Are revisions REALLY necessary?

[Dairymary 533]

Summerset, you are right, there is a difference between revisions due to complications vs regain (or failure to lose). The surgeon I mentioned would certainly not withhold treatment if surgical intervention was medically necessary. He did remove several bands and dId revisions after the damage from the band was healed. Sometimes it was bypass, sometimes it was sleeve, depending on the safest alternative. However, he still insisted on psychiatric intervention. And this only helped patients in the long run. Any obese person that doesn't think they got that way because of an unhealthy relationship with food is seriously in denial. The support group I participated in was a strong advocate for addressing both the physical and mental aspects of WLS. I believe that's why I have been so successful.

And yes, any revision that corrects a complication and relieves the patients discomfort and restores their wellbeing is a success from a medical standpoint. But when it comes to successful weightloss, regardless of the reason and type of revision, it is still the psychological changes that determined their success or failure. Sure, some people can have the surgery, go home, lose all their weight and keep it off forever. But most can't. The statistics show that. And I saw it for myself in group. Not to mention on this forum.

[LisaMergs 2,854]

I got obese not by overeating, but by having to take 60mg of prednisone a day, monthly decadron IV infusions and the inability to be active due to a debilitating illness. The end result of the steroids? No metabolism. Little to no adrenal function.

There are those of us around here that didn't overeat. I'm no better than anyone else because mine wasn't a food addiction, I'm simply saying that there ARE other reasons for serious weight gain and inability to lose it.

I personally know several people who had Lap Band and serious repercussions from it. Horrid stuff!! Two went on to have Sleeve, one did nothing after it was removed. The two sleeve revisions have been Ubër successful.

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So here is my question for you.

(And before ANYONE starts a battle on @@LisaMergs behalf -- she and I are groovy, we can discuss like adults without intervention.)

Clearly you have had awesome results with the bypass. Why did you doctor suggest it? Was is malabsorbtion? As I stated earlier, that makes MUCH more sense than the people who say they never overate but who choose the sleeve. Did he/she think this would "reset" your metabolism? More importantly, are you off all those awful meds that made you gain the weight?

I've seen your pics and you look AH-MAY-ZING. I know you can clear up some of my confusion about this.

My whole purpose for having bypass was based solely upon anecdotal evidence showing that people with autoimmune disease specifically rheumatoid arthritis were going into remission after bypass. There was no evidence shown for patients who had the sleeve. My feeling was it was worth a shot. Worst case scenario oh would be that I would be able to drop some of the massive weight I had gained from all the medications there by alleviating the pressure and extra weight put on my already damaged and painful joints.

I was one of the fortunate who went into complete remission after my bypass surgery. I know coming off all the steroids had a huge impact on the significant amount of weight that I was able to lose so quickly. But let's face it there was still plenty that has had to come off with Hard work determination and a commitment to the tool and for lack of better terminology life altering life saving gift I was given.

Two things-

Forgive my lack of proper sentence structure I'm dictating this into the phone as I'm driving to pick up a child from school, and lipstick lady is right we are super groovy and big girls and don't take anything each other says with anything other than the intent in which it was stated.

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[LisaMergs 2,854]

And I did forget to mention, the only medications I now take our drumroll please zero. Other than my Vitamins that's it. Let's all do a happy dance for that, at one point I was taking upwards of 20 pills a day giving myself daily shots weekly and monthly chemotherapy. Not a bad trade off A gastric bypass for my life

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[LipstickLady 25,682]

I knew NONE of this. Thank you for explaining. And I am **thrilled** it's working for you.

My whole purpose for having bypass was based solely upon anecdotal evidence showing that people with autoimmune disease specifically rheumatoid arthritis were going into remission after bypass. There was no evidence shown for patients who had the sleeve. My feeling was it was worth a shot. Worst case scenario oh would be that I would be able to drop some of the massive weight I had gained from all the medications there by alleviating the pressure and extra weight put on my already damaged and painful joints.

I was one of the fortunate who went into complete remission after my bypass surgery.

[Shell Renewed 176]

So to piggy back on the question.

What are your thoughts on WLS on folks who swear they were not addicted to food, rarely over ate, only consumed 1500 calories or less daily. etc?

