It's not what you are eating, it's what's eating you…

Gastric Bypass Reversals-101

Disclaimer: I’m a medical and mental health activist, NOT a clinically trained medical or mental health professional. When in medical and/or mental health crisis, please seek medical/mental health treatment, in acute care facility, immediately.

However, the nature of this topic which is gastric bypass reversals, while it’s not something I’m concentrating my activism as a blogger, on, as of late, it’s something I’m always “on call” for, because I’m probably the most public person out there, who’s farthest away from my reversal, being almost 7 1/2 years status post open roux-en-y gastric bypass reversal and over 16 years status post laparoscopic roux-en-y gastric bypass.

While nothing I ever say, SHOULD EVER be taken in lieu of professional medical or mental health issues, I have a little more leeway in this topic and credibility, as far as giving my opinion, at least about reversals of when they should be done and when they shouldn’t be.

For one, I can’t do ANY of the  bariatric surgeries or a take down of them.

I can only tell people when I think they are necessary and when I think they are NOT.

Or agree and/or disagree and give my opinions when the topic of gastric bypass reversals come up, that’s it.

Gastric bypass reversal outcomes, if you use a search engine, there is clinical medical data out there, but it’s VERY limited.

The nature of a reversal being needed, makes it the outcome pretty difficult to predict, other than that it will usually save a person’s life and/or now, when they are being done, when the quality of life of a gastric bypass patient, is so reduced, more so than the potential that any of the co-morbidities of Obesity and Super Morbid Obesity, could ever present to a patient, that it will improve their quality of life and or at least arrest certain complications, like long term nutritional deficiencies that can cause serious and irreversible complications from getting worse (I’m not talking about patients who don’t take their vitamins, I’ve addressed this topic in other blogs).

With some caveats, which I will explain as I go along.

Most people are surprised to find out that I am bariatric surgery “positive”, without serious promotion of it.

I am a medical activist and advocate, I do believe that bariatric surgery, up to and including gastric bypass, are the Obese and Super Morbidly Obese patients best chance of losing a lot of weight and keeping it off, long term.

I am not digressing when I say the same, with Opiates, I believe they for those who have severe chronic pain, have exhausted all other treatment options for pain.

That being said, I obviously, like most medical providers and medical activists , believe that to be true, both with bariatric surgery and opiates, ONLY as a last resort, because of complications and things that can go wrong, even when the most qualified medical professionals are involved, with the most compliant patients.

There are many reasons why a bariatric surgeon will tell a patient that they need a reversal, the reasons are varied and that should NORMALLY be between a surgeon and/or another medical professional and a patient.

Because those reasons are complex and too numerous for me to list, I’m not going to bother putting all the reasons why a reversal is sometimes needed.

However, when it comes to a patient wanting a reversal for medical reasons (I’m about to make another point, bear with me) but a surgeon NOT wanting to do a reversal, there are cases, which I get contacted about, because a surgeon doesn’t want to do a reversal, not necessarily for the right reasons.

Meaning, I will get bariatric patients who find me, are going to die from their complications and the ONLY reason they are given for a reversal not being done, is because of a surgeon’s fear of of a patient gaining all their weight back.

My surgeon wisely told me, as he did both my gastric bypass (2001) and reversal (2010) that my complications which I would’ve died from, posed a greater threat than the co-morbidities of Obesity ever could present to me and for how much sicker I got drastically (I had complications from 2002, 1st hospitalization in 2004, many from 2006 to 2010, especially in 2010) I wouldn’t have lived long enough to gain all my weight back, like I actually did, in my super unusual case for a patient who had long term severe complications from late 2007 to late 2009 due to meds, even though I couldn’t eat very much and projectile vomited anything and nothing I ate due to those pesky ulcer bleeds.

Usually, when patients find me who are are super sick from their complications, have had many complications and are in and out of the hospital most of the time, quite a few have feeding tubes, chances are, they are NOT going to live long enough to have to worry about co-morbidities that are typical of Obesity.

I usually tell them to find another surgeon. Because usually in these cases, their lives depend upon that.

And usually they do find a surgeon, where if a reversal is the best option, who perform them, successfully.

I also have to deal with gastric bypass patients who are TOLD to have a reversal, but don’t want one, because they are afraid of getting fat again.

I don’t take that personally, even being unusual, being heavier of needing a reversal to save my life.

