Pre-Op Preparation

 I am currently Month three Week 2 of my pre-op preparation... the dieting process with my physician.  I have been completing the consultations and this month will be referred to cardio and pulmunology for surgical clearance.  Tuesday night I had a sleep study (positive for OSA) and yesterday afternoon I had a nutritional consult.

I was absolutely enfuriated.  The nutritionist I was sent to by my PCP's office primarily focuses on inpatient medical/surgical nutrition... she only sees outpatients one day a week.  She went over my current diet with me and told me I was essentially starving myself, that I should be at least twice my current size (I'm 316lb and am 5' 4 1/2" tall with a BMI of 53.4) before she would consider bariatric surgery as an option.  She said that I was insisting on starvation and surgery for which I was inadequately prepared and that if I couldn't follow a diet now, I can't follow a diet later.

Some of the things she said are right, and she gave me some great information that was very helpful.  Whether she will forward case notes to my doctor or not, I'm unsure....  She said she doesn't approve people for bariatric surgery because it is a one-time consultation and then indicated that I would be on a pureed diet for about a year.

When I asked if she was aware of the duodenal switch, she stated she wasn't.  I was outraged, but I educated her on the procedure at which time she said something like the intestines are the way they are for a reason, when we mess with them bad things happen and that's not healthy.  I responded quite directly - neither is being this fat... it's killing me.

While I would definitely be interested in doing post-op nutritional management with her (assuming she were to educate herself about the DS), she wasn't the appropriate pre-operative nutritionist.  I called my PCP who located another but insisted we tell my bariatric surgeon that the nutritionist says I shouldn't have the surgery and that I should try weight loss before I consider surgery.  I had, of course, already called by surgeon's office and told them about the entire experience... they said just find another nutritionist.

I am 29 years old... I have been overweight for 25 of them and morbidly obese for at least 20 of them.  I have sleep apnea, a heart problem and hypertension which (we now believe is) may be secondary to sleep apnea....  Being heavy is not healthy for me, and this certainly is not the first time I have attempted to lose weight... quite the contrary.  This is sort of the last-ditch effort... and I AM currently on a weight loss plan, which is medically supervised (by my PCP) and has been moderately (or more aptly minimally) successful.  

It's frustrating that even among healthcare professionals there is a serious misunderstanding and misconstruction of obesity, bariatric surgery, and the DS.  What kinds of experiences have you guys had working with under-educated medical professionals or where you have had to essentially be your advocate for the services you needed to achieve a healthy life?

Ugh, that has to be so frustrating!!  I know with my own experience, getting my pre-op testing was a huge pain in the rear.  Doctors don't communicate and are often ignorant to what really is best for you.  I also had a bariatric surgeon tell me he only did wls (at the time I was researching RNY) on people 250 or under.  He required people to lose 50 and be at 200 before he even would consider cutting them.  200?!  If it were that easy, I wouldn't need wls!  I also was originally given a nutritionist by my insurance company for my consult and when I went to make the appointment, she told me she only does in house nutrition, as in, in the hospital.  Now, she was on the list as nutritionists who do consults for wls.  Then there was the issue finding a cardiologist who would do my exam.  See, my surgeon is in NJ and I wanted to get all of my clearances done closer to home.  No one would see me because I wasn't an actual heart patient?  I finally got someone and it went fine.  After all of my clearances were done, we were about to schedule surgery and my insurance company says they don't cover it?  I was on the phone with them pretty much every other day and not once did they tell me they didn't cover it!  I had to wait a year to switch insurance and do it all over again.  This time I went with the doctors the surgeons office recommended and while it was much easier, it took forever to get appointments.  Like, 2 months just to see the pulmonary doctor and then 2 sleep studies and 3 more appointments with her.  My nutritionist was great.  I actually found her on my own, really sweet lady out of Riddle Memorial Hospital in Media, PA.  I actually lost 20 pounds while seeing her.  

With all that being said, I have found that I have to be my own advocate.  I am not one to get nasty with people, it's just not me, but I had to a few times on the phone and in person.  I know it's frustrating, but hang in there.  Find another nutritionist, one who is familiar with wls.  Can your surgeon recommend one for you?  I wouldn't go back to the one you saw, she sounds very unprofessional.  It's not her job to judge whch surgery is best for you, it's her job to get you healthy enough to have surgery and help you learn how to eat post op.

