Reving for the third time possible RNY to DS???

[DianaCox]

OK, I see - I was (despite my scientific background - shame on me!) having a metric senior moment. 25 mm = an inch wide stoma (I was mentally off by an order of magnitude - thinking it was 0.1 inch ... sheesh), instead of about the normal 10 mm (~0.4" ). So there IS mechanical and functional failure. That's different. I was thinking she might have significant problems getting a revision with no mechanical failure.

But in any case, trying to cut down on the carbs would be a good idea - while establishing the basis for some pre-op weight loss if required.

 

[Larra]

Luckily I speak metric! And you do too, I know, it was the lake algae attacking your neurons (for anyone confused by this, there is another thread about loss of cognitive function related to exposure to lake algae).

So hopefully we are all now in agreement and Tee can contact the best possible DS revision surgeons and see if they can help her.

 

[DianaCox]

Its a VIRUS that infects algae in lakes that somehow is affecting human neurons. And yeah, that's what I'll blame it on - even though I haven't been in a lake in about 25 years.

By the way, this is beyond scientifically weird that a virus which normally has an ALGAE as a host could affect cognitive function in a human brain.

Proc Natl Acad Sci U S A. 2014 Oct 27. pii: 201418895. [Epub ahead of print]
Chlorovirus ATCV-1 is part of the human oropharyngeal virome and is associated with changes in cognitive functions in humans and mice.
Yolken RH1, Jones-Brando L2, Dunigan DD3, Kannan G4, Dickerson F5, Severance E2, Sabunciyan S2, Talbot CC Jr6, Prandovszky E2, Gurnon JR3, Agarkova IV3,Leister F2, Gressitt KL2, Chen O2, Deuber B2, Ma F3, Pletnikov MV4, Van Etten JL7.
Author information

Abstract
Chloroviruses (family Phycodnaviridae) are large DNA viruses known to infect certain eukaryotic green algae and have not been previously shown to infect humans or to be part of the human virome. We unexpectedly found sequences homologous to the chlorovirus Acanthocystis turfacea chlorella virus 1 (ATCV-1) in a metagenomic analysis of DNA extracted from human oropharyngeal samples. These samples were obtained by throat swabs of adults without a psychiatric disorder or serious physical illness who were participating in a study that included measures of cognitive functioning. The presence of ATCV-1 DNA was confirmed by quantitative PCR with ATCV-1 DNA being documented in oropharyngeal samples obtained from 40 (43.5%) of 92 individuals. The presence of ATCV-1 DNA was not associated with demographic variables but was associated with a modest but statistically significant decrease in the performance on cognitive assessments of visual processing and visual motor speed. We further explored the effects of ATCV-1 in a mouse model. The inoculation of ATCV-1 into the intestinal tract of 9-11-wk-old mice resulted in a subsequent decrease in performance in several cognitive domains, including ones involving recognition memory and sensory-motor gating. ATCV-1 exposure in mice also resulted in the altered expression of genes within the hippocampus. These genes comprised pathways related to synaptic plasticity, learning, memory formation, and the immune response to viral exposure.

 

[Larra]

Well, we are off topic now but yes that is very weird. But then again, if a virus can infect my computer, why not an algae-hosted virus infecting us?

You say it's not the same type of virus? English is so confusing.

 

[Elizabeth N.]

I don't know enough about RNY anatomy to make any kind of informed commentary, so by all means listen to Larra on that. What I *do* know something (actually a hell of a lot) about is behavior modification and, even more importantly, the incredible power that our minds hold over us.

If you have some kind of emotional "wound," something that hurts enough that you crave a "painkiller" for it, and you have developed a way to "medicate" that pain, you're not going to suddenly go without your "meds." If you take away one "med," either you will substitute another one or you will do whatever you have to do in order to be able to use the one you already use. The ability to sabotage yourself is all but immutable when this is going on.

All too often, we fob this off as "transfer addiction." I think that's way too shallow a way to look at this issue. "Treating" the "addiction" is not the same as fixing what is hurt or broken.

It took me seven years of therapy to become able to sit in the same room with the subject of eating and weight, more years of work to become willing to work on the things that drove my behaviors, and then more years of continuous, absolutely grueling work focused on healing those things, before I could see a way out of the obesity that was killing me and become able to act.

