MarinaGirl

hk1100: I had MGB surgery in April 2017, which resolved my acid reflux, BUT in Dec 2017, I started experiencing stomach pain and nausea constantly. I’ve had 2 EGDs since then that show bile reflux in my pouch. I never had this type of reflux prior to MGB surgery, and I now have Barrett’s Esophagus too, which is very concerning. My next step is to be revised to an RNY this summer. I regret having an MGB and wish I had RNY as my original bariatric surgery. UPDATE: I do not have foul-smelling BMs. That is more an issue for DS patients and people who eat a lot of carbs/processed food. My lab work shows that my vitamin levels are normal. I take 2 One A Day 50+ multivitamins, and also take separate calcium citrate and heme iron, but not together, as well as magnesium and D.

Yes, you should find a different bariatric group to work with as your surgeon’s request to pay up front sounds suspicious and is just not common or standard. Don’t ignore red flags!! I wouldn’t use this surgeon for the RNY either. For many, the DS (not SIPS/SADI) is the BEST surgery for long term weight loss maintenance and comorbidities resolution. Just make sure you select a DS surgeon that does the traditional standard of care, ideally Hess method, and has lots of years experience doing the surgery.

This thread is more than 6 years old, until nurse4126 revived it on 7/1/18 (i.e. 4 posts above). I share this so you can tailor your comments appropriately.

Took me 7 months to lose 100 lbs.

REMINDER: Do not take iron and calcium together, even in or with a multi-vitamin. The reason is because they impede absorption of the other so if taken together you will not be getting adequate iron or calcium each day and could become anemic and have mineral deficiencies. The correct way to take them is 2-4 hours apart. As well, thyroid medication can also be negatively impacted if taken with iron and calcium.

Are you drinking at least 64 oz of water a day? And how about your salt intake? Orthostatic hypotension can be due to several factors: rapid weight loss, sympathetic nervous system dysfunction, dehydration, electrolyte imbalance, malnutrition, thyroid issues, cardiac issues, post prandial hypotension, or medications. Please talk to your doc about this concern. I experienced low blood pressure upon standing in the early days after gastric bypass, but with adequate hydration, it resolved.

Bariatric-branded vitamins are not necessary or better. Taking 2 Multivitamins a day from Centrum or One A Day, or their generics (from Costco, Walgreens, etc) are fine. Try to find a multi that does NOT contain both calcium and iron as taking them together impedes absorption of both, so then it is as if you didn’t take them at all. I take One A Day 50+ as it doesn’t contain iron and then I dose my heme iron separately (2-4 hours apart) from my multi and calcium citrate supplementation. My thyroid medication is also impacted if I take iron and calcium with it , so I don’t; instead, I take thyroid RXs first thing in the morning and vitamins at lunch, dinner, and bedtime. Works out great, which has been verified with excellent lab work results. If you find your vitamins are too big, you can use a pill cutter to make them smaller. However, I didn’t need to do this myself. The only modification I did in early post-op days was to take vitamins one at a time instead of as a handful of pills. As well, don’t stress out about taking or not taking vitamins in the first month as you have plenty of them stored up in your body and won’t go deficient right away. Ease into your new vitamin regimen if that works better for you. i found chewable and dissolving vitamins made me nauseous or caused me to vomit after bariatric surgery. I think this is because they contain sugar alcohols which are no bueno for me now. Lastly, my doctor emphatically said to NOT take Flinstones or children’s vitamins as they don’t contain the right types of vitamins and amounts.

I had MGB surgery 15 months ago with a very experienced surgeon. However, 8 months post-op I developed bile reflux. It is no joke, very painful, and has caused Barrett’s Esophagus. The only solution for me is the revise to an RNY this summer. I wish I had the RNY originally.

Not everyone has buyer’s remorse.

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I found that the clear protein drinks II liked pre-op were no longer palatable to me post-op. This is not uncommon, that your taste buds change after bariatric surgery. Sometimes it is a temporary thing but sometimes not. My advice is to not stock up on too many protein products ahead of time; instead, wait until after WLS to taste test RTD (ready to drink) protein shakes and powders.

