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Post by Deleted on Jul 7, 2012 23:30:12 GMT -5
As I'm sure most of you know, Dr. Peters recently passed away.
I contacted Dr. Rabkin's office, as his program director Barb helps coordinate the DS surgeons' meeting at the ASMBS, to see what could be done about finding follow up care for Dr. Peters' patients.
A few of the "inner circle" of DS surgeons have been contacted about Dr. Peters' death and the dilemma of his patients. I was saddened to learn that Dr. McPherson also recently passed away, so there is another group of patients who have been "orphaned."
One of the DS surgeons wrote to me, and said that the FIRST thing all of Peters' and McPherson's patients should be doing is to contact their DS surgeon's office and obtain copies of their charts, ASAP. As the surgeon said (after I fixed his cell phonese - or perhaps it is surgeonese - to make it grammatical):
"I would be willing and able to follow other patients, I just do not want to get a call or an email from a patient with no records or background information and be expected to render an opinion as to why they are tired."
The patients should also have copies of ALL of their most recently labs, etc.
Please post this on the OH DS board, and ask people to contact me if they need to see someone right away - at this time, the main group of surgeons has not been contacted yet, so any needs will be met one-off. We will try to get people who are interested hooked up with a surgeon who can provide continuity of care.
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Post by newyorkbitch on Jul 8, 2012 6:40:01 GMT -5
Why does anybody need to continue with a surgeon long term? I haven't seen a DS surgeon (other than for a discussion about my c-section) in over 10 years.
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Post by Deleted on Jul 8, 2012 6:45:49 GMT -5
I think Diana makes a great point as to how important it is to maintain our own medical files. I have copies of everything dating back from before my surgery. Back then Dr. Elariny's office was so chaotic that it was in our best interests to maintain copies of everything. I'm just kept that up.
@nyb - But some of us do. I haven't had much luck finding a GP or internist so I still rely on the surgeon's office for my annual labs. Even though I'm almost 10 years post-op I feel I need a medical professional to look at my labs and make sure I'm not missing something. I have tons of specialists but no GP.
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Post by newyorkbitch on Jul 8, 2012 7:43:03 GMT -5
My hematologist or my endocrinologist or my internist - any and all of them run labs when I ask..and then I get copies and send it to the others so I don't have to repeat them. When I had carpal tunnel surgery not long ago, I had to do a pre-op clearance and get bloodwork so I just asked "hey while you're at it, can you run these things too" and they had no problem doing it. I don't want a surgeon following me - surgeons are surgeons - they are not internists or gastroenterologists or hematologists or endocrinologists. I am of the opinion that a surgeon following a patient after the first year is bad medicine - they are practicing out of their expertise. The responsible thing for a surgeon to do is to identify (or include) internists and specialists that are familiar with the DS and who are willing to take on his patients after he no longer should be dealing with them.
And yes certainly, for sure, everybody should have copies of everything in their medical records - and I mean everything.
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Post by Deleted on Jul 8, 2012 8:11:10 GMT -5
None of the specialist I go to will agree to run all my labs. This has been my main problem. I'm lucky that Dr E is local and finally have staff that understands the DS thanks to Vitalady.
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Post by Deleted on Jul 8, 2012 9:51:10 GMT -5
I see my surgeon - or, more accurately, his PA, since I have had no real problems - every year. I drive the 50 miles to SF, and always schedule it to coincide with the afternoon of his monthly "big meeting" so I can stick around for it. I also see my PCP - whom I have trained about all things DS - at about the same time each year, and make sure she is aware of the problems, if any.
However, a few years ago, I got sick with terrible stomach cramps and diarrhea. On about the third day, I was feeling better, so I made plans to hand out with a friend in SF - and the cramps came back with a vengeance. I drove myself over to Rabkin's office, was able to be seen immediately and then was sent immediately to St. Mary's Hospital (Rabkin's office is in the facility) for a CT scan with contrast - in a special small volume formula I was able to drink completely (and it didn't taste horrible either).
It is VERY helpful to have my surgeon as an option for a few things. For example, my PCP was VERY reluctant to order Flagyl non-specifically for gas pain and bloating. I got Rabkin to write a script for HER to see, which was to order flagyl ad lib for me, which made her feel comfortable with doing so. Similarly, I was hooked up with my hematologist (who is NOT with my medical center) because he is one Rabkin has worked with and "gets" the DS ferritin issues - and prescribes infusions when levels are low normal, rather than waiting for deficiencies. My gastroenterologist is not part of the DS "network" but I was seeing him before my DS for my IBS, and he has read what I have offered him and made himself aware of DS issues.
