Sleeve to bypass revision with arthritis

[Frostyauggie 1]

In 2012 I had the gastric sleeve procedure, it was very successful until several events in my life caused me to slip back into old habits. Adding to that, my surgeon closed his practice and I had no one to follow up with locally. The old habits and lack of Followup care led to the weight slowly creeping back on.

Since my sleeve procedure I’ve been diagnosed with RA which I have under control for about the past year or more. Earlier this year I began experiencing severe acid reflux and my PCP suggested I see the new BS who had just come to town. The BS advised me (after scoping me) that I have a hiatal hernia that needs to be repaired. He also recommended that I have a revision to the bypass. Fast forward three months and several pre-op tests later and I receive a call from the doctors nurse telling me that the doctor has decided it’s best not to do the conversion to bypass because I have arthritis and take methotrexate. She goes in to explain, the doctor thinks the risk of ulcers from medication and the possibility of slow healing outweigh the possible benefits. I am a 38 year old otherwise healthy female with her RA well controlled.

Has anyone else experienced anything similar to this before? Has anyone had the conversion to bypass who was diagnosed with RA before their conversion? I’m incredibly frustrated and not sure what do to from this point. Any advice you can share would be much appreciated.

[Arabesque 6,481]

Sorry I can’t offer any help in regards to a revision to bypass & rheumatoid arthritis. I did find the article below about managing methotrexate side effects. (I was interested because I have a non bariatric friend who takes it for RA too.) May be worth another conversation with the bariatric surgeon in regards to the suggestion that taking folic acid can reduce side effects. Repairing your hernia may alleviate some of your reflux issues too.

It’s unfortunate that while it’s helpful managing arthritic pain, methotrexate can also cause weight gain. ☹️

https://www.arthritis.org/health-wellness/treatment/treatment-plan/disease-management/methotrexate-managing-side-effects

[SharonRider 0]

Your story is almost duplicated to mine. So I chose to go to the mayo Clinic… this started the beginning of my journey to a revision from the sleeve. Its scary but Ive come to accept it is the only choice for me. Im not currently taking any meds as my RA is in remission

[Frostyauggie 1]

I just hate that it’s one or the other and there is no middle ground. My rhum has no concerns with me having a revision to bypass so I do not understand why the BS does. My rhum and I have even discussed possible meds after the transition.

[SharonRider 0]

I think I would seek out a different BS. Get a different opinion. Thats what I did.. i figured there is no place better than the mayo Clinic. Im not sure where you live but. Reach out somewhere. You are only 38 years old. Acid reflux is extremely damaging to your esophogus. You are at risk for developing Barretts disease or eventually cancer. I think i would definately seek out more information. The Dr at Mayo Clinic in Phoenix is definately worth consulting. You can have all your records forwarded to them for review. Have appts through zoom. My bariatric journey started in 2013. The last 3 years fighting acid reflux and a sliding hernia has severly damaged my esophogus. From a stage 1 to a stage 4 in just 1 years time. It has to be fixed. Acid reflux is a very serious issue

[SleevedK 25]

I am sorry you are dealing with this. If they won't do a bypass, the other options would be to just repair the hiatal hernia and see if that alone will stop the reflux, or to get a Linx device put on your sleeve: https://www.jnjmedicaldevices.com/en-US/campaign/LINX-GERD-relief

If you feel like you're not totally convinced you want to get the bypass then I would talk to the surgeon about those other options. Just doing nothing isn't an option, since bad reflux is such a miserable problem to deal with and can be so dangerous.

[Tracyringo 503]

On 6/22/2021 at 7:49 PM, Frostyauggie said:

In 2012 I had the gastric sleeve procedure, it was very successful until several events in my life caused me to slip back into old habits. Adding to that, my surgeon closed his practice and I had no one to follow up with locally. The old habits and lack of Followup care led to the weight slowly creeping back on.

