The Problems of Having Surgery Overseas

I was thrown a bit of a curve ball tonight. 

I live in the Middle East and had my surgery here.  There were financial advantages to the decision, certainly.  But the real reason I decided to do the surgery here rather than go to the States was because of follow-up.  I didn't want to try and manage a hand-off of my case from one doctor to another, across continents, and I certainly couldn't continue to fly back to the U.S. for doctor's visits.

The surgery went like a charm.  I've had absolutely no complications and I'm losing weight regularly and well. 

My first follow-up appointment (at two weeks) was a bit of a mess.  I sat in a waiting room for three hours because the hospital "lost the appointment".  When I was seen, it was by a doctor who had no familiarity with my case and no real insight.  I didn't see a nutritionist. 

My second follow-up was to have been just shy of the four month mark, which would have next week.  I got a call from the hospital tonight at 9:40pm (businesses are so weird here--they think it's perfectly acceptable to call at 10:00 at night), saying the doctor wouldn't be in country at that time and they needed to reschedule me--to November 5th!  That will be approximately seven months out.  Now mind you--the doctor I was supposed to meet with isn't my surgeon, but an associate.  The upside is I've at least met her before.

I'm doing well.  But still--that seems like a pretty long time to go between check-ups for a procedure like this.  I'm supposed to have my blood work done before then, but that will be the only time that's happened since my surgery.  So basically I'm doing this without any professional monitoring at all.

Do any of the vets have any suggestions for what I should self-monitor between now and then?  It's no good to say find another doctor because...there really aren't any.  I had my surgery through the country's only "center for excellence" for this kind of procedure.  There are a team of doctors attached to the unit, but I would assume if any of them could have seen me before November, they would have.  I can't just walk into a doctor's office and make an appointment.  Everything is coordinated by the state hospital.

I'm frustrated, I'll admit.

That's a ridiculously long time before a follow up appointment.  I would start by calling them back and saying you are very uncomfortable with the lack of follow up and ask them to schedule you sooner.  If they say there are no appointments and they just can't, ask them to take your number and call you if someone cancels and you could take their appointment.

I would not wait seven months before having labs done, so I would ask them to order labs now.  Most surgeons, though not all, do them at three months post op and again at six months post op.  And I would make sure you know what they are ordering and that you get a copy of the lab report your self.

One of the challenges is you can't get a doctor on the phone.  Heck, I can't get one to answer my emails.  I have the number for the unit's executive assistant, who was an absolute rock star prior to my surgery, but who seems to have disappeared since (I believe she's been seconded to the executive suite--that was her assignment the week I was admitted to the hospital). 

You really don't have access to physicians here like you would in the U.S.  All appointments are done through a central department and nearly all doctors work out of a hospital or clinic.  They don't have their own practices like they do in the States.

I do plan on ordering labs, but I wasn't sure what to ask for or ultimately how to interpret the results (how low is too low, etc.).  I saw the posting where you talked about zinc deficiency, which is great information.  So I was wondering about that kind of thing.

Wow, Karen!  How disappointing!  I think Kelli's right though, that is just too long to go without being seen.  At the very least get your labs and a copy for yourself, if at  possible.  I know you were just home a few weeks ago; and probably had you known what was going to happen, you could have seen someone while you were here. 

Maybe there's a nutritionist stateside who could correspond with you in the meantime?  My surgeon's office scheduled me for a 2 week post op with him, then again in 3 months.  Then a 6 week post op with NUT so I see her next week. 

I'm glad you're doing well, in spite of the lack of follow up by the surgeon's office.  Hang in there, hope it all gets worked out for you!

Thanks, hon!  I need to figure out how to get a copy of the labs for myself.  When I had my bloodwork done prior to surgery, I never got a copy.  It was all handled electronically and forwarded to the surgeon's office.  There may be other nutrionists here that I could link up with.  I need to do some research.  I'd love someone who had some background with bariatric patients, but that may be asking too much.

I moved from the US to Singapore 5 months after my surgery and since then have taken responsibility for my care.   Find a good PCP who will do your labs and educate yourself on what levels you need to maintain and the regimen you need to maintain those levels - the ASMBS website will help you with information and you could provide that reference to your doctor.

Quite honestly, a surgeon is a cutter and it is not that unusual that people are seen by PAs NUTs or NPs after the surgery,

People manage this surgery overseas ALL THE TIME - it's just maybe not quite as handheld as it is here in the US!

Oh, believe me--I've lived here for two years.  I've got lots of practice in handling stuff on my own.    But in this situation I don't know what to ask.  I appreciate your mentioning the ADMBS site.  That will be a good reference when it comes to interpreting labs.  I think I may have trouble getting another doctor to work with me, knowing the culture here.  But maybe I'll get lucky.

Hello Karen

in which country in the Middle East are you living? 

I'm in Qatar.   I've lived here since June of 2011.

Do you have access to a PCP? Perhaps you can try to get a telephone appointment with a Bariatric Nutritionist in the US. It might cost you a bit of money, but at least will know what to eat. You should try to get your blood results through the hospital or PCP.