By no means do I assume that everyone has the same kinds of issues. I'm saying that I recognize that kind of pattern, though, in a lot of people. And I think I'm seeing it in you. Don't underestimate the power these behaviors can wield over you. Fixing them is the best investment in your life.

 

[Spiky Bugger]

Some surgeries are more dangerous than others.

Also dangerous are diagnoses and "medical advice" from people who are in no position to hand out that advice.

On any internet gathering you will get some good advice from people who know what they are talking about and some really bad advice from self-appointed experts who are not only unqualified, but oftentimes, far sicker than the people they are trying to diagnose. With time and experience, you will be able to tell who is who. Meanwhile, take SOME of the advice you receive with a cup of salt...on every board.

 

[cboone]

I will take all this under advisement. I also just spoke with the surgeon in Brazil by Skype and he was amazing and kind. He thoroughly discussed the 3 revision options 1) distal RNY 2) BPD and 3) DS. He also discussed my surgical reports and labs etc. We talked about my eating habits etc. The bottom line is that he suggests eating dry foods high in protein. He thinks that there are some small things that might be contributing to my weight regain and no weight loss. He thinks that I eat wet soft foods which go right through the pouch. I drink the GNC go lean protein shakes for example to get my protein in and he says that is not a good idea because it goes right through and it is high in carbs and calories. The protein should come from meat. He wants me to add red meat which I do not eat very much. I mostly eat grilled fish and seafood like crab legs. I eat eggs and Greek yogurts. He says that genetics play a role in my weight issues and anxiety. He suggested some anxiety medication but I did not catch exactly what he said the medication was. I will have to follow up by email. Has anyone heard of taking something for anxiety in connection with the WLS surgery? He suggested a different nutritionist who is experienced with and could assist with bariatric diets and focusing on what is best and adding exercise too see if it kicks me back into weight loss before considering surgery revisions. He does think that the DS is too risky for me and highly likely to lead to a leak and mal-absorption would help but with life style changes etc. He said if I don't have the dumping from the RNY for the sweets and carbs then no surgery will give me a free pass on carbs. He also spoke that the stoma is big but he would suggest keeping it in place to avoid stricture issues I have had in the past to help get enough food in with the small pouch and adding that mal-absorption. If you had a sleeve as you do in the DS it would be larger than the pouch and stoma allowing intake of food. He thinks it is safer than the risk of DS in my case for sure. He was very polite and knowledgeable.
Thanks Larra it has been an exhausting day and not what I had hoped to hear. I will talk with surgeons suggested.

 

[DianaCox]

Now have a conversation with Keshishian and/or Rabkin. You will likely get a different point of view about the safety of the surgery.

But I think Marchesini's comments about your food choices are quite relevant, as well as the suggestion that another revision surgery should be a last choice if you are not metabolically unwell and are not having the miseries with eating (uncontrolled dumping, strictures). It won't be as easy as having a virgin DS is for most of us, but RNY to DS revision is the most dangerous one, especially in the setting of a prior revision surgery and scar tissue and concerns about blood supply - but it CAN be done.

The question is, are you willing to take the risk (I don't know what it is, but let's just say a 30% risk that you will be MORE miserable long-term with a revision that includes complications, including potentially life-threatening ones), when you could get 70% of the results by significantly, unpleasantly, but safely and do-ably changing your diet and exercise (which is what you opted for in the first place with the RNY)?

 

[Elizabeth N.]

Sounds like a good conversation and confirms what you have heard here. Stop the soft stuff and liquids. Journal your food and talk to us about what you are doing. I bet there are a lot of changes you can make.

We crazy people sometimes actually have something useful to say.

 

[Larra]

I like Dr. M's suggestions about your diet and exercise. As far as a nutritionist goes, it isn't easy to find one that is educated regarding bariatric surgery, but it will be easier to find one that knows about gastric bypass than about the DS. And there is no argument here about the revision to DS carrying significant risks.

So take in what he said, and get a second opinion from one of the surgeons we have suggested, then take your time before making any decisions. This is NOT an emergency. If you can be successful without further surgery, that would certainly be your safest option by far. And, if you are dealing with anxiety and/or depression, get appropriate help (therapy and meds) for these issues as well. Sometimes it takes more than one form of treatment to deal with a complex problem.

