why different doctors have different recommendations
From time to time someone asks why different doctors have such different recommendations, and I was just responding to a post about this on the main board, and decided to put my answer here, as well.
Surgeons have different protocols because most of it isn't based on science. As far as I know, there have been no studies to see if staying on liquids for one week or two weeks post op leads to better outcomes. If there has been such a study, I would bet most surgeons have not read it! There have been studies on what calcium we absorb best or how much vitamin D is needed to reduce the risk of osteoporosis, but most surgeons haven't read those either. It's not their area of expertise. They are trained to cut and sew, and most are very good at it. They don't get much training in stuff like nutrition, though.
I think they decide what type of diet and vitamins and stuff to recommended based on one or more of the following:
1. What they were taught. If they learned to perform RNY under a surgeon that always instructed patients to do liquids for two weeks and to take Flintstones vitamins, they might think, that surgeon seemed to know what he was doing, I'll tell patients the same things.
2. They might base it on their experience. If they had a patient that has some sort of complication from eating solid foods one week post op, they may strongly discourage patients from doing that in the future - even if that complication was very rare and unlikely to happen again.
3. Some of it, I think, is just personal preference or opinion. for instance, some surgeons have told patients they recommend Flintstones because they assume patients will not want to spend more money for better vitamins. Or maybe it just seems to make sense to them to keep patients on liquids for a while after surgery, even if they have nothing scientific to base that on.
And I'm not saying those are bad things to base recommendations on. But you can see how different surgeons, trained in different places, with different experiences treating different patients, would come up with different "rules" if that's what they based them on.
It's OK to ask a doctor why he recommends a particular thing. It doesn't mean you're suggesting he's wrong, and he shouldn't take it that way (unless you really say it that way). But knowing why he recommends something can sometimes help you make your decision. If a doctor told me he recommended X vitamin because a study published in whatever journal showed it was best in some way, that means a lot more to me than if he told me he recommended it because he assumed I wouldn't want to spend an extra dollar per month on a better vitamin, you know?
Surgeons have different protocols because most of it isn't based on science. As far as I know, there have been no studies to see if staying on liquids for one week or two weeks post op leads to better outcomes. If there has been such a study, I would bet most surgeons have not read it! There have been studies on what calcium we absorb best or how much vitamin D is needed to reduce the risk of osteoporosis, but most surgeons haven't read those either. It's not their area of expertise. They are trained to cut and sew, and most are very good at it. They don't get much training in stuff like nutrition, though.
I think they decide what type of diet and vitamins and stuff to recommended based on one or more of the following:
1. What they were taught. If they learned to perform RNY under a surgeon that always instructed patients to do liquids for two weeks and to take Flintstones vitamins, they might think, that surgeon seemed to know what he was doing, I'll tell patients the same things.
2. They might base it on their experience. If they had a patient that has some sort of complication from eating solid foods one week post op, they may strongly discourage patients from doing that in the future - even if that complication was very rare and unlikely to happen again.
3. Some of it, I think, is just personal preference or opinion. for instance, some surgeons have told patients they recommend Flintstones because they assume patients will not want to spend more money for better vitamins. Or maybe it just seems to make sense to them to keep patients on liquids for a while after surgery, even if they have nothing scientific to base that on.
And I'm not saying those are bad things to base recommendations on. But you can see how different surgeons, trained in different places, with different experiences treating different patients, would come up with different "rules" if that's what they based them on.
It's OK to ask a doctor why he recommends a particular thing. It doesn't mean you're suggesting he's wrong, and he shouldn't take it that way (unless you really say it that way). But knowing why he recommends something can sometimes help you make your decision. If a doctor told me he recommended X vitamin because a study published in whatever journal showed it was best in some way, that means a lot more to me than if he told me he recommended it because he assumed I wouldn't want to spend an extra dollar per month on a better vitamin, you know?
Kelly
Please note: I AM NOT A DOCTOR. If you want medical advice, talk to your doctor. Whatever I post, there is probably some surgeon or other health care provider somewhere that disagrees with me. If you want to know what your surgeon thinks, then ask him or her. Check out my blog.
My surgeon has very strong ideas about how she wants things done (both in terms of medicine and in how her office is run), but one of the things I like is that she is still willing to alter her post-op recommendations to accommodate new research/information and her ever increasing experience with WLS patients. She altered her vitamin recommendations (expanded the list) to align it more completely with the ASMBS recommendations (but not until after I and my surgery!) and it is my understanding that she eliminated the extended period of liquids post-op (she apparently never included a purée stage) when she found that non-compliant patients who were "cheating" and eating soft foods before they were supposed to actually experienced fewer issues with eating solid foods again.
I like the fact that she is willing to learn and change for the benefit of her patients rather than just sticking to what she was originally taught (especially since she was a general surgeon for quite some time before starting bariatric surgery). She now does primarily WLS (band, RNY, and VSG... she no longer does the DS because too many patients were not being compliant with vitamins and were developing problems because of vitamin deficiencies).
