SnowDaisy

So there's hope...lol

Nectar Sweets or Nectar Naturals by Syntrax are great tasting.

How are you doing now?

Hi I had my first meet yesterday with Dr Warnock who thinks that i would be a good candidate for RYN Bypass (revision from sleeve). I just wanted to connect with anyone else who has has Dr Warnock for information, outcome and expectations. xxx

Thank you for your reply. Yes that would be too far for me because of some of our other commitments right now. But, you raise a good point regarding looking at other surgeons. I thought I was restricted in choice of surgeon due to our insurance which is Tri-Care Prime. According to the surgeons office manager (the one who deals with all the paperwork to the insurance co) it looks like I will get the op if I want it. Can I change my mind about the surgeon even if they have done some work towards the surgery...for example, blood work and upper GI? There is something not sitting right with me right now about this little journey so far. Xx

Yes, snowdaisy, it does. Depends on your Tricare plan. Definitely contact and discuss your options if you haven't received a letter indicating your new coverage and deductible and cost amount. For example, I am in TX, our premium went up $279 per month ADDITIONAL and our deductible went up to $12,000. Terrible trade-off. Each state is different, each plan is different. Not all plans are the same. Stay informed before making a decision. The number is on your card. I'm sure if you live close enough to a military facility/hospital, you will be ok. We don't. We canceled and went a different way. Hope this helps. Wow...that is horrendous. We have Tri-Care Prime and we currently live in Oklahoma. However because the military hospital where we live does not perform bariatric surgery I have been referred to a civilian surgeon in Texas. We have not received any letters from Tri-Care. I hope they are up-front with us about any additional charges because there is no-way we could afford a co-pay like that. Thank you for your reply xx

Will Obama Care affect Tri-Care?

Do any of you know the bougie size that was used in your weight loss surgery? Can any of you attribute your success or failure to that bougie size? The bougie size used on my sleeve was a 38. I lost 100lbs very quickly but I started to lose restriction within 8 - 9 months. I am three years out and I am seeking a revision because I have regained most of the weight I lost. A year ago I had to have a scope because if reflux disease and I was devastated to learn that stomach was large/normal. In fact, my gastroenterologist told me he would found it hard to believe that I'd had a sleeve gastrectomy if I hadn't told him. I believe the bougie size plays a huge part in wether the sleeve will be successful long term. The sleeve will eventually stretch no matter what the initial bougie so the start size is extremely important. No matter what op you have it is the restriction that is the most important tool; if you lose that tool then it seems like your back to square one. Xxx

Consensus paper created to avoid problems often experienced in the learning curve Based on experience from almost 13,000 operations in 24 centres 90% agree: LSG is a valid procedure both stand-alone and for successful, but complicated, gastric bands Recommendations include using a bougie above 32F to size sleeve, and to completely mobilise the fundus, to avoid complications.

Did you read the study above? You did not mention the bougie size used on you or your husband. According to the research a 32f is gold standard to "long term" success. And it would seem that data is now coming in that anything other than a 32 "could" lead to regain. I use the "could" because yes some people don't use what they have learnt to modify what they eat any more because of lack of restriction. I respect your opinion that bougie size don't make any difference but I do not agree. Another angle on this as I see it is, we are all different and the capacity for the stomach to stretch might be more so for some than others. Xx

I just read this article and posted on Bougie Size thread but I think it might be useful information here too. http://www.bariatricnews.net/?q=news/1197/sleeve-gastrectomy-best-practices-published

A Reliable Study http://www.bariatricnews.net/?q=news/1197/sleeve-gastrectomy-best-practices-published I would like to draw attention to: Surgical technique The panel achieved consensus on the technical aspects of the performance of LSG, which were summarised as: Sizing the sleeve - in addition to it being important when performing LSG to use a bougie to size the sleeve (100%), the optimal bougie size is 32F–36F (87%). The panel believed that using a bougie <32F might increase complications significantly and that using a bougie >36F could lead to the lack of long-term restriction and possible dilation of the sleeve, resulting in failure of weight loss or long-term weight regain. In addition, invaginating the staple line with sutures might result in temporary or permanent reduction of the lumen size (83%), depending on the suture type used (absorbable versus nonabsorbable). Staple heights and firings - consensus was achieved for some points including that it is not appropriate to use staples with a closed height less than that of a blue load (1.5mm) on any part of a sleeve gastrectomy (81%). Although panellists voted against this as they did not agree that anything less than a green load should be used. When using buttressing materials (79%) and when resecting the antrum, the surgeon should never use any staple with a closed height less than that of a green load (2.0mm) (87%), because the gastric antrum wall is the thickest part of the stomach. Mobilisation – it is important to completely mobilise the fundus before transection (96%), otherwise the surgeon could miss a hiatal hernia and leave behind too much stomach, decreasing the restrictive component of the operation.

