cmykphoto

Very upset with my surgeon (lap RNY) Won't do a revision

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Hi!!

Okay, so I had my original lap RNY in December of 05. I have gained a significant amount of weight within the last 2 years. I do know a lot of it is from me grazing :( I work from home so it's easy - not an excuse though :(

Went to see my surgeon last week for a few reasons. I feel like I have an ulcer and was pretty certain I have a large hernia. So, he put me on nexium and scheduled a CT scan and blood work.

He did schedule the CT to see if I have a fistula as well as he thinks I 'may' have one due to my rapid weight gain.

I did ask him about doing a revision of my original RNY. He flat out said no. Too many complications and risks for me. The only reason he does revisions is to fix fistulas.

So, if my CT scan comes back and shows a hernia and no fistula then I am out of luck getting a revision.

This is so frustrating as I have read so much (especially here) that revision RNY's are successful. I so much want a second chance. I am almost 40 over 250 pounds and my husband and I want to start a family. So, not only do I have my age against me in getting pregnant but add me being so overweight lowers my chances even more. I left his office in tears.

I won't be able to bear it if we cannot get pregnant because I failed my surgery. I am heart wrenched about this. Every time I really think about it (like writing this) I am in tears.

I know for sure I have the hernia but do knot know about the fistula. At this point I pray I do have it so he will redo my RNY.

Any advice anyone can offer?

Thank you all so much,

Karla

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the only thing I can think of if he wont do it, is to research and find another surgeon who will.

unfortunatly, you also need to remember that if they do a revision it will still take a while for you to recover, and lose the weight. This would put off having a family for a while.

Honestly, if it were me- I would try to get pregnant for a bit first. better to do it now before you look to have a revision.

also, did you ever try that 5 day pouch test? I know there is a post about it around here somewhere- you can run a search for it. Maybe your pouch is still working fine, just the grazing is getting to you. My surgeon told me the #1 thing that causes weight gain is grazing.

I hope everything works out for you, good luck with starting that family!

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Thank you Xan :)

I will definitely do the 5 day pouch test. I read a lot about here too.

What I am now researching is about how soon can we start trying for a family after the revision. My husband is the best MAN on the planet and wants my health to be

priority. He says I am his second half and he cannot imagine life without me :) How wonderful is he?!! I am so lucky :) Him being the best person, best husband and best friend would make me feel so devastated if I cannot get pregnant. Because of my grazing and regaining.

I have a good friend who is a OBGYN and she has told me that women do of course get pregnant after 40 and it's happening more and more. She knows my whole medical history. She did say that losing most of my weight will significantly improve our chances and will be easier for me during the pregnancy. I really want to stay clear of fertility treatments (will do it if necessary of course) but am terrified of having multiples!! :)

So, now with time and weight against me I am still left with the question of what to do. Hubby wants my health to be the best it can be and would rather wait on trying for a family until I am healthier.

I guess the first step is to do that 5 day pouch test. Then find out from my current surgeon the results of the CT scan. Am I facing a hernia surgery or a hernia and a full RNY revision due to the fistula?

If no fistula and my pouch is the correct size (this I am pretty certain is not so as I can eat A LOT more at one sitting then I used to). Then I will have to research other surgeons. That has added a whole other stress as I trust Dr. Kim so much.

My surgeon is Dr. Keith Kim in Celebration, Fl. From what I have read is so SO respected in the industry. Why he will not do a revision is really beyond me....

Edited by cmykphoto
grammar and adding a few sentances

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Do you have infertility issues? Have you tried to get pg? I have to say while its not ideal to get pg while so heavy, it shouldn't prevent you from having a baby. I got pregnant with all three of my boys when I was between 240 and 260. My highest pg weight was 273. My first was an IVF baby conceived while on metformin for PCOS. The other two were conceived the old fashioned way. I was still nursing the brother that came before though and they said that evened out my hormones. Honestly pg was a great weightloss method for me. LOL! I lost between 10 and 18lbs in the first trimester with each baby.

Is it ideal to get pg while overweight? no, Is it doable and possible? Absolutely!