Since my sleeve procedure I’ve been diagnosed with RA which I have under control for about the past year or more. Earlier this year I began experiencing severe acid reflux and my PCP suggested I see the new BS who had just come to town. The BS advised me (after scoping me) that I have a hiatal hernia that needs to be repaired. He also recommended that I have a revision to the bypass. Fast forward three months and several pre-op tests later and I receive a call from the doctors nurse telling me that the doctor has decided it’s best not to do the conversion to bypass because I have arthritis and take methotrexate. She goes in to explain, the doctor thinks the risk of ulcers from medication and the possibility of slow healing outweigh the possible benefits. I am a 38 year old otherwise healthy female with her RA well controlled.

Has anyone else experienced anything similar to this before? Has anyone had the conversion to bypass who was diagnosed with RA before their conversion? I’m incredibly frustrated and not sure what do to from this point. Any advice you can share would be much appreciated.

I have arthritis that took out both my hips in my early 40s. I have it in my back and joints too. I get steroid injections in back and neck when I absolutely have to. I cannot take pain meds except for tylenol and when its really bad I get norco. I also had the sleeve done but revised to RNY last year because I ended up with really bad GERD that gave me esophagitis D. Good luck

[lilsicilian22 1]

I’m so sorry your dealing with this.. I too have RA and was revised this past May..My surgeon of course was aware of my RA but never showed any cause of concern regarding my revision .. I don’t know.. maybe see out another surgeon? I pray this all works out for you and please don’t give up.. best wishes to you

[Frostyauggie 1]

On 6/30/2021 at 2:09 PM, Tracyringo said:

I have arthritis that took out both my hips in my early 40s. I have it in my back and joints too. I get steroid injections in back and neck when I absolutely have to. I cannot take pain meds except for tylenol and when its really bad I get norco. I also had the sleeve done but revised to RNY last year because I ended up with really bad GERD that gave me esophagitis D. Good luck

Can you share with me what your experience going from Sleeve to RNY has been like? I am trying the medical managed weight loss option right now but so far it’s not helping with the reflux. What are the biggest differences to you between the two procedures and how they affect your daily life? Thanks for sharing.

[Tracyringo 503]

14 hours ago, Frostyauggie said:

Can you share with me what your experience going from Sleeve to RNY has been like? I am trying the medical managed weight loss option right now but so far it’s not helping with the reflux. What are the biggest differences to you between the two procedures and how they affect your daily life? Thanks for sharing.

I still have GERD and take a PPI twice daily with the RNY which sucks but my esophagitis when last checked went from a grade D to a grade A which is really good.

I also have no problems with keeping my weight stable. The VSG was great but I struggled in maintenance keeping it steady. My weight fluctuated a lot more and the lowest I got was 164.8 for a day, lol. I could usually maintain 175ish but was constantly stressed out. I would say I ate around 1000-1200 calories to stay in that range and under 1000 to stay in high 160s. RNY has been much easier to maintain my weight. I now weigh 154 and my weight fluctuates between 152-155. I have no problems or stress maintaining it !! This makes my daily life much easier because I dont constantly think about it anymore. I would even say I eat more now then what I did with VSG which sounds crazy but its true.

I have dumping syndrome which keeps me away from heavy carbs and sugar. I do eat these things in small amounts and usually dont have any problems but I have to be very careful of when and how I am eating those things.

I am less interested in food with RNY. Some days its a chore to eat ! I think this comes down to not being able to eat whatever I want when I want so if the food isnt great I really dont want to bother with it. My mind set has become totally different in regards on how I view and look at food.

I am 14 months out from my revision and 4 years from my VSG.

Good luck to you !

Edited July 29, 2021 by Tracyringo

[rivergirl 5]

I also have RA (was diagnosed post-VSG) and am headed toward a revision for GERD in the next few months. My rheumatologist automatically put me on injectable methotrexate so i didn't have to deal with any GI side effects. It's really easy and cheap - I still have to draw it up myself from the vial with an insulin needle. But I have no side effects from it.

My bigger problem will probably be figuring out what i can take for as-needed pain relief...

[I♡BypassedMyPhatAss♡ 800]

I am interested in finding out if those here with RA noticed less severe disease activity after losing their weight. Supposedly losing weight helps reduce the inflammation in your body that causes disease activity to be more severe.

