Newly considering revision and need some guidance

Katherine

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Joined
Nov 13, 2015
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Hello! I had RNY in 2003... lost 80lbs and kept it off for about 9 years. I have hypothyroid and have gained it ALL back in the last 3 years and am STILL gaining. I have lost and gained the same 10-15lbs over the last two years and have gained 15 lbs n the last three months alone. I had intended on going to Mexico and get RNY to DS. The Dr's website and the brochure they sent me said they did this surgery. Then they told me it is not possible, and finally admitted it is possible, but only by 2-3 surgeons in the world.

I was self pay the first time and according to my insurance company they will not pay for a revision if the first surgery was not covered by insurance. My BMI is 39, and was when I had the first surgery, so I qualify. I recently called a Dr. in Dallas and they said self pay was $22k. Well I don't have that kind of money! So I don't know if I should go with the revision to distal RNY, if there is any point in attempting to appeal with the insurance, save for the next several years for self-pay, or just crawl under a rock!

I was revision to a DS because I don't want to even think about the possibility of eventually needing a third surgery. I just feel a little overwhelmed and don't know where to go from here. I live in Texas, but am willing to travel to a surgeon. Any advice?

Thanks,

Katherine
 
Welcome, @Katherine
The Dr's website and the brochure they sent me said they did this surgery. Then they told me it is not possible, and finally admitted it is possible, but only by 2-3 surgeons in the world.

Sounds like the surgeon you contacted doesn't even do the DS. While the RNY to DS surgeon list IS small, it's more than 2-3. http://bariatricfacts.org/threads/current-list-of-known-rny-or-lapband-to-ds-surgeons.1403/

I just feel a little overwhelmed and don't know where to go from here. I live in Texas, but am willing to travel to a surgeon. Any advice?
Dr. Greenbaum has the best self pay price. Maybe contact him?
 
Welcome! I am in a similar situation and need to self-pay for the revision. Dr. Greenbaum's price is about $23,800 and while less than others, it is still a considerable amount of money. Check the Obesity H website for postings regarding the distal RNY. After readings the posts about malabsorption side-effects and poor results, I knew it was something I did not want.
 
Have you already been to this website on the 7-day pouch test? http://5daypouchtest.com/
Getting back to basics is a wise move,\.

But the 5 day pouch test is a made up test by a RNY'er on OH who created it for shits and giggles. Long term it doesn't help at all. If the stoma is stretched ain't nothing gonna fix that one outside of surgery.
 
Thank you for your responses. I emailed Dr. Greenbaum and literally, not only did I get a response within 15 minutes, but it was from Dr. Greenbaum himself. He said his institution is currently revising the self pay cost so he cannot quote one at the present moment, but he would get back with me, and that he would like to have a phone consult do discuss things further. Dr. Ayoola (sp?) in Tx has a self pay price of $22k. I think it is unlikely that I will be able to have the surgery if my insurance won't reconsider.
 
Thank you for your responses. I emailed Dr. Greenbaum and literally, not only did I get a response within 15 minutes, but it was from Dr. Greenbaum himself. He said his institution is currently revising the self pay cost so he cannot quote one at the present moment, but he would get back with me, and that he would like to have a phone consult do discuss things further. Dr. Ayoola (sp?) in Tx has a self pay price of $22k. I think it is unlikely that I will be able to have the surgery if my insurance won't reconsider.
While you wait for prices, also take a solid look at your insurance to see if there is any way around it. If you need help with that, we have two members who will help you figure out what you can do.
 
Rather than just talking with some random insurance company employee by phone, get a copy of your EOC (evidence of coverage) and read what it says about coverage for revisions for yourself. The people who work there have no interest in your wellbeing, and even the nice ones aren't always right. The person most likely to read the specifics of your policy correctly is you (and we can help you if there is something confusing). The EOC is a lengthy document, not just the summary of benefits they routinely provide. If you get your insurance through your job, your HR dept should be able to provide it, or spouse's HR if insurance is through your spouse. You may, or may not, also have appeals rights, and your EOC will have this info as well.
Regarding distal RNY, there is no proof that it helps significantly with weight loss unless you go to ERNY (e for extended) which leaves you still stuck with the pouch and stoma and all the problems from that, such as dumping and not being able to take NSAIDs, and adds to that the vitamin issues of the DS. Many of us consider it the worst of both worlds, though there are some people who have made it work for them. The only advantage of ERNY that I can think of is that the surgery carries less risk than RNY to DS revision, which is a very complex surgery and, as you have learned the hard way, not done in Mexico. Probably just as well, the complication rate is high and recovery can be prolonged.
Sounds like your hypothyroid may not be adequately treated. Make sure your levels are good, and if you are symptomatic even with "good" levels, maybe consult with a specialist. There is no surgery that will find hypothyroidism.
 