Honestly one of the reasons I didn't do this sooner is I knew I wanted one more child and I was getting older and worried my fertility would decrease if I had the RNY and then waited the recommended 2 years. I also had horrible morning sickness and barely got in enough nutrition as it was.

How long would you have to wait after the revision?

Good Luck! I hope you figure out a solution that works for you.

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Carolanne,

We have not tried to get pregnant yet.... I own my own business and due to the economy has taken a deep decline financially. So, I was SO successful and busy before that it just did not seem like the right time to get pregnant. Now I am trying to revive my business desperately. My husband is a senior mechanical engineer with Seimens (his specialty are gas turbines that run power plants). So, he travels A LOT. Months at a time sometimes. He is really gifted at what he does and he is also multilingual so that makes him in demand even more!

But, I have no known infertility issues. My concern is my age (turning 40 in January) and my weight.

Don't get me wrong I have friends who have gotten pregnant while being as overweight as I am. But, they are much younger then me. Do you mind me asking how old you were when you began your family?

I am not sure how long I would have to wait after the revision to start trying.... That is one thing I am trying to do a lot of research on now...

I hate this and if any short term post op's are reading this - please do not make the mistakes I have made.

:)

Edited by cmykphoto
apparently my spelling is bad too :)

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it seems like your approach is a good one. Do the test, and wait for the results of your scan. If it is ristula, obviously you want to remedy that. If it is not (and I hate to say this at the risk of sounding mean, which is not my intent) perhaps try to limit your food on your own? you may not lose as fast, but its something. I am usre you still remember how much you should be eating... maybe if you ate the small amounts and forced yourself to get used to it, it may work- and in them eantime, work on getting pregnant.

I am not sure how tall you are etc- but I got pregnant very easily at about 275 lbs. I had minimal complications throughout, the only problems I really had were that I needed an emergency c-section after 36 hours of labor, because my poor baby got stuck in the birth canal and we couldnt get him out. This would have happened regardless of my weight apparently. My top pregnancy weight was 315. Granted, I was 27 at the time, but it still worked out.

I am by no means trying to talk you out of revision- just sharing my story to try and give you some hope :)

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I would worry that if you do have a revision and get pregnate you may gain the weight back anyway. I would never suggest getting a revision and end up pregnate within a few months it is to hard on your body. I would try to have a child now if possible then see about a revision just my 2cents worth.

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Xan,

No worries! I never thought your thoughts were mean at all or trying to discourage me from the revision :) I am the kind of person that wants to hear the truth of things whether I want to hear them or not.

My surgeon did talk to me about going back to the basics. Measure out 5 ounces etc.... That I have no problem with (I say that now but after I start it I may disagree with myself! :) But, would going back to the basics work for someone who has enlarged their pouch so much? I guess that will be found out by doing the 5 day test...

I am 5'x5" and honestly do not know my exact weight. When the nurse said I had gained 43 pounds in one year I was in tears. So, I am thinking I am either at or close to my original surgical weight. I just could not bear to hear or see the exact number.

My main concern and hubby's is that I get healthy. The other realistic concern is that he travels A LOT because I am not taking in nearly the amount of income I used to at all. So, he had to take a traveling position within Siemens to keep us afloat. I cannot even imagine having a child, trying to rebuild my business, and then add to that a revision of my RNY. And because of finances hubby still has to travel 90% of the year. No joke. Just cannot see how it is feasible to do all of that in that order.

But, will of course do the 5 day test, see what the surgeon says about my hernia and if I do have a fistula. Then proceed to working my butt off on losing this weight. GRAZING is my enemy!!! UGH! Working at home makes it so EASY to do....

Ugh....

I cannot thank you all enough for talking to me about this :) I don't feel so alone in this. No one I know has had WLS so it's hard for them to understand the complexities of my concerns...

Thank you all so deeply :)

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Will the 5 day pouch test even work? I thought that was for people who had the RNY and not the lapband? This is more of a question.

I wish you the best in whatever happens!

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I would worry that if you do have a revision and get pregnate you may gain the weight back anyway. I would never suggest getting a revision and end up pregnate within a few months it is to hard on your body. I would try to have a child now if possible then see about a revision just my 2cents worth.

