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Hey everybody, I just started my journey this week! The good news is Aetna, my insurance company, and probably many of yours, has revised their obesity surgery guidelines effective May 1, 2020. They have removed the need for weight loss or maintenance of 3 months or 6 months, and now only require 12 intensive appointments in a multi-component program that you are most likely already in the middle of :) So great news... I also talked to the insurance peeps yesterday and asked specifically about the 12 intensive appointments, and they said, it was just a number to guarantee that you were an established bariatric surgery patient following a program, but that the new guidelines were now just based on approval of completing your doctors program!!!!!! Spread the word, you could be a lot closer to a surgery date than you thought :) I have attached the url to the medical bulletin below :) http://www.aetna.com/pharmacy-insurance/healthcare-professional/documents/obesity-surgery-precert-form.pdf On April 21, 2020 this revision was made on the medical bulletin and can be found here http://www.aetna.com/cpb/medical/data/100_199/0157.html#dummyLink2, under the review history on the right side bar, then look for 04/21/2020 "This CPB is revised to state that bariatric surgery is considered medically necessary when criteria are met and member has participated in an intensive multicomponent behavioral intervention designed to help participants achieve or maintain weight loss through a combination of dietary changes and increased physical activity. The intervention must be intensive (12 or more visits) and occur within 2 years prior to surgery. This CPB is revised to remove the requirement that the member maintain or lose weight during this program. This CPB is revised to state that bariatric surgery for is considered medically necessary for adults with a BMI greater than or equal to 35 with nonalcoholic steatohepatitis (NASH), and for adolescents with a BMI greater than or equal to 40 with NASH, when criteria are met. This CPB is revised to require cardiac clearance, obstructive sleep apnea screening, and optimized glycemic control as prerequisites for obesity surgery." I SOOOOOO Hope this makes someones day :) So glad to be here! Aetna PreCertification.pdf

In my opinion WLS is a magic bullet. It is the game changer when it comes to losing excess weight and maintaining the new weight. We don't always succeed on the first try. Sometimes people need a second try or maybe even a third. Inadequate weight loss after lap band is quite common, revision to bypass also and many patients do quite good after revision. Maybe you want to do a quick medline search about this. You're now a few years older and more experienced. Maybe you're now being able to handle problematic things in your life differently. You might also be more disciplined now when it comes to certain things. Think about your younger self and compare it to your now-self. I'm sure you're able to handle things way smoother than you did e. g. 10 years ago. The same can be true for this whole weight loss thing. Of course there is the chance that you might fail again. There is always the chance of failing, doesn't matter if it's weight loss, learning a new language or performing at your job. If we couldn't make these changes before any WLS at all, why is it possible for so many people after they had WLS? It just is because WLS is the game changer. Lapband is different. It doesn't provide the same hormonal changes a bypass does. I always cringe when I read or hear this. "Dedicated". "Eliminate". "Avoid". Same with "struggling", "fighting" or "food is the enemy" etc. - being at war is so damn exhausting. Make peace with food. It's easier in the long run. If you don't white-knuckle things you might discover something interesting: not all lifestyle changes are a struggle or need dedication in the long run. You might indeed discover (or re-discover if you were into sports in younger years) that exercise can be fun and fulfilling. Or that healthier food doesn't taste that bad. Or the opposite around, that this junk food is actually not as tasty as you always thought it is. You might discover, that when you feel more comfortable in your body and with yourself that you don't feel that need to eat in the same strong and overwhelming way. You might notice that you say "No, thanks but I don't want it now" when you get offered French fries or chocolate or whatever and really mean it. However, there are many people who aren't able to maintain their "new lifestyle". I have no idea what makes or breaks this. I sometimes have thoughts in the back of my head that maybe some people are just lucky in reacting very good to WLS and don't actually need to watch their intake that much. They also don't live in the gym. When you browse around the board you're going to notice that maintenance calorie intake is very different in different people, even though their stats are quite similar. Nobody can tell if WLS/revision to bypass is making it easy (or less hard) for you or not. I sometimes feel it's like playing the lottery. You won't know to what group of patients you will belong before you got the revision. Short term weight loss doesn't really bring some benefits (someone correct me if I'm wrong please), however, one doesn't have to get to a normal weight to reap the benefit of weight loss. So many patients feel like "failures" because they don't get to a normal BMI. Yet, when you look at the studies actually not that much patients ever get down to a normal BMI. And sh*t on "eliminating carbs". Like really take a big dump on it. (Years ago we should eliminate all fats, now it's carbs. I wonder what the future will bring.)

