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Post by nyuboi on Jun 26, 2012 15:20:24 GMT -5
DSettes,
Went to bed at 7pm last night and woke up at 1pm this afternoon. Guess I was a little tired from everything... I woke up today feeling very anxious and second-guessing. I know deep down inside I did the right thing -- it was the logical thing to do and the voice of reason. I think the thing I am freaked out about more is losing Lenox Hill. Let's be honest -- Dr. Roslin is the first name that comes to mind when you think NY Metro Area and DS. He does these weekly that it's practically second-nature to him... If it was a RNY there's plenty more fish in the sea, but with a DS you want someone who does it as often as other surgeons do RNY, you know? Especially with the skill required to pull off such an operation in general let alone to do it laparoscopically. There's only one other surgeon I felt really comfortable with in the area who was very pro-DS and has Dr. Roslin's same philosophy about pyloric valve preservation, and that was Dr. Inabnet. Unfortunately though he doesn't take my insurance but his associates do but for something as complex as DS, ehhh... In any event, theres some loopholes with insurance law in being able to seek out of network benefits when theres no one in-network capable within 100 miles, etc., and I could always go out of state for something this serious to stay in-network. The cool thing with Dr. Roslin was in the event insurance didn't approve (we didn't expect the approval we received) he was only going to charge me $5,000 self-pay for the DS (which might have had to do with being the second DS patient of his with a bmi less than 35 or so, not sure, not including hospital of course, versus $20,000 Columbia said...)
I just reviewed a letter Dr. Inabnet had sent to Dr. Roslin where he wrote "The best ancillary weight loss procedure for him would be a gastric bypass with his symptoms of acid reflux disease and esophageal dilation, but I would also consider performing the DS with a common channel of no less than 150cm or longer." This is very consistent with my experiences. Almost all would do an RNY because of how it has been done in my weight with diabetes patients and all -- and more importantly because RNY is much more likely to cure my GERD problems than DS, but Dr. Inabnet was at least open to letting me choose. (Frankly I would rather stay on 80mg or Prilosec a day or 1-2 Nexium a day with DS versus RNY... my decision was never really DS versus RNY, it was really DS or not). ... the problem with a traditional sleeve is it would have to be very very gentle because of the complications I have from lapband so Dr. Roslin never felt it would be enough... basically my esopagus now serves as a second stomach, lol, I could upload the x-rays if you guys want to see an esophagus larger than a stomach from the band making it dilate galore... I obviously will have to remove the band in 4-8 weeks regardless of if I choose to do a revisional procedure or not. All the surgeons tell you when getting a band it's reversible, but one surgeon said it best to me: "It's removable, not reversible."
Well, anyway, I guess it's best I break from these thoughts and clear my head. If and when I decide I am 100% DS-ready then I can always worry about finding an experienced Roslin #2. Hehehe.
One last thing, does this sound really weird? My family felt i should send Dr. Roslin a large edibile arrangement basket or something similar with a card saying "sorry for the inconvenience." NOT to kiss his ass or hope I can be his patient again (I honestly dont expect him to change his position) but just as a respectful thing to do? It doesn't sound so crazy... And, truth be told, if it wasn't for him I wouldnt have known there was a band complication so serious. When I went for a consult last March to discuss revisional surgery he demanded an instant UGI because of my symptoms and sent me right across to the hospital and when I came back told me what was wrong and that it has to come out and to choose if I want to do RNY or DS when it does come out, but that taking it out isn't an elective decision and one of necessity. So if I had stuck with my Long Island hospital and never saw him I might have had a football for an esophagus right now. This will be odd when I see Dr. Roslin next month in the op prep area when I take my friend in for his surgery (he is getting a lap band to RNY revision with Dr. Roslin, although Dr. Roslin and I were trying to get him to consider DS...). It's all good.
Paul
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Post by Joanne on Jun 26, 2012 16:07:48 GMT -5
Hi Paul I just PM'd you, too.