This is a concern for me as well. I know we would wait way past a few months to start trying. But, for women that are over 40 it could take me months and months to even get pregnant anyway. But, we would never take anything like this lightly and would wait until I am physically much better (losing most of the gained weight).

And I am currently researching all over the place about women with RNY and pregnancy to see more results on 'when' to start trying after RNY for someone my age :(

Things change SO dramatically (fertility wise) when you turn 40. Your chances of getting pregnant are significantly reduced. I think I heard Dr. Sanjay Gupta (CNN doctor) say something like 5% after 40! I have no concrete data on this and it's on my research list.

Also, my very good friend who is an OBGYN would help with decisions too. She had consulted with a doctor who was doing research on women who had pregnancies after WLS. So, she is well informed on my anatomy and it's issues :)

:)

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Will the 5 day pouch test even work? I thought that was for people who had the RNY and not the lapband? This is more of a question.

I wish you the best in whatever happens!

Oh, I do have the RNY. not the lapband. I put lap as a short for I had my surgery done laparoscopic not open...

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Everyone one who has RNY will have their pouch stretch or grow to a certain extent after 18 months to 2 years anyway.. it's intended to.

According to my doctor a woman's final pouch size should be around 6 or 7 oz of volume and a man's would end up in the 9 to 10 oz of volume. Added to that, the fact that our bodies learns to reabsorb calories around the same time period as the pouch getting to it's 'full term' size.

So, don't be discouraged by the regain.. it can happen.. it's a known possibility so we need to monitor the quality and quantity of our food choices and keep track of where that scale is going (whether we use an actual scale or the fit of our clothing to track that last one)...

So, my advice would be to do what you know to do.. go back to the pouch rules... measure you food out, stop drinking 30 minutes before you eat, don't start till you're at least 30 minutes after, 60 is even better. Get good healthy proteins into you... make sure you're hitting the minimum at least of the fluid intake.... reduce/eliminate any simple carbs from your daily diet... Focus on protein first, if there's room.. veggies & fruits and then and ONLY then should you even look at a carb.. (you get all the carbs you need from veggies, fruits and dairy so there is none of this "but my body needs the carbs- no, no you don't!)

Use the pouch test if you need to de-carb your cravings.. know that though most lose some weight on that, some of us do not (I don't.. have tried it three times and weighed more after than when I started.. I won't be doing that again.. and yes, that's a facepalm on me, for sure!.. the very definition of insanity)

Use a food logger if you need help tracking what you're putting in.. the ones I know off the top of my head:

FitDay - Free Weight Loss and Diet Journal

Free Calorie Counter, Diet & Exercise Journal | MyFitnessPal.com

Burn Fat, Lose Weight, and Gain Muscle - DailyBurn

Calorie Counter, Diet Tracking, Food Journal, Nutrition Facts at The Daily Plate

Free Diet Plans at SparkPeople

Free Diet Plan and Online Weight Loss Programs at FitClick

If you do decide to do the pouch test, I've tagged a thread or two here with the tag "5dpt" if you want links to tips and recipes and whatnot.

Good luck.

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Oh, I do have the RNY. not the lapband. I put lap as a short for I had my surgery done laparoscopic not open...

Thanks for the clarification. I read it as lapband. Hopefully the pouch test will work for you!

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Hey CM, well im not your age however I do have kids and I know how much having them means to me. You will get your kids some way shape or form, right now you have to get back healthy girl. We all make mistakes so hey I dont want to beat u up about that we beat ourselves up enough about our mistakes. The only other option is to try to appeal by writing a letter to the insurance company, however w/o your dr's apprvl it probably wont get you far he must feel that you arent practicing good enough habits for the revision to work im guessing. So next option would be to finance it as I was going to do because I actually wasnt big enough to qualify at first. You'll be in my prayers I really do hope everything works out! :) Chin up

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Hey CM, well im not your age however I do have kids and I know how much having them means to me. You will get your kids some way shape or form, right now you have to get back healthy girl. We all make mistakes so hey I dont want to beat u up about that we beat ourselves up enough about our mistakes. The only other option is to try to appeal by writing a letter to the insurance company, however w/o your dr's apprvl it probably wont get you far he must feel that you arent practicing good enough habits for the revision to work im guessing. So next option would be to finance it as I was going to do because I actually wasnt big enough to qualify at first. You'll be in my prayers I really do hope everything works out! :) Chin up

Hi!!