I’ve read over and over again that WLS is not a magic bullet. It takes dedicated, sustained lifestyle changes. But, if we can’t maintain those changes (eliminate carbs, low calorie diet, avoid trigger foods) before surgery, how can we expect to maintain them after surgery? I’m thinking long term here: 5, 10, 15 years after surgery when the magic of weight loss is gone and it’s just daily life. If I can’t stop eating now, how could I expect that to change in 10 years? Really looking for help here. I had lap band surgery in 2014 and I weigh 15lbs more than my highest pre-surgery weight. I gained back all weight I lost and more, and have the same bad habits. I’m thinking of revising to gastric bypass, but I’m wondering if I’ll just fail again. BUT, if I can theoretically make a sustained life-style change post-surgery, why can’t I actually just do that now? (I try, every single day, and I fail week after week). I feel like it’s possible or impossible. If surgery doesn’t make it easy, what benefit does it have beyond short term (1-3 year) weight loss?

I had a lap band for 11 years also and starting having major issues with it the last two years. I lost 80 pounds and regained half of it. When I got it removed they discovered it had slipped up around my esophagus and caused a hiatal hernia. My surgeon removed the band, fixed the hernia and revised it to a gastric bypass all in one surgery. That was only a bit more than five months ago and I already weigh less than the lowest weight I got after my band. So far I have been pleased with the decision and haven't regretted it--other than wishing I had gone with the bypass in the first place! Good luck to you!

I’m sure I’m right behind you, here on Long Island NY. I’m sure mr cuomo will follow suit. Grrr. I agree about certain things but I’m a revision and in so much pain everyday.

Good for you!!! Rock it! You’ve got it! my revision was 3/18 to 4/29 and nothing. I’m hoping the governor will open up 5/15 but I doubt it. I’m in NY.

NY here, Long Island - we are only 2/7 in the phasing. I've been postponed twice, with no date pencilled in yet - I'm so antsy - it's a revision, so I'll deal, but my hernia is so panful and the surgical coordinator said I'm one of the first in line when we do open up. Received a explanation of benefits from my pre surgical testing visit, which was 6 days prior to my surgery and they are denying my claims because I didnt get surgery 21 days later... protocol I guess. I guess I have to call and fight it - I mean, I was scheduled 3/18, cancelled 3/15 for the COVID issues. then was 4/29... I guess they'll have to see or be told what happened .. I hope they pay the bill

I was rescheduled yesterday for May 11th. Revision Band to Bypass

May 6th scheduled today! Revision band to sleeve.

I had my surgery in February, so I'm not that far behind. I'm not gonna lie. The first week is awful. I remember texting my family telling them I had "buyer's remorse," and that I thought I made a really bad decision. I seriously thought I'd made a big mistake. Much of it was getting the anesthesia and pain meds out of my body, which took about 4 -5 days. But it gets A LOT better, I promise. After about a week or two, I felt pretty good, still sore, but not so miserable. And now, about 8 weeks out, I feel great. I lost a good amount of weight, am back to eating normal texture food, and exercising without restriction. 8 weeks may seem like a long time, but it goes by before you know it. I feel 100% myself, now--but that first week or so...UGH! Have patience, follow your doctor's advice and don't worry. You're body just underwent some major internal revisions and it will take some time to get used to it. Most people I know were in the hospital for two nights following surgery, so if you got out after one, your doctor must be happy with how your are doing, even if you don't feel so great. In the meantime, take small, frequent sips of Gatorade or Pedialite, or try a sugar-free ice pops (they were my salvation!). Watch some Netflex, read a good book, and allow yourself to heal. You will get there

I'm like NovaLuna--I was so happy about getting my slipped lap band revised to RNY that I would talk to anyone that was willing to listen!😁 Now that it's five months out I'm a bit more private about it. If anyone asks I tell them, but most don't.

