Once Bitten, Twice Shy

[Twice Shy 0]

In 1991 I had a Gastric Bypass. My beginning weight was 284 lbs and I got down to 150 lbs within the first 6 months. I stopped there and was really quite happy with my loss as I was the smallest I had ever been in my life (including in high school). I thought I looked pretty great. It didn't last, though, and now, 20 years later I am almost back where I started--and sick about it.

Looking back, I can see where I made my mistakes (I refused to exercise, other than the normal increase of activity due to a smaller frame and more energy, I didn't give up sugar, and I could probably name a number of other things that I did wrong). I am now looking at starting again, but there are so many more options than there were when I first had this done. I was planning to look into the lap band procedure, but then I began hearing about the sleeve. As I have been doing some online research about that process, it seems that there are more long-term benefits to that surgery than the lap band.

Of course, money is an issue with no coverage for either procedure by my insurance company, so I was very happy to hear of the Jerusalem Clinic and their extremely reasonable price for this surgery. I am not naive enough to believe that everyone has a wonderful experience or that I am going to have a top-rate hospital for the advertised price, but from what I have read on these boards, while not top-of-the-line, I can expect a clean facility with a doctor who apparently knows what he is doing.

My question then, is what about follow up? I have been reading a blog from a woman who had the sleeve done in San Francisco in 2008, I think. She was required to go through psych evals, pre-surgery weight-loss, and extensive followup visits including a lot of lab work at key points following surgery. She is EXTREMELY into being an athlete now and has gotten down to size 0 and 113 pounds. Honestly, I still don't need to do all that. I think that I gave up on myself last time by allowing myself to break the rules such that I regained the weight back, and I really do want to go down to probably 125-135 lbs rather than stopping at 150 like I did before, but reading her journey makes me a bit nervous about living a "normal" lifestyle if I expect to get the results I want.

I have decided that I want to begin exercising as it is good for the body and I am now 50 years old and will really need to work on exercise in order to cut down on the excess skin after getting to goal, but I don't want every day to have my first thought be about going to the gym, competing in triathalons, and all that stuff. I want to be comfortable riding my bike (I have a beautiful one I haven't gotten on for the last 5 years), swimming, speed walking, or just playing a game of volleyball when I feel like it, or even just attending the local gym to work out 3 times a week. Is this possible? Can this sleeve work to get you to a reasonable goal weight without killing yourself at the gym?

The second part of my question is about whether there is anyone out there posting here that has gone through a bypass and has or is considering doing a second surgery. When asking the person at the Jerusalem Center about that, she suggested that I would be better off with the lap band rather than the sleeve. But the big bonus in the sleeve is the removal of the hunger thing and the lap band (nor the bypass) had that. I'd like to get some input from someone who has been there. Plus, I'd love to know how it is going the second time around. Thanks in advance for any responses.

[bilka 6]

Hello!

First of all, I know nothing about the band, but there's a whole section about it here http://www.verticalsleevetalk.com/forum/13-band-to-sleeve-revisions/ , I read that many people did it, I am sure you can find answers there!

Second... I am so NOT killing myself in the gym. I go to the gym a couple of times a week, sometimes more IF I feel like it. I hate sport, I know it's good for me and that's the only reason why I do it. I am not going to become an athlete! And I am still losing.

I had my surgery done in Greece but I live in Italy, so I had no follow up. Luckily I had no problems. My GP made me have some blood tests after surgery and she's keeping an eye on me, so I guess it's good if you talk to yours as well. I had no psychiatric evaluation, obviously, before the sleeve, but since I got back I am seeing a psychologist on a regular base because I want help dealing with sleeve, the changes etc without breaking down, but this is my choice.

This is my experience and I hope it can help a little...

[Heatherr 149]

Hiiiiiiiiiiii!!!!!!! ::waving::

I'm still pre op, but at this point I have read and reread so much information and journeys that I feel like I have some insight. You do NOT have to be mega athlete superstar to be successful, you just have to move. What you described as your exercise goal sounds perfect. Obviously, you know you have to watch what you eat as well, but you don't have to become obsessive about eating and exercise, just smart.

Start now - there's no time like the present.

For what it's worth, I've been losing an average of 3lbs per week just by following the diet and exercising. I feel great! I can't wait until I have my sleeve to help that weight come off even faster.

GL to you and welcome.

[Twice Shy 0]

Hello!

First of all, I know nothing about the band, but there's a whole section about it here http://www.verticals...eeve-revisions/ , I read that many people did it, I am sure you can find answers there!

Second... I am so NOT killing myself in the gym. I go to the gym a couple of times a week, sometimes more IF I feel like it. I hate sport, I know it's good for me and that's the only reason why I do it. I am not going to become an athlete! And I am still losing.

I had my surgery done in Greece but I live in Italy, so I had no follow up. Luckily I had no problems. My GP made me have some blood tests after surgery and she's keeping an eye on me, so I guess it's good if you talk to yours as well. I had no psychiatric evaluation, obviously, before the sleeve, but since I got back I am seeing a psychologist on a regular base because I want help dealing with sleeve, the changes etc without breaking down, but this is my choice.

