Lack of WLS knowledge by physicians
Since having my VSG in December, my primary care physician (who admits to knowing very little about WLS) has reminded me several times on both of the occasions I have seen him that my sleeve could stretch and I could gain back my weight. He has also indicated that I could lose too much weight but that I have alot of excess to lose in the mean time.
I am not looking for a mindless cheerleader but some basic support would be nice. Am I being too sensitive here or is he talking failure already? Perhaps time for a switch of physicians?
Thanks for letting me vent!
Keith
I am not looking for a mindless cheerleader but some basic support would be nice. Am I being too sensitive here or is he talking failure already? Perhaps time for a switch of physicians?
Thanks for letting me vent!
Keith
I've had the same PCP for about 25 years. Good guy...average physican. Over the years I have had to explain alot of weighloss surgery stuff to him. Things like telling him which labs to order, because of malabsorption that I need a baseline bone scan, B-1 malbsorption. I told him a few weeks ago that the RNY was originally performed to cure Irritable Bowel Syndrome...Only after awhile did they discovered that it worked for weightloss. He didn't know the connection between IBS and RNY. In many ways I am the expert and he the learner patient. Educate yourself here and elsewhere. You are your best advisor.
If you go into the hospital you need to know and explain your surgery to the doctors and nurses there. When I went in and tried to explain certain needs they looked at me like I was from Mars!! And this was at the hospital where I had my WLS performed!! I think most hosptials have gotten better and newer doctors have a clue on the plumbing inside...Just do your homework.
If you go into the hospital you need to know and explain your surgery to the doctors and nurses there. When I went in and tried to explain certain needs they looked at me like I was from Mars!! And this was at the hospital where I had my WLS performed!! I think most hosptials have gotten better and newer doctors have a clue on the plumbing inside...Just do your homework.
Keith,
My suggestion would be to think that he is trying to encourage you to stay on the correct path. It is very easy during the months post op to feel like you will never has issues with weight again. The truth is you will have to exercise and eat right for the rest of your life. I have no question that without being careful, I could easily gain weight back.
I have met many people who have slipped back to their old ways and are just as heavy as they were pre-op. Your pouch/sleeve/etc is going to stretch over time. You will be eating more, it is up to you to control your food choices and amounts to be successful. I think this is what your MD is trying to tell you.
Good Luck
Jim
My suggestion would be to think that he is trying to encourage you to stay on the correct path. It is very easy during the months post op to feel like you will never has issues with weight again. The truth is you will have to exercise and eat right for the rest of your life. I have no question that without being careful, I could easily gain weight back.
I have met many people who have slipped back to their old ways and are just as heavy as they were pre-op. Your pouch/sleeve/etc is going to stretch over time. You will be eating more, it is up to you to control your food choices and amounts to be successful. I think this is what your MD is trying to tell you.
Good Luck
Jim
Think of it as a chance to educate him. 
My PCP is following my journey very close. He is a large man himself and is trying to lose weight the "old fashion way". Admitted to picking up a few pounds over the Holidays and was struggling to get back on track.
At my last visit he had a student doctor in doing his clinicals. He, doc in training, was looking at the lab results pointing out the cholesterol levels etc. I asked to see them and began looking at the iron, vit D and B levels in particular. Gave him a brief lesson on why those are critical for WLS patients.
My PCP is following my journey very close. He is a large man himself and is trying to lose weight the "old fashion way". Admitted to picking up a few pounds over the Holidays and was struggling to get back on track.
At my last visit he had a student doctor in doing his clinicals. He, doc in training, was looking at the lab results pointing out the cholesterol levels etc. I asked to see them and began looking at the iron, vit D and B levels in particular. Gave him a brief lesson on why those are critical for WLS patients.
Never, and I mean NEVER, trust a fart!! 
