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Post by nyuboi on Aug 9, 2013 2:39:37 GMT -5
I'm not understanding why he is uncomfortable with YOU, the PATIENT, sharing HIS advice, which YOU PAID FOR. They are YOUR HIPAA rights, not his. I don't buy the argument that he's worried someone will take medical advice intended for you. What boundaries? Did he TELL you about these boundaries? I felt the same way. The HIPAA laws are to protect my confidential health information, not the feedback another surgeon gave me. No, never told me of these boundaries. It's not like I said anything untrue to slander him or defame his character. I posted two emails that were both two sentences when trying to engage with others about the sleeveless DS idea, and I even warned him the purpose was for the board.
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Post by goodkel on Aug 9, 2013 2:52:07 GMT -5
Out of the frying pan, into the fire. I don't believe this is about your posting his emails per se - it is about your questioning him and doubting him - his litigious-meter was tripped. I was wondering if it got back to him that I contacted half of the DS surgeons on the vetted list for feedback..... That's why I made it a point in my email to say I wasn't challenging him, that I believe his advice, and that I just wanted to make sure I was fully understanding why DS was being ruled out. I thought you said that YOU told him it was to answer questions broached to you here. He has been here before and could have found this thread all on his own.
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Post by Girlrocker on Aug 9, 2013 10:06:11 GMT -5
Have no clue what legalities, issues are. When I decided to seek a revision I had been away from WLS support groups for over five years, so I was way out of the loop and disconnected. I found Dr. Keshishian because he was in my insurance network, along with some other surgeons, included a very reputable one at Cedars, Dr. Quilici (who wanted to do a band over bypass, and I said no). I saw Dr. K first and was thunderstruck...but still unsure, and told him I had other consults set up. His reaction was, by all means go, he encouraged me to do that.
However, I agree with Kelly, that perhaps this is in the long run the best thing for you. You shouldn't head into any surgery hating it, and while I get you are making some jokes here/there to cope with the situation, really, you didn't seem peaceful with having the RNY and I think you will benefit from this addtional time to really sort through all the information you have now. I think you need a surgeon who will approach your situation and tailor a procedure specifically for you that factors in all your issues. I know you have to be miserable not being on the other side, but you want to be on the right side, one you can get on board with.
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Post by Deleted on Aug 9, 2013 10:09:17 GMT -5
I have no clue what any legalities might be in this situation--and I apologize for not making that clear in my previous post. My point is this: The world of bariatric surgeons is small, the Internet is at everyone's fingertips, and people talk. Learn from this and don't shoot yourself in the foot again.
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Post by Girlrocker on Aug 9, 2013 12:36:22 GMT -5
Gail R mentioned on your other update post about surgery being canceled, that perhaps you should have paraphrased, and I think that's a good observation, since you were posting direct emails. Again, I really have no knowledge of the legal ramifications of this. However I'd think at this point, you can use the experience to ascertain so you can continue to sort what your next steps are, and walk a better line of sharing information and getting what you need.
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Post by newyorkbitch on Aug 9, 2013 14:05:28 GMT -5
I have another thought - maybe it's only one of the reasons he cancelled. He knew you were still questioning the advisability of having the RNY, and perhaps he did not want you to cancel at the last minute and leave a big hole in his surgical schedule. He also, rightly so, felt that you did not trust him even after he explained to you his reasons for the procedure he was advising. That's not a good way to go into surgery, not for the patient and not for the doctor.
Also, you waited way, way too long to do the research you needed to in order to feel comfortable. This is all very last minute, and you're still doubting your surgeon's advice. I completely understand why he cancelled.
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Post by goodkel on Aug 9, 2013 15:36:10 GMT -5
I have another thought - maybe it's only one of the reasons he cancelled. He knew you were still questioning the advisability of having the RNY, and perhaps he did not want you to cancel at the last minute and leave a big hole in his surgical schedule. He also, rightly so, felt that you did not trust him even after he explained to you his reasons for the procedure he was advising. That's not a good way to go into surgery, not for the patient and not for the doctor. Also, you waited way, way too long to do the research you needed to in order to feel comfortable. This is all very last minute, and you're still doubting your surgeon's advice. I completely understand why he cancelled. Exactly. Plus, didn't you already cancel surgery with him before at the last minute?