 

[buffalobillsfan]

I usually don't jump in these discussions because it can be a heated topic and usually the well-versed people explain options and pros and cons very well. Being bored and also being the type of person who sees things from both sides, I felt I wanted to add my opinion.

I completely agree on taking to Dr Rabkin and Dr K. Having just had an emergency bowel obstruction surgery I am leaning towards being very sure that another surgery is your ONLY option. The more times they open you up and mess with your guts, the more opportunities for issues. It would suck to have any type of complications and wish you had your current body/problems back. My thought before my DS was that I would rather die on the OR table than live like I was (death probably wasn't far off at my former weight). Now I almost feel that I'd rather die than be BACK on the OR table.

I also spent years in therapy to work on my food addiction/transfer addiction issues. I figured that I would still have the surgery even though they weren't resolved because it still gave me a better chance for SURVIVAL. My carb demon came back 8 months after my surgery when I moved temporarily from California to NY to watch my mother die for 4 months. I still have my issues and I eat a lot of carbs but not having comorbidities and being able to fully live is better than I could have imagined. At least self-hatred and shame went away with the weight loss. However, so far I have maintained 100% of my excess weight loss and not everyone who eats carbs has that luck. My luck can run out and no one ever really knows who will be able to eat carbs or not and for how long. It's a constant roll of the dice. If I only lost 50% of my excess weight then I might still have the self-hate thing going on. I continue to work on myself regardless as I'm always a work in progress. I'm so grateful I didn't wait to be fully healed mentally because I would still be waiting That being said, it would suck for you if you ended up with insufficient weight loss (either technically or in your own mind) because you still couldn't stop eating poorly. With any revision, your weight loss can be hampered and you have already figured out that your body is efficient in keeping your weight up.

Like Larra said, it isn't an emergency. Sometimes when it is hard to make a decision the best thing to do is not make it right now. I would also gently suggest continuing on with your surgeon interviews and homework but give the suggestions for eating with your current configuration a try. Consider joining Overeaters Anonymous (the stricter weigh and measure meetings) and get a sponsor. It will help with accountable eating and with the mental issues we have around life and food. It was the other program that worked for me while I worked it. I just don't know if you situation is dire enough to warrant another surgery. BUT, I'd be curious to hear with the best revision doctors say. I don't know Dr K personally but I know Rabkin is a straight shooter and will give you honest professional advice. Good luck in your decision.

 

[buffalobillsfan]

Also, I have anxiety and take Wellbutrin for it but I've also used Zoloft in the past with success.

 

[cboone]

I like Dr. M's suggestions about your diet and exercise. As far as a nutritionist goes, it isn't easy to find one that is educated regarding bariatric surgery, but it will be easier to find one that knows about gastric bypass than about the DS. And there is no argument here about the revision to DS carrying significant risks.

So take in what he said, and get a second opinion from one of the surgeons we have suggested, then take your time before making any decisions. This is NOT an emergency. If you can be successful without further surgery, that would certainly be your safest option by far. And, if you are dealing with anxiety and/or depression, get appropriate help (therapy and meds) for these issues as well. Sometimes it takes more than one form of treatment to deal with a complex problem.

Dr. M thinks there may be a need for a mood regulator to help with grazing. He says if you are grazing and frequenting opening the refrigerator to search for food even when you are not hungry that there maybe some anxiety. But I have put in for consults with the California doctors and will seek these other opinions. But if just diet and exercise would fix my problems with weight loss and weight control I would never have had a need for WLS I know I still must do my part and I am learning my issues and trying to resolve them but I need a tool to give me a kick start and some help along the way. But we will see.... I will start using spark people again and track what I am eating and share. Thanks everybody

 

[DianaCox]

Sometimes, even those of us who are die-hard DS fans, and die-hard RNY (the surgery, not the patients!) haters, will step back from recommending revision - even if you have access to it - when the situation doesn't call for it, or at least doesn't constitute an emergency. I hope you understand why there are mixed signals about it from the members here.

 

[star0210]

For me,...grazing is about boredom and fidgetyness. (I don't think that's a real word lol) It's the worst when I'm at work in my office sitting at my computer all day. That's when I find it hardest to resist snacking or picking on things I have no business eating.