Keith:
You could educate your PCP that it seems unlikely that the sleeve is going to stretch to any clinically significant degree, since the stretchy part of the stomach, the fundus, has been removed as part of the procedure. Your stomach size has been reduced by 85%. No amount of "stretching" is going to restore it to anywhere near its original capacity.
Unless you work at eating a lot of calorie-dense foods and don't burn any calories with physical activity, your VSG will work as advertised.
I hear this stretching stuff all the time in the RNY support group I am in. Even in an RNY, the fundus is bypassed, so stretching is highly unlikely. Some people have issues with stretching the outlet of their pouch, but this is very rare and it is not fully understood why it happens. It is agreed by the surgical staff that you have to work hard to make it happen. You don't have this issue since your pyloric valve is still in place.
According to NUTs and surgeons I have had contact with, failures seem to come about because people consume too many calories by eating the wrong stuff, not because they somehow cause damage to their new anatomy. Even if you gain lots of weight back, you can still return to the proscribed diet and your surgery will again work as it should.
There is a lot of mythology out there so you will have to be on guard at all times!
Good luck!
You could educate your PCP that it seems unlikely that the sleeve is going to stretch to any clinically significant degree, since the stretchy part of the stomach, the fundus, has been removed as part of the procedure. Your stomach size has been reduced by 85%. No amount of "stretching" is going to restore it to anywhere near its original capacity.
Unless you work at eating a lot of calorie-dense foods and don't burn any calories with physical activity, your VSG will work as advertised.
I hear this stretching stuff all the time in the RNY support group I am in. Even in an RNY, the fundus is bypassed, so stretching is highly unlikely. Some people have issues with stretching the outlet of their pouch, but this is very rare and it is not fully understood why it happens. It is agreed by the surgical staff that you have to work hard to make it happen. You don't have this issue since your pyloric valve is still in place.
According to NUTs and surgeons I have had contact with, failures seem to come about because people consume too many calories by eating the wrong stuff, not because they somehow cause damage to their new anatomy. Even if you gain lots of weight back, you can still return to the proscribed diet and your surgery will again work as it should.
There is a lot of mythology out there so you will have to be on guard at all times!
Good luck!
OneFinger
on 2/19/11 12:23 am
on 2/19/11 12:23 am
I've got to agree with others that this is a opportunity to educate your PCP. About a year ago I got really pissed off with my PCP when I asked about losing the weight and all he suggested was Weigh****chers or Nutrosystem (which I had already done and regained the weight).
I then went to a weight loss specialist (suggested by my insurance) and had the surgery.
I just had my 4-month post-op checkup with my WLS surgeon this week and he casually mentioned letters he was sending to my PCP on my progress. I had no idea he was sending him a status on me and my progress. I'm also due for another round of labs and my WLS surgeon suggested I have those done by my PCP with results also sent to him (WLS surgeon). He stressed the importance of getting my PCP on-board with my status and long-term needs.
Personally, except for the weight loss issue, I've really liked my PCP. Now that I know my WLS docs are helping him understand what's going on with me, I'm more anxious to continue my relationship with him.
High Weight = 310 Surgery Weight = 300 Dr's Goal = 200 My Goal = 190 
Gentlemen,
Thanks for all your replies. As I wanted, thoughtful & sage advice! :)
I do think I will need to educate my PCP just not sure he wants to be educated on WLS. I think what I am hearing you guys saying is that educating myself is the key. I also think that my PCP has my best interests at heart perhaps his delivery could use some polishing.
Speaking of self-education, labs that were done in January showed higher than normal levels of bilirubin. My PCP ascribed that to the surgery near my liver and that those levels should reduce over time and not to be alarmed. I am scheduled for more blood work in May. I don't know whether to investigate and contact my surgeon or simply wait for the next set of labs? Given my PCP's admittedly low knowledge of WLS, do I trust his judgment on these issues?
A balanced view by my PCP is appreciated. I suppose we are on a learning journey together.
Once again, thank you for your advice and suggestions. Much appreciated!
