that my problem could probably be resolved by behavioral modification. Further that he had never revised a Fobi procedure.
When I had my psych eval (one on one due to my seeking a revision) I made sure my life and the path I've walked was an open book. I passed with flying colors and commended on the personal work I had done to get to where I am now. I've openly admitted to having gone through years of therapy to get to this point and time and again. I had to learn to live alone and on my own free of abusive relationships, identify why I found myself in them, deal with it, etc. My present life is a testimony to the success of the work I have done.
After all this work, to finally be approved for a revision, proven that I can succeed this time around, and be told by one of the only two surgeons that Kaiser uses in my area that he had never done the procedure I would need and that he didn't know if he could help me, I cried. Dr. "Moe" responded with telling me I needed to see a therapist because I was crying. I responded by telling him that I wasn't crying because I needed therapy but that I had come so far and worked so hard for this and was upset that he was telling me that he didn't think he could do anything to help me.
Rather than making my appointment with Dr. "Moe", I made my appointment with Dr. Liao, his partner. I have spent several hours online trying to find information on revisions after having the Fobi procedure, if it is possible, if Dr. Liao has experience in this type of revision, etc. I would sincerely appreciate any information the forum can give me.
Kate
My appointment is with Dr. Liao on 10/10/2011.
I have worked hard in resolving the emotional issues that resulted in my regaining the weight; faced them, admitted them, and dealt with them - beginning with getting rid of the abusive spouse and learning to live on my own, free of drama, free of bad relationships for the past nine years. This may be TMI but it becomes important a bit later in my post.
Yesterday, I attended the required class at GBMC given by one of the surgeons (the partner of the surgeon with whom I had made the appointment). I went into the class feeling successful and confident. I have faced my demons, learned to eat right, lost 31 pounds. At first, I thought that perhaps I could do this on my own but the nutritionist pointed out that that without a revision, I may not be able to keep it off. From my own perspective nine months down the road, I really do want the revision to help me get the rest off and keep it off.
It appears that I was the only person in the class seeking a revision. I waited until the end of the question and answer session to ask about the revision procedure. Dr. Moe (the nickname the others on this board use for this surgeon), who had actually said that he tells patients that they might lose too much weight to qualify to go out and eat a hamburger, alluded to my own pre-op weight loss as proof that my problem could probably be resolved by behavioral modification. Further that he had never revised a Fobi procedure.
When I had my psych eval (one on one due to my seeking a revision) I made sure my life and the path I've walked was an open book. I passed with flying colors and commended on the personal work I had done to get to where I am now. I've openly admitted to having gone through years of therapy to get to this point and time and again. I had to learn to live alone and on my own free of abusive relationships, identify why I found myself in them, deal with it, etc. My present life is a testimony to the success of the work I have done.
After all this work, to finally be approved for a revision, proven that I can succeed this time around, and be told by one of the only two surgeons that Kaiser uses in my area that he had never done the procedure I would need and that he didn't know if he could help me, I cried. Dr. "Moe" responded with telling me I needed to see a therapist because I was crying. I responded by telling him that I wasn't crying because I needed therapy but that I had come so far and worked so hard for this and was upset that he was telling me that he didn't think he could do anything to help me.
Rather than making my appointment with Dr. "Moe", I made my appointment with Dr. Liao, his partner. I have spent several hours online trying to find information on revisions after having the Fobi procedure, if it is possible, if Dr. Liao has experience in this type of revision, etc. I would sincerely appreciate any information the forum can give me.
Kate
My appointment is with Dr. Liao on 10/10/2011.
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You now have a very different battle to fight - you need to get Kaiser to pay for an OUTSIDE bariatric surgeon who is qualified to revise a Fobi to something else - and your options are pretty much limited to revision to a DS.
There are only a VERY few surgeons in the US qualified to do this revision. The only ones *I* personally would consider are either Dr. Rabkin in San Francisco, or Dr. Keshishian in Glendale CA.
And you didn't fail your surgery - your surgery failed YOU. Any surgeon who tries to tell you otherwise has his head up his ass.
Just a follow up on my original posting. Through the assistance of Dr. Fobi's office, I was able to convince Kaiser to approve the GI series prior to my surgical consult rather than after as is their standard practice. I met with Kuldeep Singh, MD, yesterday, *****viewed the GI images and found a hiatal hernia. His office was wonderfully cooperative with communicating with Kaiser and my primary care to facilitate what needs to be done prior to repairing the hernia and doing my revision which should take place within a month.
On an aside, after reading a rather nasty post to me in another thread accusing me of not having a job, etc., I returned to this thread and read my first posting to see why such an accusation would be made about me. I referred to my former employer who was uncooperative as to my taking time off for appointments. I have never stated that I was not employed. On the contrary, I am employed as a legal professional and also doing historical research in preparation for a historical book on Maryland during the American Revolution. This is really nobody's business but since the accusations were made against me, that is my response.
