Please forgive me if you have seen this question or me nosing around the boards. I am just so confused.

I had a VSG in October 2007. I did well-loosing 80lbs with an additional 80 to go-at 6months out. At that point, I became hungry again and could eat more. I am now back up to 295 from 249 and miserable. I feel fat again. Not that I was skinny at 249, but I felt waaay better than I do now. Yesterday I had to click the driver's seat back and I almost cried. My clothes don't fit and I can't afford (nor do I want to buy) new ones. I feel like I threw away 10 grand.

I went to Mexico and was self pay. I have not had health insurance in all this time and no one has ever checked my stomach since surgery. I guess they assumed that since I was feeling ok and my labs were good that everything was all right in there. I am just starting to accept that I didn't fail on my own. I never thought about the possibility that there may be internal issues.

I am going to have health insurance in about 3 months....FINALLY!!! I will then get someone to look at my tummy and will start the whole revision process.

Though I have a VSG and the most logical choice would be to revise to a DS, I am not so sure that is the best option for me. I really want to stay with the Cleveland clinic as I have a host of conditions (psoriasis and psoriatic arthritis) that require specialists (and won't resolve with weight loss) and I would prefer that all my doctors were in the same system.

I have been looking through all the forums and I can't stand the DS forum. I tried the revision and failed surgeries too. I am not gaging the DS viability on those over in the DS forum, but due to ****ty attitudes and bullying demeanor, I cannot glean any real information from there.

I know so many people who have had the RNY and are doing well many years out. I know 2 failures as well. I don't want to fail again and I know that I will require counseling to deal with the need to medicate with food.

I will have Anthem BCBS of Ohio and the doctor I would like is Dr. Bipan Chand.

I appreciate any help/input/advice that anyone can give.

Jessica

I'm sorry you have had such a bad experience with the other forums. Unfortunately, in their zeal to convince people that DS is the "best" WLS, many of the DSers push people away because of the negativity on that forum. I know several people in "real life" who have had the DS, though, and none of them are nasty! Of the 5 people I know: three of them lost the weight they wanted to (or at least close to it) and have maintained MOST of the loss (the 10-20 pound "bounceback" is common for them, too) without any significant medical or nutritional issues (that I am aware of, anyway); one did NOT lose all of the weight (but she still eats much mroe than she should); the last one is maintaining her weight loss but has horrible problems with smelly diarrhea (the smell is controlled with pills, but the diarrhea is not, no matter what she eats or what medication she tries... so she carries a change of clothes in her car). I also know one person who had the RNY, then had the bypass portion converted to the DS-type bypass. I have not seen her in a while, but she was not losing very quickly and I don;t know how much she eventually lost.

Make sure that you are prepared to live with the vitamin regimen required after RNY (and whatever additional vitamins you may need because of your particular nutritional issues) and that you are prepared to give up NSAID pain relievers (which leaves only Tylenol for OTC help or prescription pain meds if you need something stronger). You should also be aware that the lack of vitamin absorption is PERMANENT but the caloric malabsorption is only temporary. (By the time you are 18-24 months out, you will be back to absorbing about 90% of the calories you ingest. DSers retain more of the malabsorption since their bypass is more extensive.) If you are counting on being a "dumper" to keep you away from sweets with the RNY, that will likely NOT happen since only about 30% of RNYers dump (and some of those lose the dumping reaction (or it lessens) over time). I'm not sure why, but lots of surgeons are not telling people that the number of dumpers is so low.

Basically, RNY will help you GET the weight off because of the malabsorption, but all you will have to rely on to KEEP it off is your healthy eating habits and the smaller stomach (which you already have). To be honest -- and I'm sorry if this sounds harsh, because I truly do not mean it to be... I just want to be open about an important aspect of this -- but if you were not able to sufficiently change your eating habits and are regaining weight with the sleeve, I am not sure you will be more successful long-term with the RNY. Changing the eating habits and addressing the emotional/psychological contributors to the obesity are key to maintaining the loss... and I think you already have a tool to do that since even though your sleeve may now allow you to eat more, you will have to address that eventually anyway... or you will be one of the RNYers *****gains since, as I already mentioned, the caloric malabsorption is tremporary. (I prefer not to call anyone a "failure".)

The DS is more forgiving about how much (and what) you can eat because of the significant intestinal changes. Two of the DSers I know admit that they chose it because it would still allow them to eat higher fat foods and sugar. Unfortunately, that also means you have to take almost twice the vitamin supplements as with a RNY and it increases the risk of medical problems that are rooted in nutritional deficiencies. (My surgeon no longer does the DS... just band, RNY, and sleeve... because too many DSers were not being compliant with vitamins and labs and were developing problems down the line.)