But mostly, it is comforting to me to know that in an emergency, I could either get to him or get in contact with him, and that he would be available to talk to another doctor about my anatomy and make suggestions about what to do.
But one of the things that has come out of this discussion for me is that despite the fact that I DO have access to one of the best DS surgeons for follow up, I should have a copy of my own medical records on hand, and I don't have some of them available online, especially the old ones.
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Post by goodkel on Jul 8, 2012 10:00:37 GMT -5
Everyone definitely needs to keep a copy of all their records, but I haven't required the services of my DS surgeon since he released me from the hospital five years ago.
In an emergency situation, you don't even need a bariatric surgeon. Any gastroenterology surgeon is capable of fixing a leak or a blockage.
On a day to day basis, all anyone needs is a pcp or other doctor willing to write the orders for the labs you request.
There is no cause to worry if your DS surgeon dies or retires.
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Post by Deleted on Jul 8, 2012 10:22:50 GMT -5
Kelly makes a good point, so let me follow up with a clarification: of course nobody really needs to be affiliated with their ORIGINAL DS surgeon - especially those who went out of the country to get surgery, or who had surgery with someone who turned out to be an unreliable flaky gypsy. However, it IS helpful to have some sort of pre-arranged loose affliation with a DS surgeon with whom you feel comfortable, in case you have an abdominal emergency and whom you could pull in to consult with your local doctors should something occur.
Kel, I recall that when you had your bowel obstruction a while ago, you were delerious with pain and very concerned that the local surgeon was going to get inside you and take down your DS - that would be one of those situations in which it would be REALLY comforting to know you had a back-up surgeon in your pocket to talk to and to advocate for you with your local docs.
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Post by goodkel on Jul 8, 2012 10:37:06 GMT -5
Absolutely, the more DS-knowledgable medical professionals you have on your team, the better.
But, there are people who traveled for their surgery for lack of a local DS surgeon who don't need to be booking flights in a panic to find a replacement DS surgeon.
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Post by Deleted on Jul 8, 2012 10:47:47 GMT -5
Absolutely, the more DS-knowledgable medical professionals you have on your team, the better. But, there are people who traveled for their surgery for lack of a local DS surgeon who don't need to be booking flights in a panic to find a replacement DS surgeon. No, I didn't say anything about "booking flights in a panic" - I was talking about getting affiliated with a DS surgeon in advance of any problems, who would have a copy of your surgery report and a few other records, who would know who you are (or could figure it out from his own files) so that the surgeon could be CONSULTED (e.g., by phone) if a problem occured. Someone who if for any reason you needed to be able to tell your local doc to "please call my surgeon" would be available to do that. AND - if it came down to it - you would have in your back pocket IF you came up with an issue that needed a DS surgeon to attend to. I'd just want to have that set up in advance. I personally would also want to have a relationship with a surgeon who could be consulted about nutritional issues, but that's because I've been spoiled. |
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Post by newyorkbitch on Jul 8, 2012 11:30:43 GMT -5
I am very fortunate that I live in NYC where there are multiple DS surgeons, and a lot of very good doctors. I also have robust health insurance. But I cannot imagine contacting Gagner for any reason on this earth. If I had some kind of DS-specific need, I would call Dan Herron. In fact I did call Dan Herron when I needed his opinion about whether or not to have a c-section, and at his suggestion, one of his team scrubbed in during my c-section in case anything weird were to have happened. (Nothing weird happened at all, fyi).
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Post by Deleted on Jul 8, 2012 11:49:40 GMT -5
As noted previously, this could be an issue not only with respect to your surgeon dying, but also if s/he becomes a flake or you have a breakdown in your relationship or even loss of insurance coverage for that surgeon (while I would pay out of pocket in order to stick with Rabkin, that may not be an option for some). It would be nice to know which surgeons are willing to consider taking on someone else's patients, and under what circumstances. The WLS world is rife with surgeons who refuse to take on other surgeons' patients.
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Post by SLVinNorCA on Jul 8, 2012 13:26:28 GMT -5
This response doesn't really relate to the surgeon dying issue. However, there is a VERY good reason to stay in contact with your surgeon, and that's to give back to them the continuity of your lab work results and any other issues. My personal opinion is that they saved our lives, it's the LEAST we can do for them to help them keep accurate and up-to-date stats on their patients.
