Are revisions REALLY necessary?

[Babbs 14,680]

@@Travelher

Oh, I'm not a bander, I'm a sleever. I've just made the observation after almost 3 years on this forum

[teedsg 250]

There are many reasons for having a revision and it's not always due to eating too much. Just my 2 cents

[Butterflywarrior 241]

I really think it depends... some people did not address there underlying issues due to lack of support, insurance issues etc. But some people really screw up despite help and should not get revision unless they are truly ready for change but there are many reasons a revision may be necessary

I kinda feel like some of us are way to critical, judgemental and even self righteous

The government and many plans allow drug a alcohol addicts multiple expensive admissions into rehabilitation without a blink.

People. Who smoke like chimney are allowed transplants,. Chemo etc

Why are we so critical about WLS and eating addictions

Nothing is really one size fits all...

[gpmed 623]

For me personally, I believe I received a tried and true WLS method when I had RNY. It's been proven to work. If I ending up gaining back so much weight that I'd quality for WLS again, I will feel that I messed up big time. I can't say for sure what I'd do if I reached that point cause I'm not there, but I think I'd be too embarrassed to ask for a revision. I will have failed cause of me, not the surgery.

However, I disagree with the quote about the lap band. My hospital stopped performing that surgery more than a year ago because it just doesn't work well enough for enough people. So if someone had RNY or sleeve gastronomy after a band, I'd see them as getting the "right" surgery this time and not fault them so much for the first one not working. If they failed to change their habits so that RNY or sleeve didn't work, THEN I'd say it's on them.

Just my $0.02.

[shedo82773 1,236]

But bottom line with any of them was if the patient didn't drastically change their lifestyle, the revision was just as much of a failure as the first time around.

Hummm, but if the revision was made because of GERD or complications and the revision fixed these issues - isn't that a success in itself?

There was one surgeon in my area that refused to do revisions unless the patient first went through six months of psychiatric therapy to address their food addictions and/or eating disorders.

ockquote>Luckily my surgeon (she was the one recommending revision, btw) didn't insist on this after I made up my mind of actually getting the revision - might have been that I would have been admitted as an emergency during this six months period because my band was beginning to erode into the stomach when it was removed. Gastroscopy didn't show it, they only noticed it during the procedure of band removal so in the end I was lucky. I wasn't so fond of revision and between the first consultation and the second one was a time period of six months. I hoped, things might resolve on their own (kind of stupid, I know) because I didn't want to take the risk of two surgeries, even though I gained some weight back after the fill was removed from the band a year before I made the consultation at this center because I still had volume reflux and dysphagia sometimes, though removing the fill helped these issues quite a bit. I'm now back where I was before the fill was removed weight wise, a bit lower maybe.

What I'm trying to bring across here is, that it depends on the reason you're getting revision if therapy or nutritional counseling makes sense to try before getting a revision. I agree it makes sense if the reason for revision is weight regain. However, no amount of therapy or nutritional counseling will free you of certain complications. It might even be dangerous to postpone revisions, depending on the reason the revision is taking place.

However, in general I think most surgeons are a bit more differentiated in their opinions than it might come across on these boards sometimes.

The OP wanted thoughts on someone elses post in another forum. She also added her own and they included special circumstances. I would imagine that they would be mechanical problems etc.

As for my opinion, I hope everyone gets a good understanding of what they are about to do to their bodies and the requirement of their minds. The surgeon will help with the mechanics, but the mental part is totally up to each and everyone getting wls. If you're not able to change your relationship with food, any amount of surgery won't help in the long run. Well, with the exeption on having your mouth sewn shut...

And again, if there is a mechanical problem (slippage, gerd...) with your first wls, I'm absolutely for revision, if it is a viable option.

It's a touchy subject and I hope everyone gets surgery without complications and gather the emotional strength they need, before the surgery, to change their lives.

Nilla

Funny thing here...I had a freind that had her jaws wired shut because they broke it during the removal of her wisdom teeth. She had stuff like chicken and homemade noodles whisked up in the blender. She sucked it thru a straw between her teeth!! So I'm sure if someone wanted to eat with their jaw wired shut it CAN be done. LOL Funny stuff. I was afraid she uld choke to death.wo

[LipstickLady 25,682]

I love love love that most of us were able to have a friendly discussion on what could possibly be considered a controversial topic like adults. Only a few incidents of indignation and one borderline name calling incident a few posts above.

It's really refreshing!