This is my experience and I hope it can help a little...

Thanks for the info. How much is 25 kg as compared to pounds? I am hoping to do this in October, as work evens out then with the start of a new fiscal year. My plan is to be off work on Thursay through the following week and return on the next Monday (about 10 days). I don't plan to tell anyone at work about this and wonder if I am giving myself enough time for recovery. My bypass had a recovery of around 8 weeks. Of course this was 20 years ago before laser surgery and I have a huge scar from stem to stern and I came out of it not only with staff infection, but with major back issues because they moved my ribcage open and I was apparently lying on them for the 4-5 hours of surgery until they closed me back up. I do extremely well with surgery so I actually healed and got on with life faster than most, but it is so encouraging to know that this procedure leaves only small scars and is fast and easy compared to my former recovery.

[Twice Shy 0]

Hiiiiiiiiiiii!!!!!!! ::waving::

I'm still pre op, but at this point I have read and reread so much information and journeys that I feel like I have some insight. You do NOT have to be mega athlete superstar to be successful, you just have to move. What you described as your exercise goal sounds perfect. Obviously, you know you have to watch what you eat as well, but you don't have to become obsessive about eating and exercise, just smart.

Start now - there's no time like the present.

For what it's worth, I've been losing an average of 3lbs per week just by following the diet and exercising. I feel great! I can't wait until I have my sleeve to help that weight come off even faster.

GL to you and welcome.

Thanks for the encouragement. Are you scheduled for your sleeve? Where are you going for the procedure - or are all of the posters on this site patients (or potentially) of the Jerusalem Center?

Actually, rather than losing, I feel as though I am gaining 3 pounds per week--ok, a bit of an exaggeration. I just really feel out of control with food right now, though. I'm looking forward to finding out more about my options and making an appointment to get this done. Honestly, I haven't yet told my husband I want to do this (he didn't know me when I had my other surgery, and when I mentioned doing something surgically again about 2 years ago he was definitely NOT for it) but I am hoping that arrned with my new information about this procedure he will come around.

[Lakelady 2]

I'm not trying to be a doubter but how do they sleeve you if you've already had a GB? Do they put the system back together and then so the sleeve? Just curious.

[thinoneday 445]

Lakelady, that is my question as well. . .if you have gastric bypass, then your inners are reorganized? So how would that work???? interesting. . .

[Tiffykins 673]

I would go over to obesityhelp.com and seek answers on revising from RNY to DS on the Revision forum or DS forum. Going from a malabsorptive procedure to a restrictive only procedure is highly discouraged, and getting the BOB (band over bypass) has a whole slew of issues that have lead to more surgeries for patients that sought that procedure. Taking down an 11 year old RNY is going to be extremely dangerous, and only a handful (like 4-5) surgeons have the experience with the surgery. If you go with the BOB procedure, you'll need fills/unfills to get restriction, and those range $100-$300 a pop.

You're risks quadruple for complications, and you'll need a true revision surgeon. If you were going to consider a BOB procedure, then going to a band, sleeve, or RNY surgeon is more desirable, but to have your RNY taken down and converted to a sleeve, honestly you need a true revision surgeon. Like I said, there are only a handful of true revision surgeons that even are trained and have performed numerous RNY to DS or VSG surgeries because it is such a huge and complicated surgery.

As for your working out questions, I only worked out for 4 months from months 4-8 months post-op, and I'm extremely successful. I don't have a great, toned beautiful body, I look damn smashing with clothes on. I went from a size 22/24W to a size 2, from 263lbs to 125lbs, and was able to maintain my loss for a year until pregnancy weight started creeping in.

Best wishes in your research!

[Ruby 26]

Thats- really great info.. as i am preop about 7 weeks still.. but i am curious how i will deal with depriving.. and sugar!! lol i am really hoping for a new beginning with myself..

Hello!

First of all, I know nothing about the band, but there's a whole section about it here http://www.verticals...eeve-revisions/ , I read that many people did it, I am sure you can find answers there!

Second... I am so NOT killing myself in the gym. I go to the gym a couple of times a week, sometimes more IF I feel like it. I hate sport, I know it's good for me and that's the only reason why I do it. I am not going to become an athlete! And I am still losing.

I had my surgery done in Greece but I live in Italy, so I had no follow up. Luckily I had no problems. My GP made me have some blood tests after surgery and she's keeping an eye on me, so I guess it's good if you talk to yours as well. I had no psychiatric evaluation, obviously, before the sleeve, but since I got back I am seeing a psychologist on a regular base because I want help dealing with sleeve, the changes etc without breaking down, but this is my choice.

This is my experience and I hope it can help a little...