Beachie
On an aside, after reading a rather nasty post to me in another thread accusing me of not having a job, etc., I returned to this thread and read my first posting to see why such an accusation would be made about me. I referred to my former employer who was uncooperative as to my taking time off for appointments. I have never stated that I was not employed. On the contrary, I am employed as a legal professional and also doing historical research in preparation for a historical book on Maryland during the American Revolution. This is really nobody's business but since the accusations were made against me, that is my response.
Beachie
Hi. I am Yehuda.
I had my fobi pouch revised to the DS with DR. Keshishian.
I do not want to scare you out of seeking a revision to the DS, but you must understand that revising a fobi pouch is far more complicated than any other revision. The only acceptable surgeons to go to are Keshishian or Rabkin. I doubt any other surgeon would even be willing to do such a revision.
Best wishes to you:-)
I had my fobi pouch revised to the DS with DR. Keshishian.
I do not want to scare you out of seeking a revision to the DS, but you must understand that revising a fobi pouch is far more complicated than any other revision. The only acceptable surgeons to go to are Keshishian or Rabkin. I doubt any other surgeon would even be willing to do such a revision.
Best wishes to you:-)
Dear Gail, Diana, Yehuda, Hislady,
Thank you for your responses to my posting. I have been online researching this all weekend and on the phone this morning placing calls, including one to Dr. Fobi's office in Long Beach which I wished I had been able to do on Saturday as it would have given me more direction.
The person at Dr. Fobi's office was also a patient of 15 years and very understanding. There are doctors on the east coast familiar with the Fobi procedure and who do revisions, in addition to Dr. Fobi, himself. My first hurdle is to get the final approval from Kaiser which will come on Wednesday. I was approved for the program to have a revision with my operative report from Dr. Fobi in their hands to read and review. If I get the approval for the revision on Wednesday(Geanine, the nutritionist who has supervised me says it's a done deal) , then Kaiser has basically said it's necessary, etc. right? Just my trail of logic here.... If the procedure they want me to have(vS) isn't the correct one for revising a Fobi pouch, then that's their mistake. I don't want to make any waves before I get the approval in my hands but I want my information and ammunition ready for the fight when it comes.
Dr. Fobi's office said that the upper gi, etc. should have been done from the get go so we know what is going on with the first surgery. The silastic ring could have eroded and been passed through. A slippage usually doesn't happen. It's "backa**ward" for Kaiser to want to wait for me to have the appointment with the surgeon before doing the testing because the surgeon needs to see this to evaluate what he can do. I did call my primary care and left a message asking if she could order the testing for before the consult with Dr. Liao. I talked to her about this before and she said she couldn't because of the way Kaiser works but I explained on the voice mail that I had spoken to Dr. Fobi's office and they recommended it be done first. I'm also waiting for a call back from Dr. Liao's office manager and will call them in a few minutes.
Things look better today than they did on Saturday or Sunday.
Kate
Thank you for your responses to my posting. I have been online researching this all weekend and on the phone this morning placing calls, including one to Dr. Fobi's office in Long Beach which I wished I had been able to do on Saturday as it would have given me more direction.
The person at Dr. Fobi's office was also a patient of 15 years and very understanding. There are doctors on the east coast familiar with the Fobi procedure and who do revisions, in addition to Dr. Fobi, himself. My first hurdle is to get the final approval from Kaiser which will come on Wednesday. I was approved for the program to have a revision with my operative report from Dr. Fobi in their hands to read and review. If I get the approval for the revision on Wednesday(Geanine, the nutritionist who has supervised me says it's a done deal) , then Kaiser has basically said it's necessary, etc. right? Just my trail of logic here.... If the procedure they want me to have(vS) isn't the correct one for revising a Fobi pouch, then that's their mistake. I don't want to make any waves before I get the approval in my hands but I want my information and ammunition ready for the fight when it comes.
Dr. Fobi's office said that the upper gi, etc. should have been done from the get go so we know what is going on with the first surgery. The silastic ring could have eroded and been passed through. A slippage usually doesn't happen. It's "backa**ward" for Kaiser to want to wait for me to have the appointment with the surgeon before doing the testing because the surgeon needs to see this to evaluate what he can do. I did call my primary care and left a message asking if she could order the testing for before the consult with Dr. Liao. I talked to her about this before and she said she couldn't because of the way Kaiser works but I explained on the voice mail that I had spoken to Dr. Fobi's office and they recommended it be done first. I'm also waiting for a call back from Dr. Liao's office manager and will call them in a few minutes.
Things look better today than they did on Saturday or Sunday.
Kate
I know the 15 year out patient you are reffering to is David. I was a patient there before I was revised to the DS.
This may sound unreasonable at first, but I must urge you to not listen to any advice Dr. Fobi's office give you in terms of getting a revision. Just as you were mislead in getting your initial surgery you will be mislead in getting a revision.
The duodenal switch (DS) is a combination of restriction and malabsorbtion, but is very different from your fobi pouch. The restrictive component of the DS is the vertical sleeve gastrectomy (vsg or sg for sleeve gastrectomy). The malabsorbtion component is permanent and is how we maintain our weight los.