[Babbs 14,680]

I love love love that most of us were able to have a friendly discussion on what could possibly be considered a controversial topic like adults. Only a few incidents of indignation and one borderline name calling incident a few posts above.

It's really refreshing!

We've got a few really awesome newer members that I think really helps with the tone of things.

You know who you are

[LisaMergs 2,854]

@@Babbs

Agreed.

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[jess9395 5,448]

@@theantichick

I always hate hearing about people who tested negative for RF and their docs didn't go ahead and treat for it even though all the S&S were present. I'm so glad you're with docs who did!!! That alone helped you avoid any degeneration.

First time I saw my rheumy, he said, " we will run the blood work, and see what it says, but if it walks like a duck and quacks like a duck, I don't need to see it swim like a duck". Thank goodness. As it were, my factors, ESR etc were all through the roof.

Have you had the Vectra DA bloodwork done? If not, I would HIGHLY rec you ask your docs to run it. Very specialized test, needs to be sent out to a special lab, but what they can see on it is AMAZING!!!!! I can't recall my actual numbers, but for argument sake, say a score of 25 out of 100 said moderate disease is present, mine was like an 86!!! Crazy!! This was 3 months prior to my bypass, a year ago. They are running it again next month for comparative value. Should be interesting.

The test is highly specified, and truly they can see things on it that they can't with standard RA patient blood draws and labs.

Good luck sweetie!!!

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Yes! This has been my daughters experience as well, her rheumatologist told us almost 30% of RA patients are "factor negative" and blood tests are not as definitive as they once thought

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[theantichick 2,204]

@@theantichick

I always hate hearing about people who tested negative for RF and their docs didn't go ahead and treat for it even though all the S&S were present. I'm so glad you're with docs who did!!! That alone helped you avoid any degeneration.

First time I saw my rheumy, he said, " we will run the blood work, and see what it says, but if it walks like a duck and quacks like a duck, I don't need to see it swim like a duck". Thank goodness. As it were, my factors, ESR etc were all through the roof.

Have you had the Vectra DA bloodwork done? If not, I would HIGHLY rec you ask your docs to run it. Very specialized test, needs to be sent out to a special lab, but what they can see on it is AMAZING!!!!! I can't recall my actual numbers, but for argument sake, say a score of 25 out of 100 said moderate disease is present, mine was like an 86!!! Crazy!! This was 3 months prior to my bypass, a year ago. They are running it again next month for comparative value. Should be interesting.

The test is highly specified, and truly they can see things on it that they can't with standard RA patient blood draws and labs.

Good luck sweetie!!!

Sent from my iPhone using the BariatricPal App

Yes! This has been my daughters experience as well, her rheumatologist told us almost 30% of RA patients are "factor negative" and blood tests are not as definitive as they once thought

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And it doesn't have to be RA to be auto immune arthritis. too many doctors rely too much on bloodwork.

sent from mobile device

[Djmohr 6,965]

My whole purpose for having bypass was based solely upon anecdotal evidence showing that people with autoimmune disease specifically rheumatoid arthritis were going into remission after bypass. There was no evidence shown for patients who had the sleeve. My feeling was it was worth a shot. Worst case scenario oh would be that I would be able to drop some of the massive weight I had gained from all the medications there by alleviating the pressure and extra weight put on my already damaged and painful joints.

I was one of the fortunate who went into complete remission after my bypass surgery. I know coming off all the steroids had a huge impact on the significant amount of weight that I was able to lose so quickly. But let's face it there was still plenty that has had to come off with Hard work determination and a commitment to the tool and for lack of better terminology life altering life saving gift I was given.

Two things-

Forgive my lack of proper sentence structure I'm dictating this into the phone as I'm driving to pick up a child from school, and lipstick lady is right we are super groovy and big girls and don't take anything each other says with anything other than the intent in which it was stated.

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This is very interesting to me, since I also have RA/PsA. When we started discussing biologics, I asked my rheumy's opinion of WLS. She was enthusiastically behind it, citing WLS as many times reducing the inflammatory factors. However, she and my surgeon (and my research) all said that the bypass was NOT a good option for someone with auto-immune because of the complete contraindication for NSAIDs and steroids, where the sleeve only has a relative contraindication for those meds.

Not criticising you or your docs, just find it interesting how there are so many differing opinions in the medical community.

