2 years w/sleeve considering D/S

[Butterfly]

I may post this to the revision forum as well so I apologize if you see it twice.

I'm a 45 year old woman who has been morbidly obese since about the age of 20. My weight crept up slowly year by year until I reached a little over 500 pounds 2.5 years ago. At the time, I had insurance that wouldn't pay for any type of WLS so I had to take the only money I had to self pay for the gastric sleeve. I paid $14K to a surgeon locally. He made me lose 65 pounds before he'd do the surgery and I had it done in July 2014. I worked the program pretty faithfully and got myself down to 299 pounds as of fall of 2015.

At that time my best friend passed away and I went into a bit of a tailspin. I started eating fast food too often and in amounts too large. Let me say that after about 90 days post-op I never really felt the restriction that so many people talk about so I had to just rely on measuring food and stopping when I'd eaten all I'd measured. My fast food binging lead me to gain about 60 pounds in 7 months.

In June I decided to stop this nonsense and went back to walking on my treadmill (although I could only do about 10 min a day) and measuring my food. I went to a support group meeting and was told "You should have never had the sleeve. The sleeve isn't for heavyweights. You should have had the duodenal switch. You've most likely ruined and stretched your sleeve out." I was devastated. Since the end of June I have lost 20 pounds, but feel I should be doing better since I am (no lie) eating between 700-900 calories a day only. For the last two weeks I've lost 1 pound while never eating more than 900 calories in a day.

Where I am now: I am back in college and will be starting a nursing program in a few weeks so I am not able to work full time. My low wages qualify me for Medicaid, but I believe Medicaid will not pay for the D/S surgery. It *may* pay for a revision to gastric bypass, but I am not sure. I just got the insurance about a month ago.

I get the feeling that the D/S would be the way to go if I get another surgery. I own my home outright and could get an equity loan to pay for it as long as it wasn't too much. I feel like such a failure and I'm so embarrassed to think of telling my family that I will get ANOTHER surgery.

For those of you who have had a D/S, did any go to Mexico? Any surgeons there you would recommend or stay away from? I admit the thought of going so far from home for surgery scares me quite a bit.

Sorry for the long post and thanks for any input any of you have. I've been feeling so lost and depressed about all of this.

 

[southernlady]

I may post this to the revision forum as well so I apologize if you see it twice.

I'm a 45 year old woman who has been morbidly obese since about the age of 20. My weight crept up slowly year by year until I reached a little over 500 pounds 2.5 years ago. At the time, I had insurance that wouldn't pay for any type of WLS so I had to take the only money I had to self pay for the gastric sleeve. I paid $14K to a surgeon locally. He made me lose 65 pounds before he'd do the surgery and I had it done in July 2014. I worked the program pretty faithfully and got myself down to 299 pounds as of fall of 2015.

At that time my best friend passed away and I went into a bit of a tailspin. I started eating fast food too often and in amounts too large. Let me say that after about 90 days post-op I never really felt the restriction that so many people talk about so I had to just rely on measuring food and stopping when I'd eaten all I'd measured. My fast food binging lead me to gain about 60 pounds in 7 months.

In June I decided to stop this nonsense and went back to walking on my treadmill (although I could only do about 10 min a day) and measuring my food. I went to a support group meeting and was told "You should have never had the sleeve. The sleeve isn't for heavyweights. You should have had the duodenal switch. You've most likely ruined and stretched your sleeve out." I was devastated. Since the end of June I have lost 20 pounds, but feel I should be doing better since I am (no lie) eating between 700-900 calories a day only. For the last two weeks I've lost 1 pound while never eating more than 900 calories in a day.

Where I am now: I am back in college and will be starting a nursing program in a few weeks so I am not able to work full time. My low wages qualify me for Medicaid, but I believe Medicaid will not pay for the D/S surgery. It *may* pay for a revision to gastric bypass, but I am not sure. I just got the insurance about a month ago.

I get the feeling that the D/S would be the way to go if I get another surgery. I own my home outright and could get an equity loan to pay for it as long as it wasn't too much. I feel like such a failure and I'm so embarrassed to think of telling my family that I will get ANOTHER surgery.

