Considering RNY Revision - have GERD - and questions!

Hi Everyone,

I have just discovered this website, and I have been very impressed with your responses and great input and advise.  As such, I am hoping you can help me.

I originally had a stapling surgery back in the mid 1980's when I was in my early 20's.  Back then, the follow up visits mainly were monthly weigh checks and the doctor asking how you were doing.  Luckily, I fared very well and lost well over 100 lbs.  Things were great for 4-5 years, then I started gaining the weight back.  

I was ashamed and thought I had either done something wrong or something had gone wrong with my pouch.  At that point and time I didn't have the resources or confidence or support to work my way through trying to figure out what had happened.

Since then, I've struggled with my weight quite a bit.  I am faced with needing to lose 150+ pounds now.  I worry every day that I'm going to die prematurely and not be here to grow old with my husband or see my kids and grandkids grow up.

I have been a GERD sufferer for almost 5 years now.  For those of you who don't know what GERD is, it's acid reflux.  I recently learned that left untreated that GERD can possibly lead to esophogial cancer, so in spite of my resistance to see a doctor because I don't want to be beat up because of my weight, I went to the doctor.  They did blood tests and ruled out that I have a bacteria.  Now I have to have an endoscopy so they can see what is going on in my esophogus and stomach.

In researching what the treatment options are for GERD, I have determined that it's either a drug treatment, or a lap procedure to correct the problem internally.  I then wondered how close to where my stomach ring and stamples the GERD procedure would be - if I have to have it - and found some very interesting facts about GERD and obese patients.

I've learned that most obese patients who have GERD fare better from having a RNY instead of the procedure that treats GERD only.  Not only is that problem usually resolved, but obviously there are alot of other benefits from having an RNY.

I never thought I'd even be considering another bariatric surgery, but I have to admit that I am.  My concerns are whether or not my insurance company (Anthem) will cover this since it technically a revision surgery - even though it's been over 25 years. 

Another thing that is way different for me now compared to back in the 80's is that back then my doctor didn't prepare me for the fact that the pouc h could stretch out and that I could gain the weight back.  Now I've seen all the comments about that here, and I have to admit that I'm scared of going through the whole thing again and maybe gaining. 

I am planning on going to a seminar this week at a local Bariatric center and since my endoscopy for the GERD is coming up next week, I don't know if I should try to talk to my PCP and see what his thoughts are and if possibly he my ask the dr. performing the procedure next week to gather the info he would have to if this were pre-op testing. 

Sorry for being so long winded, but I just needed to get it all out.  I'm hoping some of you can help me with your thoughts and comments and wisdom.  Thanks for reading!!

Well, I have no idea what your insurance would or would not cover, but there is probably a good chance they would cover it if you need to lose 150 pounds and have severe GERD.  But you need to call them and ask.

Your pouch can stretch after RNY and in fact it's supposed to stretch a little over time.  It can stretch too much but that is actually not very common.  Some people do regain weight after RNY.  Some gain back all that they lost but I don't think that is very common.  Some people maintain their weight loss for a very long time.

I'm sorry you didn't get good follow up after your first WLS.  I think the follow up with a dietician, support groups, etc. would make you much more likely to have success now.

Hello there! You and I have some things in common. I had VBG (Vertical Banded Gastroplasty) back in 1989. For me it kept 100 pounds off for 20 years. Then I had an episode where I could not even keep water down, had an endoscopy and the gastroenterologist either broke the band or the staples because from that very day (about 3 years ago) I could eat like I had not eaten in 20 years. So, within 2 months I had gained back 50 pounds and have now gained back the whole hundred. Very disheartening to say the least.

So, now that I am 53 years old, carrying around all this excess weight is very painful for my back, my knees and I'm just so exhausted. I'm miserable with myself.

So, I checked into it and thank the Lord, my insurance (Tricare Prime) approved me for RNY. My surgery is coming up shortly.

I too have had GERD for many years and I'm hoping that once I have the RNY that I will be GERD free.

I won't lie, I am nervous as a revision is a more serious and more complicated operation than if you were having RNY for the first time. However, I look at it like this. If I stay this weight the rest of my life, I'm going to have a LOT of complications from it and not be able to participate in my own life like I'll be able to once I am a more normal weight. I feel like a prisoner trapped in this fat body.

God bless and I hope and pray that no matter your decision, you will be healthy and happy.

Wynter

Boy we do have a few things in common!

Did the fact that you've already had WLS cause your insurance company make it more difficult to get a decision from your insurance company?  I know it's been so long for both you and I, and while I don't honestly remember how similar what I had done then is to the current day RNY, I still wonder what the insurance company will say. 

I've read several comments about people having hernia's on here, and I sure hope I don't end up having one too because it would sur complicate things.  Do you know what they will be doing as far as your old staples are concerned?  Do they leave them in and add on, or remove them? 

