Revision at 32 BMI???

Thank you ladies for directing me to the LW Boards....never in my life did I think I would ever be referred to as a "lightweight"!!! hahahaha

Anyway...I had VSG on May 11, 2011...lost around 85 pounds...stopped losing at 8 months out :(

I have been having recent issues with mild weight gain and hunger despite exercise daily and controlled eating. I'm saddened that I have to obsess over food/exercise and weight gain again. Trust me I know surgery is simply a tool but I'm busting my butt to stay at a still unhealthy weight.

I'm looking into revision and have an appt tomorrow with my surgeon, Dr. Antanavicius at Abington General in PA. My BMI is currently 32 and again maintaining that is a MAJOR daily struggle!! I am hoping he is willing to talk about options.

I was also directed to Dr. Greenbaum in NJ. I called his office and was told that he will not revise at my current BMI. I understand this but think it is unfortunate that I will have to have an increased BMI.

Why must I struggle daily and fight this fight when I know deep in my heart that I cannot win this battle without the malabsoption component. I have accepted this but I cannot allow myself to regain weight just to qualify for a revision (preferably to DS).

Is their hope for me?? Has anyone been in a similar situation. I self paid for my VSG and will likely have to do the same for a revision, I am willing to fight for my health but I may need some help from you all...............

Thank you in an advance.  Jennie

Welcome to the lightweight board.

It all depends on whether you are trying to go thru insurance or self-pay. Self-pay has far more latitude. You may have to travel, even outside the country to get the sleeve revised to a DS (I would NOT even think of going to a RNY from a sleeve as you lose all the benefits of the sleeve, like being able to take NSAID's, being able to drink normally (not wait 30 before and 30 after), also the RNY chances dumping and typically has weight gain after the first two years. (edited cause it doesn't even make sense to me, originally said after the first OF the year)

Huneypie revised from the sleeve to the DS this past year...you might want to touch base with her.

Liz

Hi Jennie, my surgeon Dr Himpens only does 2 step DSs and I can wholeheartedly recommend him.  There's a lot of scar tissue to get through when you're a 2 parter and other surgeons were asking things like 'what if it was necessary to convert for an open procedure', etc and there was no way I wanted that.

The surgery alone is ~$16K.  I stayed in a local B&B the night before and went home after 4 nights in hospital (was meant to stay more nights locally, but was doing so well I preferred to go home and be with family rather than be in a B&B alone).

Bugirl's surgeon, Dr Toon Sonneville, does do packages, eg collect from airport, include hotel, etc.  Belgium is a good place for lightweights (my BMI was 30 at revision).

Dr Himpens was first rate.  I had a textbook recovery.  I can give you details of the B&B I stayed in (it was immaculate and the owner was soo lovely - really accommodating).

Logistically Dr Sonneville may be easier, but Dr Himpens is a superb 2 part DS surgeon (both surgeons are listed on www.DSfacts.com).

My diet was Atkinsbound pre-DS due to my IBS so my diet hasn't really changed much post DS and the 40lbs I've lost to date are pretty much only due to the DS.

BTW PM me if you want more info.

I suspect you could get switched in Brazil or Mexico (or eastern Europe possibly).  I didn't try Brazil and Dr Ungson/Dr Aceves's offices never got back to me (I think I emailed Aceves as Ungson has a rep for being hard to contact).  I'd have wanted the surgery done by both in Mexicali just across the border from San Diego, but all I got was the auto response saying they'd be in touch.  In the meantime things progressed in Belgium and I didn't chase the Mexico option.

YOU CAN MAKE THIS HAPPEN IF YOU'RE DETERMINED TO DO IT, ((HUGS)).

While I think DS probably is the revision direction you will want to go, I highly recommend doing your own research regarding all options, and not just taking the word of us on a board.  For instance, there are some issues that southernlady5464 brings up regarding the RNY that are just simply not true.  I am sure that I have espoused a few of my own inaccuracies over the years, which is why always doing the backup research is a good idea.

May I ask what those issues might be?

Sure.  Southernlady stated that she would not want to do the RNY because it would mess with her normal drinking "(not wait 30 before and 30 after), also the RNY chances dumping and typically has weight gain after the first of the year." 

Waiting 30 minutes before eating is not something that a lot of RNY surgeons require, as there seems to be no medical necessity for it. 

Also, while there is a chance of dumping on RNY, this chance is only 30%.  I do believe that southernlady has a point here, however, because the only way to know if you are going to dump is by having the surgery, and that certainly could be a bad risk if you are unwilling to take it. 

Lastly, southernlady stated that the RNY typically has weight gain after the first year.  This is wholeheartedly untrue.  A significant number of RNY patients do not regain their lost weight at all.  Many not only lose 100% of their excess weight, but keep it off for over 5 years (and some even longer).  Of those that regain, a lot of them only regain after 2-3 years, and that is not due to the RNY, but due to eating/exercise habits.  It is true that RNY patients lose their malabsorbtion properties after about 18 months to 2 years.  And it is true that even though the vili in the intestines grow and learn how to compensate for the shorter intestinal track, RNY patients never truly regain the absorbtion of vitamins and minerals (and thus need to be on them for life).  However, the lifetime-vitamin regimen would be true for DS patients as well.