Lora
I like the fact that she is willing to learn and change for the benefit of her patients rather than just sticking to what she was originally taught (especially since she was a general surgeon for quite some time before starting bariatric surgery). She now does primarily WLS (band, RNY, and VSG... she no longer does the DS because too many patients were not being compliant with vitamins and were developing problems because of vitamin deficiencies).
Lora
14 years out; 190 pounds lost, 165 pound loss maintained
You don't drown by falling in the water. You drown by staying there.
I don't think there is anything wrong with having strong ideas about how she wants things done, and I would have strong ideas about how I wanted my office run, too. But I think it's very good that she is open to learning and that she changes her recommendations as she learns new information. New research comes out all the time, and if a doctor is paying attention to their patients, they should be learning new things as they gain more experience (like noticing that her patients that ate soft foods sooner had fewer problems). I think the best surgeons are probably those that both keep up with new research or other published information AND learn from their experience with patients.
One thing that stands out to me is that if she made the observation that "non-compliant" patients had fewer problems with solid foods, she must be pretty good at establishing a good rapport with patients. Because many patients don't tell their doctors if they are being non-compliant. They are afraid their doctors will be mad at them or something. But enough patients must have felt comfortable enough with her to be honest, in order for her to make that observation. That's pretty impressive to me.
One thing that stands out to me is that if she made the observation that "non-compliant" patients had fewer problems with solid foods, she must be pretty good at establishing a good rapport with patients. Because many patients don't tell their doctors if they are being non-compliant. They are afraid their doctors will be mad at them or something. But enough patients must have felt comfortable enough with her to be honest, in order for her to make that observation. That's pretty impressive to me.
Kelly
Please note: I AM NOT A DOCTOR. If you want medical advice, talk to your doctor. Whatever I post, there is probably some surgeon or other health care provider somewhere that disagrees with me. If you want to know what your surgeon thinks, then ask him or her. Check out my blog.
You know, I had never thought about how many patients would tell their surgeon that they had not been following the post-op diet because i am pretty open with my doctors (if I dont feel comfortable being honest with them, I switch doctors), but you are right... it does take a good rapport in order for patients to be honest. I do think that many patients have a good relationship with her, because she is very compassionate towards her patients and is very passionate about helping them I prove their health via WLS.
Lora
Lora
14 years out; 190 pounds lost, 165 pound loss maintained
You don't drown by falling in the water. You drown by staying there.
In general, I've rerely felt shame when dealing with medical providers. I do drink alcohol (prefer wine). When I get on my "oh Lord, I hope it's not an ulcer" wagon, it's because I drank what I thought to be excessive, or offensive to my gut.
Well once when I did my 6 month post op, i hid my face and told the doctor that I've been drinking alcohol and I've been a heavy drinker prior to surgery, and am mindful of the kind of alcohol I drink now. I explained that I drank nearly daily from early on, and I dont want "a" ulcer.
Doc looks at mee and says that there are no concluse or reliable studies that suggest that alcohol causes ulcers. He advised that my slower weighloss could likely be due to the fact of my increased wine consumption. It felt good getting that out. And after confessing that to him, I've been drinking less. Havent had a glass of wine in nearly 3 days. I was drinking 2 glasses a day, to none for 3 days...pretty darn good for me.
Now if I can just cut out these morning cigarettes, I'll be fine (mornin ones produce bowel movement). Dr. fears that cigarettes and caffiene CAN cause ulcers.
Well once when I did my 6 month post op, i hid my face and told the doctor that I've been drinking alcohol and I've been a heavy drinker prior to surgery, and am mindful of the kind of alcohol I drink now. I explained that I drank nearly daily from early on, and I dont want "a" ulcer.
Doc looks at mee and says that there are no concluse or reliable studies that suggest that alcohol causes ulcers. He advised that my slower weighloss could likely be due to the fact of my increased wine consumption. It felt good getting that out. And after confessing that to him, I've been drinking less. Havent had a glass of wine in nearly 3 days. I was drinking 2 glasses a day, to none for 3 days...pretty darn good for me.
Now if I can just cut out these morning cigarettes, I'll be fine (mornin ones produce bowel movement). Dr. fears that cigarettes and caffiene CAN cause ulcers.
Back to the original topic, maybe each doctor depending on the type of surgery perform (ie. length and wideth of opening etc.), draw their own conclusions "unofficial studies" based on their patient reports. These doctors may advise accordingly. Not really sure. But to me it would seem right to allow the stomach as much time as practical to heal and get adjusted to reintroding food. Not sure what the course, and cut offs should be. Maybe guidliness are formded based onl old studies concerning stomach healing. I'm realy guessing here. Hopefully the docs know more scientifically than my random guesses.
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