my second visit to the surgeon

For the past couple of weeks I had saved up alot of questions to ask my doctor.  I got into his office and asked how many surgeries he had done ...and I got stopped cold in my tracks, he told me how many surgeries, which was well over 100 just last year and has been doing them for 4 years, but he told that is the way that things are done in the usa and not in France.

Apparently my question asking is rude.  He said if I didnt feel confident about him to find someone else.  I asked him how do I feel confident about a surgeon that I have NO information on.  So finally he volunteered a bit of info, he has done alot of surgeries and is teaching it to others.  Apparently in France, if your not a good doctor, your not a doctor at all.

Ok, so my surgeon is a complete asshole.  He is a good surgeon however, and so we got past that hump and moved on to my other concerns.

He does not want to do a duodenal, but said if he goes in and for some reason we cant do the roux en y that he will do the first part of the duodenal, and that I will come back some months later to get the other part.  He sent in the papers this afternoon and my social security here in France has 15 days to approve it.  He says they cant refuse it because its medically necessary and that I fit the criteria.  I will call him back at the end of august and schedule a date in September to have the surgery.  My total cost will be 900 euro and I will be in the hospital for a week.  He explained that in France they did not decide to allow the surgery until it started being done lap because before that the risks were too great. In 5000 france bariatric surgeries last year there were 4 deaths.  His clinic is in a privately owned clinic, the owner does not allow for bad doctors.  I will have to go on a pre op diet 5 days before consisting of fatfree sugar free yogurt and non sugar drinks.  He says he thinks the cause of so much leakage is the equipment being used and he prefers to do it by hand.  He also said some of it is just based on a persons ability to heal the first 4 days after surgery.

 Oh, also...i have spent the last 2 months trying to lose weight on the sparks websit. I got on his scale today and have lost NO weight.  He says its not my fault once you get past a certain BMI its almost impossible to lose and noticable amount of weight.  So why have I been dieting the last 2 months? 

ok, gotta go, my experience today has left me a bit unsure what to think.  Talk to you guys soon.  Laelle

 

 

 

You have EVERY RIGHT to ask a doctor his surgery stats - how long he has been practicing, how many surgeries, how many deaths, how many complications, how many times from lap to open, etc. etc.  That is your RIGHT! 

I hope this doesn't come off as rude, but I'm just going to be honest - I do NOT consider a doctor who has been performing surgeries only four years (no matter how many hundreds per year) to be experienced.  Bad doctors have to become bad doctors somehow, and that's playing doctor on YOU.   So the whole, there are no bad bariatric doctors in france thing doesn't hold for me. 

And what's up with him not wanting to do a DS, but if RNY doesn't work he'll do it?  and only half?!?!?!  HUH?!?!?  you can't have it both ways, either stand behind and perform a surgery or you don't.

I would suggest checking out other area surgeons before making a final decision.  This is so important and you want to arm yourself wtih the best knowledge possible and have the most confidance in your surgeon as possible.  :)  Good luck!

I can totally understand the different customs in different cultures and your doc was probably really taken back with all of your questions, especially if it is not customary in France to question your doctor.  We have become so independent in the US and our medical care costs so much that we are very concerned about the quality of care that we receive for the good money that we pay for it.  We can pick and choose what doctor we go to (as long as the doctor is on our insurance plan) and that makes for more competition.

As far as the rny, sometimes they are unable to do it because the liver is too fatty and is too large to perform the RNY because the liver basically sits on top of the stomach.  That is why some surgeons put their patients on a modified liquid diet to shrink the liver.  I had a 5 day pure liquid diet (no protein shakes after day 2)

Laelle, don't worry about not losing any weight for the past two months.  Too soon you'll be on this great ride that we call WLS and you'll never look back.

I agree that I have a right to ask any question that concerns my life and my health and I did not understand how he had a problem with it, but my French husband did.  This surgeon has been a surgeon for many years, a cancer surgeon first, then 10 years ago began doing bariatric surgery, but up until 4 years ago France did not have the rny, they did only lap bands.  What really has me upset is that he didnt think I have a right to know these things.  I know he spent some time training in the usa and maybe this experience has affected the way he thinks about the american attitude.