Uhhh ... no its not: http://dictionary.reference.com/browse/bougie?s=t The 34Fr or 34F part is the unit of measure, meaning 32 french, which is the unit of measure. Well most definitely a "tool" for the "measurement" where the surgeon is concerned...but "restriction" is what I considered "my tool".

The sleeve can be revised to a gastric bypass apparently and subject to some more test that's what has been offered (subject to insurance approval). There is a band they can apply to the sleeve but it's another restrictive operation and as I have severe gastritis I can really have that. As for reducing the size of the actual sleeve, I most definitely be up for that too. But again it's restrictive so I might not get that. So Yes, I would put myself through it again if I get the all clear health wise. I do have some tests to rule out some other conditions I might have. So, how about you? What are your plans? Are you still losing weight? Regardless of the size of the pouch, I wonder about the mal absorptive side of your procedure. Xxx

I met with the surgeon and he flipped past the question of the boughie but he is not a fan of the sleeve anyway. He stayed on the subject of why I should never have got the sleeve in the first place...I had a hernia prior to my original op and apparently having a hiatal hernia is now a contraindications of having a sleeve with tricare. Plus I already had reflux disease, gastritis and this is also a reason not to have the sleeve. So I'm afraid I didn't really get a lot of time to ask questions... I did the breath test for h pylori and a blood test...the breath test cam back negative for the h pylori bacteria but the blood work came back with very border line type 2 diabetes. I have some other health issues that might preclude me from the bypass so I am sitting on hot bricks right now. Xx

2big, this very good advice, it's a time to really get it all together. I got to say though for me the first six months, maybe even 7 I was holier than thou on what I should and should not be eating.

I cannot speak for the bypass but with the sleeve I really do believe that it's a combination of boughie size, the shape of the sleeve and the fundus. My new surgeon is going to look via an upper GI on Monday 23rd to have a look...I'll post the outcome when I find out...the findings could shed some light. I would like to say one thing though....I didn't regain all this weight just because I lost the restriction...I have hypothyroidism that has been problematic over the last 2 years and I didn't help the situation either...as soon as I realized any form of restriction had ceased I should pulled the reigns in...but I guess old habits and all that.

I was a sleeve patient but I have zero restriction. I had good restriction in the beginning and lost all of my weight by 6 months, ironically that was when I noticed a change in restriction....by 18 months the restriction all gone. Needless to say nearly all my weight has been regained...I'm seeking a revision right now. Xxx

Great job catching it so soon! My dietician has a great way for us to monitor our weight once in maintenance. A 1-3 pound up or down is considered a 'green' light meaning it could be a normal fluctuation. 3-5 pounds up is considered a 'yellow' light meaning slow down and assess what you need to change you're headed in the wrong direction. Anything more than 5 lbs gained is 'red'. Stop immediately. Start logging food and Water intake if not doing so already. Call and make a dietician appt. If you have gained but food and water choices are good. The important thing is to catch it fast. I for one go into ostrich mode when gaining weight. I bury my head and then 40 or 50 lbs later try and change. After my rny I vowed I'd never play that game again. I really like that...

I bought a set of stainless steel measuring cups in Matalan ... The set consisted of 1 cup, 1/2 cup, 1/4 cup and 1/3 cup. They are invaluable. I believe you can buy them in Kirklands. Good luck Xx

Hi Crazy8 I think most of us can echo so much of what you say...I know I can. Especially hiding feelings through humor., enduring other problematic health issues that are a result of or exacerbated because of weight. I'm hoping to get my second chance soon. And that's how I'm going to look at it after gaining all my weight back after a sleeve, a second chance. My surgeon told me I'm a good candidate for the bypass, so I hope it won't be too long. I too have arthritis but mine is in my back so can empathize with physical pain.I hope after your WLS you get to have those knees sorted. I have heard of other people getting total knee replacements so I know it's possible for you...perhaps you should try to get another doctor re this. All the best xxx

You are so not far out from your operation though so still on the soft food. You are still healing too so I believe that your stomach could be swollen thus allowing more in. And you are right, leaner and denser food is going to help. Good luck xx

My surgeon said it almost doesn't matter what size it is because you don't know the surgeons technique. He said some go up right against it and some pull away from it some. Yes, my original surgeon told me that he goes in tight to the bougie...(lol, sounds like a dance move)...but he told me that bougie size does and can affect the weight loss outcome but he wouldn't go lower because of the complications that are more likely to occur afterwards. Xx

http://www.obesityhelp.com/forums/vsg/4517656/Bougie-Size-Infamous-Pen-Photo-Question/ It's the tool/size guide they use when making up your sleeve. Xx

That's why I have been reluctant to post the failure of my sleeve. I believe strongly that posts of a failure can have a negative affect on some people. That said, I know that rose colored specs way of looking at things is also not very informative too. It's true, I have lost my tool for success, but I do have to admit that once I lost that tool I did not help matters and slipped into "old ways". I loved that feeling of restriction...I welcomed it. Xx