New to site/surgeon info/Dr. Castro

[laura73]

Hi all. I'll try to keep this short. Had sleeve in 2009. After healing, no restriction. Had suspicion surgeon closed quick bc of anesthesia issue vs surgeon was not a good choice/I didn't research well.

Now have epigastric pain, hiccups, burping. Had barium swallow this week and my stomach is stomach shaped. Not sleeve shape. Only thing radiologist would tell me is that I have significantly delayed emptying. I found out shape of stomach by requesting a copy of the films.

I see a surgeon Dr. Castro in Dallas in 2 weeks. I have limited options due to health insurance requiring I go to one hospital group. I'm hoping to get sleeve/resleeved. This isn't as easy as a first time sleeve yet not as complex as other revisions such as RNY-DS. I cannot self pay. With symptoms, I don't have time to try to save up.


How can I get info/reassurance other than I know a few people who have gone to him? I saw list of vetted revision surgeons in DS forum. Is that for revisions for people who've had DS or revisions in general? What is the vetting process? I'm scared. I'd resigned myself to being a WLS failure. Now I hurt and I can't ignore what was done to my anatomy.

Any info about Dr. Castro, complexity of resleeve, lists of surgeons and vetting process would be appreciated!

[Deleted]

Hi and welcome. I'm sorry you're in such misery--I totally understand that this is not just about your weight. There's nothing quite like stomach misery .

Here's the thing that I'd like to mention first: What OTHER options do you have to improve your stomach problems? Is surgery the ONLY answer? And if so, what KIND of surgery/ies would give you relief from your problems?

If I were in your shoes, I'd be thinking about the possibility of fixing the most pressing problems first and waiting for a bit to see about options for WLS revisions with a true, dyed in the wool WLS revision surgeon.

A couple of ways to get some more info about the surgeon: Go on PubMed and look to see if he has published any peer reviewed papers, and if so, what was the subject material? Also, look up his license/record through your state's medical licensing board. You should be able to ascertain whether he has had any complaints or sanctions in the past several years.

Ask to see his curriculum vitae. Don't take no for an answer and don't let the people at his office fob you off with a short bio statement. Ask specifically for that document. You could post it here or PM me and we can go over it together to see what information we can glean from it.

[laura73]

Thank you both for your replies. I will look at PubMed and licensing board. Asking for a CV is also smart. I have thought about a DS. Ideally I'd prefer no surgery and that's why I was hoping it could be fixed by resleeve. I was awake during part of my surgery. I heard and felt things including the endotracheal tube and my arms secured and lab draw and catheter insertion into my bladder and scrub to my belly and first incision and placement of instrument into incision. I suspect that my heart rate or blood pressure went really high and surgeon rushed through. I woke up in PACU sobbing and telling his bariatric nurse coordinator what happened. He documented only that I was anxious post-op and gave me IV Ativan. The anesthesiologist came to my room the next day and followed me as transporter pushed me down for barium swallow and he told me there was no way I was awake and I imagined it. I pointed to first incision site. How would I dream that? And trying to move tongue and teeth against ET tube- not just anxiety. So I was a bit of an emotional wreck. Ended up very sick 2 months later. Took PCP a few weeks to figure out it was my gallbladder. Had it out without problem-same surgeon. I was under delusion that he had to do it bc he understood my sleeve. Continued to gradually get sicker. Pain and vomiting. Dehydration. Again had labs, barium swallow, and put on Carafate for "gastritis". Ended up in the hospital for almost a week because a gallstone was blocking my bile duct. I had early pancreatitis. This ordeal wiped me out emotionally and financially. Once I healed, I had no restriction. I asked surgeon for pic of my sleeve bc coworker had sleeve one month after me with same surgeon and she had pic. Hers looked like a tube. Mine looked like an empanada.
This is getting long. Part of my point with the DS is that I'm terrified of any surgery and want least invasive to fix my problem. There's a Dr. Ayoola in the area, not in my insurance network, who does DS. It scares the heck out of me. If there's a non-surgical way to relieve symptoms I'll pick it and probably forego any WLS. My PCP suspects that's not the case. I look forward to hearing what the surgeon has to say- even though I'm not sold on him. The image of my stomach looks like a regular stomach but there's a small bulge on top and a larger bulge on the bottom near where it empties. I wonder if that pouched out area is why I'm not emptying. I haven't talked with my insurance company to find out options for specialists outside of our system. How do I know who is a true revision surgeon? The one I'm seeing has done lots of band to sleeve and band to RNY. Anyway, thanks again for your suggestions and please wish me luck.