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Post by Joanne on Aug 9, 2013 16:04:44 GMT -5
And didn't you post only a day or two ago that you were going to see Fielding and were considering canceling on Tuesday?
As far as the attorney being copied, my guess is that it's not related to HIPAA. I work in healthcare administration and my guess is that it's protocol when a patient is dismissed or cancelled.
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Post by nyuboi on Aug 9, 2013 17:58:08 GMT -5
As for DR. FIELDING....
He does not feel my esophagus is damaged. He thinks there is some light motility problems from the severe acid reflux disease. The UGI and x-rays they did show a big hiatal hernia - he said a good portion of my stomach is sticking into my chest. There is a chance that fixing this hernia alone could improve the GERD. Whether or not enough to get a DS is the mystery.
He feels the DS would be a "unnecessary risk of failure of the GERD," and that we should go into any procedure correcting GERD not making it worse.
Having said that, he is still willing to do a DS. He said I have three options:
1) Do the RNY.
2) Do a standard BPD (Scopinaro)
3) Do the DS.
He said I can choose, but he suggests RNY. The middle option, BPD, would give me the malabsorption of the DS (100-150 common channel), without the part that will make GERD worse, no high pressure. He suggests this over a DS.
Or, lastly, the DS. He will do it if I want, but says the risk is if my GERD gets worse or I am bad off, I could end up needing a conversion to a gastric bypass, and he said this is "major major surgery" if this has to happen. (Something Dr. Spaw had said..)
He said there is no point in a sleeveless DS, that most of the weight loss comes from the restriction, and that the weight that is kept off is from the malabsorption.
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Post by larra on Aug 9, 2013 18:48:47 GMT -5
I've been following this saga with the rest of the gang. I don't claim to know what the right answer is. I do know that any patient having any kind of bariatric surgery, whether virgin or revision, should go into that surgery with full confidence that he/she has made the best possible decision and committed to making the most of that decision and dealing with whatever complications may occur.
that isn't where you are. I realize that you have a unique and complex individual situation that makes the decision making process much harder than usual. I think it was perfectly reasonable for you to get a second, third, tenth opinion. I also think it's reasonable that the people whose opinions you sought do not all agree with each other. Even the most qualified of doctors can and do sometimes disagree.
Given these facts, I believe, in the long run, that it's a good thing Dr. Roslin cancelled your surgery regardless of why he did so. You are NOT confident about having RNY. You are NOT committed to this course of action. Maybe someday you will be, but that day hasn't arrived. The fact that Dr. Roslin dropping you as a patient may make it harder for you to get whatever surgery you eventually have, if any, covered by insurance is irrelevant. You were not mentally ready for surgery next week and not at all sure about this decision, which would have been just about irrevocable. It's elective surgery. You did not have confidence in your surgeon's judgement - not that you think he's a bad surgeon, you clearly don't think that, and not that you said anything negative about him, I am not accusing you of anything. Simply that you were not confident about your decision, not confident about his opinion, and not ready for surgery next week.
So take this (unwanted) opportunity to continue your thinking and learning about your options and then, when you are certain about what you want, go to the surgeon in whose judgement you have full confident and proceed from there.
PS while I can't speak to what choice is best for you, I will say that I think BPD without DS is a crappy choice for just about anyone. The negative effects of this operation for nutritional health and diarrhea are well documented. That's why the modern day DS was created.
Larra
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Post by Joanne on Aug 9, 2013 18:58:33 GMT -5
Applause Larra
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Post by newyorkbitch on Aug 9, 2013 21:35:30 GMT -5
It is still looking like the RNY is what the majority of doctors have recommended to be the best for your situation.
Now you have to find a surgeon who a) takes your insurance and b) is willing to take you as a patient.