Once you have insurance coverage, I would encourage you to seek help from a bariatric nutritionist (I'm sure the Cleveland Clinic has one) and counselor to see if you can make the sleeve work before you subject yourself to another surgery.

Again, I apologize if any of this sounds harsh. As a professional counselor, though, I believe that people need to hear the truth, even if it is unpleasant, to make a truly informed decision... and I have seen too many people struggle with regain after RNY because they did not address the behaviors and emotional/psychological issues that caused them to gain the weight in the first place. They expected that the surgery would "fix" their weight problem for them... and it simply doesn't work that way. Even those of us who are maintaining our weight loss (I am over 4 years out and maintaining within 5-7 pounds of my lowest post-op weight) still sometimes struggle with some of our old food demons.

Lora

If you are eating more at 6 months after the sleeve you will be able to eat more 6 months after the RNY as well. 

I would seriously think about the DS.   With RNY, you will start feeling hungry again and you will be able to eat more over time.  You will malabsorb calories for a year or two, but after that all you have is restriction and your eating habits to keep the weight off.  since it sounds like that was an issue for you after VSG, you might do better with a surgery like DS where you will always have malabsorption.

I think RNY is a good surgery and the attitudes of some DS folks really bug me, too.  but I think what matters is what surgery would be good for you, not what surgery worked out well (or didn't work well) for someone else.

Thank you all so much for your replies...and don't worry-none were harsh. :) That is the reason I am here again. I need the input, the hard truths and the facts. I do not want to jump into another surgery without thoroughly researching a revision.

I do medicate with food. There is no denying that. I just assumed I failed the surgery and not the other way around. However, I also know that I really need to be physically evaluated in addition to counseling. At the six month mark, it felt like I lost my restriction and my hunger came roaring back. Those "just a few bites to fill me up" days seem like a distant memory. My sister is nearly 18 months out of RNY and doing great. I can't help it-I am jealous.

I appreticate all this input because its what I think about all the time. I mean, I really don't want to revise if truth be told. But, I also know that I have been powerless over food for so long and really looked at my VSG as a miracle. I knew going in that it wasn't a cure, but I certainly didn't expect the hunger or lack of restriction to come on so soon. I would love to get control over this train wreck and get back to at least 249lbs-which is the lowest I had been following VSG.

Thanks for letting me ramble and for taking the time to reply.

Jessica :)

I had the VSG as part of my first WLS.  They did them differently in 2002.  They didn't use bougies and my surgeon made mine pretty large.  I don't remember ever feeling much restriction and by the time I had my revision I was able to eat as much as I ever could and I was constantly hungry.  I don't know if it was the way it was done or what but when I had my revision I didn't want to get resleeved because I didn't trust that it wouldn't stretch out again.  I wanted as much restriction as possible even though I know it is possible for the RNY pouch to stretch out, too.  I am very careful to eat smaller portions and not test my limits.

Thanks, LadyTazz.

That's exactly the way I feel--if I am going to have a revision, then I damn sure want restriction AND malabsobtion. I fear that the DS will leave my stomach untouched and I will continue to be able to eat too much. I don't want to have surgery after surgery and just keep making things worse.

I could just cry right about now....blech...

Btw, thanks for responding as a person who has done VSG to RNY. I really need input from people like you since you have experienced this.

I was hesitant to respond because my VSG was done so differently in 2002 and wasn't very small in the first place.
I do have to say I love having restriction.  I love going to a restaurant and having leftovers for another meal or two.  I love being satisfied with far less then I ever thought would satisfy me.  I hope it stays for a long, long time.

Maybe the first steps for you would be to see a surgeon that does revisions and get evaluated to see where you stand physically right now, and also to see a therapist to talk about issues of emotional eating and changing your eating habits.  When you get the info from the surgeon and see what the therapist can help you with, you'll be in a better position to make a decision, I think.

And while you're doing those things, or whatever else you need to do to get you started, stick around here.  You'll get to learn all about RNY and you can talk a lot about the mental side of this journey.  It's not a substitute for therapy, but you can learn a lot, including learning some stuff about yourself.

 I am sorry to hear you have had such a hard time with the VSG.  I really wanted it but fate said no way and my insurance wouldn't cover it.  I am so glad i got the RNY as i am already seeing stories of people changing from the VSG to the RNY.  In the past the VSG used to be the first step of WLS with the RNY following.  

But it sounds like you already have an awesome idea of what you want.  You have been so lucky to be so healthy though having no medical support when you came home from your operation.  

Hope you get back on track and you keep us updated.