[laura73]

How much does the DS affect absorption of medication?
I was disappointed and saddened to hear about Dr. Stewart. I will look up the two surgeons you listed- thanks!

[larra]

I'm so sorry you have had such an awful time with your sleeve!

From the description of your x-ray in your second post, it sounds like you might have a stricture in your sleeve, in other words, an area of narrowing with widening above it more of a normal sleeve below it. Obviously I haven't seen the films and this is just a guess, but it would explain the problems you're having. It's possible, if this is the case, that it could MAYBE be helped with endoscopic dilation of the stricture, and I would recommend discussing this question with the surgeon, esp since you don't really want any further surgery.

As far as the DS and extended release meds goes, yes, it can interfere, but almost every XR med can be replaced with a shorter acting med that you would simply take more often. Sometimes doses need adjustment. It would be unusual for a need for XR meds to be a reason not to have the DS, so if you do need surgery, I hope you will keep an open mind to all your options.

Larra

[sheanie]

I believe you were awake, like you said you were. Your anesthesiologist sounds like he knew this, too.

As for how to know which surgeon you should go to, you listen to Diana Cox and the people here. They have been here for years and know this stuff like no one else.

It sounds like at the very least you need an EGD and dilation or stretching of the area, at the very least. Or, you could go for the full DS with a re-sleeve (or sleeve, as I suspect you didn't get one in the first place).

Lots of us take extended release meds after DS. Like already answered, some need the dosage adjusted. My antidepressants worked the same post-op and were XR versions.

[CVHarris]

Im glad that you decided to come check the site out. I told you these people know their stuff and know about doctors also.

[laura73]

Wow. I'm overwhelmed with all the thoughtful and informative replies. It's a waiting game right now but you all have given me things to think about and research. If my symptoms are related to a stricture, I may be able to get non-surgical relief from my symptoms. That would be great and would allow me time to further research options as far as getting my insurance company to approve a different surgeon if I decide on a DS. Or resleeve. I am concerned about the med absorption bc I am on an XR anxiety med. I had anxiety pre WLS but afterward, I was a mess. The surgeon's note about me being anxious in PACU really makes me angry bc he covered his behind, and the anesthesiologist's, by referring to my anxiety diagnosis. The irony here is that my mild anxiety turned disabling after surgery and subsequent cholecystectomy delay followed by delayed diagnosis of bile duct blockage and ERCP. I know people post in these boards asking for advice and then don't take it. I'm being honest and laying it out there that I'm struggling with this from a mental health perspective. I logically know I could benefit from a DS yet have significant fear about undergoing anesthesia. I've had the light sedation for a colonoscopy since my WLS and I did ok. I was terrified. I'm trying to take this one step at a time yet it's in the back of my mind that I just turned 40 and am teetering on a diabetes diagnosis and my chronic back pain/stress fractures aren't helped by my obesity. Again, thanks for all of your info. You've been non-judgmental which is something that concerned me from lurking on other sites. I will keep you posted on my progress.

[larra]

Laura, I realize you are still gathering info at this point and have not made any decisions about surgery, and I think that's great. The more info you have, the better your decision will be.
One other piece of info you might look into is asking whoever prescribes your anti-anxiety meds about non-XR alternatives. There are so many good anxiety meds available these days, I bet there is something else, or a different formulation, that would work for you if you did decide on the DS.
I also hope that if/when your sleeve problem, whatever it may be, is resolved, that would go a long way to improving your quality of life and easing your anxiety.

Larra

[CVHarris]

I'm glad you decided to come over here I told you these people know their stuff and know about doctors.