I think your family has a nice gesture in mind with Dr Roslin, but I don't know that it's necessary. But perhaps a brief, heartfelt email might smooth the waters. I can't speak for Dr Roslin, and certainly don't know all that transpired, but just plain old common sense tells me that if you approach it the right way he would reconsider. I think that you would need to let a little time pass, and make 100% sure that you are ready with your decision. It wouldn't hurt to ask.
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Post by Band to DS on Jun 26, 2012 20:29:31 GMT -5
Hi Paul I just PM'd you, too. I think your family has a nice gesture in mind with Dr Roslin, but I don't know that it's necessary. But perhaps a brief, heartfelt email might smooth the waters. I can't speak for Dr Roslin, and certainly don't know all that transpired, but just plain old common sense tells me that if you approach it the right way he would reconsider. I think that you would need to let a little time pass, and make 100% sure that you are ready with your decision. It wouldn't hurt to ask. Paul, I'm sorry about all that's happened, but you definitely made the right decision to postpone your revision. Please listen to Joanne. She's a smart lady. Also, stick around here & try to meet up with some local DS folks so you can learn more about the surgery & its requirements. Finally, a good counselor or therapist will help you sort through your feelings & clarify your best options. I truly wish you the best. Shelli
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Post by Band to DS on Jun 26, 2012 20:32:32 GMT -5
Oh, and, I don't understand why a surgeon would recommend the RNY & not the sleeve. A RNY pouch is much smaller than a sleeve & is therefore likely to cause problems with your esophagus as well. Just my two cents.
Shelli
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Post by chicarita on Jun 26, 2012 21:23:51 GMT -5
I think while the edible arrangement is certain,y a nice gesture, I don't know that it's necessary.
I would send a heartfelt but brief note explaining that you realized you weren't ready and apologize for the short notice, etc. Or even better, when you see him for your friend's surgery, look him in the eye and apologize for messing up his schedule and mean it.
BUT regardless, you did the right thing. Don't lose sight of that.
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Post by goodkel on Jul 4, 2012 1:53:02 GMT -5
Ok Enough. nyuboi has been given all the information he asked for and more so now its time for him to make his decision. He needs to live with it, not us. We will be here to support if need be. Fighting back and forth isn't productive and it looks ugly. He asked, we answered, we can't make the horse drink unless it wants too. Looks like his leaning towards a conservative DS which isn't a bad thing. Its not an RNY which is a lot harder to pick up the pieces after. Put it to bed. Agree. ~EXALT~
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Post by sheanie on Jul 5, 2012 11:16:41 GMT -5
Paul, my BMI was 31. I was a lightweight. My highest (undocumented by a doctor's scale) weight was above 250. I do not publicly admit the actual number due to the embarrassment of never having told my own husband. My surgery weight was 219. I stand 5'2" in real life. My surgeon's office claims that I stand 5'3", which I vehemently dispute. Their measuring stick thingie stands on top of a 1" thick rubber mat, so there. I now weigh ABOUT 110. Last time I was on a scale was last time I went to the surgeon's office, last August. I just had my breasts augmented, so I'm sure I weigh more now (I got 300's inserted, and yes, they are spectacular, thank you).
I have not regretted my decision for one single second. The DS saved my life. My particular surgeon makes it a habit to perform tiny, tight little sleeves. Mine has been a bitch, but I now can say that I can eat relatively normally. It just takes me longer. I have absolutely NO side effects from the malabsorptive portion of my DS. In fact, I am, for the first time in my life, constipated, due to the calcium intake. Read my past posts for more on that topic, if it interests you. I'm sick of the topic. LOL
So you are in great company being a light weight. Never fear. If you understand the DS, are smart enough to know what foods contain protein, can read your lab levels, you're way ahead of where I was at the start. Main thing is that you can LEARN these things. If you don't think you can comply with the protein requirement, don't get the DS. If you aren't going to take vites, likewise.
My only regret DS-wise is that I didn't do this 25 years earlier. I look back on how much I've missed in life with great big tears of regret and sadness. Well, mainly I look back on all the sex I've missed. Hiking the sand dunes? Not so much. That just leaves sand in your crotch.
As far as knowing your common channel length, psshhtt. Common Shmommon. I had no idea what mine was, never found this site until after my surgery. I stumbled upon the DS by sheer stupid and dumb luck. Some of us are able to bumble through life in this manner, living by the Grace of God. The rest of the crowd, though, hate us. So keep that part quiet.......