I'm a Kaiser patient and after my 3 month checkup, Dr. Rabkin's office wouldn't normally see me again. However, I WILL be forwarding my labwork and correspond with his office yearly. I respect Him and will do everything in my power to give back to him anytime I can.
S~
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Post by goodkel on Jul 8, 2012 13:52:03 GMT -5
Absolutely, the more DS-knowledgable medical professionals you have on your team, the better. But, there are people who traveled for their surgery for lack of a local DS surgeon who don't need to be booking flights in a panic to find a replacement DS surgeon. No, I didn't say anything about "booking flights in a panic" - I was talking about getting affiliated with a DS surgeon in advance of any problems, who would have a copy of your surgery report and a few other records, who would know who you are (or could figure it out from his own files) so that the surgeon could be CONSULTED (e.g., by phone) if a problem occured. Someone who if for any reason you needed to be able to tell your local doc to "please call my surgeon" would be available to do that. AND - if it came down to it - you would have in your back pocket IF you came up with an issue that needed a DS surgeon to attend to. I'd just want to have that set up in advance. I personally would also want to have a relationship with a surgeon who could be consulted about nutritional issues, but that's because I've been spoiled. I didn't say that you did. But, you know full well that there are pre-ops and new DSers here that get anxious about every little detail. And worrying about this one is unnecessary. They need to know that. |
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Post by newyorkbitch on Jul 8, 2012 19:29:35 GMT -5
I understand if somebody would want some kind of "relationship" with a DS surgeon in the event that a DS-related surgical issue were to come up. Although after the first few months, it's hard to imagine what a DS-specific surgical issue might be.
But for nutritional issues...no need whatsoever. In fact most DS surgeons are not only not helpful in this area, but many are actually harmful.
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Post by preachermomma37 on Jul 8, 2012 22:24:10 GMT -5
Let me preface that I only live 25 minutes from my surgeon's office and that they have a fabulous follow-up program. My doctor told me once I had surgery that he would be my "tummy" doctor from that point on. Meaning if I had any symptoms related to my gastrointestinal area he should be the first I call and rely on. At this point I honestly don't trust anyone else and Dr. H will see me annually indefinitely.
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Post by newyorkbitch on Jul 9, 2012 6:36:32 GMT -5
Personally, I think it's crazy to see a surgeon for issues that should be dealt with by a gastroenterologist. It's like going to a podiatrist for an ear infection. I would never, ever "trust" a surgeon who told me he could be my gastroenterologist for the rest of my life. Because he can't. It's not his specialty. It's arrogant and irresponsible and dangerous. It is essential to have an internist and/or gastroenterologist that you see annually, who understands the issues related to malabsorption. This is what we need - not longterm relationships with surgeons who are practicing outside of their expertise. I think it is extraordinarily irresponsible of a surgeon not to have a network of referrals to which to send patients. Since the DS will, for sure, result in the need for medical attention the rest of one's life, a DS surgeon MUST have internists/gastroenterologists/hematologists/endocrinologists to whom to send people. This is how it should be done: www.cornellweightlosssurgery.org/about/our_tea.html?name1=Our+Physicians+and+Staff&type1=2Active |
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Post by happycatbert on Jul 9, 2012 7:44:26 GMT -5
Well, I will chime in here. My PCP has been ordering my labs, etc. since Dr. Peters got sick. That's not my concern. I have, however, had surgery for possible obstruction/adhesions, have a pretty hefty amount of abdominal mesh, and if I were to land in the hospital again, there is no one around here that has a clue about the DS from a surgical perspective. I think it's important to have contact with a surgeon who can at least advise what's going on in there. I wouldn't want some nameless surgeon to mess with me without guidance.
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Post by goodkel on Jul 9, 2012 15:22:12 GMT -5
Kelly makes a good point, so let me follow up with a clarification: of course nobody really needs to be affiliated with their ORIGINAL DS surgeon - especially those who went out of the country to get surgery, or who had surgery with someone who turned out to be an unreliable flaky gypsy. However, it IS helpful to have some sort of pre-arranged loose affliation with a DS surgeon with whom you feel comfortable, in case you have an abdominal emergency and whom you could pull in to consult with your local doctors should something occur. Kel, I recall that when you had your bowel obstruction a while ago, you were delerious with pain and very concerned that the local surgeon was going to get inside you and take down your DS - that would be one of those situations in which it would be REALLY comforting to know you had a back-up surgeon in your pocket to talk to and to advocate for you with your local docs. I do have Dr. Elariny's contact info on my medical info sheet in case they need to contact a DS surgeon in the same time zone, but I have never met Dr. Elariny nor had any contact with him. Yes, the ER was reluctant to give me a scan with contrast and I requested that they contact a bariatric surgeon on call. He ordered the contrast scan over the phone, came in, and then kindly offered to "fix" my DS to an Rny. I told him that he only had permission to touch my DS if the only other option was death. If I had been unconscious and something like that had been done to me without my permission, I would be a very rich woman today. But, my internal hernia and blockage were fixed without anyone ever needing to contact a DS surgeon. My DS wasn't touched. |
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Post by preachermomma37 on Jul 9, 2012 18:54:12 GMT -5
I guess I will be addressing this issue with Dr. Houston at my next appointment in August. I had never thought of it in the way above. I don't if its because I've never had to see any of these other specialist, ie. gastro, internist, or hematologist, but I will definitely bring it up at my 3 month check-up.