BTW, biologics are now off the table for me for the forseeable future. My inflammatory factors are down, and we still have dosing room on sulfasalazine and we haven't tried plaquenil yet. Mtx failed and I developed an allergic reaction to it, so at least I don't have to give myself chemo anymore! LOL. So the sleeve has worked amazingly well for me. Not remission, but meds are working better and we're able to avoid the real heavy hitters indefinitely.

It is interesting how doctors differ in their opinions. I have autoimmune diseases as well. Medications really truly were the reason i packed on so much weight so quickly. I have Psoriatic Arthritis and hypothyroidism.

At the same time, I had a very severe case of GERD causing me to cough every day all day for over a year with no solution.

We had to heavily weigh the right choice of surgery for me. GERD is 100% resolved, issues with pain control for my joints are an everyday battle and I can not and will not risk taking any nsaids even with treatment.

Because I have Psoriatic arthritis oral steroids are out as well as it kicks up the psoriasis so bad that it has caused serious infections that have caused me to be hospitalized over the years.

I also never over ate. However, I ate crap all the time so i was actually malnourished while being morbidly obese. In fact my family and friends could not understand how i was so heavy because they saw how much i ate, they just did not realize that all the carbs were killing me.

Anyway, since bypass I am still on biologics (Stelara) and Cyclosporine to keep my Psoriatic arthritis under control. It has been well controlled for the last 2 years so we have slowly be reducing the quantity of those medications. We tried lowering the dose of Stelara over a year ago and I went into a full on several month episode so we increased it back to where it was. We are discussing trying a reduction again in the spring as everything looks like it is going into remission. That being said, anytime i have surgery it seems to kick back up again so we are going to wait until after my plastics in January to try again.

The biggest thing about having WLS is the head game. You have to change the way you live and learn to make better choices. I think for the most part i have done this well. Of course there are times when i indulge but 90% of the time, I do have to fight with my head.

In the beginning, it was easier for me because even if i did indulge, the weight still came off.

Now that I am two years post op, those decisions matter. I will gain or lose based solely on my behaviors. I believe this MUST be true of anyone going through or that has gone through WLS.

Yes, some people will lose slower than others - I was one of them. It took me 18 months to lose my excess weight and alot of hard painful work to actually get there. Others have lost their weight of similar proportions within the first 12.

I am sort of glad it took me longer, and took me understanding that I am now in the drivers seat, not my pouch. What i choose to put in my body and how often will dictate whether i lose, gain or maintain. If i choose to get no exercise at this point, it will and does have an impact on whether i lose, gain or maintain.

I am in the drivers seat......not my surgery. The sooner some people realize this there will be less need for revisions in my opinion. Of course, I am NOT referring to those that have a equipment failure.

I personally feel that a surgeon that is considering a revision for those persons who failed to lose the weight (not by malfunctioning equipment/surgery) really do need to see someone to assist with why they have not lost the weight.

There is a nurse in my doctors office who had bypass surgery at the same time i did. I know this because she told me and seemed almost upset that I lost all of my weight and she has lost very little. She immediately blamed the surgery for not working. Then proceeded to tell me that her schedule simply did not allow for her to focus on herself so she is unable to get the right Protein and even fluids in her body. She skips meals and then eats whatever is handy in a few minutes in between patients.

Ok, that is not the surgery failing, clearly she is still following the same behaviors she was before surgery. Dont get me wrong, I get it....she is taking care of patients. But, there comes a time when we have to be selfish and focus on ourselves if we want to be successful in the end.

I literally started taking care of everyone else but me from the time I was 16 years old. I was a working married mother of 2 by the time i was 19 going through a horrible marriage. By 22 I was divorced and a single mother working 3 jobs just to make ends meet. By 25 i was remarried to my wonderful hubby of 29 years and working a high paying very stressful job. I did so well in my career and became the primary breadwinner. Well, then there was the stress of that so again, not taking care of me just working like a crazy person.

By the time i was 51 i was in big trouble health wise and was literally told, i would end up in kidney failure soon if i did not lose weight.

So, it was time for me to be very selfish and start taking care of myself.

For the last two years, I have been focused on my health and well being and when you are morbidly obese, that is a necessary part of getting your health back.

So, i say again......your head really has to change in order to be successful. It is why they send you for physch evals before this surgery. I honestly think they could do a better job of assessing patients and setting them up with the right people to help them through the mental part of WLS. Most of us need some sort of help.

