CORRECTIVE RNY SCHEDULED. FAILED VBG DUE TO ABDOMINAL TRAUMA IN AUTO...

I had Vertical Banded Gastroplasty done 12 years ago (July 7, 1993) and have to have RNY now because I have 2 staple line disruptions, the band is corroded into my stoma (pouch), and I have a hole at the top of stoma allowing food and liquid to flow into the lumen (old stomach) due to abdominal trauma in an auto accident in 2001. My original VBG was at UPMC in Pittsburgh but I am now in the metro Atlanta area and going to have RNY at Emory. I have an appointment Thursday and don't know yet if I am going to be admitted on the spot for an 'emergency' procedure or if I'm just going to get a date. My GI here did ALL THE FOOTWORK for Emory, he got me approved for a gastric operation rather than bariatric because I really don't need it as bariatric. I am 5' 5" and now down to 201 (at one point after the accident I did balloon up to about 270). We've been in a nightmare battle between BC and Emory because bariatric coverage ended July 1st on my husband's plan. The GI got it approved as gastric due to the fact not that I have gained some of my weight back but I have lost 40 pounds since the New Year without trying, have a high elevated white count due to the foreign object (the band) in my stoma (white count now is 16,000), I have had a fever since day before Memorial Day (daily fever of 100) and the leakage could cause a massive infection in my system, that he needs to explore the internal reason why I am vomiting and have terrible diarrhea and am now on liquids only (almost ten weeks since I have been able to eat ANY solid food) My PCP and my GI have been SO HELPFUL but I am SO SCARED! I talk to both doctors as well as their personal assistants daily on the phone. We are all too the point all I have to do is say 'hi' and the recognize my voice. We are all busting our humps to get me in the OR ASAP but Emory has been NO HELP. And going there is my ONLY option. The surgeon here advised me I will take a team and it will take the team about 7 to 8 hours to do what needs to be done. They have all ready prepared me to come home with a feeding tube (for a couple months) and colostomy (up to six months). That the extent of my damage is so that they will be removing everything post pre op this time and leaving just the esophagus attached to part of the intestines but there will be no stoma, no stomach, no nothing that is 'original'. WHich I thought through my research was what the gastric bypass was to begin with. Am I wrong? I haven't met the surgeon in Atlanta. His assistant (resident) saw me when I went down about the first week of June. Then he went to France for a few weeks, then some conference, guess he's back now, LOL. But my GI doc here has spoke to him several times, averaging about an hour each conversation, trying to get them to help do something. Deaf ears I guess since I am still siting here getting more scared everyday. I do have a few questions for the board though. As I mentioned, when we went to the clinic we met with an assistant/resident. This resident we saw has told me that having corrective surgery increases me to high chances of complications, 23 - 26% chance (23 - 26 out of 100 of their corrective patients don't make it) I may die on the table. Do I need to be worried? Doesn't this seem a bit high? Although I know doing nothing my doctors here tell me I will definently die within 2 years tops. Another question I have for those who have been through corrective/revised surgery. As I mentioned, I am at this point not much more than my doctors classify 'borderline' obese. I am concerned with just how much weight I will loose even before I get to the point of being able to get back into solid food. I can't 'afford' to loose 80 pounds. Seventy would be close to the limit in everyone's opinion. Any suggestions or examples of others weight loss success? My next question is this. I went through and read prior patient posts about my surgeon and a lot have nothing good to say about the staff but that the surgeon is good. We have jumped through so many hoops and done a horse and pony show for Emory and not to get into a lot of details other than the lack of bedside manner of the staff to the way one of their doctor's was rude to my long time doctor here (don't ask, I wont go into it, it wasn't the surgeon that is going to do my procedure but a partner) but how in God's name am I supposed to trust these people with my life now? The surgeon isn't the problem, it's the staff ... if I am being made to feel this crappie PREAPPROVAL and PREOP than what can I expect afterwards? I just don't know WHAT to do! Now as far as this one woman in the office actually she is the office coordinator. HOW do I deal with this WITCH at my surgeon's office! I like my ex husband's new wife better than I like this woman. There is NO ONE else at the clinic I can talk with for some things and I'd rather say hell with the surgery than deal with her! I admit in my life I have met some people that I just don't like or can barely tolerate but until I met this woman I think I can honestly say I had ever hated a person but that was before her. That is the ONLY word that comes to mind when I think of her, talk to her or know I have to have any interaction with her! I have never done anything to this woman for the attitude she gives me. She has now taken to when I do need to speak to her about something she OVER RIDES my words with interruptions and CONTINUOUSLY talks over me. I tell her key things she has to know for my case, to put in my chart and later find it's not there because of her actions she doesn't get the information. She has even OUTRIGHT lied about returning my calls even though her 'log book' reflects she has called and I GUARANTEE if her phone bill was checked my number would NOT be on it but my issue is I need the surgery. I started keeping an EXTREMELY detailed log of interactions with her early in this mess! She wants to argue with me about returning m my calls because 'I called it's in my log' but you know, if a phone log was my biggest problem my life would be great. I just don't know what to do about her! I have spoke to the director of surgery who assures me she will be dealt with (I mean this woman wont even return two different doctors calls here so I know it's not just me but also doctors involved with me and it doesn't make me feel any better either) Any advice and direction would be greatly appreciated. Thanks in advance ~~ Lisa

May I ask why Emory is your only option? I agree that any WLS revison is more dangerous than the original procedure, but those odds do sound rather high. Given that your life is at stake, have you consulted with any other surgeons? Is the one you're seeing experienced in doing revisions of bariatric surgery? Please, before you go with this guy, at least talk to a couple other surgeons. There's Dr. John Husted in Nashville, considered to be a world-class revision specialist, and others around the country.

Yes, Emory is the only feasible option. We started going to doctors back in Jan when my health began to REALLY decline. Our first consult months ago was with a GI Specialist (surgeon) here (we live about 60 miles north west of Emory) and he said either Emory or University of AL in Birmingham. When we went to AL the trip was just too far for us to make for ongoing care. It's about 9 hours from our home here. And we talked about TN and NC but they are both out of network and insurance refused to pay anything toward either facility and our out of pocket was going to run about $60K at both places and we just can't do that We met with an additional four surgeons in the Atlanta area who also do revisions/corrective procedures and all recommended Dr Smith at Emory. He does have almost 18 years experience and is chief of staff there. As I think I mentioned we actually haven't met him but hear nothing but good about him ... it's his staff that we've dealt with to date and they are LESS than to be desired I all ready have plans implemented with medical staff here to take care of me post operatively so the big thing is getting through the procedure in one piece and then it SHOULD be smooth sailing. I'm still pretty scared though

Lisa, If this is a life and death question for you I say take the risk, how ever DO NOT! take the BS from the staff. If you feel that their care is not up to par then you have every right to file a formal complaint with the hospital and the AMA, Although nurses and office assistants do not take a hypocratic oath they are bound by human decancy to treat others how they would like them-selves or their family to be treated... and YOU would not be over stepping your bounds to remind them of that. I myself am a nurse and see people like you are discribing all of the time in the work place it is so very sad that these people are allowed practice medicine without compassion or empathy. My advice ... do not take it personally and give them hell and just keep this in mind.. the squeeky wheel gets the grease and the longest running call light ALWAYS gets answered (because if it dosen't its neglect) MJS RN CA (

Just to ease your mind: a 23-26% chance of complications is not a 23-26% chance of dying. Complications are infection, blood loss, hernias, bowel obstructions, etc. Death is a complication (the big one!) but the chance of dying is much lower. (Though higher than with a "virgin" gastric surgery)