Thanks for writing me :) And yes we are ready to start a family. But, my health has to be first. For many reasons other then weight and childbearing....

As for the revision - my insurance isn't rejecting it. I have not even gotten to that point yet ;) My surgeon won't do a revision unless I have a Fistula. I had the CT scan on Tuesday so I am hoping to know the results about the fistula and my hernia.

I am blessed that my hubby works for Siemens (largest single employer in all of Europe last I heard) and so working for a big company like that we can get awesome health care. We have United Health Care - he got us their best coverage (90/10) etc... So, my hope will be that if I need a revision I will not have to go through what I went through with Cigna 6 years ago. I had to go through 3 appeals! And, then on the Thursday before my surgery it got approved.

Believe me, I try so hard not to beat myself up. But, I just cannot believe that all I fought for to get the surgery, the aftermath massive transition (we all know all too well!!) that I let it all go. At least I know I did in part. Grazing is my downfall. Always has been - even before the surgery. UGH!

BUT, I do have to say that I never in all my years post-op I have NEVER gained this much weight in one single year. I was in shock, tears, shock and more tears when they weighed me. I think the weight gain might be a reason my surgeon may suspect a fistula.

And how crazy is it to actually hope you have a fistula so your (speaking about me here) will do the RNY revision! That is crazy!

What I do not get is that WLS is supposed to be a tool (and I know all too well I took this for granted) to lose weight and lead a healthy life - possibly extending our lives from obesity. So, why would surgeons refuse to do a revision? I have done a lot of research and yes, there are additional risks. Complications and instead of a .5-1% morbidity it goes up to 2%. But, shouldn't this be MY choice? After reading and spending time really thinking about it etc... Should I not be the one to choose if I want a revision? These are rhetorical questions that I would love to be saying to my surgeon right now :)

My biggest question I have (and I will be asking my surgeon as well about this as I want to hear his 'scientific' response) is that yes, going back to the basics is all well and good. But, what if my pouch has stretched out so much? I don't know how to know if it has grown. I am sure it has being 6 years post-op. But, is going back to the basics of my original pouch size reasonable or even realistic?

I dunno... I have SO many questions to ask Dr. Kim or at least have his nurse ask for me and give me some answers to some of these questions.

New post-ops! Never ever take your eyes off the ball. I did it and now I am fighting to get back. It sucks.

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Your surgeon is correct, revisions do carry with them an increased risk. I'm an RN on a bariatric unit and have taken care of several revisions. From my experience the surgery is longer, has a longer hospital stay and has an increased risk for leaks, post-op.

Many insurance companies will not cover a revision unless there is a fistula. That's the case of mine. Others will cover it if you meet the criteria for wls. You really need to check your insurance company's criteria.

In regards to the stretching. Like Kel mentioned, your pouch will stretch normally. It is made that way. Your stoma also will stretch but it can become too stretched. There are a couple courses of action if this has happened. The first, is a revision but there is also Sclerotherapy. There aren't a lot of surgeons who do the Sclerotherapy so you may have to hunt for one.

Sclerotherapy is done during an EGD. It is out-patient and is usually covered by insurance. What they do is inject your stoma with a chemical that essentially burns the area a bit, causing it to scar down in size. If your stoma is excessively stretched it may have to be done more than once. You can't expect a huge weight loss but it can help you get back on track.

What you can do now is do exactly what Kel suggested. Get yourself back on track. If things are stretched, yes, it will be harder to get it off but it isn't impossible. You do have to get a handle on your grazing. Revision or not, if you aren't following the rules, you can expect a weight gain. At least that is true for most people.