Me neither. The less weight you carry, the harder a calorie deficit is both on the body and on the mind. I never thought much about this until my recent post-op liquid phase. It was godawful this time and I had truckloads of cravings for just normal food. Sandwiches with cucumbers, rice with tofu, salat with tuna... Yes, the liquid phase wasn't exactly fun after my first revision and while I wasn't heavy by WLS standards I did carry some extra weight from the unfilled and failing lapband and the calorie deficit I was in for some time didn't feel as awful as it did this time. So when people who've regained some weight but are still only slightly overweight by BMI maybe should be careful when deciding on how aggressive their calorie deficit should be to lose the weight again. Yes, a less aggressive calorie deficit takes more time to lose the excess weight, but IMO "back to basics" 800 kcal a day or even less is not a very wise thing to do.

Very helpful, informative book for those of us who like to read, hi-light, underline and review. Dr. Matthew Weiner, M.D., bariatric surgeon explains one surgery vs. another including revisions, why some lose faster than others, why some are more successful over time than others. Not preachy nor judgmental in any way, just factual. Explains how our bodies go through hormonal changes post-op to establish a new metabolic set point. 150 pages, easy read in one sitting. $11.99 on Amazon for paperback. Well worth it!

Just guessing but I always assumed its the different modalities of caloric restrictions that keep the numbers nearly the same but I think no one really knows because some people's BMRs seem reset to a higher threshold while others have it lowered. I honestly feel sometimes that these revisions are like a third category of WLS with totally different expectations, outcomes, complications etc. than a virgin surgery. But I also think it's not across the board as a rule that it will be different. But I have encountered a few people that have noticed it feels/works different than what they are used to from their initial surgery. Also unless someone had a VSG first they likely do not know how that type of restriction feels compared to an initial RNY restriction. I don't have a clue what a virgin RNY is like but I know what a virgin VSG converted to RNY is like (to me) and that SUPER strong restriction disappeared (but its not an issue for me because I didn't need to lose more weight or count on it for controlling meal size) so I can see how it would be worrisome if someone was counting on it.

Ah yes, had that happen only yesterday again, lol. Sometimes I forget that it will take some more time after revision before being able to get to my personal "bypass normal eating". I also have a bit of a stomach ache today. Woke up with it and it feels like I ate something yesterday that obviously didn't sit well though I'm not sure what it could be. Hopefully I will be able to tolerate the same foods with the RNY than I did with the MGB. I was doing fine both physically and mentally with the amounts and kinds of food I could eat. 😖 Maybe the changes you need to make aren't that big in the end? "I need to make big changes" - only thinking about having to make big (most likely unwanted and uncomfortable) changes would scare me away from wanting to do it and postponing it into a vague future that most likely won't happen anytime soon if ever. 😳

1) most people do not lose weight nearly as quickly with a revision as they do with a "virgin" surgery 2) your nerves have been cut, so you may not feel full for awhile. Once they start regenerating, and once you're eating solid foods again (if you haven't started already), you should start feeling that again 3) are you on a PPI? A lot of us are on PPI's the first 3-6 months post-surgery, even with RNY (I was on it for a year, but that was before the bad press about them came out. i'm guessing my surgeon is now limiting it to a few months). There may be a chance the GERD will yet clear up...

I just had a revision on 3/9 I had a sleeve 8/2016. I lost 50 lbs. I had GERD before the sleeve but not too bad. The first 2 years after sleeve my GERD was nearly gone. BUT then it came back with a vengeance. It was awful, waking from sleep with bile in my throat, burning all day everyday, and the tightness in my chest. Top that off with a hernia and a fold in my sleeve. I started gaining weight back because crackers and bread were the only thing that made me feel better.My Dr gave me 2 choices, live with it, or do revision. I lived with it for about 8 more months and could no longer do it. I was honestly afraid to do another surgery. I am in week 6.5 post surgery, and am very disappointed at my weight loss so far. I lost 13 lbs, the first 3 weeks and only 1-3 the next 3 weeks. I'm only eating 700 cal a day an losing nothing. AND I have had days where I have some GERD. I am taking my meds and they help but I thought I would have none. The biggest issue I have is the fear that I feel totally different. With my sleeve I felt full really quickly and knew when I was full. So far I feel like I can eat more, I haven't, but I feel like I will be able to. I don't get the same feeling. My thought was that at least I'll lost weight after doing this again, but it doesn't seem like that will be happening.