There are only 2 doctors in France that do the duodenal switch and he is one of them.  Its not like it is in the USA.  You dont have a huge choice in your doctors. But there is also a good side to that, France does not allow bad doctors to have a license, and they track their stats carefully.  Remember France is not the size of the USA, and Its healthcare system is not set up on money, its set up on health.  French people have no need to question their doctors because they know how the society is set up and how it chooses its doctors.  Its a tottaly different culture here.  They trust their doctors.  This is just very hard for me to deal with, I grew up in a different world than this.  I found the surgeon who delivered my daughter by csection 2 years ago to have the same French attitude and he was brilliant.  But he had never done a csection on a morbidly obese woman, so I set the standards for future doctors to go by.  I wish I was back home having this surgery, but I have to be honest, if I was back home the insurance I use to have in the usa did not give a crap if i died from this disease as my french doctor puts it.  It is wrong to put the life of people in the hands of insurance companies, I am glad here in France its in the hands of their highly trained surgeons however poorly trained bedside manner they may have.  I was telling one of my French friends about this and he was like dont worry French surgeons may think they are God, but are in fact wonderful surgeons.

I told my surgeon that although I may be fast on my way to death, I did not want to die today on the operating table, and if I ask a question that he does not like, its based on that fact alone and not that I am in any way trying to insult his skills as a surgeon.  He said that he has never had a leak, but that one day he would, he knows it happens in 2 percent of surgeries so why should he be any different.  He has never lost a patient, but that he knows one day he might, 4 people out of 5k died in France last year from the surgery...so he knows it happens.  Even tho he fussed at me for somehow offending him, by the end of the conversation he was very helpful to answer any of my questions, he simply did not want to be treated as cattle.  I guess thats how all of us wish to be treated.  I think he had more of a problem with the way americans and american doctors relate to eachother than me personally, but it really felt personal to me.

I would find a different doctor who will perform  the DS.  If that is the surgery you want get a surgeon who is experienced with the DS in BRAZIL.  Go to duodenalswitch.com and gert their information.  Good Luck to you.

Jennifer

Thanks Jennifer, but I dont have the money to pay for this surgery, its paid almost 100 percent in France.  If it wasnt for this, I wouldn be able to have it.  I dont want the surgery if my doctor, based on his reports, feels its not safe.  I can tell he was interested tho because after he answered my other questions, he asked my why I first asked him about the duodenal.  I told him that I had heard alot of good things about it.  He said that he had a friend who use to do the surgery but quit doing it because of some pretty serious complications some of his patients are now facing.  He said that there just isnt enough long term information out there to do it unless all else fails. He does have several patients that are scheduled to have the operation tho based on them not being good candidates fro RNY. What happens 10 to 20 years out from this?  He said there is not enough information on this to feel confident that he was giving his patients the best outcome possible.    France doesnt do a proceedure until other countries like the usa have perfected it, so I guess they are a little behind as far as current studies being done in france on the surgery.  He said they do it alot in italy, and they are definately watching Italy's progress on this surgery.  I feel confident having this surgery in France because I know that I have free access to doctors and labs to keep up with my health and my bloodwork.  In the usa I maybe wouldnt have taken such good care of myself knowing I had to pay for those things, I dont know.  You cant base health on money, but we all only have so much money right?  He did say however that duodenal has had some fantastic weight loss results.  He thinks its the most effective surgery there is for weight loss, he is just not sure about its safety long term.

They would not be doing it here if it was not safe...that it for sure.  BUT YOU DO HAVE TO SUPPLEMENT FOR LIFE.  There is no question that you have to have blood work done one to two times a year and supplement with vitamins to maintain your health with the malabsorption.  However, the studies that have come out for twnety years down the road show that 75-80% of the patients maintained their loss with no regain....whereas the RNY shows a 50-60% success rate.  There are studies to prove this....however it is your decision and your doctor's.  I am just giving you information....especially when you have a high BMI the DS increases your chances of success.  It is definetly written about in studies.  I am NOT saying you CANNOT be successful with th RNY because as you can tell there are MANY people that are.  I just know for myself I need a more powerful tool to help me maintain my loss.

Jennifer

I was really hoping he would do duodenal but since he doesnt do it, i have to be satisfied with what I can have.  lots of people are happy with the RNY and this doctor thinks its a great surgery, so I will just be happy with it and look forward to losing some major weight in the near future.  thanks for letting me rant.