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Post by nyuboi on Jul 24, 2012 17:21:23 GMT -5
An update, ah? Well... my lap-band is getting worse. I now throw up solid chunks of food instead of just bile, indicating my esophagus is likely serving as a stomach above my band. It is very dilated, and naturally has to come out. In fact, my existing surgeon from my local hospital called me and said, while he respects I did not go through with the DS if I wasn't sure, that he must then remove my band -- that since I am not ready for revisional surgery they must get the band out before I give myself permanent damage or potentially turn it into a life/death situation is esophagus tears or something. (More on why I stalled in a second). Now, without offending my existing surgeon, I do not feel comfortable with him taking the band out. To be honest, my friend who had lapband with Dr. Roslin has no scars and I have like 3-4 from the band. I can only imagine what it will be like removing it. Naturally, I would prefer a top surgeon than who is familiar with revisions and complications who will be best at cutting through scar tissues without making me look worse than necessary. Obviously, I will not have a choice if I cannot get a top "Caslle Connolly" surgeon in the next week or two. But why not try, right? (I do not want to offend my existing surgeon, but if doesn't even do RNY and only does lapband, I can't imagine he would be as good at removing the band with a major complication as Lenox Hill, Columbia, etc.) Again, I will not put it off at a dangerous cost though and am prepared to proceed if I must.
The issue? Well apparently none of the top doctors (particularly the vetted DS surgeons) take my insurance. In the case of the person, I want -- their hospital does not even take it. THIS IS WHERE I LOVE MY SECOND FAV. SURGEON. Although lightly unethical in what Im about to say, you can tell he genuinely cares. Without going into details, he has guided me that my lapband pain may warrant -- a visit to an E.R. that can't turn you away. After seeing my upper GI, they would admit me, at which point this top surgeon would have to resume my care and schedule surgery to remove the band forcing insurance to pay an out of network provider. Now... the negative is obviously I will be in the hospital 2 days before the actual procedure, one day for admission, a day of tests being ordered, and then the surgery. But I think it's worth it. Now... he explained that after admitted I can discuss which surgeries with him. He said I can choose an RNY, a modified conservative DS with 150 plus CC with a very gentle sleeve cause of my GERD at the same time, or "worse case scenario we just take the band out." At a minimum, I would get the band removed -- and he would understand if I choose to do only that. He believes I have a solid chance of an instant insurance approval for DS at the same time, because they have to pay for the admission and hospital stay and all anyway, and that the actual procedure at the same time is the least of the insurance concerns. Now, that topic makes for a nice transition...
My friend Paul was supposed to have an RNY with Dr. Roslin this month. GHI has denied his request, done a peer to peer with Dr. Roslin, and now denied his first level appeal. He is heading towards a hearing likely. HE HAS A 45 BMI and has only lost 20 pounds with the lap-band in 2-3 years, defined under the law as "inadequate weight loss." Their reason: "There is no technical failure with the band." This is where he can't believe I am getting approval for DS. But this has verified the reality Dr. Roslin and I were originally concerned about: Once the band comes out, I will likely never get a DS approval. My complication appears to be making it extremely easy because it warrants the hospital, "laparoscopic gastric surgery" (a loose term with leeway for a doctor), etc. So doing it while under due to a highly serious complication with the band is not costing them a lot. In the above case of getting out of network via my emergency with an E.R. visit, that will be out the door -- can't show up at an E.R. and say i urgently need a DS, lol. So... that leaves me with in-network people (and Dr. Roslin no like me anyway if you recall the above), and even then "fat chance" (no pun intended) that I get approval. So the reality is, if I opt for DS, I will be spending a fortune (although Dr. Roslin was originally going to charge me 5K since I was a lab rat, lol).