How does reducing their stomach size really help? I get that malabsorbtion might, but the sleeve or band? Again, no judgement, just confused.

@@LipstickLady I sort of fall into this category, though I'd say I had a mild addiction to food (a night snacker). Though I was overweight for many years, it crept up super slowly and mostly during times of extreme stress and long hours at work when I'd forget to eat most of the day, then get home order takeout because I was too exhausted to cook, then go to bed with a full stomach.

My metabolism has been very sluggish for a few years, then I had an accident and had reduced mobility for almost two years, using a cane. That's all it took for me to really pack on the pounds.

The surgery is helping so much because I lose almost no weight at all on a 1200-1500 calorie diet. These first few weeks of my sleeve I'm under 1000 calories (closer to 700) at all times, and it's coming off, more slowly than many here due to my slow metabolism, but I'm happy nonetheless Now that I'm losing, my mobility is better, so I am getting momentum on fitness and help my metabolism. The sleeve will help me maintain even if my metabolism remains sluggish. My little story

Edited November 18, 2016 by Shell Renewed

[trainer-1 22]

I had a revision front band to gastric sleeve.......I never "ate around my band" and it was highly effective for 8 years until I began having reflux during the night and aspirating. Aspiration pneumonia can kill you!! I was unable to have enough fill in my band for it to be effective, so without my "tool"......my weight began creeping back up. I developed pre-diabetes at end began having joint problems due to the weight gain. So glad you surgeon recommended the sleeve. He said it was a restrictive procedure like the band, and since I did so well with the band that it should work for me. Band failure can be completely unrelated to the direct actions of an individual.

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[theantichick 2,204]

My whole purpose for having bypass was based solely upon anecdotal evidence showing that people with autoimmune disease specifically rheumatoid arthritis were going into remission after bypass. There was no evidence shown for patients who had the sleeve. My feeling was it was worth a shot. Worst case scenario oh would be that I would be able to drop some of the massive weight I had gained from all the medications there by alleviating the pressure and extra weight put on my already damaged and painful joints.

I was one of the fortunate who went into complete remission after my bypass surgery. I know coming off all the steroids had a huge impact on the significant amount of weight that I was able to lose so quickly. But let's face it there was still plenty that has had to come off with Hard work determination and a commitment to the tool and for lack of better terminology life altering life saving gift I was given.

Two things-

Forgive my lack of proper sentence structure I'm dictating this into the phone as I'm driving to pick up a child from school, and lipstick lady is right we are super groovy and big girls and don't take anything each other says with anything other than the intent in which it was stated.

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This is very interesting to me, since I also have RA/PsA. When we started discussing biologics, I asked my rheumy's opinion of WLS. She was enthusiastically behind it, citing WLS as many times reducing the inflammatory factors. However, she and my surgeon (and my research) all said that the bypass was NOT a good option for someone with auto-immune because of the complete contraindication for NSAIDs and steroids, where the sleeve only has a relative contraindication for those meds.

Not criticising you or your docs, just find it interesting how there are so many differing opinions in the medical community.

BTW, biologics are now off the table for me for the forseeable future. My inflammatory factors are down, and we still have dosing room on sulfasalazine and we haven't tried plaquenil yet. Mtx failed and I developed an allergic reaction to it, so at least I don't have to give myself chemo anymore! LOL. So the sleeve has worked amazingly well for me. Not remission, but meds are working better and we're able to avoid the real heavy hitters indefinitely.

[livvsmum 2,369]

I'm sure there are some who need a revision for medical reasons. I had a friend who had her sleeve revised to bypass because of ongoing reflux issues.

If you are looking for it just because of regain, I doubt it's "necessary" per se. I lost 140 pounds initially, then I was severely anemic, requiring blood and Iron transfusions. This was probably a year long process and it resulted, because of the lack of energy and the resulting food and exercise choices, in a 27-pound regain. However, once the anemia was resolved, I felt more like myself with the return of my motivation and energy. I've been able to shed 15 pounds so far of the re-gain and I have 12 more to go.

I didn't ever even consider a revision. A re-set of sorts is possible. You just have to get back to basics, get back to asking yourself if you are REALLY hungry when you are eating, and stick to the plan. The "tool" never goes away.

