Another option shot down

Tried Highland in Rochester...faxed over records, they said no.  To high a risk to bleed because of the varices.   Is there ANYONE that will work on me?   Should I just give up all hope of getting any help?  I'm on a starvation diet now - 1/2 cup of food per meal.  I'm now stuck at 36 pounds lost.  That's it?!?!??!?!  36 pounds?  All this for being denied? well, time to up the life insurance, because my soon to be failing liver will be killing me. 5 surgeons have denied me, and a 6th on the way to saying no.

Have you tried any of the doctors in the City? I know it is far away from where you are located, but since it sounds like you have a high risk case, I would only want the best operating on me and some of the best doctors (not just in bariatrics) are located in the City. Let me know if you need any recommendations. Megan

I cannot even begin to fully appreciate or understand what this must be like for you.

I know the goal of surgery for surgeons is to get you off the table. This is carefully decided and sometimes a very challenging decision to weigh the risks and benefits. If the risks outweigh the benefit (or they feel you will die in surgery) then I assume they will deny surgery as not appropriate.

I will keep you in my thoughts and prayers in this very challenging time for you.

Jamie - thanks for your reply. Unfortunately, I have had doctors who have walked into the room, read the 16-20 page profile they all require.  When they see esophageal varices, they say, sorry, can't work on you and leave.  I had one appointment that lasted a whole 20 seconds!  I don't know how they can carefully decide or weight the risk and benefits when they decide in 20 seconds or less.  It seems the only decision and risk/benefit they are doing is for themselves, not for the patient.

I think the issue is surgical risk of anesthesia really and also any manipulation in this area, I wouldnt say a band would be safe due to pressure in that area and many banded pts get enlarged esophagus, a BPD/DA or VSG same as RNy really all going under anesthesia with surgical manipulation of GI system, but next surgeon you see ask why all others and he denies if the case so u understand fully (may not agree but can comprehend their rationale perhaps), I know when it is you that it is hard to see the benefit to you but again if your dead on table they do not see that as a benefit even if you disagree. be well.

The reason is I'm high risk.  It's not the anesthesia.  It's the varices and bleeding risk. Here's where I show off my "well informed patient" status: The varices are caused by my Liver.  I have NASH.  I have cirrhosis and fibrosis in the liver. This causes portal hypertension.  The portal hypertension causes the varices.  The varices are not just in the esophagous, but through-out the GI tract.  I will have enlarged veins not only in my esopahgous, but in/on my stomach, and intestines.  So, the risk of bleeding is increased.  The starvation diet I'm on, (1/2 cup of food per meal, 3 meals a day, no snacking) is to reduce the liver size and de-stress the liver.  This will help turn some of the fibrotic liver tissue back to normal liver tissue.  This will, in turn ,reduce the portal hypertension and the varices. Back to the anesthesia part.  While I have a somewhat compromised liver, it's not close to transplant stage stage yet.  Not even close enough to consider (5-10 years out MAYBE, if I don't lose the weight is what the liver specialist said).   But, there are many new drugs that do not metabolize in the liver and therefore reduce the risk of liver complication to about 0.2%. (Yes, been doing my research on that as well).

Totally aware of all of this as a RN/NP and treating many folks with end stage liver issues (psych my specialty/their depression, pre transplant etc). As stated not only anesthesia but manipulation of GI tract (in post above) so regardless of surgery band, bypass, BPD/DS, sleeve all too risky as you are aware/understand your disease prognosis and outlined so clearly above.

One last thought is to get into medical literature esp. obesity surgery journals in particular SOARD, Obesity surgery are 2 I subscribe to. and see if there are any cases similar to yourself where they operated then go to that MD!

I myself was diagnosed with NASH preop on ultrasond of GB it showed and LFTs elevated posto but both resolved with wt loss. I truly wish you well in your journey to get healthy as possible even if wls is not ther path you are able to take.

As another mentioned, you might want to try down in NYC... I would recommend Roslin/Shah (Lenox Hill), Pomp (Cornell), or Inabnet (NY Pres I believe) those docs, in addition to being leaders in their field, perform all procedures... RNY, Band, VSG and DS. What I'm getting at, is that, in the right hands, the VSG or DS might be a better option because of how the stomach is formed vs. the RNY pouch... might create fewer issues.  Plus, while many with BMIs in the SMO range (I see from your profile that you're around 56) do really well with the RNY, the DS would give you a better chance at achieving a closer to "normal" BMI as the AVERAGE percentage of loss is greatest with the DS. Either way, I wish you luck.

I am currently looking at a couple options in NYC.  Yes, it is a trip (4-5 hours), but my life is worth it. It's just frustrating when I see people walk into a doc's office after the first appointment and have a date of surgery.  I have been at this for over 2 years.  I am probably one of the most educated WLS candidates out there.  I am also educated as to my risks.