Should I revise from VSG to RNY or DS?

[Heather Modispaw]

UPDATE: I was told my the benefits person that the only surgery they do not cover is the sleeve. Well I already have a sleeve. He had no idea what DS was, but suggested I have the surgeon call the pre-authorization number to see if the code for DS is allowed.

 

[Cj7Coy]

UPDATE: I was told my the benefits person that the only surgery they do not cover is the sleeve. Well I already have a sleeve. He had no idea what DS was, but suggested I have the surgeon call the pre-authorization number to see if the code for DS is allowed.

If I already had a sleeve like you I would definitely go for the DS as long as you are willing to do the vitamins. What is your BMI? I live near you in York PA. I haven't found any doctors in the local area that does DS. Temple Batiatric in Philly will only do it if you are 60-70+ BMI. Dr Greenbaum in New Jersey is the only one I know that will do it for lower BMI. He has a great reputation & lots of experience from what I've read. The negative is that he does it open only. I have had both open & laproscopic & laproscopic is so much less pain. Laproscopic also has less chance of complications, blood clots & infection but again I have heard good things about him nevertheless.

If you want to stay locally you are most likely going to have to do a gastric bypass but if you are willing to travel a bit you can get DS.

 

[newwomanin2015]

I know a handful of people who revised from VSG to bypass. Only 1 continued to lose a substantial amount of weight. The others only lost another 20lbs or so, some even less.

I did consider revising to an RNY was I was convinced having a pouch (smaller stomach) would help since I don't have much restriction. However, my surgeon was blunt enough to tell me I wouldn't lose much. He does all the WLS here in the UK and is now Professor status (the highest you can get in the EU). He only does DSes on patients he thinks can handle post op life, and he would have still got paid had I gone for the RNY and spent less time operating on me, but he was honest with me and advised the DS.

It's your choice obviously, but think very carefully about this once in a lifetime opportunity.

Did I read correctly that you have lost more than 300 pounds?!? You are my hero! It's nice to know that are other bigger people on here besides myself that are doing it! Surgeon seems to have a higher number in his head than what I hope to reach because he said I was so big starting out, so it's good to know that those of us who are on the plusser plus size can lose more. May I ask how long you have been losing? It doesn't need to be overnight for me but have heard that most of the loss comes in the first year and then, really slows after that. Has this been true for you?

 

[DSRIGGS]

Did I read correctly that you have lost more than 300 pounds?!? You are my hero! It's nice to know that are other bigger people on here besides myself that are doing it! Surgeon seems to have a higher number in his head than what I hope to reach because he said I was so big starting out, so it's good to know that those of us who are on the plusser plus size can lose more. May I ask how long you have been losing? It doesn't need to be overnight for me but have heard that most of the loss comes in the first year and then, really slows after that. Has this been true for you?

Different people lose differently but the weight loss window for the DS is thought to be 2 years. Now I will say, I did lose the majority of my weight in year one but I also had extreme malabsorption and malnutrition because my Alimentary Limb was not long enough.

 

[newwomanin2015]

Different people lose differently but the weight loss window for the DS is thought to be 2 years. Now I will say, I did lose the majority of my weight in year one but I also had extreme malabsorption and malnutrition because my Alimentary Limb was not long enough.

I know that is not a good thing, but, sometimes wish for a little extra malabsorption, you know?

 

[DSRIGGS]

I know that is not a good thing, but, sometimes wish for a little extra malabsorption, you know?

It wasn't a good thing for me, but it is very possible you are on the other end of the spectrum from me and your channels could be a little long.....so absolutely nothing wrong with you wishing for a little more.

After my ordeal I have become very passionate about the fact that I believe the AMSBS should eliminate any procedure that does not personalize the DS to patient from their recommended standard of care. The science and data are there to show that personalization works, and that the one size fits all model might work for many but some of us on the tail end of the normal distribution are left losing too much or not enough. To me there is no reason for this.

 

[newwomanin2015]

It wasn't a good thing for me, but it is very possible you are on the other end of the spectrum from me and your channels could be a little long.....so absolutely nothing wrong with you wishing for a little more.

