Complicating factors to my DS

When I met with my surgeon, I learned that the one abdominal surgery that I had (an open laparotomy in 1990 where they tied my tubes, took out my appendix and my gall bladder, and did a hiatal hernia repair) will add a lot of complication to getting my DS.

Apparently, this one surgery counts as 4, because they did 4 things. So I will probably have the adhesions and scar tissue of someone who has had 4 previous surgeries. Also, Dr. Simper told me that when they do (or did) hiatal hernia repairs, they take the upper portion of the stomach, and wrap it around the lower esophagus below the diaphragm, and stitch it there! (I have seen photos on the internet, and that is exactly what they do!) It makes me mad, because I never complained of any symptoms of a hiatal hernia -- they just found one and took it upon themselves to repair it while they were in there!

So, Dr. Simper is going to have to undo my stomach from my esophagus in order to create a sleeve, and I will be at greater risk for leakage of gastric juices into my peritoneal cavity, because of it. Also, there is no guarantee that he will be able to do the duodenal switch part of the operation, depending on the amount of scar tissue and adhesions that I have grown in the 20 years since the previous operation. He said if it is too bad, and he can't do the delicate duodenal switch, he might be able to do something like the bottom half of a Roux-en-y, to give me some small amount of malabsorbtion.

His first intention is to do the DS, of course, and I guess I respect him for letting me know what might happen, instead of the possibility of waking up to some hybrid result, like I know some of the people on this board have done. That would be horrible, and I would feel really cheated!

So, I guess I have one more thing to be nervous about! I think the first thing I ask when I wake up will be "could he do the whole DS??????"

Moan!

Lisa

Lisa,

Maybe its time to look for a more experienced surgeon?  I know Simper does them but I've heard lots of stories about surgeons working through scar tissue, especially for those who have revisions.  That shouldn't make or break you getting a DS in my opinion.  Yes, I can see that it may add some risk.  Maybe you should get a second opinion.  Don't give up!

He is the only surgeon listed in DS Facts surgeons list fot Utah. I need to use my Utah Medicaid as a secondary insurance, or else I have absolutely no way to afford the surgery.So I don't have anyone else I could go to for a second opinion. I do know that he does good work, because I have met past patients of his who are thrilled with their DS's.

I think it's just a fact of life I'm going to have to deal with. Hopefully, he will be able to work with what I've got.

Lisa

Kerry had lots of good things to say about Dr. Rabkin along this line...
You might try searching for his posts or look up his profile.

I had a lot of adhesions from my prior RNY surgery. So many so that it took Dr. Greenbaum 4 hours to cut through them and the ones that were attached to my intestines and large bowel. From there he did the revision surgery, another 3 hours on the table.   I was in the OR so long that my surgery pushed the scheduled noon surgery forward until like 3 p.m.  Prior to my surgery I had asked if there were a lot of adhesions could I expect to not come out with a revision and Dr. G said he didn't think there would be any reason to expect that he would not be able to navigate through them.

My thoughts on the flyby:

1. My bottom line would be NO POUCH, period. Your bottom line might differ, but that would be mine. That damned pouch construction ***** up wayyyyy too many people. I consider it butchery. Intact functioning pylorus would be mandatory for me.

2. I would want more information about what he's worried about with the intestine stuff and why he thinks he might be able to do whatever he says he "might" be able to do. Then I would want to find out (medical peeps here might be able to help with info on this) what the possible different intestinal configurations could mean.

My biggest concern for long term issues in this area would be, could the intestinal configuration contribute to the godawful RH stuff we're hearing many RNY'ers reporting? I *think* that's a pouch/stoma problem, but I don't know for sure.

3. It seems to be second opinion time. I see that you have big insurance restrictions, but if I were in your shoes, I would work on building a case that you need the absolute gurus of the DS, either Keshishian or Rabkin, because of your messed up guts, and see if there's a way to convince them to let you go out of state. The folks here who understand insurance could help you figure out how to go in that direction.

I miss my pylorus. *sniff*  The strictures were just too much, between that and the gastric leak and fistulas most of my stomach had to go. I've learned that I don't have an RNY pouch though. I have a remenant stomach with intestines attached to the bottom. Can you say slide city? Can you believe I'm thinking of getting a crap band just for some restriction? 

Someone slap some sense into me.

Elizabeth, what is "the godawful RH stuff we're hearing many RNYers reporting?"

I would also appreciate any medical knowledge about the difference between a RNY intestinal bypass and a DS. Dr. Simper said that the RNY wouldn't provide much in the way of malabsorption, compared to the DS, but I would appreciate more info, if anyone has it.

Is there anyone much wiser than me in the area of Medicare and Medicaid?? Are the things that are being suggested, like an out-of-state second opinion, or a two-part surgery, actually possible?

My emotions are going between fear that he will do something I can't live with, and fear that he will open me up and say he can't do what I demand, and leave me un-operated on, looking like this:


                                                 

And that since I had my shot at the insurance paying for it, I am done!

I really wish I had had someone to go with me to the consultation, because I was so surprised at what he said, that I couldn't think of any questions at the time.

Lisa

RH=reactive hypoglycemia.

There's another obnoxious condition that's being reported with increasing frequency in RNYers that's related to glucose metabolism and stability, too. The name escapes me, but Beth aka Melting Mama is well versed in the subject, if you want to look her up. www.meltingmama.net .

Another option, perhaps. Tell Simper that you absolutely refuse a pouch construction and that he is forbidden to do that. Make sure it is in writing on your chart AND on your agreement/release you sign on the day of surgery.  Tell him to do the sleeve first, and that if he is not capable of completing the switch part, to close you up and reschedule the second surgery within three months. Call UT Medicaid and make sure they will cover a two part surgery if medically necessary, and get it in writing.