It usually goes beyond the scope of most bariatric patients that if they have gastric bypass or any other weight loss surgery to lose weight and become healthier, that it’s inconceivable to them, they could possibly become sicker and/or die, than the co-morbidities of Obesity, could ever present, like I said before, quoting my surgeon.

Those patients, I can usually only take so far.

While I help quite a few of them, because I’m quite blunt in saying, that they are going to DIE, usually in their cases, they won’t live long enough to get fat again and I urge them, like I urge anyone that I help to get both medical and mental health help that goes beyond acute care.

Although acute medical and mental health professional help, is needed in most of those patients.

Also,  I have to explain to a lot of patients, whether they had an ideal outcome, but especially in catastrophic ones, they aren’t (on rare occasion, there is extreme self sabotage or they weren’t ideal candidates and should’ve never made it through the pre-operative bariatric surgical process) to blame for their complications, moderate to severe.

Bariatric surgery, all of them, is a supposed to be a tool, not a form of torture.

While it’s not meant to be comfortable, it’s not meant to be agonizing, either.

Which brings up, the last few populations of bariatric patients (or their families) I get queries from, who want and or need help.

Those who don’t have complications that aren’t anything that’s considered abnormal in the realm of having bariatric surgery, in the first year, that any competent surgeon (which I realize, there are some bad surgeons, but there are a lot of good ethical ones, too) and their teams would’ve warned them from the start.

Such as how little one person can eat after a gastric bypass and while I know most patients are warned and are prepared, some can’t deal with it, after the fact.

Or there are a few who weren’t actually warned.

We were warned 16 years ago of what to expect, as far as having to re-learn how to eat again, in my pre-surgery process and it’s way more extensive now, as far as preparing a potential bariatric surgical patient of what to expect and the fact that complications including death, can happen.

But a reversal isn’t done, in cases where patients are truly devastated about how little they can eat, right after surgery.

Lastly, here’s a few other major things people need to know about gastric bypass reversals:

NO pre-operative gastric bypass patient should think that they can easily be reversed.

They can’t easily be reversed and they aren’t reversed, due to “buyer’s remorse”.

I get pre-ops who find me, who want that as an emotional insurance policy, that if they change their mind, after the fact, that they can just  “get it undone” .

No, gastric bypass pre-operatives should NOT assume that a reversal can be done, in cases of bariatric surgical regret (without complications) , because it IS risky (but needed as I’ve tried to explain in this and other blogs).

No bariatric surgeon, for that reason, among many, is willing to do a reversal, unless someone’s health or life, dictates it’s necessary, as a last resort for reasons, that I’ve stated and that a surgeon can elaborate on, should the topic come up between patient and provider.

I try to help anyone, who’s receptive and honest with me about their circumstances, again, with urging them, if it’s necessary, to be under the care of multiple clinical professionals, other than a surgeon and their team.

I do in these cases, because for one, not only do I know people who’ve done well long term after gastric bypass, I’m actually biologically related to one.

I also know that usually with time, when people have “bariatric surgery remorse” that isn’t complication driven, they usually get over it, in time, when they start to experience all the good things that their gastric bypasses will bring them (i.e. the positives of major weight loss)  and usually they get past devastating regret.

Which requires above, 2 separate support systems, truthfully as far as peers, as most people don’t understand initially, that bariatric buyer’s remorse does happen and aren’t as supportive as they could be.

On the flip side, when patients do accept their surgeries and what’s good about it, it’s still life changing, in under the most optimal circumstances, so that’s where the peers of the weight loss surgery community can help, life long, for those people.

Sadly, the very hardest population of people that I have to help, are people who’ve had such catastrophic complications, they couldn’t be reversed and either have died, or are in long term care facilities, and their families contact me, in wondering if a reversal would’ve or could’ve helped saved their loved one’s life.

Or there are a few patients, where either due to a bad surgeon or a good surgeon’s bad judgement, or just plain horrible luck, they had either such catastrophic complications and multiple revisions and can’t be reversed and are waiting for a stomach transplant or some other extremely rarer intervention than a reversal, and they are spending the rest of their lives in acute care setting (usually a hospital) because they are too medically complex and fragile, to be anywhere else.

