Anyone have Kaiser?

Hello all, hopefully I'm in the right place. 

I had a RNY 10 years ago and just found out that my stomach is "normal sized".  Talk about a huge disappointment and I felt like crap.  I knew something was wrong since I've gained 40 pounds in about 1 year.  I kept telling/begging for a test and finally they did it.

Since Kaiser doesn't actually have surgeons aboard as they outsource, does anyone know what my chances are of getting a revision?  I'm devastated and don't think I can live without my proceedure.  It was the only thing that helped me out of my depression so many years ago.  Now I find myself so down and feeling depressed.  That also worries me... since I'm on medication for depression, do you think it will go against being a good candidate for revision?

Thank you

Hi there!  Kaiser does have surgeons that do the surgeries at kaiser.  I would contact your primary kaiser dr to get you referred to the bariatric dept.  Good luck!

Kaiser does have doctors that perform bariatric surgery in many of its facilities.  While I didn't have surgery at Kaiser, I am a Kaiser pt. and some of my friends have had their surgery there.

I don;t know if Kaiser does revisions.  If you are in No. Ca (like bay area) Fremont and So. City do the surgery.  If you are in So.Cal, there is a facility that does the surgery there also.  The name escapes me.

Did your test tell you the volume that your stomach could hold?  I am curious as to what "normal" means.

Good luck in  your endeavors and keep us posted for sure.

I never thought to ask the doctor what volume it's at, he just told me that it appears "normal sized" again.  My heart sank and I just cried and haven't stopped.  I've been reading and hear that many doctors won't do a revision for a RNY.   

There are some very qualified Dr's that will do revisions from failed RNY's, most likely Kaiser just doesn't contract with them. If you qualify for WLS, I would seriously look into the DS. It has the highest percentage of excess weight loss, cures the highest percentage co-morbidities and has the best maintenance of weight loss long-term. Kaiser of course doesn't cover the DS, but they can be made to.

Hello and Good Morning.  You came to the right place.  I have Kaiser and I had RNY on August 10, 2007.  Kaiser contracts out to Pacific Bariatrics Medical Group (PBMG) in San Diego. First, you will need to have your primary refer you to the Options Program, which is a mandatory 26 week course at the Kaiser on Chapman and Lewis.  You might want to call Janet Wayne of Kaiser as she is the person who has the knowledge to tell you whether or not Kaiser does revisions.
In addition to the 26 week Options class, you have to have a BMI of 40+, lose 10% of your weight while going through the course, attend a seminar conducted by the Pacific Bariatrics Medical Group in Anaheim, have a pysch and internal medical evaluation and approval, and also the approval from Dr. Esteban, Kaiser, who is the doctor who ultimately approves you to have the surgery.  Although Pacific Bariatrics Medical Group is located in San Diego and Scripps Mercy Hospital is in San Diego, the Surgeons do come to Anaheim every month to allow patients to have their 3 month, 6 month, 9 month, 12 month and annual checkup in Orange County rather than San Diego.  All the surgeons are great at PBMG.  Of course my favorite is Dr. Zorn because he is my surgeon. 
Wishing you the best of luck with Kaiser and your revision.
Terry  

Ginger, you have been given some good info about Kaiser, but there is more you need to know.
     First, since your RNY was done 10 years ago, chances are your stomach wasn't transected. This means that the pouch and the blind stomach were (probably) left right next to each other. If your stomach now appears "normal" in size, that may mean that your staple line has broken down and that food can get from the pouch into the rest of your stomach. This would explain why you did ok for so long but gained 40 lbs in the past year. Of course, there is no way to know this without an upper GI x-ray or upper endoscopy, but it's very possible that this has happened. And obviously, if this is the case, your RNY is broken and it's as if you never had it, which can only be remedied with revision surgery.

    Depending on where you are now with your bmi and comorbidities, this may be an opportunity for you to think about what type of revision surgery would be best for you. I would recommend that you learn about all the available options, including revision to the duodenal switch. The DS has the best statistics of any wls for excess weight loss, maintaining that weight loss, and resolution of comorbidities. The RNY can be revised to the DS, but only by experienced DS surgeons. Kaiser does not offer the DS, BUT if you qualify for wls according to the standard NIH criteria, you can, in California, appeal to the DMHC and get Kaiser's denials overturned.
    On the other hand, if you were totally happy with your RNY until the weight regain started, you may want to go on with that. But at least learn about all the options before making a decision. If you would like more info on the DS, just send me a pm.

Larra

PS assuming you qualify for wls, you can also appeal to not take the 5-6 months of Options classes. If you already have 10 years of experience with the RNY I would hope Kaiser would not require you to take these classes, but they probably will. But again, with a little fighting you can avoid this delay.

Thank you everyone for your great responses!

Yes, my stomach is still attached.  I'm really bummed out and feel horrible inside.  I think having wls was my happiest moment in my life, and now, well I feel like a failure.  The depression left when my weight came off, but now that I started putting it back on, my depression is back.  I kept on insisting something was wrong and finally they ordered this test.

This is the test results.  I don't know what to make of it.
IMPRESSION
1.  Gastric stapling by history but no evidence of reduced size of stomach indicating tha tthe stapling is no longer effective
2.  There is a bypass still present with a loop of smal bowel attatched to the body of the stomach with no delay through the anastomosis in the small blwel or into the small bowel through the duodenal bulb.

I still get that vomit effect when something feels stuck, but instead of food, blood comes up.  Any suggestions on this?  The doctors did endoscopy about 4 months ago and showed nothing in stomach.  I have some stomach pain on and off, could this be from the staple line rupture?  I'm looking for anything that would make them fix it.

Thanks everyone, I'm glad I found you.  I know it's going to be a battle with Kaiser, but I definitely want a revision.  They can take my stomach or do whatever is necessary to ensure the surgery stays in tact.

Ginger, it sounds from this report as if your staple line did in fact break down and your gastric bypass is therefore useless. YOU didn't fail. The operation has failed technically. This is not in any way your fault. The very reason that most RNY surgeons now transect the stomach is to prevent this  complication. And the return of your depression is totally understandable, given your present cir****tances, and should not be something that stands in the way of further medical care.
     Repeat - you are not a failure. 
     I don't know what the powers that be at Kaiser will say, but to me, if you have a broken down operation, you should qualify for a revision on that basis alone. So get your pcp to refer you into the bariatric surgery program, and if he or she won't, file a grievance. And meanwhile, take the time to learn more about the different wls options presently available. Come on over to the DS forum and learn about it. We are seeing new people almost every day asking about revisions from other prior wls.

Larra

Larra,
I did look over at the DS forum, and I really liked what I saw.  I'm just worried because I'm seeing that a lot of doctors won't touch an old RNY patient like me.  Do you know if a staple line rupture could be painful at all? I'm just looking for anything to force them to help me.  I still wonder if the vomiting of blood has something to do with this rupture.  I suppose not taking my iron pills would do me good, as I'm already always anemic.

I've already had correspondence with my PCP, fortunately I saved all the documents from my surgery 10 years ago.  My doctor that performed it doesn't do it anymore and the hospital shut down, so it would be hard to get records.

I just don't get why a RNY staple rupture is hard to fix.