[Twice Shy 0]

Thanks for the input! I have wondered myself about the complications that may come from already having had surgery; but when I asked them at the Jerusalem Center, other than telling me that they recommend the band over the sleeve for former bypass patients, there didn't seem to be an issue. It is definitely an area that I need to look into more closely.

Thanks!

Also, one more question for Tiffykins. How pregnant are you? Or have you already had the baby and are on the way back down the scale? I am interested in how easy it is to begin re-losing once you have begun putting weight back on, as that is one of the things that I was thinking about as well. I mean, at one time, my stomach was just large enough to eat 2 oz., so maybe there is something that I could do to re-shrink my stomach without the need for additional surgery. But I haven't found anything yet.

[mina 27]

I heard about the ROSE procedure, here's a quick peak:

ROSE, which stands for Restorative Obesity Surgery, Endolumenal, is a new, safer, incisionless, gastric bypass revision. It is not a primary method of weight loss surgery, but a follow-up procedure that is specifically designed for gastric bypass patients with weight regain.

The ROSE procedure is indicated for gastric bypass patients who were initially successful in losing the excess weight but are now regaining some of the lost weight because the stomach and stoma have stretched out and no longer effectively control hunger and food intake.

[Twice Shy 0]

I heard about the ROSE procedure, here's a quick peak:

ROSE, which stands for Restorative Obesity Surgery, Endolumenal, is a new, safer, incisionless, gastric bypass revision. It is not a primary method of weight loss surgery, but a follow-up procedure that is specifically designed for gastric bypass patients with weight regain.

The ROSE procedure is indicated for gastric bypass patients who were initially successful in losing the excess weight but are now regaining some of the lost weight because the stomach and stoma have stretched out and no longer effectively control hunger and food intake.

Mina, THANKS! That sounds like a very interesting avenue to look into. I will check that out some more.

[Tiffykins 673]

Thanks for the input! I have wondered myself about the complications that may come from already having had surgery; but when I asked them at the Jerusalem Center, other than telling me that they recommend the band over the sleeve for former bypass patients, there didn't seem to be an issue. It is definitely an area that I need to look into more closely.

Thanks!

Also, one more question for Tiffykins. How pregnant are you? Or have you already had the baby and are on the way back down the scale? I am interested in how easy it is to begin re-losing once you have begun putting weight back on, as that is one of the things that I was thinking about as well. I mean, at one time, my stomach was just large enough to eat 2 oz., so maybe there is something that I could do to re-shrink my stomach without the need for additional surgery. But I haven't found anything yet.

I'm 18.5 weeks pregnant. I won't have any issues losing the pregnancy weight. I'll just low carb it again until I get the weight off. I gained a few pounds over the holidays and dropped those pounds in a little over a week just by cutting alcohol and carb consumption. As for the breakdown of weight gain with a pregnancy, this is what they've outlined for my weight gain:

Maternal Fat- 7lbs

Baby- 6-8lbs (average is 7.5lbs)

Increases Fluid (blood volume)-2-4 ( a mother's blood volume typically doubles during pregnancy)

Amniotic Fluid- 1-1.5lbs

Placenta- 2lbs

Breast tissue/mammary system weight increase - 1-2lbs

Watch out for the ROSE procedure, it has an 85% failure rate. This is also discussed heavily on the obesityhelp.com Revision forum. ERNY (extended RNY, where they remove more intestine to start malabsorption again since intestinal adaptation has taken over at this point for you) is also an option. They will shorten your common channel by another 50-100cm. You definitely want to know before you agree to a revision if you have a pouch or stoma dilation because if you have actual mechanical failure with your RNY even a band over the pouch isn't going to do much because once the food passes through the band pouch into your RNY pouch, you will still be able to more food, and your malabsorption is gone.

As for Jerusalem clinic, honestly, out of over 3 years on weight loss forums, I have never read of one patient having a RNY take down and revision to the VSG being performed there and honestly that is possibly why they are recommending the band over the bypass pouch to give you restriction again. Seriously, I can name 4 surgeons worldwide that are experienced with these surgeries, and with self-pay patients the cost just for the surgeon run upwards of 20-30k because it is such a complicated and exhausting surgery to take down an old RNY.

I promise I researched revisions for months once I knew my band had to come out. The risks for complications especially leaks from scar tissue and adhesions literally quadruples with revisions vs. a virgin, unaltered stomach/intestinal tract. I had a leak with a band revision to VSG after only having the band for 8 months, and actually lost more stomach tissue because of the damage the band had done. My surgeon was experienced with revisions, and I happen to be a statistic of his that I'd like to take back. I was his first and only VSG leak so it can happen even with really experienced surgeons. I'm not slamming Jerusalem Clinic, but revisions are super tricky, complicated, and I would hate to see you fork out the money, get a surgery that is as high maintenance as the BOB procedure and then continue to struggle with your weight and be looking at or for another surgery.

There have been RNY to VSG revisions performed due to reactive hypoglycemia symptoms and diagnosis after RNY, but again, it's a very complicated surgery with high risks.

Just choose carefully, and continue to research your options.