Again, not being a clinically trained professional, but after having some idea of being exposed to so many people’s stories (thousands, in the last 7 years!!!) , I have to usually go by what patients tell me what happened, what their surgeons (if it’s the original surgeon or someone else who’s cleaning up another’s surgeon’s mess or if someone had unexpected complications and the surgeon retired, i.e.) said, but I don’t believe all bariatric surgeons are bad or negligent.

Most bariatric surgeons are good and intend to do good, with the medical and mental health long term outcomes of their patients.

And I do defend bariatric surgeon’s judgements on a individual basis, whether they recommend or NOT  recommend a reversal, depending on the individual circumstances, all the time.

Unfortunately, initially, that does put me in a unique position. I get where so many people when they need or want a reversal come up, either for medical reasons or mental health ones, where I can say things (very,very, VERY carefully!!!),  that a normally much better qualified in any other topic, medically and mentally trained clinically professional, sometimes can’t for the reasons I explained in this blog.

Bariatric surgeons are sometimes can be likened to  mechanics, they  can possibly fix medical problems, if we are equating a body (which is a lot more complicated) than a car, if we use a car analogy.

Psychologists are like the emotional mechanics, of why people need help with “car repairs” if they keep “crashing their cars”, that can beyond the physical.

But this is a tricky instance, where if  patients have had mental or medical health issues due to being fat, have unresolved eating disordered issues, where medical and mental health interventions AND peer support with people who’ve been in a similar situation, can really only help when it comes to the bariatric community, with obviously a lot of clinically trained medical and mental health support, too.

And/or if you need a gastric bypass reversal, where our particular community is limited on what we can predict as a reversal outcome, but extremely peer supportive, given the unique circumstances that require our surgeries being reversed.

I have touched upon the things people need to know about themselves, the limitations of both patients and providers, as well as the fact, that most people, their lives are saved, when a surgeon says they need a gastric bypass reversal, or they do have a better quality of life.

It’s usually though not right away, especially for those who live and nearly die longer (i.e usually within 3 years status post rny) than those of us, who had a reversal, later.

I did have a better outcome than a lot of people, but NOT right away, it took years. And all of us who I know who had straight takedowns (there is a trend of surgeons now reversing and then doing a vertical sleeve gastrectomy, that’s not weight related) but had complications longer, usually have something.

In my case, I have gastroparesis, like most, but not bad. It took years for my labs to come back to a low side of normal. I can eat without getting sick, usually. I have though severe heartburn, the second I eat or drink anything.

I never regained a sense of hunger, even though I did regain a sense of satiation. I can eat quite a bit. But not often and not for like 4-6 hours at the very earliest, from waking up.

But there are still foods I can’t eat (hamburgers or meatballs, cruciferous veggies) without getting sick. My severe reactive hypoglycemia does come back  and I do start blacking out, if I forget to eat (which does happen) and/or wait too long. Or calorically go too low, which is like 1200 calories or under.

So while I can eat a lot, it’s usually infrequent, that I do so, because it’s uncomfortable to have too much food in a sluggish digestive system.

But medically, it took at least 2 years, to really heal from reversal….

But all of us vary, who’ve had a gastric bypass reversal, in both what our short term and long term outcomes were.

I hope this helps. I am putting this out here, knowing that this blog is really wordy and while my blogging activism, as well as having personal issues, not within the realm of my control, didn’t make writing this NOW, an ideal time, as far as being concise.

But apparently is needed, now, for what people are searching for in on search engines, the realm of what to expect and when a reversal is needed and why bariatric surgeons, medical professionals and seasoned reversal patients can’t forecast another’s outcome post-reversal.

I can be contacted here or my private email address or on Facebook, as Lisa Kasen (not on social media much, here is better) as well as there is a gastric bypass reversal group on Facebook, for those looking for more information, from a peer perspective regarding a gastric bypass reversal.

Note: PLEASE don’t make defend both my advocating for those who have had complications, bariatric surgery regret, as well as defending those who are happy who had weight loss surgery whether they had an ideal outcome or not.

In my case, I have to ethically do what I feel is right, as a non clinically trained medical and mental activist,  knowing people who died waiting for a surgical intervention for their Obesity and died of Obesity related co-morbidities, but also knowing people who’ve died as a result of catastrophic complications, post bariatric surgery from their gastric bypass complications.

Thanks…

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Comments on: "Gastric Bypass Reversals-101" (1)

  1. Thanks Misty for what you do not only for the reversal group but because I didn’t have the ability to link your sites…take care for now ❤

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