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Post by nyuboi on Aug 10, 2013 14:22:57 GMT -5
It is still looking like the RNY is what the majority of doctors have recommended to be the best for your situation. Now you have to find a surgeon who a) takes your insurance and b) is willing to take you as a patient. I am starting to feel that the RNY is the way to go. The DS just sounds like I'm playing roulette with my severe GERD and that theres a good chance I will make myself worse off. Plus theres two surgeons now that spoke of the chance of needing a conversion to RNY (DS to RNY - can you imagine?) The BPD is an interesting idea, but one no other surgeon had. I would be worried about the diarrhea. It would have the same malabsorption, and the restriction would come from the stomach removal, which I believe is the bottom half or so. Dr. Fielding can do it Sept. 16th. They just want confirmation of RNY, BPD, or DS before they contact insurance company. I know in my heart RNY is the logical thing to do. Once I can accept that and let the DS go I will proceed. If I were a neutral party looking in on the situation or a friend giving advice, I would tell them the RNY because of the DS risks the majority of surgeons agree on for me. Hopefully I can still be part of the DS Family on here. :-) Ehhhhhh, 1 ounce of food. No sleeve. I'll call it the little pouch that could....
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Post by nyuboi on Aug 10, 2013 15:40:23 GMT -5
Although Walter's story is inspiring. Turned down for DS by 7NYC surgeons and then traveled and got his, and Barrett's in remission.
I DO have a NYC surgeon willing to do a DS on me. So it's really what level of risk I want to take with the GERD. Without the acid reflux, this would be a no-brainer.
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Post by goodkel on Aug 10, 2013 18:28:18 GMT -5
As if you don't have enough alternatives to consider (and piss off the surgeons with) - another thought (if I haven't said it clearly already): - Get Nissen, see if it solves the problem - IF it solves the problem, THEN consider what WLS would work with it IIRC, you are not "that" MO and you are young. The reflux is the biggest problem for you right now, and is quite serious. So, fix that first, give your esophagus, stomach and diaphragm time to heal, and see where you are then. Your WLS is not as important right now, even though it is certainly understandable that you'd want a single operation. That's something I would consider in your circumstances. I enthusiastically agree with this. Instead of using WLS to deal with your reflux, why not just get that fixed first? Once it has been resolved for awhile maybe the DS will become a more viable option for you.
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Post by newyorkbitch on Aug 10, 2013 20:42:57 GMT -5
Completely agree.
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Post by nyuboi on Aug 10, 2013 21:13:15 GMT -5
I must say... I have been better since they added Prilosec to my Nexium regimen (morning and night). Taking 2 PPIs with antacids has helped. I haven't vomited at all this week, I think. Used to be a daily thing. If I can get my acid under control, fixing the hiatal hernia can only help. Then maybe I would be able to get a DS.
I'll see if it looks like I continue to improve. Maybe Dr. Fielding is right and its not a damaged esophagus but gerd.
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Post by Deleted on Aug 10, 2013 21:27:10 GMT -5
I agree with Diana fix GERD then WLS. Hopefully you will be able to find a surgeon willing to take you on and not fear a lawsuit. How on earth can you continue to smoke with esophageal issues... ouch! Good luck and I am truely sorry you are in constant pain.
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Post by newyorkbitch on Aug 11, 2013 8:01:46 GMT -5
Get the hiatal hernia fixed. Then see how it goes. One step at a time.
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Post by Deleted on Aug 11, 2013 8:33:23 GMT -5
NYUOBI I say this with the utmost respect and concern. I think you really need to step back and concern yourself with your emotional and mental well being. My apologies if I am incorrect, but it appears that this condition and decision as to whom to listen to about the proper fix has consumed you and you might need to pull back and evaluate. I know when we are ailing it is hard not to fixate on that condition and finding the fastest cure. Sometimes that fast cure isn't a cure at all or even the best course of action, and it can be regretted later in life.
Please slow down and do not rush to a "cure". Every procedure has its side effects and potential complications (can cure one issue and create another). If your main issue is esophageal damage and dysfunction from GERD you should be seeking out GI surgeons/specialists to treat that issue.