 It is just another hurdle to cross.  Just keep breathing and don't hyperventilate.  

Didn't your WLS surgeon have a NUT to send you to???

That nutritionist is IGNORANT!!!!!!  Unfortunately, it is all to common.  Have you picked a surgeon who you want to have do your DS?  If you have, please call their office and ask them who their office works with.... as in which nutritionist that their office works with.  I am in alaska, and I saw a nutritionist up here.  She was AS DUMB AS A ROCK!!!!!  I called my surgeon's office in California, and asked them about a nutritionist, and they said, yes, they had one that they worked with, and I could do the consult over the phone.  I had to send the surgeon's office a check prior to having the nutritionist do my consult over the phone, but it all worked out!!!!!

Have you looked over DSFacts.com???  If not, you should!!!!!


-Jamie

Sad to say, we hear stories like this all the time. Even nutritionists who work for bariatric surgeons often know little/nothing about the DS and give advice that is ok for gastric bypass and not for the DS.
     I do think, though, that her attitude sucks regarding wls in general, and clearly reflects ignorance about the success rate for diet and exercise for someone who is MO - 4%. It amazes me that nuts and docs continue to recommend a plan of treatment with a 4% success rate for the MO. This doesn't happen for any other medical problem.

Personally, I would ditch this one. You may not do better, but I doubt you would do worse.

My biggest concern for you, though, is with who your surgeon is, which you don't say. But I know what state you are in from your personal page, and there are no DS surgeons in your state. I would recommend you check out the list of DS surgeons at dsfacts.com.

Larra

 Nutritionists are absolutely useless for DSers, but she's useless to any wls patients, for she definitely is against any of it.  Can you imagine being twice your size?  REALLY?

Between here and other sites - we learn from each other how to keep healthy.  Get to vitalady.com website.  There's great people over there happy to help.

My surgeon is Eric Schlesinger at Tempe St. Luke.  His bio on OH isn't entirely accurate - it indicates that he does the VSG which is true, but he also does RNY and DS.

The nutritionist issue is sort of a complicated one because I have AHCCCS (medicaid) because I'm (currently) unemployed and qualified for it when I worked with AmeriCorps which was, thankfully, before Gov. Brewer issued her edict about childless adults and ineligibility... essentially, as long as I stay eligible, I can get coverage... but if I fall off, I'm not eligible for coverage later (unless the law changes).

There are only a few nutritionists who work with my plan (MercyCare), and so I was originally referred to the nutritionist at Phoenix Baptist Hospital who focuses on inpatient post-op nutrition and doesn't really do anything with bariatric surgeries....  After I contacted the surgeon's office I was told to "just go to somebody else."  My PCP's office found another group of nutritionists who only do outpatient and who do have experience with bariatric surgery (though I'm not sure if they're experienced with DS or not... at this point, all I care about is getting the note... I'll figure out what I need post-op on my own if I have to...).  I see them Tuesday morning at 9:30... so I'm pretty excited about that, then on thursday I see pain management for herniated disks in my neck, next tuesday I see my PCP for month 4 of the diet plan and referrals to cardio and pulmonology, and Wednesday I see a surgeon about my ankle. 

It would be all kinds of wonderful if the ankle surgeon could fix my ankle right quick (it's a 12+ week recovery) while I take care of all of this DS prep stuff, so that when I'm approved for the surgery I'll be ready and as soon as I feel well enough can get to exercising again.

I keep telling myself "all things in time."  I'm a counselor... so patience sort of comes naturally, at least when I'm working with others.  But this is my life (darn it) and I want to get it back on track so I don't spend the next ten years meandering through MOlandia.

Does your surgeon cover any other DS surgeon? Your doc is NOT hightly regarded by most DSers - he has a very negative history. If you truly want a DS, a TRUE DS, find a different surgeon.

Can you not work with the Mayo Hospital?  I've heard fantastic things about them, their knowledge and their post-op care.  I don't know how that all works with Medicaid, but I'm sure they have great nutritionists associated with the wls program.  And you might as well check into their surgeons too while you're checking them out.

Okay, I'm going to just say it---run from Dr. Schlesinger. He's had patients with some VERY bad outcomes, and he gave at least one patient a 20 cm common channel. And with a 20 cm common channel, all those bad things your nut was predicting DO happen.