For those of you who have had a D/S, did any go to Mexico? Any surgeons there you would recommend or stay away from? I admit the thought of going so far from home for surgery scares me quite a bit.

Sorry for the long post and thanks for any input any of you have. I've been feeling so lost and depressed about all of this.

We've had several go to Dr. Esquerra. He took over Dr. Ungson's practice when Dr. Ungson moved over to government service. http://bariatricfacts.org/threads/dr-gilberto-ungson-mexicali-mx-now-dr-esquerra.1747/.

He's the ONLY DS surgeon recommended.

 

[Butterfly]

Thank you for that. I will definitely look into him. I appreciate the response, truly.

 

[SmilinsShrinking]

Hi again. As I told you on your other post, I'm a revision, only 10 days out. I went to Mexicali with Dr. Esquerra and I would absolutely recommend going there. The price was reasonable ($12,500 for a revision) Dr Esquerra and his staff were amazing!!! I've never been treated by a doctor with such care and respect. The hospital was lovely and clean. The hotel we stayed in that first night rivals any resort I've ever stayed at. They are wonderful about answering all questions... Leading up to and since surgery.

If you have any questions, is be more than happy to answer them.

I'm sure glad you're here doing your research and not just getting an inferior surgery because it's the only one being offered.
I wish you the best!!
Joni

 

[Clematis]

I had a virgin DS with Esquerra. (I'm in Ohio.) I have nothing but great things to say about him, the staff and the hospital.

 

[Butterfly]

Hi again. As I told you on your other post, I'm a revision, only 10 days out. I went to Mexicali with Dr. Esquerra and I would absolutely recommend going there. The price was reasonable ($12,500 for a revision) Dr Esquerra and his staff were amazing!!! I've never been treated by a doctor with such care and respect. The hospital was lovely and clean. The hotel we stayed in that first night rivals any resort I've ever stayed at. They are wonderful about answering all questions... Leading up to and since surgery.

If you have any questions, is be more than happy to answer them.

I'm sure glad you're here doing your research and not just getting an inferior surgery because it's the only one being offered.
I wish you the best!!
Joni

I'm so excited for you! I hope you're feeling and doing great. $12,500 is pretty decent for a revision. I'm sure I could get that much as a home equity loan. Was that the total cost? Did you have to do any tests before you went down?

I had a virgin DS with Esquerra. (I'm in Ohio.) I have nothing but great things to say about him, the staff and the hospital.

I'm in Ohio, too! There aren't many doctors in Ohio that do the D/S. I'm going to call one in Dayton tomorrow that's on my insurance's provider list, but I fear that he's only on there for gastric bypasses. I *might* be able to get approved for a bypass, but I feel like the D/S would benefit me more.

Thank you both so much!

 

[hilary1617]

Hello and welcome @Butterfly! Dr. Esquerra is well-known and has a good reputation, and I echo the above sentiment that he is the only surgeon in Mexico that I would recommend to a friend or family member after being on the bariatric boards for years and reading about people's positive experiences with Dr. Esquerra and some really horrible experiences with others. The DS is difficult and surgeon's level of skill and experience with DS is paramount. All the best!

 

[DSRIGGS]

Welcome.

You didn't fail the surgery, the surgery failed you. The VSG simply doesn't have great long term results, especially if one has a broken metabolism. It requires dieting your entire life and let's face it we could successfully diet would we need a bariatric surgery.

As far as stretching your sleeve I doubt it is much larger than it was originally. That portion of the stomach just doesn't stretch like the RNY pouch. Studies have also been done showing that with the DS a larger sleeve compared to a smalle sleeve has no different EWL in the long term.

A DS sounds right for you so please ask away with your questions. You will find that I am a huge Hess Method proponent for the DS because it customizes your channel lengths based off your small bowel length so it gives the best chance of optimal weight loss. Not too much like me and not too little lie others. Please search for a surgeon who performs the Hess Method....and yes Esquerra does for the most part a Hess DS.

I am glad you found this site aa there is a wealth of knowledge here and some really good people.

