Ah, Neutritionists...

[maggiesara]

So I met this afternoon with the NUT from the new hospital, where I plan to have the surgery. And she's just...I'm sorry, I have zero respect for this profession. None, niente, nada. She's going on about low-fat mayonnaise, and I asked why low-fat. She said something about mayonnaise being "low-quality fat." I said, um....well, actually, it's olive oil and egg yolk. OH she said, well, if you want to use the gourmet version...and the thing is, you know, nope. I'm a trained cook, and a huge kitchen snob, but hey, Hellmann's is just fine by me almost all the time. What just frosted me was her reflexive Low Fat approach that was clearly based on no facts at all.

If you want to tell me that DS patients typically have difficulties digesting fats in the weeks after surgery, that's fine. If you want to tell me that fat will impede healing or in some other way hurt me, no problem, I'll eat low-fat mayonnaise. But if you're going to insist that I eat disgusting food, give me a genuine reason for it. Acchh, stupid little girl.

[Melinda]

I understand what you're saying about the low fat hard sell some of these nutritionists do, especially to DSers, but I think it's kind of mean to say you have zero respect for the profession. I love my surgeon's nutritionist. I realize I got super lucky, trust me! But she is very educated in DS anatomy and truly has helped me to "get back on track" with things. I am sure I am the minority, but I don't think ALL nutritionists are full of crap.

[Deleted]

Melinda, I think you're the exception that proves the rule.

[maggiesara]

Melinda, this one is hardly the first nutritionist I've met. I'm very glad you've had a good experience -- and in fact, I liked the nutritionist at my previous surgeon's practice. But my experience overall has been lousy, not just from an emotional standpoint, but because I don't think there's sufficient academic/intellectual rigor. True, I'm a reporter -- meaning I research stuff for a living -- but I don't have anything to do, professionally, with nutrition. If I know a whole lot more than my nutritionist...we have a problem.

[immakiwi]

Mine told me NEVER to eat roast chicken as the fat seeps though the skin into the meat so you still get the fat even if you remove the skin. I just tell her I poach it lol.

[Deleted]

The fat phobia is just ridiculous.

[kingy]

I thank the gods when I read these posts that I have never had to deal with nutritionists on an ongoing basis re: my DS. Had one visit me after surgery, I just smiled and nodded at her when she gave me the RNY diet and then laughed about it with my surgeon (who despairs of them ever understanding the DS).

Meanwhile I have a coworker who wanders by my desk every now and then and says "eat more fat, you're disappearing". He doesn't know I had the DS but he knows I need fat in my diet and sometimes I get so busy at work I forget to put cream in my tea etc. Of course everyone else looks horrified at him like he's trying to kill me, but it gives me a giggle.

[newyorkbitch]

I have also dealt with an excellent nutritionist who works for the bariatric surgery program at Cornell in NYC.

[kennyk]

NYB, does this NUT from Cornell follow what seems to be the norm on here for a DS lifestyle?
I am in long island and would love to find one local.

[Deleted]

Kenny, Liz Goldenberg is excellent...that's the Nut that NYB is talking about. You can find out about her here: weillcornell.org/lizgoldenberg/ She is my dh's NUT (he had his DS with Dr. Pomp) and she 1) had NO issue with us using the Vitalady plan and 2) is very much protein/fat for DS'ers.

[maggiesara]

Yes, I liked Liz and also Jaimie, who was with the Cornell practice until recently. But I've shifted to Lenox Hill because it became clear that the Cornell practice was really geared toward RNY. I figured if I was going to have this massively invasive surgery, I'd prefer it to be done by someone who did a lot of them, rather than by someone who did three or four a year.

[newyorkbitch]

Yes, Liz Goldenberg is the person I was talking about. Unfortunately she does not see patients who are not patients of the Cornell bariatric surgery practice. I saw her several times when she was at Sinai on the original Gagner team. She went with Pomp et al to Cornell. She was kind enough to speak to me on the phone a few times, to review some stuff I wanted her to look at, but she can't see me now because I'm not a Cornell patient. She did say that if I chose to do followup with Pomp annually, then she could see me. I don't need any followup with any surgeon (I have an excellent internist, hematologist, etc). Actually I don't need a nutritionist either. I just wanted to say that she is really smart and competent, supporting the point that not all nutritionists are "bad." She has been working with bariatric surgery patients for at least 15 years, in very well respected practices.

[newyorkbitch]

Pomp has done a lot of DS's. A lot. For at least 15 years. I'm sure Roslin is a good surgeon, but I also think the issue of followup care is important in the first few years. I like that the Cornell practice has a big team.

[maggiesara]

I know Pomp has done a lot of DS's, but he made it quite clear, when I met with him, that his preference was for RNY. Jaimie was so unused to dealing with DS patients that she couldn't even find the right nutrition handout. And to be honest, although my surgical outcome was great, when Pomp removed my lapband, I thought the follow-up was shamefully bad. Pomp never returned the three phone messages I left for him, his PA could not seem to understand the procedure I was having (the lapband removal), and nobody from the team checked on me at any time when I was in recovery or once I had gotten home for more than three days. So I moved to Lenox Hill.

[newyorkbitch]

Did he say why his preference was for RNY?

[sheanie]

Maggie Sara: You are my new favorite newbie. I absolutely LOVE the way you write, your style and smarts.