JMO, but it is pretty clear to me this situation has consumed you and I don't want to see you rush to a decision that may not be the best. Do your research but redact physician names if you want to post and get opinion/advice from the board.
BTW, how tall are you? At 260 I would doubt that you even qualify for a DS (you probably mentioned BMI somewhere in this 7 page post). Do you have any other comorbidities?
I can tell you that my son lost 35 pounds after his Nissen so it can have WLS properties in of itself....so please think about that.
Good luck
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Post by newyorkbitch on Aug 11, 2013 8:51:33 GMT -5
nyuboi, you should get the hiatal hernia fixed by a surgeon who does those all the time. Hopefully you will put the WLS on the back burner. Is Mt Sinai or Cornell or Columbia-Pres on your insurance?
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Post by Deleted on Aug 11, 2013 9:00:58 GMT -5
nyuboi, you should get the hiatal hernia fixed by a surgeon who does those all the time. Hopefully you will put the WLS on the back burner. Is Mt Sinai or Cornell or Columbia-Pres on your insurance? The hiatal hernia repair in and of itself could cure the severe GERD, and they would probably do a Nissen as well.
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Post by newyorkbitch on Aug 11, 2013 9:04:14 GMT -5
I'm just suggesting that he go to a surgeon who specializes in those procedures and does them all the time.
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Post by Deleted on Aug 11, 2013 9:10:38 GMT -5
Hernia repair is a pretty common surgery so I have no doubt that there are many experienced surgeons in this field, in the NYC area.
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Post by newyorkbitch on Aug 11, 2013 9:10:54 GMT -5
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Post by newyorkbitch on Aug 11, 2013 9:11:41 GMT -5
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Post by newyorkbitch on Aug 11, 2013 9:15:59 GMT -5
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Post by newyorkbitch on Aug 11, 2013 9:16:33 GMT -5
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Post by Girlrocker on Aug 11, 2013 13:01:54 GMT -5
NYUOBI I say this with the utmost respect and concern. I think you really need to step back and concern yourself with your emotional and mental well being. My apologies if I am incorrect, but it appears that this condition and decision as to whom to listen to about the proper fix has consumed you and you might need to pull back and evaluate. I know when we are ailing it is hard not to fixate on that condition and finding the fastest cure. Sometimes that fast cure isn't a cure at all or even the best course of action, and it can be regretted later in life. Please slow down and do not rush to a "cure". Paul/nyuboi, I think this is some of the best advice yet, besides dealing with the hernia first, Scott/illnids said it eloquently. I hope you take this - and what everyone has posted here - to heart. I can understand posting the way you did, quoting the surgeon names/emails in an effort likely to control the volume of the information you were receiving, understand the complexity of it. It esclated in a way I think caused me concern as well, and probably others. There's now a wealth of information here also valuable to the community at large. I hope you take the time to re-group and make the best, long-term health decisions possible.
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Post by Deleted on Aug 11, 2013 15:09:30 GMT -5
NYUOBI I say this with the utmost respect and concern. I think you really need to step back and concern yourself with your emotional and mental well being. My apologies if I am incorrect, but it appears that this condition and decision as to whom to listen to about the proper fix has consumed you and you might need to pull back and evaluate. I know when we are ailing it is hard not to fixate on that condition and finding the fastest cure. Sometimes that fast cure isn't a cure at all or even the best course of action, and it can be regretted later in life. Please slow down and do not rush to a "cure". Paul/nyuboi, I think this is some of the best advice yet, besides dealing with the hernia first, Scott/illnids said it eloquently. I hope you take this - and what everyone has posted here - to heart. I can understand posting the way you did, quoting the surgeon names/emails in an effort likely to control the volume of the information you were receiving, understand the complexity of it. It esclated in a way I think caused me concern as well, and probably others. There's now a wealth of information here also valuable to the community at large. I hope you take the time to re-group and make the best, long-term health decisions possible. Eloquent, wow! Can you please speak to my wife? I am pretty sure eloquent is not an adjective she has ever used to describe me before! Thanks and ;D
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