 

[Larra]

Hi and welcome! Scott got it right. You didn't fail, the operation did. You have no restriction, and since that's the only tool you get with the sleeve, that means you have nothing to help you and your broken metabolism. Many people with sleeve or gastric bypass find that, to maintain at even a weight above their goal, they need to eat about 800 calories/day. That effort, for most people, is not sustainable.
I think Dr. Esquerra would be your best bet. Just 2 things - first, you may need an upper GI or endoscopy to determine whether or not you need a re-sleeve. Second, I've heard somewhere that Dr.Esquerra only accepts patients with a bmi below a certain level, perhaps 50. I don't know what your bmi is at this point, and would recommend you ask his staff about this. I think this is a precautionary measure since most of his patients are coming from far away.

 

[DianaCox]

First find out if Medicaid covers it - it depends on the state and the program. I found this - it isn't current, but it appears to indicate that bariatric surgery is covered under some circumstances (indicating you have to get preauthorization for it on page 12 of 54): http://www.buckeyehealthplan.com/fi..._BCHP-OH_Member-Handbook_West-NE_20141215.pdf


As for your family, tell them you are having the second part of a staged surgery, one for which you hoped the first stage would be enough, but clearly it wasn't. But yeah, you shoulda had a DS.

 

[Butterfly]

Hello and welcome @Butterfly! Dr. Esquerra is well-known and has a good reputation, and I echo the above sentiment that he is the only surgeon in Mexico that I would recommend to a friend or family member after being on the bariatric boards for years and reading about people's positive experiences with Dr. Esquerra and some really horrible experiences with others. The DS is difficult and surgeon's level of skill and experience with DS is paramount. All the best!

Thank you! I am definitely going to be contacting Dr Esquerra's office tomorrow to get more information. I've had a couple of people give me two other names of surgeons in Mexico, but Dr Esquerra is my first choice if I head down there. Thanks so much for responding.

Welcome.

You didn't fail the surgery, the surgery failed you. The VSG simply doesn't have great long term results, especially if one has a broken metabolism. It requires dieting your entire life and let's face it we could successfully diet would we need a bariatric surgery.

As far as stretching your sleeve I doubt it is much larger than it was originally. That portion of the stomach just doesn't stretch like the RNY pouch. Studies have also been done showing that with the DS a larger sleeve compared to a smalle sleeve has no different EWL in the long term.

A DS sounds right for you so please ask away with your questions. You will find that I am a huge Hess Method proponent for the DS because it customizes your channel lengths based off your small bowel length so it gives the best chance of optimal weight loss. Not too much like me and not too little lie others. Please search for a surgeon who performs the Hess Method....and yes Esquerra does for the most part a Hess DS.

I am glad you found this site aa there is a wealth of knowledge here and some really good people.

I admit, your post made me a little teary. I've felt like such a failure because I've spent $14K on something that just seemed to stop working. I KNOW that I messed up by gaining weight back/eating wrong, but 1 pound lost in the last 2 weeks? I'm walking daily and most days eating only 800 calories. I don't know what else to do. Thank you for the info, I'm going to try to read up on the Hess Method.

Hi and welcome! Scott got it right. You didn't fail, the operation did. You have no restriction, and since that's the only tool you get with the sleeve, that means you have nothing to help you and your broken metabolism. Many people with sleeve or gastric bypass find that, to maintain at even a weight above their goal, they need to eat about 800 calories/day. That effort, for most people, is not sustainable.
I think Dr. Esquerra would be your best bet. Just 2 things - first, you may need an upper GI or endoscopy to determine whether or not you need a re-sleeve. Second, I've heard somewhere that Dr.Esquerra only accepts patients with a bmi below a certain level, perhaps 50. I don't know what your bmi is at this point, and would recommend you ask his staff about this. I think this is a precautionary measure since most of his patients are coming from far away.