If you just had the sleeve part without the malabsorbtion, you will not lose the weight you want, and you will likely regain much or all of what you do lose. If you did not do well with a fobi pouch, which works primarily through restriction, then you will likely not do well with another restrictive surgery like the sleeve. What you will likely need for long term success is the malabsorbtion of the DS.
Please research this operation, and I would urge you to at least consult with Dr. Keshishian. He is really the best surgeon to deal with a fobi pouch.
This may sound unreasonable at first, but I must urge you to not listen to any advice Dr. Fobi's office give you in terms of getting a revision. Just as you were mislead in getting your initial surgery you will be mislead in getting a revision.
The duodenal switch (DS) is a combination of restriction and malabsorbtion, but is very different from your fobi pouch. The restrictive component of the DS is the vertical sleeve gastrectomy (vsg or sg for sleeve gastrectomy). The malabsorbtion component is permanent and is how we maintain our weight los.
If you just had the sleeve part without the malabsorbtion, you will not lose the weight you want, and you will likely regain much or all of what you do lose. If you did not do well with a fobi pouch, which works primarily through restriction, then you will likely not do well with another restrictive surgery like the sleeve. What you will likely need for long term success is the malabsorbtion of the DS.
Please research this operation, and I would urge you to at least consult with Dr. Keshishian. He is really the best surgeon to deal with a fobi pouch.
WIth the Fobi procedure (I have the pouch, the silastic ring and the roux-eny) I lost all my excess weight the first time around. I understand how part of the weight issue could be genetically coded, however, I am also very aware of how I sabotaged myself with my eatings habits and the emotional issues that I hadn't dealt with prior to the surgery and for the next ten years. The husband needed to be dumped along with the weight. I needed to learn to be on my own, happy, and value what I had or wanted to have in my life more than I valued the food. I've come full circle and as my nutritionist agreed, all I need is one more chance with the procedure. The weight will come off and stay off this time.
I spent the morning and half the afternoon on the phone and online doing research (added to Saturday evening and all day Sunday online). I found a handful of surgeons here in the Mid-Atlantic area who performed or had performed the Fobi procedure and did revisions. I have an appointment with Kuldeep Singh, MD on 10/10/2011 and felt very comfortable with his office staff - at least from the lengthy telephone conversations (plural) that I had with them and how wonderfully helpful and supportive they were.
With that said, I finally got through to the nutrionist (love her to bits) who had actually been expecting me to call her, particularly after having the session at the hospital with the infamous Dr. Moe. I'd left a voice mail at the Kaiser office I usually go to but she was at a different location this week. She asked how I was doing and I started with a few quite colorful metaphors about Dr. Moe to which she responded with "He said THAT to you???? Did he say it in PUBLIC?????" Yes and Yes. Turns out, I was sent to Greater Baltimore Medical Center and Drs. Moe and Liao ONLY because that was the closest location for me and that St. Agnes and Dr. Singh also worked with Kaiser even though they weren't Kaiser affiliated. She had worked with them many times in the past and as far as she was concerned, I would just go with him rather than with GBMC and that whatever procedure he chose to do would be covered. A revision was approved and that was all there was to it. She also called me back a short time later to tell me that she had spoken to my primary care and the GI series was ordered so that it would be in hand for the consult rather than waiting for the surgeon to order it and take even more time. I've had the order for blood work in hand. The only two things out there are the chest xray and the pre-op physical.
Things look a lot better now than they have all weekend. I'm back on track. Weight off by early next year, ice skates... LOL
Kate
I spent the morning and half the afternoon on the phone and online doing research (added to Saturday evening and all day Sunday online). I found a handful of surgeons here in the Mid-Atlantic area who performed or had performed the Fobi procedure and did revisions. I have an appointment with Kuldeep Singh, MD on 10/10/2011 and felt very comfortable with his office staff - at least from the lengthy telephone conversations (plural) that I had with them and how wonderfully helpful and supportive they were.
With that said, I finally got through to the nutrionist (love her to bits) who had actually been expecting me to call her, particularly after having the session at the hospital with the infamous Dr. Moe. I'd left a voice mail at the Kaiser office I usually go to but she was at a different location this week. She asked how I was doing and I started with a few quite colorful metaphors about Dr. Moe to which she responded with "He said THAT to you???? Did he say it in PUBLIC?????" Yes and Yes. Turns out, I was sent to Greater Baltimore Medical Center and Drs. Moe and Liao ONLY because that was the closest location for me and that St. Agnes and Dr. Singh also worked with Kaiser even though they weren't Kaiser affiliated. She had worked with them many times in the past and as far as she was concerned, I would just go with him rather than with GBMC and that whatever procedure he chose to do would be covered. A revision was approved and that was all there was to it. She also called me back a short time later to tell me that she had spoken to my primary care and the GI series was ordered so that it would be in hand for the consult rather than waiting for the surgeon to order it and take even more time. I've had the order for blood work in hand. The only two things out there are the chest xray and the pre-op physical.
Things look a lot better now than they have all weekend. I'm back on track. Weight off by early next year, ice skates... LOL
Kate
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