Just my thoughts.

[LisaMergs 2,854]

My whole purpose for having bypass was based solely upon anecdotal evidence showing that people with autoimmune disease specifically rheumatoid arthritis were going into remission after bypass. There was no evidence shown for patients who had the sleeve. My feeling was it was worth a shot. Worst case scenario oh would be that I would be able to drop some of the massive weight I had gained from all the medications there by alleviating the pressure and extra weight put on my already damaged and painful joints.

I was one of the fortunate who went into complete remission after my bypass surgery. I know coming off all the steroids had a huge impact on the significant amount of weight that I was able to lose so quickly. But let's face it there was still plenty that has had to come off with Hard work determination and a commitment to the tool and for lack of better terminology life altering life saving gift I was given.

Two things-

Forgive my lack of proper sentence structure I'm dictating this into the phone as I'm driving to pick up a child from school, and lipstick lady is right we are super groovy and big girls and don't take anything each other says with anything other than the intent in which it was stated.

Sent from my iPhone using the BariatricPal App

This is very interesting to me, since I also have RA/PsA. When we started discussing biologics, I asked my rheumy's opinion of WLS. She was enthusiastically behind it, citing WLS as many times reducing the inflammatory factors. However, she and my surgeon (and my research) all said that the bypass was NOT a good option for someone with auto-immune because of the complete contraindication for NSAIDs and steroids, where the sleeve only has a relative contraindication for those meds.

Not criticising you or your docs, just find it interesting how there are so many differing opinions in the medical community.

BTW, biologics are now off the table for me for the forseeable future. My inflammatory factors are down, and we still have dosing room on sulfasalazine and we haven't tried plaquenil yet. Mtx failed and I developed an allergic reaction to it, so at least I don't have to give myself chemo anymore! LOL. So the sleeve has worked amazingly well for me. Not remission, but meds are working better and we're able to avoid the real heavy hitters indefinitely.

Knowing full well the contraindications for NSAIDS, bypass was the only WLS that showed remission in autoimmune disorders. My docs are part of a center of excellence, both with the University of Chicago and Northwestern University, and my rheumy is Duke- trained and one of the top researchers in RA and Lupus, so I felt pretty comfortable with their recs.

Giving up ibu was mentally harder than anything else, considering I've not had to take more than 3 Tylenol since my surgery!

Sucks about the MTX for you...wondering were you doing pills or injections? pills had me puking and were much less effective than the shots.

Plaquenil was useless, as were every other med...been there, done them all. My last drug, Actemra, provided a LITTLE relief- about 10%, which lasted a whole week after I was infused. It was the IV decadron that kept me going along with the daily pred.

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[theantichick 2,204]

Knowing full well the contraindications for NSAIDS, bypass was the only WLS that showed remission in autoimmune disorders. My docs are part of a center of excellence, both with the University of Chicago and Northwestern University, and my rheumy is Duke- trained and one of the top researchers in RA and Lupus, so I felt pretty comfortable with their recs.

Giving up ibu was mentally harder than anything else, considering I've not had to take more than 3 Tylenol since my surgery!

Sucks about the MTX for you...wondering were you doing pills or injections? pills had me puking and were much less effective than the shots.

Plaquenil was useless, as were every other med...been there, done them all. My last drug, Actemra, provided a LITTLE relief- about 10%, which lasted a whole week after I was infused. It was the IV decadron that kept me going along with the daily pred.

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Yeah, my rheumy didn't talk about remission, but said that especially since the sleeve completely removes some of the stomach tissue that drives inflammation, it had the potential to help a lot. I'd not seen any of the research with complete remission. However, I don't think I would have gambled my ability to take NSAIDs and steroids. My rheumy hates steroids, so I haven't been on them in forever, but she does like to keep it as an option for really bad flares.

I haven't had any NSAIDs since surgery, I figure the less I take them the better even though they're allowed by my rheumy and surgeon and I'm on a PPI. My rheumy wants to keep all treatment options on the table, because we caught this so early there's no joint degeneration. Right now 3 months post-op, my pain level is less with zero NSAIDs and less than max dose of sulfasalazine than it was prior to surgery with over 10,000mg of ibu a week. And my inflammatory factors are almost normal. We'll treat even with normal inflammatory factors since I'm seronegative and we're trying to fend off joint damage.