I really don't have much restriction, it's true. I'm sure if I tried to eat a whole pizza like I used to that the restriction would kick in, but I rarely ever eve felt it so it really does feel like I'm doing this by myself at this point. Right now my BMI is at 55 so I would need to lose some weight, but if I am to do this it won't be before May of 2017 when I have a break from college. I'll need to be at about 300 pounds to be under 50 so I've got work to do in the meantime. Thank you SO much for your response.

First find out if Medicaid covers it - it depends on the state and the program. I found this - it isn't current, but it appears to indicate that bariatric surgery is covered under some circumstances (indicating you have the get preauthorization for it on page 12 of 54): (link removed, wouldn't let me post it)
As for your family, tell them you are having the second part of a staged surgery, one for which you hoped the first stage would be enough, but clearly it wasn't. But yeah, you shoulda had a DS.

Thank you. How kind of you to even try to look that up for me! My very first call tomorrow will be to a surgeon here in Ohio who does the D/S. On his website he lists the Medicaid program that I'm on as one of his insurances, but I'm wondering if it's just for the sleeve or RNY. I've seen a few websites say that Medicaid doesn't pay for a D/S. That could have changed though, and I want to find out from him. I guess I could try to have his office file for a pre-certification even if he's not sure it would go through. I guess I could also just have Medicaid pay for a revision to an RNY, but D/S seems more for me.

I like your wording on what to tell my family! Thank you again for your response, I've felt so lost and frustrated.

Thanks to you all.

 

[DianaCox]

You WILL tell us who your proposed surgeon is - we pretty much know them all, and know their qualifications.

And under no circumstances "settle" for an RNY - you already have half a DS, and there is a reason we call the gastric bypass "Ruined - and WHY?" It doesn't work long term for the vast majority of people, especially when you've clearly got metabolic issues AND have "failed" a prior bariatric surgery.

 

[Butterfly]

You WILL tell us who your proposed surgeon is - we pretty much know them all, and know their qualifications.

And under no circumstances "settle" for an RNY - you already have half a DS, and there is a reason we call the gastric bypass "Ruined - and WHY?" It doesn't work long term for the vast majority of people, especially when you've clearly got metabolic issues AND have "failed" a prior bariatric surgery.

The website that I was looking at had given me a Dr Teel who was covered under my plan, but when I called the office I found he is no longer with them. They gave me the name of Dr Mujeeb Siddiqui and said he does the D/S for Caresource (my insurance) but that he "usually" doesn't do revisions. They said I can either come in for an appointment (an hour away from me, but I'm willing) or have my sleeve surgeon fax over my surgery report and progress notes to see if Dr Siddiqui will do it.

I called Caresource directly to see if they covered the D/S and got a woman who seemed a little clueless. At first she said they just cover the RNY and the lapband. I said "That's it? I wasn't aware anyone was still doing the lapband? The office I called said that Caresource has paid for the D/S for patients" and she said "Yes." I then asked her why she told me just those 2 were covered. She sort of stammered and said "Those are examples." So I'm honestly not sure.

I guess the first step is to call my surgeon and ask him to send the fax to their office. I may also request an appointment as well.

 

[DianaCox]

You need to get a copy of your Evidence of Coverage (your actual insurance contract, about 100 pages, that explains coverage and exclusions in DETAIL, as well as the appeal procedures), as well as their bariatric policies. Then you need to figure out which bariatric surgeons they cover.

Teel is gone, and if I recall correctly, good riddance. Siddiqui sounds familiar to me, but I'm not sure how much we know about him.

 

[Larra]

Never, EVER trust what some low level insurance employee tells you over the phone. EVER! They know nothing about bariatric surgery (with rare exceptions) it's all the same to them. They just answer you as fast as they can so they can move on to the next person in the line. No one cares about this as much as you.
Dr. Siddiqui is a vaguely familiar name, though I'm not sure why. If you are interested in him as a potential surgeon, make very sure he does the DS, AND that he does revisions even though revision from sleeve is done by all the DS surgeons I can think of, AND make sure he does the real DS and not something variously called loop DS/aka SADI/ aka SIPS, that is not the same as a DS but some surgeons are calling it the DS. There are strange things that go on in the world of bariatric surgery, and you need to know this and ask the right questions.