When is it appropriate to consider revision?

[Kaze 94]

I'll skip the formalities. I had the sleeve in June of 2016. I initially lost a considerable heft getting down to 225 lbs (heaviest was 300). After some time, I gained back about 20 pounds and have been consistent ever since (this past month I've gained a little more still which is severely depressing). I don't feel I eat ridiculously and I did a food diary and my calorie intake isn't excessive, averaging around 1900ish calories which is closer to the goals of a young woman versus a young man such as myself.

When is it appropriate to start considering revision? Based on my surgeon's comments, he may not be inclined to do it OR he meant that it'd be nearly impossible to do laparoscopic again because I have previous abdominal surgeries with tons of scar tissue. I am considering a Bypass revision (though I read a source that suggests a sleeve to duodenal switch might be more effective, yet brings more concern for nutrient deficiency) because it should have considerably better results and also I read that bypass can minimize reflux. I still have take Omeprazole and I've only been able to ween myself off to minimum three days a week for it, so that would be a minor plus. I know for a fact I would need to completely rehsape my relationship with food as some personal stressors caused me to significantly lose conscientiousness towards my diet. I know I need depression and anxiety control beforehand so I go in with a better mentality, but I strongly believe I should at least consider revision. I'm still morbidly obese (BMI ~39.2 as of today!) and I'm almost bad enough to bypass the "must have comorbitity" component of most insurance coverage (BMI of 40 or BMI of 35 w/ considerable problems.)

Secondary question, does anybody have experience with revision surgery coverage through Medicaid? I had Medicare and Medicaid (though down to the wire of Medicare coverage post kidney transplant) for my sleeve, but I just have Medicaid now.

Edited April 15, 2018 by Kaze
additional comment about GERD

[ALFxRNY 540]

I haven’t been through any surgeries yet, but I suggest calling your insurance to find out what their policy is on revision. Good luck!

[Bryn910 519]

I am getting a revision from sleeve to bypass next month. I had my sleeve for 7 years before considering a revision. I wish I had thought of it sooner.

I developed severe GERD and I only lost about 30 pounds in the first 6 months of being sleeved. And I believe that’s because of the liquid diets and me being afraid to eat anything. I also felt no restriction and I tried every diet on the face of the planet.

To get this process started, I suggest you find a surgeon that takes Medicaid patients and call a Medicaid health representative to discuss this process. It may also help to speak with a therapist about your dealing with food. Good luck to you

[FluffyChix 17,415]

Honestly? I'd start with my psych therapist and RD to make sure you're on the right diet and have the right meds for the depression/anxiety. With your kidney transplant you can't afford to fork this up. And another surgery will be hard on your new kidney.

You CAN get back into control. Find out what diet your doc (kidney) wants you on. And work with them, maybe even OA (Overeaters Anonymous) and or Greysheeters - overeaters group. They can help you so much.

You can relose the weight you've gained and get down principles that will help keep you from eating emotionally. I'm sorry you're struggling with this.

I'm sure anti-rejection drugs don't make it super easy to lose either. Any decision you make toward a malabsorption surgery needs to have your nephrologist in the conversation cuz it can be really hard on kidneys.

[Sosewsue61 3,185]

I agree w @FluffyChix consult all your specialists first and therapists because if you didn't make the permanent changes in your relationship to food w the sleeve - no surgery will fix that. Plus depression and your other health issues can contribute to this perfect storm you are experiencing. I wish you good luck, and you have had some good success, just build on it. You don't mention exercise, add more of that if you can - it helps everything - especially depression.

[Kaze 94]

Honestly? I'd start with my psych therapist and RD to make sure you're on the right diet and have the right meds for the depression/anxiety. With your kidney transplant you can't afford to fork this up. And another surgery will be hard on your new kidney.
You CAN get back into control. Find out what diet your doc (kidney) wants you on. And work with them, maybe even OA (Overeaters Anonymous) and or Greysheeters - overeaters group. They can help you so much.
You can relose the weight you've gained and get down principles that will help keep you from eating emotionally. I'm sorry you're struggling with this.
I'm sure anti-rejection drugs don't make it super easy to lose either. Any decision you make toward a malabsorption surgery needs to have your nephrologist in the conversation cuz it can be really hard on kidneys.

My relationship with food, I'd say, is infinitely better than it was pre-surgery, but I won't kid myself and claim it's where I should be. I definitely will pursue a therapist for that after I find a doctor to address anxiety and depression.