[BayougirlMrsS 3,933]

My sister in law is a great example of this..... She went down to Mex about 9 years ago and had the band placed. She did fine at first... Lost some weight, but then stopped and started gaining it back. So she went to a dr. in NOLA that said she had a hernia (not sure what that had to do with it) but that he could see some issues with her band and that it was too small for her and would replace it when he did the surgery. And so he did... he placed a New band and again... it worked for a while and then stopped. By then i had my band placed Nov. 2009 and was have great success (still have it and still, knock wood, keeping weight off). So now i know how the band works and how to eat... blah blah blah.... and i noticed that she would eat chips, candy, ice cream... Instead of "food". So i ask, she said it was the only thing she could keep down... So when we did get together she would complain about her band not working. I suggested she go see my dr and see if he could help her. So she did and when he told her nothing was wrong with the band and that she need to see a PHY about her eating habits and underlying issues with food... Well that didn't go over and she said he was a quack and never went back..... Fast forward to two-ish years ago... she found a dr. willing to remove her band and do GB... This time was better, she lost and lost fast... had all kinds of PS for the skin... life was good for her..... THEN, it started happening again.... Yes she has stated gaining the weight back again.... So that's Three WLS for her.... I told my brother that it would happen again when i saw her eating... and sure nuff i was right.

I read about many of the issues with the lap band while I was intially researching WLS.

It seems that some bands were made of substandard materials, prone to corrosion or improperly fitted to begin with.

In those cases, i can understand not wanting to have something literally rusting or corroding on my insides.


As for the rest of it, I'm inclined to agree. I saw a post from a lap band to sleeve revision patient who has regained the weight and is now trying to qualify for a bypass. Personally, I think it would be malpractice to continue to operate on someone who obviously has an underlying issue that surgery will not address.

It might not be the answer that is popular, but all of the procedures work. Not following the diet is the part that doesnt work.

Huat eaeloer today there was someone inquiring about revision, and asking about eating mashed potatoes on liquids.

I'm deff not saying that the band doesn't have it problems... of course it does. But for me, i think a lot of it is user error. If you don't follow the rules it won't work no matter what. I learned this a couple years ago when i fell off the wagon and started eating the slider foods... but when i couldn't fit into my jeans... I looked with in and saw what I... was doing. Not the band... Me, the band wan't making me by chip and ice cream.. I was. Hopped back on the wagon, lost the 20 and 15 more.

My friend Tami had the sleeve a year before my LB and has gained most of her weight back...Friend Jenny had the GB in 1999 and has gain at least 50lbs back. It happens... sometimes i think we all get a little comfortable and lose site of who we are and where we are in life and it just gets away from us...

Do i support the revision for "actual" complications... YES.... But, sometimes it's so much easier to blame things and others for our failures instead of looking with in and taking ownership of our actions. In some cases i think the dr's are too willing to just go onto the next surgery and in some cases the next.... All about the dollar in some cases....

which ever the case, i wish everyone continued success and always remember..... What you put into it, is what you get out of it....

[KeepCalm 223]

That was my problem - I couldn't eat anything healthy/good for me, it would get stuck and come back up. I didn't gain though (until my unfill), probably because I was still going to the gym and riding my bicycle everywhere...

Awesome conversation! Thanks guys!

I also want to add some other insight and even empathy to banders. It has also been my observation that Protein rich foods ironically can sometimes be difficult for banders to eat. That causes them to choose foods like crackers and other crunchy carby stuff that break down faster and go down much easier, thus causing gain. Once again, that falls into the special circumstance category. If I were in the same situation and frustrated by not being able to eat without food getting stuck or making me sick, I would probably do the same thing.

[Travelher 915]

Hm just saw my third post on this site today re the band revision where the person indicates the band broke after pregnancy. That is when mine stoped functioning properly before it eventually broke. She had it happen twice! 2 bands broke, one after each pregnancy. She is now getting a revision. Wonder if that is a thing?

[Aggiemae 739]

That was my problem - I couldn't eat anything healthy/good for me, it would get stuck and come back up. I didn't gain though (until my unfill), probably because I was still going to the gym and riding my bicycle everywhere...

Awesome conversation! Thanks guys!

I also want to add some other insight and even empathy to banders. It has also been my observation that Protein rich foods ironically can sometimes be difficult for banders to eat. That causes them to choose foods like crackers and other crunchy carby stuff that break down faster and go down much easier, thus causing gain. Once again, that falls into the special circumstance category. If I were in the same situation and frustrated by not being able to eat without food getting stuck or making me sick, I would probably do the same thing.

So only healthy foods caused problems? Interesting.