I was diagnosed with RA nearly 18 years ago, and got a Lap Band in 2013. I lost some weight but never got anywhere near goal, and then developed reflux, so my BS started discussing revision, but I was nervous about revising to bypass due to my occasional need for steroids... I was on pantoprazole twice daily for a few years for the reflux, and then I developed a kidney stone from overuse of PPI's, so it was at that point I decided that it was time to remove the band, so it was removed this past April.

I'm looking at revising to RNY, as my BS says the sleeve wouldn't work for me since I had reflux with my band. My Rheumy is 100% on board with revising to RNY, she says she thinks my condition will markedly improve due to less inflammation in my body. So I've stopped the celebrex and now I'm using CBD oil daily for pain to see if I can live forever like this. Rheumy says if I do need steroids in the future after RNY, she would opt for a single injection vs a medrol dose pack like I've had in the past.

I'm most curious to find out if those on the post op side have seen improvements in their conditions. It would help me to decide whether or not to go forth with the revision. Thanks in advance!

[gabbykittyvsg 184]

On 6/23/2021 at 8:12 PM, SharonRider said:

I think I would seek out a different BS. Get a different opinion. Thats what I did.. i figured there is no place better than the mayo Clinic. Im not sure where you live but. Reach out somewhere. You are only 38 years old. Acid reflux is extremely damaging to your esophogus. You are at risk for developing Barretts disease or eventually cancer. I think i would definately seek out more information. The Dr at mayo Clinic in Phoenix is definately worth consulting. You can have all your records forwarded to them for review. Have appts through zoom. My bariatric journey started in 2013. The last 3 years fighting acid reflux and a sliding hernia has severly damaged my esophogus. From a stage 1 to a stage 4 in just 1 years time. It has to be fixed. Acid reflux is a very serious issue

I'm a happy Mayo Clinic patient too! I live about 75 miles from the Rochester mothership. Mayo has a super strong presence in my town through the Mayo Clinic Health System so I don't have to go to Rochester. My surgeon is awesome, I had her for the sleeve and consulted with her as soon as I found out I had the hiatal hernia. She ordered the esophagram and endoscopy which showed the severe reflux and other damage. There was no doubt in my mind what I wanted to do to fix things and thankfully my surgeon had the same idea. I just got insurance approval and have a date of March 1st.

[gabbykittyvsg 184]

On 12/20/2021 at 6:11 AM, WhispersOfAngel said:

I am interested in finding out if those here with RA noticed less severe disease activity after losing their weight. Supposedly losing weight helps reduce the inflammation in your body that causes disease activity to be more severe.

I was diagnosed with RA nearly 18 years ago, and got a Lap Band in 2013. I lost some weight but never got anywhere near goal, and then developed reflux, so my BS started discussing revision, but I was nervous about revising to bypass due to my occasional need for steroids... I was on pantoprazole twice daily for a few years for the reflux, and then I developed a kidney stone from overuse of PPI's, so it was at that point I decided that it was time to remove the band, so it was removed this past April.

I'm looking at revising to RNY, as my BS says the sleeve wouldn't work for me since I had reflux with my band. My Rheumy is 100% on board with revising to RNY, she says she thinks my condition will markedly improve due to less inflammation in my body. So I've stopped the celebrex and now I'm using CBD oil daily for pain to see if I can live forever like this. Rheumy says if I do need steroids in the future after RNY, she would opt for a single injection vs a medrol dose pack like I've had in the past.

I'm most curious to find out if those on the post op side have seen improvements in their conditions. It would help me to decide whether or not to go forth with the revision. Thanks in advance!

I don't have personal experience but have a very good friend who has severe RA and deals with it through meds and an anti-inflammatory diet. Rare sugar and few carbs help a ton, according to her. This is the kind of diet change we need to do with the bypass anyhow.

[gabbykittyvsg 184]

On 7/28/2021 at 4:54 PM, Frostyauggie said:

Can you share with me what your experience going from Sleeve to RNY has been like? I am trying the medical managed weight loss option right now but so far it’s not helping with the reflux. What are the biggest differences to you between the two procedures and how they affect your daily life? Thanks for sharing.

with your reflux, the sleeve is pretty much not a viable option for you. The sleeve creates a high pressure system that makes the reflux worse. My surgeon explained that with bypass most of the stomach that produces the acid is cut away and there isn't that high pressure system.