With all the RNY'er's I've seen, not drinking with a meal is something that is part of the RNY. I know MY surgeon told me to not drink before or after a meal. My husband's surgeon says the same thing of his RNY'ers (and he is in NY not TN like mine is.

The reasoning behind it is there is no pyloric valve to hold food back if you drink with your meal, it will wash thru the pouch which is the medical reason for not drinking 30 before or 30 after a meal. DS'ers and VSG'ers still have their normal functioning stomach even if it's MUCH smaller.

Not drinking 30 minutes after your meal will keep the food inside your stomach pouch long enough for you to feel full.  

Also, if you drink too soon -- the food will get washed OUT of your pouch and into the intestines too quickly which can lead to dumping syndrome, food getting stuck, feeling sick, and lead you to hunger again.  It's a cycle that many people get caught up in very early post operatively.

A 30% chance is bad enough for me to not even chance it. And don't even get me started on the chance of RH with the RNY. Just google it or do a search here on OH and many of those who had the RNY are wondering what it is and why it'****ting them 2-5 plus years out, even if never diabetic before WLS.

What I didn't mention is that there is evidence that diabetes is not resolved long term with the RNY. See the link here: http://www.obesityhelp.com/forums/amos/4588814/Weight-Loss-S urgery-Doesnt-CURE-Diabetes-Forever/

With any WLS if you reach a EWL of 50%, you are considered a success...but everyone I know who has had the RNY has regained weight or never reached a normal BMI to begin with. Since the malabsoprtion of food only lasts 18 - 24 months, it stands to reason, you overeat or eat carby foods and you will regain. With the DS, malabsoprtion is considered permanent as even 10 years out, if a DS'er goes back to basics, we drop lbs.

I did edit my post cause I meant 2 years not after the first of the year (even that didn't make sense to me).

But the real kicker is how many RNY'ers are on the revision board trying to figure out how to revise to the DS. Or on the regrets board.

Now, LW RNY'ers are like any LW's, we typically do get to goal and have an easier time staying near goal but it takes hard work in maint to keep it off and sometimes, nothing helps...it's gonna happen. We just hope to keep the amount down.

 

I would agree with most of what you just wrote. I still have a significant issue with the advice to jot drink 30 minutes BEFORE eating. Certainly, drinking during meals or within 30 minutes after cause all of the problems you stated. I have no problem accepting that advice. However, I have not seen any medical research to backup the advice to not eat 30 minutes BEFORE meals. I just wanted to make that part clear.

I know a lot of RNYers (who are not LWs) who have reached a normal BMI, and kept it that way for quite some time (and some still, 10 years later). I also disagree that a 50% excess weight loss is considered a success for RNY. I do think their are some surgeons out there who say that, but I don't necessarily think they are good surgeons.

As for dumping, I get where you are coming from. And believe me, RH is a real concern.

I just want anyone *****ads these forums to do their own research in addition to reading these forums. I don't want them to just listen to us posters - and that includes me.

I do appreciate your point of view - and never meant to imply that you don't know what you are talking about.

I just want anyone *****ads these forums to do their own research in addition to reading these forums. I don't want them to just listen to us posters - and that includes me.

If the OP didn't already have a sleeve, then going to a RNY would be a solution but given that the OP already is halfway to a DS already, finishing the procedure makes sense...not going to a RNY.

As to the 30 min rule no studies but it seems most surgeons agree with this:

Eating Behaviors for Success
    •    Eat slowly and be aware of when you feel full. When you feel full, stop eating! If you continue to eat, you may develop intense chest pain and vomit.
    •    Chew, chew, chew! You need to make sure you chew your food very well before you swallow it. This makes it easier to digest and pass from your gastric pouch into your small intestine.
    •    Avoid drinking fluids 30 minutes before and with your meals. If you fill up your small gastric pouch with liquid, you won't have room for your food. Furthermore, the liquids may accelerate passage of the solid food out of the stomach and possibly cause some discomfort.
    •    Drink enough fluid between meals to meet your fluid requirements. You need six to eight cups of fluid per day to prevent dehydration.
    •    Avoid food and beverages high in sugar. High sugar foods can cause "dumping syndrome." After gastric bypass surgery, some people feel light-headed, sweaty, or faint soon after consuming concentrated sugar.
    •    Limit high fat foods. These foods may make you feel nauseated. They are also high in calories and will slow down your weight loss. Using a low-fat, reduced-fat, or light version of a product is okay.

And see, the last one would also get me in trouble...I ADORE fat (butter, esp...the real kind)...and it's good for me. :)
 

Liz

 

I agree that the DS would be the OP's best way to revise (I think I said that). But your bold part is what doesn't make sense. As you know, with no pyloric valve, there is nothing in the pouch to keep the liquid in. So as soon as the liquid hits the pouch, it is already leaving the pouch. Which means that when you begin eating (and as we agreed, should not be adding anymore liquid) your pouch is not full from liquid, because the liquid should already be gone. So your precious pouch space is not taken up and you can eat the right amount of food. And, since there is no liquid in the pouch, your food is not being accelerated out of the stomach abnormally.

I guess at this point it is a matter of opinion, or which research and facts you believe. And I must say that if it weren't for some hiatal hernia issues and reflux problems, the sleeve would definitely been a strong candidate for me.