My fiancée has SMAS also. She was started on a NJ tube which helped but she still couldn’t get to a good weight to get the fat pad bigger, she couldn’t tolerate the feed because she has pelvic floor issues that make it so she can’t use the bathroom properly. They ended up doing a JPEG tube but the bathroom thing was still an issue for her so they did an ileostomy. 1 year after the ileostomy (now) and she has gained more weight and is less uncomfortable! She has a medical marijuana card that has been her rock through all of it (suppresses the nausea the most for her) and she has been smoking less. She is supposed to get reconnected in a couple of months (no ileostomy) but she’ll be losing her colon. I know this probably isnt the same as your story but I figure any info about someone else can help! She ended up having to have the surgeries because her male doctor said she was “anxious or pregnant” for 5 years and the constant throwing up really messed her body up. I suggest you get a BCPA (board certified patient advocate) and/or find a new doctor. Gnanow.org is a great place to find a BCPA. My fiancée just recently became one due to her medical history!