I was on the mtx pills, and woke up with a rash all over, and a severe episode of pleurisy. A higher than normal dose of benadryl didn't knock it down, so I went to the ER (it was the one I worked at the time, so that was fun) and got some IV steroids and fluids and more benadryl. My rheumy wasn't convinced it was the mtx, but it wasn't working for me anyway so we stopped it. I have wondered since if I might have had a better response if I was using injections. But oh, well.

[LisaMergs 2,854]

@@theantichick

I always hate hearing about people who tested negative for RF and their docs didn't go ahead and treat for it even though all the S&S were present. I'm so glad you're with docs who did!!! That alone helped you avoid any degeneration.

First time I saw my rheumy, he said, " we will run the blood work, and see what it says, but if it walks like a duck and quacks like a duck, I don't need to see it swim like a duck". Thank goodness. As it were, my factors, ESR etc were all through the roof.

Have you had the Vectra DA bloodwork done? If not, I would HIGHLY rec you ask your docs to run it. Very specialized test, needs to be sent out to a special lab, but what they can see on it is AMAZING!!!!! I can't recall my actual numbers, but for argument sake, say a score of 25 out of 100 said moderate disease is present, mine was like an 86!!! Crazy!! This was 3 months prior to my bypass, a year ago. They are running it again next month for comparative value. Should be interesting.

The test is highly specified, and truly they can see things on it that they can't with standard RA patient blood draws and labs.

Good luck sweetie!!!

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[theantichick 2,204]

@@LisaMergs Yes, my initial Vectra last year was 44. So not horrific, but still pretty high. Being a nurse and knowing the high incidence of auto-immune in my family, I was a pretty demanding patient. I had an atypical first symptom - horrible nodules in the arches of my feet (not RA nodules under the skin, this was like a horrible plantar fasciitis with fibromas) and I finally got a doc to give me a hefty round of steroids, and found not only did my foot pain completely resolve, joint aches and pains I'd been living with for years ALL went away. I had a pain level of 0-1 for the first time in recent memory.

So I knew it had to be an inflammatory process, and wouldn't take no for an answer until my PCP referred me out to a rheumy. And my first 2 rounds of tests were negative because of the ridiculous amount of NSAIDs I took at the time (some 10,000mg a week) and the rounds of steroids I'd been on. And absolutely nothing on xray (and they xrayed SO many joints!!) When my ESR and SED finally popped, they jumped to over 2x normal, and then she ran the Vectra. That's when she dx me with seroneg RA. Then after she started seeing my daughter (who has Alopecia and some form of spondylarthropy - likely PsA or ankylosing spondylitis, they're still testing) she then took a closer look at my nail beds and said it was likely PsA but it didn't change the treatment plan. I don't know when she plans to re-do the Vectra, but I imagine she will soon.

[Babbs 14,681]

Awesome conversation! Thanks guys!

I also want to add some other insight and even empathy to banders. It has also been my observation that Protein rich foods ironically can sometimes be difficult for banders to eat. That causes them to choose foods like crackers and other crunchy carby stuff that break down faster and go down much easier, thus causing gain. Once again, that falls into the special circumstance category. If I were in the same situation and frustrated by not being able to eat without food getting stuck or making me sick, I would probably do the same thing.

[LisaMergs 2,854]

Ugh is all I can say... Horrid when WE have to deal

With it-- unbearable to see our kids go through it.

Sounds like you're in good hands though

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[Travelher 915]

Awesome conversation! Thanks guys!

I also want to add some other insight and even empathy to banders. It has also been my observation that Protein rich foods ironically can sometimes be difficult for banders to eat. That causes them to choose foods like crackers and other crunchy carby stuff that break down faster and go down much easier, thus causing gain. Once again, that falls into the special circumstance category. If I were in the same situation and frustrated by not being able to eat without food getting stuck or making me sick, I would probably do the same thing.

I hope it continues to work for you! I was so puzzled and frustrated when mine went haywire. I was an early bander so there was no info about complications then. Was frustrating to have it work so well and then one day...wtf is this?