Edited by MiladyB

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As I was reading through this I was thinking "if you are grazing now, what makes you think you won't graze after a revision if you find a surgeon who will do it?", then I began to think more and realized "there by by the Grace of God go I...." This could happen to any of us, a stretching of the pouch or any other of the parts that stretch causing us to regain. Perseverance, following the rules and eating healthy is the only lifestyle that will keep us losing and healthy. Hopefully you will get back to measuring your foods, stay away from all those foods that aren't healthy, get in your protein, fluids etc etc. Go back to basics - that's the only way. If you do have a fistula and get more surgery, you'll have to get a new mind-set as well, so begin now, even before you know what is to come. :)

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You have forgotten something very important here. you still have that amazing tool inside your body and you could still use it to get back on track. If you cannot have the revision then take matters into your own hands and use that tool. Remember the pre op diet. Do that starting tomorrow but modify it a bit to get you enough nutrients and calories in. then start on smaller meals less times a day. Start an exercise program and stick to it. Even with a revision if you do not make the changes then you will not be successful again. You have a goal now to have a baby so give that goal a chance. You can do as you did it once before right? focus get in control and go for it!

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i would still try to gte prego now, and change my eating habits at the same time. You can still eat right, and be prego. My friend lost 60lbs while pregnant. She followed what her nutritionist set up for her, and continue her journey. Had a healthy 9lb boy. Just go back to the basics. I say good luck to you!!

One question for anyone, why wouldn;t the 5 day pouch test work on a gastric band? We do have a pouch.

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Hi!!

Okay, so I had my original lap RNY in December of 05. I have gained a significant amount of weight within the last 2 years. I do know a lot of it is from me grazing :( I work from home so it's easy - not an excuse though :(

Went to see my surgeon last week for a few reasons. I feel like I have an ulcer and was pretty certain I have a large hernia. So, he put me on nexium and scheduled a CT scan and blood work.

He did schedule the CT to see if I have a fistula as well as he thinks I 'may' have one due to my rapid weight gain.

I did ask him about doing a revision of my original RNY. He flat out said no. Too many complications and risks for me. The only reason he does revisions is to fix fistulas.

So, if my CT scan comes back and shows a hernia and no fistula then I am out of luck getting a revision.

This is so frustrating as I have read so much (especially here) that revision RNY's are successful. I so much want a second chance. I am almost 40 over 250 pounds and my husband and I want to start a family. So, not only do I have my age against me in getting pregnant but add me being so overweight lowers my chances even more. I left his office in tears.

I won't be able to bear it if we cannot get pregnant because I failed my surgery. I am heart wrenched about this. Every time I really think about it (like writing this) I am in tears.

I know for sure I have the hernia but do knot know about the fistula. At this point I pray I do have it so he will redo my RNY.

Any advice anyone can offer?

Thank you all so much,

Karla

Ask a different surgeon

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No respectible surgeon will do a revision if there is nothing to revise. Revisions are done for complications and abnormal stretching. It sounds like you just need to buckle down and use the tool you have. Insurance companies will cover revisions but only if it is medically necessary and weigt gain is pretty significant. You can doctor shop to try to get one to do what you want...but do you really want a doctor that would perform something unnecessary on you? Think about it.

If there is no fistula...and believe me...you DON'T want one of those, there is another easier alternative revision called a Stoma Fix. No insurance companies pay for that yet and it's done endoscopically. They just go in there and restaple the stoma to slow the food again. It feels like a brand new pouch.

Another reason you don't want revisions that are not needed is scar tissue. You don't want adhesions and scar tissue causing blockages. You can only cut and sew tissue so many times before you have failure.

Don't be so hard on yourself and put more stress on yourself. Go back to eating smaller meals. Stop snacking and grazing. Don't drink fluids with meals. And try the 5 day pouch test. You can do this. Let's face it. We all became overweight and failed to keep it off by doing unhealthy things. Surgery isn't going to fix your own self control. If you need to, see a counselor. They can help you get back on track. And we're all here for you as well. Good Luck....Sue

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My advise mirrors several here-get pregnant now!!!

Go at it like Bunnies and try to have a baby and if you do get pregnant-get under the care of a nutritionist and you should be able to carry a healthy baby, not gain weight and maybe even lose weight while pregnant.

After the itty bitty you can really get the weight off and then you will have a bigger reason to-you will want to play on the floor with the little one!

Good luck-but get pregnant before that option is off the table!!!

I went into full menopause at 42, just saying....

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