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Post by Deleted on Jul 18, 2012 13:39:57 GMT -5
UPDATE:
From Dr. Rabkin's Program Director, who emailed the DS surgeons (edited for typos and clarity):
"Well I have given it a week since I emailed the group. No one has responded back that they would not see Dr. Peters' patients. Doctors Anthone, Keshishian, Rabkin, Greenbaum and Roslin emailed me back they would be happy to see these patients, but they first must get copies of their charts....hope this helps."
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Post by jbandmmomma on Jul 18, 2012 15:32:12 GMT -5
This response doesn't really relate to the surgeon dying issue. However, there is a VERY good reason to stay in contact with your surgeon, and that's to give back to them the continuity of your lab work results and any other issues. My personal opinion is that they saved our lives, it's the LEAST we can do for them to help them keep accurate and up-to-date stats on their patients. I'm a Kaiser patient and after my 3 month checkup, Dr. Rabkin's office wouldn't normally see me again. However, I WILL be forwarding my labwork and correspond with his office yearly. I respect Him and will do everything in my power to give back to him anytime I can. S~ This is an awesome point! |
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Post by nightowl on Jul 20, 2012 0:34:57 GMT -5
UPDATE:From Dr. Rabkin's Program Director, who emailed the DS surgeons (edited for typos and clarity): "Well I have given it a week since I emailed the group. No one has responded back that they would not see Dr. Peters' patients. Doctors Anthone, Keshishian, Rabkin, Greenbaum and Roslin emailed me back they would be happy to see these patients, but they first must get copies of their charts....hope this helps." Very happy to hear this. |
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Post by SLVinNorCA on Jul 29, 2012 8:51:28 GMT -5
This response doesn't really relate to the surgeon dying issue. However, there is a VERY good reason to stay in contact with your surgeon, and that's to give back to them the continuity of your lab work results and any other issues. My personal opinion is that they saved our lives, it's the LEAST we can do for them to help them keep accurate and up-to-date stats on their patients. I'm a Kaiser patient and after my 3 month checkup, Dr. Rabkin's office wouldn't normally see me again. However, I WILL be forwarding my labwork and correspond with his office yearly. I respect Him and will do everything in my power to give back to him anytime I can. S~ This is an awesome point! Thanks ;-) |
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Post by msbatt on Jul 29, 2012 10:32:34 GMT -5
Six months after my DS, my surgeon retired. His partner, Dr. John Husted, was *supposed* to take over my long-term care---and we all know just how 'long-term' Dr. Husted does anything. 18 months post-op, I saw Dr. Al Spaw, the guy who because Dr. Husted's partner after Dr. Anderson retired---ad by that time, Dr. Husted had moved to---well, somewhere.
I haven't seen a DS surgeon since. My PCP orders my labs. A local general surgeon did my hernia repair, and saw me when I had a bowel obstruction. He's a far more caring and thoughtful surgeon than Dr. Husted. Although he'd never even HEARD of a DS until he saw me the first time, he was immediately interested and wanted to learn more.
About three years after the hernia repair, I broke 7-count 'em-7 ribs, and he saw me in the ER. (Placed a chest tube because I had a collapsed lung!). He immediately remembered that I had a DS, and started asking me questions about it---how I was liking it, had I had any problems---even commenting on the fact that not only had I not GAINED any weight, I'd even lost more in the three years since I'd seen him. He's recommending the DS to all his MO patients now. From time to time, one of them calls me up to ask questions.