I'm also struggling. I guess boredom is a little bit of an issue, but I'm a happy introvert so staying home for long periods of time is not a big problem. But because I live in a small apartment, the kitchen is always a few steps away. It's hard to keep track of time since I don't have a regular schedule and I've stopped tracking. I just had a revision 7 weeks ago but I feel no restriction - I can eat whatever I want. To be clear, I don't (but I could). It's really hard to stick to tiny portions when they are so unsatisfying to eat. I've realised that I just enjoy the act of eating/chewing. It doesn't matter what. So I need to be careful about that. But I'm sticking to protein and veggies (mostly) and the weight is still slowly coming off. I usually get my 10,000 steps daily (a two-hour, 7-8 km walk at night, usually after 9 p.m.) which is keeping me sane. I find the most important thing for me is to keep busy and not in front of the computer! I start teaching online in 2 weeks so that will give me a bit of a schedule, but I need to work out how I can get my work done, but still do other things as well, including going outside for some fresh air and sun. Not sure how it'll work out. I live alone, have already been self-isolating for 6 weeks and will have about 4 months more to look forward to (unless things dramatically get better). The struggle really hit me this week. I've decided that I also need to start doing some weight training and core exercises, to help keep my body conditioned.

Hello everyone! I'm brew here hoping to get myself back on track without needing a revision. I was was close to my goal weight of 188lbs, 3 1/2 years ago. I was blew out my knee and bulged discs in my back when I was an EMT. Being laid up on crutches and in constant pain; the weight slowly creeped back. I'm in the 250lb range now. I'm fighting to get the weight back off now that I'm mobile. I was 360lbs when I started my journey, do not want to wind up back there. My PCP has put me back on thyroid meds and metformin hoping it will aide in weight loss. So far nothing. Not gaining but not losing either. I having invested in vitamin patches and would like to try the pouch reset. Has anyone else tried this? What was the result? I am also a Weight Watchers member. I am looking for support outside of my family and to make me friends. Thanks for reading!

I had my surgery (not DS - revision to long-limbed RNY) on March 3rd 2020 and in the past couple of weeks I've noticed the same. The smell is so bad it lingers for a long time and every time I go past the bathroom I think I just stock up on some air fresheners, even though I live alone. A lot of clay coloured stools, but sometimes there are darker ones too (sometimes at the same sitting). Thankful I can work from home for the next few months and I can figure out which foods are more problematic than others.

Some of us have a much longer bypass - mine was 150 cm. This may be more common for revisions though - the main reason I chose it is that my surgeon explained to me that a revision to a regular bypass (short-limbed) is not as successful as a longer-limbed revision, similar to a MGB, but without the possible GERD complication. Anyway, now that I'm eating normally (only 6 weeks out - seriously, no restriction, no other problems), the gas and smell is a major issue everytime I go to the toilet. I'm thankful that I'll be working from home over the next 4 months, would hate to have to deal with this at work!

I was put on Actigall after my sleeve in 2013. After a RNY revision in February it was not prescribed. Different docs do different things.

Yes, I am still overweight and I am in my range but the way that it has been explained is that I have hit this point too soon and should not be losing weight at this fast of a pace. I journaled on my own after my Dr. told me that I would most likely need revision surgery. All of my blood work, which is done every 3 months, always comes back great. I kept a food journal on my own and I was able to slow it down to a loss of 2-5 pounds per month. I was blessed enough that insurance paid for my surgery.

I wish I knew how frustrating the stalls were gonna be. Hadn't made me regret a single thing, but they are soooo frustrating! I wish I knew that people aren't going to mention that you look like you are losing weight. I'm down 50 pounds, and have only had TWO people say anything. Again, no regrets, but a little feedback for your hard work helps! My ONLY regret is that I wish I hadn't mucked around so long with my lap band before I decided to revise to RNY!

Leslie... I am considering a sleeve revision with the same dr. How did it go?