I was never told not to take NSAIDs. This is the first I've ever herd of that. I use them when I need a pain med for headache etc. Thankfully, I have never had an ulcer or acid reflux. I do have dumping syndrome, but haven't had an episode in years because I've learned what not to eat.... its a good training tool for sure! The only 'complication' I have had from my RNY is I am now lactose intolerant. However, I can imagine that dumping syndrome would be HUGE with a ERNY. I have an appointment with a specialist for my thyroid and am going to ask about armour thyroid, which is dessicated thyroid and liver. I have heard people who have had a difficult time with their thyroid have had good responses.
 
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@Katherine I don't think you understand the anatomy of your gastric bypass. Dumping is related to food passing too rapidly from the pouch through the stoma. So whatever dumping you have now you would still have with distal RNY or ERNY, no more no less. We don't (or very rarely) see dumping with the DS because we maintain the function of the pyloric valve to regulate food leaving the stomach.
The part about no NSAIDs certainly should have been discussed with you before your surgery. Maybe it was but that was a long time ago. In any event, the risks are related to two things: the diminished blood supply to the area of the anastomosis (connection) of the pouch and the stoma, and the presence of the blind stomach. With the DS we have neither of these things. You are very fortunate that nothing bad has happened to you with the NSAIDs you have taken.
Acid - very unlikely to cause problems with gastric bypass. This is one of its few advantages.
Lactose intolerance - same problem with the DS.
 
I was never told not to take NSAIDs. This is the first I've ever herd of that. I use them when I need a pain med for headache etc. Thankfully, I have never had an ulcer or acid reflux. I do have dumping syndrome, but haven't had an episode in years because I've learned what not to eat.... its a good training tool for sure! The only 'complication' I have had from my RNY is I am now lactose intolerant. However, I can imagine that dumping syndrome would be HUGE with a ERNY. I have an appointment with a specialist for my thyroid and am going to ask about armour thyroid, which is dessicated thyroid and liver. I have heard people who have had a difficult time with their thyroid have had good responses.
I would also urge you to try real thyroid. I have several friends who found the synthetics had stopped working. The theory is that the pills are now being manufactured in other countries and something has changed their effectiveness. I have no idea if this is true but these 3 people have had much better luck with the real thing.
 
Larra, I know the dumping is due to not having the pyloric valve, I just thought food entering lower in to the intestine would intensify the symptoms, but thats good to know that it won't. What I don't really understand is the difference between what was done to my intestines in RNY and what is done to the intestines in the DS. I've read several descriptions, and am feeling a little slow, but I'm not getting it.
 
@Katherine, they are completely different operations, and there are illustrations somewhere on this website that I would recommend. I'll give a brief description:

with gastric bypass, your stomach is partitioned to form a tiny (1 oz these days) pouch at the top of the stomach, and the rest is left in as the "blind stomach". The small intestine is divided not too far down and connected to your pouch in a RNY configuration. So, most of your stomach, the entire duodenum and a little bit of jejunum is bypassed. Gastric bypass works mostly by restriction (tiny pouch) and has minimal malabsorption fo calories, but has permanent malabsorption of B12, calcium and iron, and maybe other B vitamins.

DS has a stomach shaped roughly like a sleeve and most of the stomach is removed (no blind stomach, no pouch, stomach empties as always through the pylorus). The duodenum (the part of the small intestine right after the stomach) is divided not very far past the stomach. The small intestine is divided roughly half way along and the LOWER half is connected to the duodenum, meaning that about half the small intestine is bypassed. The UPPER part of the small intestine is reconnected to the lower half to create a common channel, which is where the food and the digestive enzymes meet. this creates a lot of calorie malabsorption, esp of fat and somewhat of protein.

I think reviewing diagrams of both operations will help you. To revise from gastric bypass to DS your entire gastric bypass must first be restored to the normal anatomy and THEN the entire DS created. that's why it's high risk and so few surgeons do it.
 
I've never heard of a so-called denial based on "they will not pay for a revision if the first surgery was not covered by insurance" - that sounds like bullshit. There MAY be a one-bariatric-surgery-per-lifetime limitation, but it's different enough that it sounds like the person you were talking to was blowing hot air.
 
Thank you everyone. I have passed my insurance info to Dr. Ayoola's office, perhaps they can get further. Larra, I did look at the diagrams but I understood the explanation you gave me much better! So, I've seen that DS ppl do much better than ERNY... as more intestine is bypassed in the distal RNY, it seems like the presence of the pyloric valve must somehow account for the better outcomes? Or is more intestine bypassed in DS than even a distal RNY?

Thank you all for helping to to understand all of this.
 

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