Keith
Thanks for all your replies. As I wanted, thoughtful & sage advice! :)
I do think I will need to educate my PCP just not sure he wants to be educated on WLS. I think what I am hearing you guys saying is that educating myself is the key. I also think that my PCP has my best interests at heart perhaps his delivery could use some polishing.
Speaking of self-education, labs that were done in January showed higher than normal levels of bilirubin. My PCP ascribed that to the surgery near my liver and that those levels should reduce over time and not to be alarmed. I am scheduled for more blood work in May. I don't know whether to investigate and contact my surgeon or simply wait for the next set of labs? Given my PCP's admittedly low knowledge of WLS, do I trust his judgment on these issues?
A balanced view by my PCP is appreciated. I suppose we are on a learning journey together.
Once again, thank you for your advice and suggestions. Much appreciated!
Keith
I think it is an ongoing education for both your PCP and your surgeon. While your PCP may not be as knowledgable about WLS and your "revised" anatomy, your WLSurgeon, may also not be as familiar with some of your other conditions or co-morbidities.
From the beginning, I made sure all Labs, Imaging results, sleep studies, surgical reports, etc., etc., went to both my PCP and WLSurgeon.
I just had my annual physical last week. My PCP was "thrilled" with my results and sincerely appreciated that I have worked diligently to keep him in the loop regarding everything that's gone on this past year.
Bottom-line, YOU have to take responsibility for your health and make sure the physicians and other medical personel who are working WITH you, fully understand all aspects of your life and care.
If you don't have a PCP or surgeon, who will work with you, answer your questions, and refer you when appropriate to another physician who may have more knowledge or expertise, you may want to look for another, more open minded and patient focused physician.
One last point, physicians and surgeons are just men and women, just like us. Yes, they may be very educated and some (many) are very smart. But in spite of what they sometime may think of themselves (some have tremendouse egos) they aren't GODs and sometimes may not be all knowing. As you go through this journey, you may end up knowing more than them and get the opportunity to educate! Good Luck!
From the beginning, I made sure all Labs, Imaging results, sleep studies, surgical reports, etc., etc., went to both my PCP and WLSurgeon.
I just had my annual physical last week. My PCP was "thrilled" with my results and sincerely appreciated that I have worked diligently to keep him in the loop regarding everything that's gone on this past year.
Bottom-line, YOU have to take responsibility for your health and make sure the physicians and other medical personel who are working WITH you, fully understand all aspects of your life and care.
If you don't have a PCP or surgeon, who will work with you, answer your questions, and refer you when appropriate to another physician who may have more knowledge or expertise, you may want to look for another, more open minded and patient focused physician.
One last point, physicians and surgeons are just men and women, just like us. Yes, they may be very educated and some (many) are very smart. But in spite of what they sometime may think of themselves (some have tremendouse egos) they aren't GODs and sometimes may not be all knowing. As you go through this journey, you may end up knowing more than them and get the opportunity to educate! Good Luck!
Eating junk food and CRAP is not a reward...it's a punishment...
it's a DEATH sentence...Reward yourself with Good Health!
Highest Weight: 287 Lbs-January 2010; Reached Goal 195 Lbs - Dec 2010
Total Lost: 92 Lbs; Completed FULL MARATHON (26.2 Miles) 10-16-2011
it's a DEATH sentence...Reward yourself with Good Health!
Highest Weight: 287 Lbs-January 2010; Reached Goal 195 Lbs - Dec 2010
Total Lost: 92 Lbs; Completed FULL MARATHON (26.2 Miles) 10-16-2011
Whenever I meet a new doctor, I bring with me a packet of information about the DS. I don't only include information about my surgery, but about labs that I need, and any other relevelant information (i.e. the need for a bone density scan) etc.
I suggest you do the same. It makes your life a lot easier, when you educate your doctor.
I suggest you do the same. It makes your life a lot easier, when you educate your doctor.
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