I have a RNY gastric bypass looking for revision options

I am trying to see what my options are. I am 5 and 1/2 years out from my initial surgery and have been gaining weight with no success in taking it off. My highest weight prior to surgery was 321 and I got down to 170, over the last 2 years I have been going higher and higher with a current weight of 230. I don't know what my options are. I feel like a failure and I am embarrassed

I feel your pain. I was hoping to have a distal rny revision, but insurance has denied twice. (not medically necessary) The next step is to appeal. Now, I'm wondering if I should re-consider a rny to DS revision.  My GERD is why I looked at the distal, but I can get a larger sleeved stomach with the DS to help reduce GERD. (My GERD never went away with RNY, only improved...now it has worsen with weight gain)

Do you know why you're gaining weight? (My reason was a slow resting metaolic rate) Have you tracked your calories? Have you gone back to former eating habits?  Is your stoma enlarged?

I have BCBS and they have requirements for revisions, so you will need a copy of what your insurance will require. 

I suggest you use the search feature (symbol to left of OH at upper right) to research rny revisions for quicker answers to your questions. The bariatic weight loss forums (including other websites) seem to have less activity than a few years ago. This one seems more active than most.  DT

So my weight gain is high for my eating habits. I have definitely had days now and then when I graze or eat things I shouldn't but not enough to explain the amount of weight I have gained. Considering in June 2013 I was 172 and today 238. Also,my weight can and does fluctuate up to 10 pounds in a week. Not even exaggerating. My insurance is UHC and I haven't even really started checking into anything until today. I don't have GERD,never have. Now I do have extreme bloating everyday and pain with eating. I'm miserable almost daily from food. I could go on and on. 

When I calculated your weight gain (66lbs) and divided it by 24 months, it was 2.75 lbs a month and 320 calories a day. (272 calories based on 56 lb gain)  How many calories are you eating a day? After having a large weight loss, our metabolism have slowed somewhat. It is possible to eat 272-320 extra calories a day by grazing or things we shouldn't. 

Do you know what's causing pain with eating?  Are you still chewing your food to mush? The pain could be your stoma, when larger bites of food are trying to pass through. This was my warning sign, to slow down and chew better. I didn't want to stretch my stoma.

I still chew to mush....I still have issues with chicken, getting stuck, that is when I usually drink with something, not much else. So I assume that my stoma is still small because I still have issues with that occasionally. I chew really really well, plus I take small bites as I have braces on now too.

I have a question for you, you have GERD. I thought the RNY is actually a treatment for GERD and we don't really have much acid occurring after bypass? Is that wrong? I never ever have heartburn or indigestion, just belly pain, pouch pain, bloating, gas.

I've had GERD most of my life. My GERD did improve with weight loss, but I didn't lose all my excess weight. I also had some urinary incontinence, which did go away with my weight loss. Since I've gain weight, my GERD has gotten worse and urinary incontinence has come back. Most of my weight gain is in my abdomen, which is causing pressure on both my pouch and bladder.

I also am one of those rare rny'er. I can take my B12 by tablet and absorb it. I have enough acid (even though I take Nexium) to help with the absorption.

Are you looking to get a revision because of the GERD?

I'm 12 days of having my revision from the sleeve to RNY and hiatal hernia repair because of GERD. I don't know it its my body still recovering, but I still feel a slight burning sensation in my chest that goes to by back. It's hard to tell it its the heart burn. Before the surgery I could feel the acid coming up esophagus. Now its a slight burning I don't feel anything coming up like before the surgery. I'm wondering if its just my body still in the recovery process since I had the bypass and hiatal hernia repair.

Also, I get this nasty taste in my mouth. I was getting that before surgery, and still, its not bile. I feel that taste when I get around perfume and nasty chemicals.

Any advice?

No. I need a revision due to a slow metabolism. RMR  was 1400-1500 calories for me to mainatin a weight of 232 lbs. 

Since your only 12 days post-op, it probably is due to recovery. Are you on a PPI? If not, call your doctor and let him know your symptoms and ask for a prescription. 

Right now I'm taking dexilant.

First, you need to journal your daily intake (my fitness pal), to see how many calories you are eating now. (I was eating around 1600 calories, which seemed appropriate for 200 lbs. When I weighed 230, I had a RMR done, which showed I needed to eat 1400 calories! That accounted for my weight gain over 18 months)

Do you still have restriction with your stoma? Most matured stomas can hold between 8 to 12 oz per meal. Mine is 8-10 oz. Do you still measure your food? I still do, because when I eye ball it, I usually make my portions too big. Do you still eat your protein first, then eat veggies? Do you drink with your meals?  This can cause the food to be washed out of your pouch and allows you to eat more.  Do you wait at least 30 mins after eating before drinking fluids?  I actually wait 1-1.5 hrs before I drink my fluids to allow all my food to slowly drip out of my pouch. Are you getting in at least 60 gms of protein daily. I eat 80gms to have normal labs. Do you drink at least 64 oz of fluid? I drink 80+ oz. How many carbs do you eat? Did you know that we absorb 100% of simple carbs?  Digestion starts in the mouth. I do fail in this area, but I am working on it. We should eat complex carbs. Sorry for all the questions, but these will be questions a dietitian will ask.

Second, you should see your surgeon about your concerns and options for revision. You will probably be put on a supervised diet with your dietitian, like I was. You will need this for documentation for your insurance. My dietitian put me on a 1200 calorie diet with 200 calories of activity daily. (the activity was low for me due to my knees) I lost 3 pounds quickly (water) and 2.5lbs over 4 months. It was midway through this diet that I had my RMR done. I was hungry all the time, so my surgeon increased my calories back to 1500 and I gained 3 pounds back quickly.

You need to get a copy of what your insurance requires for a revision. My insurance requires 3 co-morbities with a 35 BMI. I have been denied twice (2nd request was a peer to peer review) and now I have to appeal. This is a long ordeal. I started back in October.

Please research this site and internet for revisions. Keep in mind that a revision from rny to a DS is only performed by a few very experienced surgeons in the US and you may have to travel to get it done.