So once again I am time crunched, surprise surprise ah? Fortunately I have had the opportunity to since do much more research and talk to patients. I am much calmer about the "gentle sleeve" and "light bypass with 150 or more CC." Having said that, I obviously would be putting it off slightly more if insurance wasn't an issue. Although remember what you say on here: Think twice, cut once. Just to be safe, I am not smoking (I could smoke just for a band removal). I suppose I am pondering ending up at the E.R. next week (followed by surgery for the band removal) -- but I better be sure I did not want DS in the near future because there will go insurance approval for it forever. But some say its only money and if it buys time, ahhh. Now realize there's the risk I could wake up from my DS and be told they could only remove the band based on what they saw, or that only my band comes out even if I opt for DS while in the hospital... But if I agree to add that on and make it revisional, I need to be be prepared to wake up with some bypassed intestine's. ;-) (Reminds me of the gas-x commercials). The great thing: He wont mind regardless of what I schedule and will do me as a second DS in the day if necessary or just a band removal -- very nice surgeon.
So thats what on my mind. I have no interested in RNY or a sleeve alone because with how gentle I need the sleeve to be it is not expected to do any better than the band (not to mention weight loss can be hindered even with a DS with my starting esophagus problems according to Dr. Roslin's post on here, but not what he said in person). So that's my update for now. Let's assume at the very least that "crapband" is coming out one way or another in the coming weeks, but likely next week. I of course can stall more if I eat gentle and dont vomit more but the reality is if I am not ready for revisional surgery it must comes out in the next 7-21 days. Anyone want my used band to put on display?
Hoping EN doesn't kill me before the band does, Paul
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Post by nyuboi on Jul 24, 2012 17:32:15 GMT -5
Paul, my BMI was 31. I was a lightweight. I have not regretted my decision for one single second. The DS saved my life. My particular surgeon makes it a habit to perform tiny, tight little sleeves. Mine has been a bitch, but I now can say that I can eat relatively normally. It just takes me longer This actually brings up something I was wondering about DSers (not people who had it done in 2 parts though where the sleeve tends to be less with more stomach removed). WHAT IS IT LIKE WHEN YOU OVER-EAT? Do you just feel full, like a stomach ach since its your natural antaomy? Do you throw it up? I am used to the band, but its very different... The food is stuck in your chest and doesnt actually make it below the pouch of a stomach down into the stomach, so you still feel hungry but physically cant eat without throwing it up. I am told this is much better with a DS. What is like though? Years out can you guys eat... say... at least 1/3rd the amount you used to? Do you have the chewing very very well small bites problem of lap-band? (I need alkaseltzer to dissolve my food sometimes if its caught in my band to get it to go down).
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Post by goodkel on Jul 24, 2012 18:14:37 GMT -5
Paul, my BMI was 31. I was a lightweight. I have not regretted my decision for one single second. The DS saved my life. My particular surgeon makes it a habit to perform tiny, tight little sleeves. Mine has been a bitch, but I now can say that I can eat relatively normally. It just takes me longer This actually brings up something I was wondering about DSers (not people who had it done in 2 parts though where the sleeve tends to be less with more stomach removed). WHAT IS IT LIKE WHEN YOU OVER-EAT? Do you just feel full, like a stomach ach since its your natural antaomy? Do you throw it up? I am used to the band, but its very different... The food is stuck in your chest and doesnt actually make it below the pouch of a stomach down into the stomach, so you still feel hungry but physically cant eat without throwing it up. I am told this is much better with a DS. What is like though? Years out can you guys eat... say... at least 1/3rd the amount you used to? Do you have the chewing very very well small bites problem of lap-band? (I need alkaseltzer to dissolve my food sometimes if its caught in my band to get it to go down). The first thing you teach yourself is how to not over eat. Small bites well spaced. If you eat too much for your stomach, it will come back up. Just don't do it. Early post op this probably means two small teaspoons of something every 2-3 hours. As time goes on you'll learn the signals that will tell you when it is time to stop. They vary with everyone. Some people sneeze, some have to blow their nose. But, the best thing to learn is to stop when you are no longer hungry, not to pack in as much as you can without throwing up. At five years out I eat like a normal person. I chew, swallow, and drink with my meals like a normal person. You know those portion sizes that always seemed ridiculously small? Well that IS a normal portion size. Skipping any rice or potatoes, a Healthy Choice frozen dinner will do you.
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