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Sleeve to DS/RNY revision



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I have not been here in quite some time so Iittle update -background. I was sleeved 12/27/17. Starting weight was 256, I managed to lose 61 pounds and got to a low of 195, ( this was May of 2019)then I started to regain. I refocused, got back on the right eating plan/exercise but continued to gain weight. Went to see the nutritionist last fall for help. We went over my food logs and by the numbers I was a little low in calories for the amount of exercise I was doing so we adjusted my plan but still no weight loss. I was 242 in Jan/Feb. I was prescribed the generic form of Contrave in March for a 3 month trial, managed to lose all of 5 pounds down to 237. Labs have been decent- except now I developed high cholesterol and my primary prescribed Atorvastin(Lipitor) and I have been on that since May. I consistently tell the dietician that I feel no restriction and can eat way more than I think I should. However in all this time, not once have I had a scope to check to see if my pouch has been stretched out. My primary thinks I am eating to much, the nutritionist thinks I'm not eating enough so I'm just trying to eat enough Protein and stay low on the carbs. I have gone as low as 900 calories and as high as 1500. carbs as low as 20 and high as 75. All of that to say I found out my original surgeon does not believe in performing revisions so I have a consultation in 2 weeks with a surgeon that does perform revisions just so I can get answers. I still have sleep apnea, that has improved some but not enough for me to come off my CPAP. Recently I have had mild cases of heartburn late at night so I have altered my diet again, cutting out dairy, coffee, spicy foods to see what could be triggering it. I did intermittent fasting in July of just watermelon and Water and managed to get down to 224. I know this was not healthy but hey I was willing to try anything. So all of that to say, with my weight as it is now, my BMI is 36. I meet insurance requirements for BMI with my sleep apnea as comorbidity but the surgeon must find it medically necessary for revision- but if surgeon requires weight loss and lose weight that puts my BMI under requirements, would insurance deny the revision?

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Most surgeons won't require you to lose weight, or won't report out your loss, if it puts your BMI too low for insurance. Mine was 40 going in with no comorbidities and that's what was reported. Good luck, it sounds like you are trying a lot of stuff and something is just not working.

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it depends on the insurance company. Most use whatever you weighed when you started up with the program with the new surgeon, but some use a weight closer to the surgery. I guess the best thing to do is just call them and ask. Or the surgeon's office might know if they've dealt with that company before.

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    • Prdgrdma

      So I guess after gastric bypass surgery, I cant eat flock chips because they are fried???  They sell them on here so I thought I could have them. So high in protein and no carbs.  They don't bother me at all.  Help. 
      · 1 reply
      1. NickelChip

        It's possible for a very high fat meal to cause dumping in some (30% or so) gastric bypass patients, although it's more likely to be triggered by high sugar, or by the high fat/high sugar combo (think ice cream, donuts). Dietitians will tell you to never do anything that isn't 100% healthy ever again. Realistically, you should aim for a good balance of protein, carbs, and fat each day. Should you eat fried foods every day? No. Is it possible they will make you sick? Maybe. Is it okay to eat some to see what happens and have them for a treat every now and again? Yes.

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      1. NickelChip

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      How do you figure out what your ideal weight should be? I've had a figure in my head for years, but after 3 mths of recovery I'm already almost there. So maybe my goal should be lower?
      · 3 replies
      1. NickelChip

        Well, there is actually a formula for "Ideal Body Weight" and you can use a calculator to figure it out for you. This one also does an adjusted weight for a person who starts out overweight or obese. https://www.mdcalc.com/calc/68/ideal-body-weight-adjusted-body-weight

        I would use that as a starting point, and then just see how you feel as you lose. How you look and feel is more important than a number.

      2. Clueless_girl

        I did find different calculators but I couldn't find any that accounted for body frame. But you're right, it is just a number. It was just disheartening to see that although I lost 60% of my excess weight, it's still not in the "normal/healthy" range..

      3. NickelChip

        I think it's important to remember that the weight charts and BMI ranges were developed a very long time ago and only intended to be applied to people who have never been overweight or obese. Those numbers aren't for us. When you are larger, especially for a long time, your body develops extra bone to support the weight. Your organs get a little bigger to handle the extra mass. Your entire infrastructure increases so you can support and function with the extra weight. That doesn't all go away just because you burn off the excess fat. If you still had a pair of jeans from your skinniest point in life and then lost weight to get to the exact number on the scale you were when those jeans fit you, chances are they would be a little baggy now because you would actually be thinner than you were, even though the scale and the BMI chart disagree. When in doubt, listen to the jeans, not the scale!

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      1. This update has no replies.
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