One lady *****sponded told me a revision will really complicate things quite a bit and it's hard to find a really good doctor with revision experience.  Have you find that to be the case?'

I'm really anxious to hear how your procedure goes.  I will live vicariously through you for awhile!

Hello again! As far as the insurance, it was a very easy approval. I am very blessed to have Tricare Prime (my husband is retired military). Every insurance is different in what they approve or what they require. If your surgeons office has an excellent financial department, they usually get you approved if there is any way possible.

You definitely don't want a surgeon that has little or no revision experience. My surgeon, Dr. Jeffrey Lord of Sacred Heart Hospital in Pensacola Florida has a great reputation and a lot of experience. So much so, that I have traveled to this hospital from my home which is just over two hours away. There is a WLS surgeon here locally, however, I don't feel he has enough experience in revision surgery.

It is a more complicated operation. I believe my surgeon plans on cutting the old staple line away, it will have to be done a little bit differently than someone getting RNY as a first time wls.

I will let you know how it goes. I pray I don't have to go home with a drain tube. It's more common for revisions I'm told and I think my doctor said if I do have to have one that it's usually for six weeks.

I won't lie, I am scared but am doing my best to trust in God that I have the right surgeon and that I've made the right decision. My metabolism is so messed up that last year on a VERY strict diet and exercise program it took me 8 months to lose 34 pounds. That may be ok for someone who only has 50 pounds to lose but for someone who has way over a hundred to lose that's just frustrating. Of course I've gained it all back. It takes no time to gain it and forever to lose it.

I believe that it may also be slower with RNY than for first timers however it should at least be better than what I could do on my own.

Take care and I hope all goes well with your insurance and your future surgery.

Wynter

I am sorry to hear that your weight loss surgery from so many years ago wasn't successful.  Unfortunately that is the case for most from back then.  Things are very different now.  As far as your GERD - RNY is very successful for treating GERD providing you to lose a substantial amount as well.  IT is actually the weight loss surgery best at treating GERD.  As far as other treatments for GERD - yes, there is medication treatment which is very successful but the surgery which is called a Nissan Fundoplication, is only done in very severe cases and many times for people with severe hiatal hernias.  I had this procedure back in 1998.  One day I had a an endoscopy and was diagnosed with an ulcer.  Once the ulcer was healed after  a few months on Prilosec and carafate - a few weeks later, I developed terrible heartburn and reflux.  The doctors thought this was strange since the ulcer was healed - they rescoped to checked.  I was put on Prilosec 4 times per day plus another medication called Propulsid.  Nothing helped.  Within the next 6 weeks, I was just vomitting mouthfuls of acid all day long and couldn't keep any food down.  I lost 35 pounds in this 6 week period.  They did a few tests to check my acid levels and motility of the esophageal sphincter.  It was determined that I needed surgery to correct the reflux.  I didn't have a hiatal hernia which was odd for such a severe case of reflux.  I had the surgery and my reflux was gone.  Then in 2008, when I had my Gastric Bypass it was really hard to find a surgeon that was willing to take me on as a patient due to my reflux surgery - it was a very difficult surgery due to my changed anatomy of my esophagus and stomach.  I was told that it might have to be reversed in order to do the RNY but he wouldn't know until he got in there but that if it did, there was a good chance I wouldn't have a return of the reflux with the weight loss and new configuration of the RNY.  He was right, it did have to be reversed and I have no reflux.  I do take 1 protonix a day just as a precaution to prevent ulcers and to make sure I don't get reflux but I haven't had any.

Please, make sure you find a highly skilled revision surgeon - there aren't many in the country but it is very important.  Yours is going to be a tricky surgery and you don't want just anyone operating on you.  Also, make sure you take a PPI - protonix, nexium or prevacid for atleast a year after your surgery to protect from reflux and ulcers - and if you really want to careful, be like me and take for life.

I had GERD...very bad actually.  I learned during my pre-op testing I had a large hernia.  My surgeon told me the RNY would resolve that when he repaired the hernia during my surgery.  I am now 100% GERD free.  It is wonderful to be able to sleep at night without waking up with that horrible reflux that had become really severe.  I thank God that has been resolved.  Good luck on your journey.

Thanks so much for the info.....  I do hear alot about hernia's, so it makes me wonder if I might have one too.  Did they have to open you up when you had your surgery because of the hernia? 

I can only dream about being able to sleep and not have to take a Prilosec before bedtime.  In the last month or so it's even getting to the point that I feel the burn during the night even after I've taken a pill before bedtime and have started needing to take a couple of Tums during the night.  I know this can't be a good sign....

No....he did not have to open me up to repair the hernia, and my recovery was extremely easy, even with the hernia repair.