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Post by goodkel on Jul 29, 2012 10:57:09 GMT -5
Six months after my DS, my surgeon retired. His partner, Dr. John Husted, was *supposed* to take over my long-term care---and we all know just how 'long-term' Dr. Husted does anything. 18 months post-op, I saw Dr. Al Spaw, the guy who because Dr. Husted's partner after Dr. Anderson retired---ad by that time, Dr. Husted had moved to---well, somewhere. I haven't seen a DS surgeon since. My PCP orders my labs. A local general surgeon did my hernia repair, and saw me when I had a bowel obstruction. He's a far more caring and thoughtful surgeon than Dr. Husted. Although he'd never even HEARD of a DS until he saw me the first time, he was immediately interested and wanted to learn more. About three years after the hernia repair, I broke 7-count 'em-7 ribs, and he saw me in the ER. (Placed a chest tube because I had a collapsed lung!). He immediately remembered that I had a DS, and started asking me questions about it---how I was liking it, had I had any problems---even commenting on the fact that not only had I not GAINED any weight, I'd even lost more in the three years since I'd seen him. He's recommending the DS to all his MO patients now. From time to time, one of them calls me up to ask questions. Exactly. ~exalt~ for mentioning it. While nice to have, remaining in touch with a DS surgeon is not necessary. After the broken ribs, did you finally take down the trapeze over your bed and stop with the acrobatic sex Cirque du MsBatt?  |
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Post by Deleted on Jul 29, 2012 13:24:09 GMT -5
Obviously, some of you (by necessity or otherwise) feel perfectly comfortable having no contact with a DS surgeon. For the most part, it is possible to never deal with your DS surgeon or ANY DS surgeon again, if you are very proactive and reasonably lucky.
However, some of us would NOT feel comfortable not having a DS surgeon in our back pocket, just in case, myself included. For those whose surgeons have died, retired, have become unreliable, or are just assholes, I wanted to make sure that you know that there are other DS surgeons willing to talk to you, even though you were not their patient originally, and their minimum requirement seems to be that you have a copy of your operative report and other medical records for them to review if you ever DO need them.
I am fortunate in that my surgeon retired, but his brother took over the practice, and I have had a working relationship with him as well since the very beginning. I think it's important that people know that there are some DS surgeons who are willing to take on other surgeons' patients, since many bariatric surgeons are notorious for refusing to do so. If this information is of no interest to you, feel free to ignore it.
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Post by pandykorn on Jul 30, 2012 2:34:50 GMT -5
i went to one follow up, now just see my PCP, i got a letter in the mail to come in for a 1 year check up- i kind of want to go in order to "keep in touch" even though i know nothing useful will happen and it is a difficult 2 hour trek for me- but honestly i dont want to go because i feel like a failure that hasnt lost enough weight. .....
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Post by Deleted on Jul 30, 2012 2:40:21 GMT -5
i went to one follow up, now just see my PCP, i got a letter in the mail to come in for a 1 year check up- i kind of want to go in order to "keep in touch" even though i know nothing useful will happen and it is a difficult 2 hour trek for me- but honestly i dont want to go because i feel like a failure that hasnt lost enough weight. ..... So, besides depriving yourself of possible guidance of your surgeon, you are (1) allowing yourself to feel like you got the right surgery for you, but YOU failed; (2) allowing your surgeon to NOT use your poorer stats as a measure of how well his patients do; and (3) depriving him of the ability to recognize what does and doesn't work - based on your age, comorbidities, intestinal measurements, etc. - so s/he can make adjustments for people who come behind you. That's why we call it paying it forward - it's not only just about you. And that's my harangue for the day. |
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Post by goodkel on Jul 30, 2012 3:13:45 GMT -5
i went to one follow up, now just see my PCP, i got a letter in the mail to come in for a 1 year check up- i kind of want to go in order to "keep in touch" even though i know nothing useful will happen and it is a difficult 2 hour trek for me- but honestly i dont want to go because i feel like a failure that hasnt lost enough weight. ..... Don't feel bad, sweetheart. I had my DS right around the time of two other DSers who lost all their excess weight in 6 months. It was disheartening to see their success when my weight seemed to be coming off much more slowly. I started at 265 and was 180-90 ish at one year. I avoided carbs and kept the faith and eventually hit the 120's a year later. Slow and steady won the race. I also didn't struggle with the vitamin deficiencies one of them did. The weight loss window is often 18 months, but it can go to 24 frequently as well, as did mine. Don't give up hope! Your DS is still working for you. Why don't you see if your surgeon would give you a 1 year consultation over the phone since the two hour trip is so inconvenient for you? It can't hurt to keep in touch and he could coordinate any testing he wants through your pcp, particularly if you explain how difficult the trip is for you. |
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