PPIs for short term use are fine but people who take them for 1+ years are at increased risk for some serious issues as I mentioned above, plus kidney disease, heart attack, infections, and vitamin deficiencies. They weren’t developed/approved for long term use. According to the drug label, Nexium is recommended for no longer than eight weeks for acid reflux issues and six months for ulcer healing purposes. But not treating acid reflux puts you at increased risk for esophageal cancer, which does not typically have high survival rates. Therefore GERD/reflux is something that people must not ignore and should work closely with the right medical team to monitor and treat.

Where did I say I want a revision to DS?

What kind of gastric bypass did you have (RNY or MGB) and are you on a PPI? And how far out are you from surgery?

I’ve lost a lot of weight since WLS 14 months ago, am below goal weight, and now have issues with coccydynia (aka tailbone pain). There are a variety of ways to relieve this discomfort (Google them), but when they didn’t do much for me I went to a pain clinic and had pericoccygeal injections of local anesthetic and steroid performed under fluoroscopy done. I had this procedure twice and have been pain free for a couple of months now. I hope it lasts for awhile. Getting a coccyx pillow for your office chair and car seat is helpful if you sit for long periods of time. You can buy them on Amazon or at a medical supply store.

Are you on a Proton Pump Inhibitor (e.g. Prilosec, Nexium, Protonix, Prevacid)? Excess acid sometimes presents as hunger. After bariatric surgery, our smaller stomachs still produce acid as if our stomachs were bigger; therefore, the majority of surgeons recommend PPIs for 3-6 months post-op. Your nerves were cut during surgery, which means you may not feel much restriction initially. This will change later but until then it is imperative you do not try to eat to fullness; instead, measure your food (protein first) and only eat small portion sizes.

A history of GERD/acid reflux is a definitely a contradiction for VSG. Many people post-RNY are able to go off PPIs, which is a very good thing. Not sure if you’re aware that PPIs are not a great long term solution as they may lead to negative consequences, such as increased risk of fractures, osteoporosis, and dementia.

On the West Coast, the BEST DS surgeons are Dr. Ara Keshishian in Pasadena, CA and Dr. John Rabkin in San Francisco, CA. They are also the most skilled at revision surgeries. Another great DS surgeon is Dr. Folahan Ayoola in North Texas (Denton, Frisco, & Flower Mound). They all do the real DS, not SIPS (aka SADI), which isn’t the same thing. With SIPS/SADI surgery, you don’t get long term fat malabsorption, will have less weight loss than DS, there is no medical code for surgeons to honestly bill for it as insurance companies consider it experimental, and yet you’ll have permanent requirements for extra vitamin & mineral supplementation to prevent serious deficiencies.

I recommend you find a surgeon that does the real DS (Hess method) instead of SIPS. DS has the best long term results of any bariatric surgery. As well, there is no medical billing code for SIPS, so most surgeons that do SIPS fraudulently code their surgery as DS; therefore, you could run the risk of having to pay the entire bill if insurance finds out. Most insurance companies consider SIPS (aka SADI ) experimental so rarely cover it.

Try to lose as much weight as you can during the honeymoon phase as fat malabsorption for SIPS (aka SADI) patients wanes after a year or so. This is not the case for DS patients *. You also need to try and keep your carbs as low as possible as they are absorbed, so you may not have good results if you consume too many. * There is a scientific paper posted on the ASMBS website titled, “Physiopathological Differences After Duodenal Switch And Single Anastomosis Duodeno Ileal Bypass (SADI-S).” Summary: DS patients have more fat malabsorption than SADI patients, and these differences are bigger as time goes by.

Congrats on your upcoming DS surgery with Dr. K. He’s the BEST! I’m hoping to get revision surgery scheduled with him this summer.

Just be aware that the MGB has a risk of bile reflux, whereas the RNY does not. So make sure to discuss this with your surgeon. FYI: I had the MGB and am below goal weight (yeah, success), but I am suffering from bile reflux so will be revising to RNY this summer.

HUGE improvement in my arthritis (RA & osteoarthritis) after WLS!

Anyone considering WLS after a Nissen Fundoplication should make sure your surgeon is VERY experienced with this scenario and to get 2nd or 3rd opinions. This is not something to make a rash decision on. Good luck; I feel your pain.

I would not recommend the Omega Loop bypass or MGB or OAGB for someone with severe GERD and/or a Nissen as the risk of bile reflux is too high. I had MGB 14 months ago and now have bile reflux, which has accelerated esophageal damage, along with acid reflux. I will be revising to an RNY gastric bypass this summer.