I also will consult with my nephro docs because malabsorption did worry me as far as medication, so I'll see what their input is. My WL surgeon did affirm that medication absorption is rarely effected by bypass or the duodenal switch, but when I pursued my sleeve I just was too worried about it.

If I pursue and go forward with revision, I will be in the highest plane of vigilance this time around because I'll go into it with side factors (like stress, anxiety, etc) dealt with or under control so I don't slip. I'm only in the preliminary stages of considering it. I might seek a second opinion from another weight loss surgeon at the hospital I work.

On a positive note, I did an assignment for one of my classes where I had to keep an extremely detailed food diary and I did make several adjustments because of it...whole grains as much as possible, more vegetables around, I'm going to invest in some fish (though I don't like it blech) and other things to boost healthy categories. I get a considerable amount of my daily calories from fat which I'm sure isn't helping even though my sum total calorie intake isn't terrible.

[Kaze 94]

I agree w [mention=323408]FluffyChix[/mention] consult all your specialists first and therapists because if you didn't make the permanent changes in your relationship to food w the sleeve - no surgery will fix that. Plus depression and your other health issues can contribute to this perfect storm you are experiencing. I wish you good luck, and you have had some good success, just build on it. You don't mention exercise, add more of that if you can - it helps everything - especially depression.

Yes on the perfect storm! Ugh! Like I said in a reply above my relationship with food is better than before surgery, but somewhere along the track I grew apathetic (probably because of depression!) and I've hit a brick wall since, so I will absolutely be working on that from here on out. Revision would be something I really seek out hard sometime next year if dietary and activity adjustments just don't work. I don't exercise as much as I want to but I'm hoping with next semester I'll have a more structured schedule and I WILL be putting ~3 hours of treadmill every week minimum. Even if it's just walking, it's something!

Thank you all for your kind and thoughtful responses! I will definitely be working on the "things I can change" stuff first and foremost and only really go for revision in due time if my weight doesn't see tremendous benefit down the line.

[AtlantaRed 651]

Not that a revision is a bad thing, I'm getting one, but 1900 is a lot of calories. When I was sleeved, I was told 800-1000 calories lifelong.

[Kaze 94]

Not that a revision is a bad thing, I'm getting one, but 1900 is a lot of calories. When I was sleeved, I was told 800-1000 calories lifelong.

It's low (1800 was actually the average) for normal eating circumstances, and I feel 800-1000 is still low even for surgery. Perhaps they meant the first year after? Either way I know I can eat more of "slider foods" than I'm comfortable with but I definitely get restriction with heavy and dense foods.

[AtlantaRed 651]

For us, it was low calories forever. Even if we get down to a "normal" weight, we will never be able to eat like a naturally normal weight person and keep the weight down.

[Kaze 94]

On 4/15/2018 at 6:29 AM, Bryn910 said:

I am getting a revision from sleeve to bypass next month. I had my sleeve for 7 years before considering a revision. I wish I had thought of it sooner.

I developed severe GERD and I only lost about 30 pounds in the first 6 months of being sleeved. And I believe that’s because of the liquid diets and me being afraid to eat anything. I also felt no restriction and I tried every diet on the face of the planet.

To get this process started, I suggest you find a surgeon that takes Medicaid patients and call a Medicaid health representative to discuss this process. It may also help to speak with a therapist about your dealing with food. Good luck to you

Hey Bryn! I was following up to see if you got your revision to bypass! I see you now belong to Gastric Bypass Patients so I assume you did. How are you doing and feeling?

Edit: I see, May 9th! Good luck, one week!

[Bryn910 519]

2 minutes ago, Kaze said:

Hey Bryn! I was following up to see if you got your revision to bypass! I see you now belong to Gastric Bypass Patients so I assume you did. How are you doing and feeling?

Edit: I see, May 9th! Good luck, one week!

Yes. One more week! Getting nervous now haha.

I will update you and please stay in contact

[Kaze 94]

Just now, Bryn910 said:

Yes. One more week! Getting nervous now haha.

I will update you and please stay in contact

Will do. I'm still definitely considering it. I've made a few dietary adjustments and my weight has at least trended back down to where I WAS prior to a few months ago which is still ~25 lbs more than my lowest weight. I read some information about revision that confirmed AtlantaRed's comment about the general WLS diet being 800-1000 calories, and knowing I can eat almost double that (though it's probably less since that food diaryhad a lot of less than ideal choices such as fast food, shame on me) which is definitely fueling me to ask about it. I also heard reflux that doesn't go away is another thing to consider getting a revision to bypass for...I definitely still have GERD! Ugh!