RNY to DS Revision DR. Greenbaum

I have been lurking on this board for months and I DO pay attention but I think I just fell for an okey-doke  I am so upset as I type this.  I contacted Dr Greenbaum in Spring of 2010 seeking a revision to DS.  He told me due to a backlog he was not accepting new patients until January of 2011.  I contacted his office to make appointment in January and they said he was not accepting any new patients but to try later in the year.  In May of 2011 I contacted Dr G and basically told him I thought it was not right for him to keep me hanging on if he was not doing the revisions so he had me contact Tina  (patient coordinator) and we started the insurance approval process. He assured me that he still did RNY to DS revisions but on a case by case basis.   In September my paperwork was sent to insurance company and I was approved for a RNY to DS revision.  I live in New York so my pre-op appiontment and meeting with DR G were on the same day.  Out of left field at the pre-op appointment he tells me he will NOT do the DS but instead a distal bypass. At no point during all the months I was in contact with him and he reviewd my records as they were submitted did he indicate there would be a problem with my RNY to DS conversion.   My surgery is scheduled for November 28, 2011.  I feel like I was purposely strung along until the last minute.  I am NOT happy with this.   I want to know from anyone who had a similar experience were you able to find another vetted DS surgeon who agreed to do the revision?  At this point I will take out a mortgage on my house to have this done if it is medically feasible with an experienced DS surgeon.   I thought I was days away from my DS.   I just do not want to make another surgery mistake.   If this or something similatr has happened to you please share how have you resolved your revision issues.  Anyone with some suggestions or  advice please help! I posted this message to this board because I think you will all understand my frustration.  Thanks for letting me vent    

Vee

This looks like de ja vu to a post not long ago that I read.  I would NOT let him do any type of other RNY on you.  You've worked hard to get approved and there are surgeons out there that do RNY to DS revisions all the time.  Contact Dr. K or Dr. Rabkin.  I hear they are revision Gods.  I'd check with your insurance on getting your approval transferred over to a new surgeon and cancel your surgery with Greenbaum.

That is what I am going to do.  I have already made one bad surgery choice.  I do not want to rush into this surgery when it just does not feel right.  My pre-op appointment was yesterday and I spent all night trying to think this through.   I need to be sure that the DS is not a valid option before I consider any other type of revision.


Vee

Coincidentally, I asked Dr. Keshishian about this last night.  This is an edited version of his answer (mostly his words, tidied up by me, because we were talking informally and English is not his first language), and I believe his answer is quite similar to what Rabkin would say (but that's me saying it):

I can remember maybe 2-3 patients for whom I recommended no revision of RNY to DS, and it was mostly because of anesthesia risk, and not anatomical.

I am not quite sure of the basis for the specific concerns [of the surgeons who limit what kind of RNYs they will convert to DS based on the anatomy of their RNY]. These are difficult cases to do, and sometimes they are very difficult!  But I enjoy doing them.
I accept essentially all RNY to DS revisions that make medical sense. Rarely – if at all - are they refused because of anatomical concerns.
 
Greenbaum and Roslin, for whatever reasons, seem to have become very risk-averse in the last few years with respect to RNY to DS revisions.  I don't know the actual reasons, whether it is because of restrictions put on them by the hospitals they use, their med/mal insurance, their own concerns about their skills, their desire to keep their complications stats low - it could be any or all of these reasons, or something else entirely.  What I DO know is that Keshishian and Rabkin rarely if ever turn people away for anatomical concerns related to the construction of their RNYs, to my knowledge, and their complication rates are not that high (but I don't keep track of these things - it is just my general impression based on what I have read online and personal communications - you need to talk to them personally about this).

Greenbaum and Roslin have a lot of fans, and I'm sure they are great doctors.  But I am suggesting to people that they look to Keshishian or Rabkin for RNY to DS revisions, and this is one of the primary reasons why.

And personally, I think it SUCKS that he strung you along for over 18 months without even bothering to find out what kind of RNY you had, and thus whether he would offer you the DS you wanted in the first place.

I am so angry with myself.  I read this board regularly and when I contacted Dr  G I discussed this issue with him.  Dr G assured me he was still doing RNY to DS revisions.  At no point including reviewing my post operative reports, my scans, and medical records did he indicate that he would not or could not do the RNY to DS revision.  Literally days away from the surgery he drops this bomb on me.   I actually felt pressured due to the surgery date but I remembered I have to live with the results of this surgery for the rest of my life.  If he expressed concerns about this revision earlier I would have felt better prepared.  At this point if the RNY to DS surgery is feasible I will pursue that with another doctor.  I have made one bad surgery decision and I do not want to make another one. 

Vee

So he knew all along what your RNY looked like, and strung you along anyway?!?  You have every right to be outraged at HIM if there was no new information that would cause him to "change his mind" at this point!

Yes, you can be angry at yourself - we tried to warn people about what APPEARED to be going on.  But that doesn't absolve Greenbaum of responsibility for apparently misleading you, if he had all the information needed to make this evaluation a long time ago, and he just didn't tell you until he had you by the short hairs with a surgery date and insurance approval.

Take it from someone who wanted to revise to the DS and accepted an RNY don't do it if you feel it isn't right for you. If you weren't successful with RNY the first time I doubt it would work with the distal. I lost 36 lbs with the distal. I had to fight with insurance to get my second revision to the DS. I'm not at a normal bmi or even at my first goal weight, but I did a lot better than i did with the distal. Fight for what you want now. Don't do like I did and have to fight for it later.

Btw in the decision by the Department of Managed Health Care it stated that usually when the first surgery fails a revision should not be to the something like the original surgery because usually the problem is metabolic. Good luck to you in whatever you decide.

Yes he knew.  Like I said since I read this board regularly I specifically asked him if he was still performing RNY to DS revisions.  He assured me he was committed to the DS surgery because in his opinion it is the superior weight loss surgery.  That is why I was so surprised yesterday.  We have exchanged numerous emails and even talked on the phone on at least 3 occasions.  I went in thinking everything was set for the RNY to DS revision and suddenly he mentions distal RNY.  My date was November 28, 2011  I just feel that I was misled.  I am also bothered because I DID ask him if he was still doing these revisions and he assured me he was.  Has anyone recently been successful getting a RNY to DS revision from Dr Greenbaum? 

Vee

I *think* his major criterion (or one of them anyhow) is how your pouch was created with your RNY, whether or not your stomach was transsected in the creation of your pouch. I can't imagine that information not being around in your records (and you got imaged in some way too along the way, right?). Color me puzzled. If I ever get a chance to get a clear answer from him about what absolute criteria he has (if any) about whether he'll do a DS vs. distal RNY, I will certainly share.

Can't help you with names of anyone who's recently gone RNY to DS with him, sorry. I can well imagine you must be absolutely beside yourself. :-(

IF, for some reason, a distal RNY revision ends up being the only option, then he's still an excellent choice. But I sure hope that is not the case for you.

There are people who live just fine with very distal RNY's. It's a challenge fersure. I spent some time with Vitalady and Vitaguy this past summer, who have that kind of plumbing, and watched how they manage their nutrition. It is work. But it DOES work.