A good NUT is hard to find. Christine Becker at GHP is really good with the DS eating. The other NUT very well could have led to my death early post-op with her mal-advice concerning my severe lactose intolerance. But Christine Becker researched each of the food packages on the stuff I purchased in their "store" at GHP and cleared which ones I could eat. It was very much appreciated because at the time I was so sick I wasn't making much sense.

You research things to death like I do. On top of that, you can smell when someone doesn't know their stuff. That's a rare talent (I keep telling my husband this) that very few people have.

My "good" nutritionist didn't start out that way. She started out speaking the low-fat propaganda. GHP also stuck DSers in a conference room one week post-op with all RNY's. I complained about that, because I was told to follow RNY protein guidelines. They do it differently because of me. They used to cross off the RNY advice and hand-write in the DS protein amounts, but kept everything else the same. By the time I left, they had color-coded the DS stuff so we had the correct (mostly) information.

But, we've said it here all the time: We go to the surgeon for cutting; we come here for the after advice and everything else. Hell, if I didn't need a doctor's order for my labs, I'd never see one again. Well, except for my hematologist for infusions, of course. He's a gem.

[maggiesara]

Many thanks, Sheanie. NYB, my geographical sis! Pomp said he hated taking pills -- so the pill regimen for DS patients squicked him out -- and that since he shared a bathroom at work with five other doctors (a docs-only bathroom? How....charming), the idea of stinking it up distressed him. I said I was already taking 13 pills a day, for a variety of comorbidities, PLUS the damn insulin shots, so the pills didn't scare me. And I live alone with a cat who stinks up her litter box: If I can take it, she can.

Jaimie, the nutritionist, told me the practice had seen a lot of problems in its DS patients -- malnutrition of various kinds. But she couldn't really give me a number. And when I asked if I could talk to a previous patient, it took quite a while -- as in, a couple of weeks -- for them to find one. My sense is that the practice shifted sharply away from DS a few years ago. A cynic would say, well, RNY takes less time and the doc gets paid the same, and perhaps that's the reason. Or perhaps (more likely, in my view) they've seen some bad outcomes, their patients have trouble with compliance, AND the financial argument is persuasive. In any case, it's just not something they're into. And I knew, from reading this board and others, that it was the surgery I wanted, in part because I knew that while I have been reasonably serious about eating low-carb for many years now, I also knew that eating low-fat was not going to be an option. Pick your poison.

[newyorkbitch]

I think that there are reasonable, excellent physicians who are concerned about the longterm issues with the DS. And I don't disagree with the hesitation to do the DS on many people - it takes intelligence, assertiveness, research, money, time.....to live successfully and healthily with a DS for a life time. And I am sure that there are plenty of DSers out there who had, have, and will have DS-related health problems. I don't think it's a bad thing at all for doctors to try to dissuade people. I do know that Pomp (and also Dan Herron, whom I like a lot), will do the DS on some people. But I for one am glad that extreme caution is used when doing it.

[newyorkbitch]

FYI maggiesara:

www.surgicallyslim.com/bpd_ds.htm

[maggiesara]

I'm sorry, I'm not sure why you offered me that link. I've read quite a lot about the various surgical options, and am very certain that DS is the one that's right for me.

Please understand, I'm not dissing Pomp for moving away from DS, for whatever his reasons. But given that he has moved away from it, and that his practice performs very few a year, it seemed to me to make sense to work with a practice that had a DS orientation.

[newyorkbitch]

If it were me, I would push the DS with Pomp and do it there, but that's just me. I gave you that link just so you could read about Dan Herron if you were interested - that's the other surgeon I would consider besides Pomp and Roslin. I wouldn't touch NYU with a ten foot pole.

[newyorkbitch]

Also I guess I'm just not happy to have this type of surgery with a one-surgeon practice. I had emergency (bowel obstruction) surgery 2 years post-op, and I was very, very glad that there was a team of surgeons at Sinai, all of whom were equipped to deal with my issue (Pomp, Herron, Inabnet). I had two bowel surgeries inside of 48 hours - Pomp did one, Inabnet did the other. I consulted with Herron when I was pregnant to discuss whether or not I should have a planned c-section due to all my previous surgeries. He was wonderful, and a member of his team scrubbed in during my c-section "just in case." It was uneventful.

[maggiesara]

I tell you what, I'm going to ask you to stop here. I've got enough nerves about the surgery, and second-guessing my choice of surgeon isn't helping. The practice at Lenox Hill has several surgeons. I'm not suggesting you're doing anything wrong by saying what you're saying, only that I can't handle it right now, so as I favor I'd appreciate it if you could back off a little. Thanks.

[sheanie]

There's another reason why a practice couldn't get you in touch with a successful DSer. That office may not give adequate after-care and the SUCCESSFUL DS patients have jumped ship for better, more intelligent care.

My own surgeon mused during my pre-op appointment, in front of my husband, that he never saw his DS patients after the first year post-op. Well, I'm here to tell you why. I got sick of getting the wrong information from almost everyone in the practice. I got RNY dietary instructions. I had to fight to get copies of my own lab results. The nurse who called after I got my labs done was snarky and sarcastic. And last, but not least, I live 3.5 hours away.

You only need the surgeon for cutting. But you only want to do this surgery once. Make sure you pick a surgeon who is going to do it right the first time. A doctor who does a lot of DS's is a better choice than one who does afew a year. You don't want to come out of surgery with just the sleeve, either.

But above all else, you have to be comfortable with your choice. That's what's important.