After my ordeal I have become very passionate about the fact that I believe the AMSBS should eliminate any procedure that does not personalize the DS to patient from their recommended standard of care. The science and data are there to show that personalization works, and that the one size fits all model might work for many but some of us on the tail end of the normal distribution are left losing too much or not enough. To me there is no reason for this.

Completely agree!

 

[Heather Modispaw]

If I already had a sleeve like you I would definitely go for the DS as long as you are willing to do the vitamins. What is your BMI? I live near you in York PA. I haven't found any doctors in the local area that does DS. Temple Batiatric in Philly will only do it if you are 60-70+ BMI. Dr Greenbaum in New Jersey is the only one I know that will do it for lower BMI. He has a great reputation & lots of experience from what I've read. The negative is that he does it open only. I have had both open & laproscopic & laproscopic is so much less pain. Laproscopic also has less chance of complications, blood clots & infection but again I have heard good things about him nevertheless. If you want to stay locally you are most likely going to have to do a gastric bypass but if you are willing to travel a bit you can get DS.

CJ7Coy are you a Jeeper??? I have no problem committing to the vites that go along with DS. I've had a phone consult with Dr. Greenbaum in NJ. I also have a consult with a local surgeon here in Baltimore on 9/21 to see if I have any options other than DS and RNY. Mini gastric bypass is a possibility. I would keep my sleeve and then have the intestinal bypass portion. Once I hear what the local doc says I'll decide if I want to move forward with DS in NJ with Dr. Greenbaum. That will involve me enrolling in my corporate health insurance that wouldn't be effective until January, but I can do presurgery testing on my current insurance prior to then. I've had open abdominal surgery last year to remove my spleen after a motorcycle accident. That was pretty easy. My broken back, not so much! LOL My current BMI is 38.

 

[southernlady]

CJ7Coy are you a Jeeper??? I have no problem committing to the vites that go along with DS. I've had a phone consult with Dr. Greenbaum in NJ. I also have a consult with a local surgeon here in Baltimore on 9/21 to see if I have any options other than DS and RNY. Mini gastric bypass is a possibility. I would keep my sleeve and then have the intestinal bypass portion. Once I hear what the local doc says I'll decide if I want to move forward with DS in NJ with Dr. Greenbaum. That will involve me enrolling in my corporate health insurance that wouldn't be effective until January, but I can do presurgery testing on my current insurance prior to then. I've had open abdominal surgery last year to remove my spleen after a motorcycle accident. That was pretty easy. My broken back, not so much! LOL My current BMI is 38.

My starting BMI was 35.2. The DS can easily be customized to fit YOU but the best method is the Hess method regardless of size.

If you already have the sleeve, ALL you are doing is adding the Switch portion.

The mini gastric bypass is a terrible idea.It would get RID of the sleeve and turn it into a pouch.

Notice that the MGB takes the pyloric valve out of the equation.

If he isn't touching the sleeve, then it isn't a MGB but the second stage of a DS.

 

[Larra]

Mini-gastric bypass is not a standard of care bariatric operation and is not covered by any insurance policy that I've ever seen (and since I help people with insurance appeals I've seen A LOT of policies). There is, to my knowledge, only one group in the USA doing it. The big problem with it is that it can easily cause severe problems with bile reflux, which is not treatable with antacids because bile is not an acid, it's a base (the opposite of an acid). And bile is very damaging to the esophagus.
I get that you are still exploring all your options, but you are looking in the wrong direction on that one.

On your policy, it is sadly outdated. Almost no one is doing VBG anymore because if the high failure rate. There are probably one or two old guys still doing it, but that's about it. It used to be a standard of care operation but isn't anymore. Yet your policy covers it. Sad.

I think like @southernlady that you should pursue whether or not the DS is covered. It is not the same as the BPD and just isn't listed on your policy as covered or not covered. Again, a very outdated policy! But it is a standard of care operation and has been for many years now. Keep trying.

 

[Heather Modispaw]

Mini-gastric bypass is not a standard of care bariatric operation and is not covered by any insurance policy that I've ever seen (and since I help people with insurance appeals I've seen A LOT of policies). There is, to my knowledge, only one group in the USA doing it. The big problem with it is that it can easily cause severe problems with bile reflux, which is not treatable with antacids because bile is not an acid, it's a base (the opposite of an acid). And bile is very damaging to the esophagus.
I get that you are still exploring all your options, but you are looking in the wrong direction on that one.

On your policy, it is sadly outdated. Almost no one is doing VBG anymore because if the high failure rate. There are probably one or two old guys still doing it, but that's about it. It used to be a standard of care operation but isn't anymore. Yet your policy covers it. Sad.

I think like @southernlady that you should pursue whether or not the DS is covered. It is not the same as the BPD and just isn't listed on your policy as covered or not covered. Again, a very outdated policy! But it is a standard of care operation and has been for many years now. Keep trying.

Larra, have you ever had to deal with an appeal through ChampVA for the DS?

 

[Larra]

No, Heather I haven't. I don't know whether Diana has or not. You first need to request authorization and see what happens. If you get approval, you don't need to worry about appeals. If not, you need to know what your appeals rights are. This information should be somewhere in your policy. Given that it's through the government and (as I am learning from what @southernlady posted) similar to Tricare, you may have very limited appeals rights, but at this point I really don't know. You should be able to get a copy of your EOC (evidence of coverage) and find out.

And as I tell everyone, don't trust someone over the phone to figure this out for you. Read the policy for yourself. You care about this more than anyone else.

 

[Heather Modispaw]

Mini-gastric bypass is not a standard of care bariatric operation and is not covered by any insurance policy that I've ever seen (and since I help people with insurance appeals I've seen A LOT of policies). There is, to my knowledge, only one group in the USA doing it. The big problem with it is that it can easily cause severe problems with bile reflux, which is not treatable with antacids because bile is not an acid, it's a base (the opposite of an acid). And bile is very damaging to the esophagus.
I get that you are still exploring all your options, but you are looking in the wrong direction on that one.

On your policy, it is sadly outdated. Almost no one is doing VBG anymore because if the high failure rate. There are probably one or two old guys still doing it, but that's about it. It used to be a standard of care operation but isn't anymore. Yet your policy covers it. Sad.

I think like @southernlady that you should pursue whether or not the DS is covered. It is not the same as the BPD and just isn't listed on your policy as covered or not covered. Again, a very outdated policy! But it is a standard of care operation and has been for many years now. Keep trying.

Here's the thing, with CHAMPVA you do not need preauthorization for surgery. I pulled the Policy Manual online and it says that Section 29.15 (Surgery for Morbid Obesity) is dated as last changed on 12/23/2011. http://www.va.gov/PURCHASEDCARE/pubs/champva_policy.asp
I won't make any final decisions until I hear everyone out and I do have the option of enrolling in BCBS through work to have Dr. Greenbaum do DS in NJ. I just hate the thought of travel!

 

[Larra]

Travel is one of those things that I chalk up to logistics. Of course it's inconvenient and all, but it's temporary. Your choice of operation, on the other hand, is something you will live with for the rest of your life.
Many people travel a lot farther than from MD to NJ to get the DS. You can do it. I'm not going to say it's easy or fun because I'm not an idiot, but you can do it.

 

[southernlady]

Here's the thing, with CHAMPVA you do not need preauthorization for surgery. I pulled the Policy Manual online and it says that Section 29.15 (Surgery for Morbid Obesity) is dated as last changed on 12/23/2011. http://www.va.gov/PURCHASEDCARE/pubs/champva_policy.asp
I won't make any final decisions until I hear everyone out and I do have the option of enrolling in BCBS through work to have Dr. Greenbaum do DS in NJ. I just hate the thought of travel!

That part is similar to Medicare coverage. As long as you meet the criteria, you are covered. But they don't issue pre-authorizations.

Heather, if it were me, I would call them and ask them if they have a newer policy than 2011.