Good Morning. White lab coats

We've had a couple of recent post-ops with some pretty difficult and even life threatening experiences in the hospital following their surgeries but I want to talk about when it's ok to question the medical establishment.  

I'm talking about many surgeons not necessarily yours.

When I was a new post-op I was told not to be blinded by the white lab coat and I've gone 4 years following that guidance and am still here to tell about it. A few things I've learned or have been told:  1) surgeons are not trained in vitamins or nutrition (yes, some are self taught)   2) the vitamin plans they tell you to follow are hand-me-downs or sold to them by vitamin company reps   3) surgeons are not trained on how to get you to goal weight   4) surgeons will believe anything they hear or read if they hear it enough or read it often enough (i.e. hand-me-down WLS guidelines)   5) theory that goes along with whatever they think they know is more valid than your experience   6) giving everyone regardless of surgery type the same guidelines is easier for them to manage and keep up with   7) low carb protein supplements will not make you gain weight even if your surgeon tells you they will   8) you will not become toxic if your vitamin D goes over the top of the range on your labs...they really do not know what toxic for D3 is, so they tell you what sounds reasonable in their untrained mind (toxic is over 250 on your labs BTW)   9) you do not have to get all your nutrients from food   10) just because your labs indicate you're within range doesn't make your labs "perfect" 

What have you been told that is totally ridiculous?  Somebody talk about the liquid pre-op diet, please.

Next....
   

Actually, I've had very little experience with NUTS and Dr's since my surgery.  I've seen my surgeon a handful of times since but they were pretty much follow up visits, get on the scale, you're doing great, etc. 

One thing I want to add to your list is to keep track of your own labs and trends.  My AST/ALT was high since surgery, every lab showed it, but I never heard from the Dr's office.  When I was there (one of those handful of visits) I pointed it out and they're like "oh yea"... so... are they REALLY looking at my labs?  Oh, and the NUT that did call me and yell at me for supplementing D and other vits without being told too...

Surgeons and NUTS, in their classes before surgery, do NOT tell you how to maintain. 

I'm feeling at a loss now because the new Internist I went too won't be on board ordering the labs I want.  So I have to go shopping again...

The stereotype (yes from the surgeons) is what bothers me the most. I will go into detail... I was 225 at my highest weight ever, when I got that big I realized I was destroying my life and immediately turned around and started changing my habits and behaviors. I cut OUT, all carbonated drinks,sugars, breads in half and increased my protein...SOUND FAMILIAR! 
When I went to my seminar 3 yrs later I weighed in at 208... Yes I had lost weight, in fact I had gotten to 190 and plateaued...Could not get any further, had every lab drawn possible, nothing wrong... On to the pre-op diet, The day I met my Surgeon (4 wks prior to surgery) I had made it to 203 and was told I could NOT gain 1 ounce more at all..What happenens, I gained 2 pounds... They did not kick me out because it was a minimal amount but he flat out told me "You are not following the program set before you, you are eating everything you see"....WHOA, back off DOC! I was still doing the plan, I was on my cycle and he never believed me... The 2 week diet was allowed 4 Low carb high protein slim fast shakes and 1 meal replacement bar... I drank only 3 and had a bar a day for 2 weeks, I WALKED my A$$ off too, anytime the kids were eating, I walked, dinner, I walked, Im sure you get the idea...That 2 weeks I lost a grand total of 3 pounds...I was told I should have lost 10-15 if not more. When I go in the day before surgery, he tells me, the plan is intended for you to not gain, and there is no way possible,if you followed, for you to gain weight...Well at 600 calories a day, what do you think!  He was shocked that I had not lost more and looks me directly in the eye and says" you really do have a problem with weight"
HE FINALLY BELIEVED ME!.... Any way the point is they look at us as FAT and LAZY and unwilling to actually lose the weight the way others lose it..... Oh wait, I need to add in here he is the same surgeon who did my GB and was stumped when I came in the ER in extreme pain, no fever and my WB cells normal, needless to say the exploratoty surgery saved my life... I AM NOT NORMAL!

Thanks for posting. Bookmarked. I have a file for my rny journey. I read to keep copies of med records. I have both positive and neg hpylori results from lab corp. I am making copies of my pre surgical lab orders and surgical orders. This surgery is like a school coarse....u must read,study,read books and not just rely on the net,ask questuon and ask advice from others and the list goes on.

Gina,

I completely agree with you.  Surgeons are trained to cut.  Granted, I want someone who is really good at cutting (low infection & complication rates).

Before picking a surgeon, do your research on the surgeon.  There is a surgeon in my area who does hundreds of weight loss surgeries.  I wouldn't let him do surgery on my dog.  His infection and complication rates are high. The way he treats his patients just isn't right, but he is a lower cost provider in this area and people flock to him. 

The best part about my surgeon is that he leaves most of the follow-on care to his internist (who is also his wife) and his NUT.  These two ladies know their stuff.  Even at that, they aren't perfect.  Like Gina says, they are happy with labs in normal ranges for normal people.  My NUT is big on whey protein, but she doesn't discern the form of the protein.  As we know, collagen protein isn't the right protein for WLS patients.  She has recommended protein bullets with collagen at nearly every support group I have attended. 

Remember, you are in control of your care and recovery!  You have to understand what is happening and the right course of action to take. 

Don't blindly follow your "cutter" or you may have nutritional deficiencies from your Flintstones chewables (don't take these, they are crap and often recommended by surgeons).

Kay

Great post Gina! I think education is key. My program gave me a starting point, but I really did alot of research and listened  to what experience has to offer. We have alot of successful postops here with alot of wisdom, and I attribute that to my success so far. Did not follow the flinstones or the tums reccomendations. I still use protein supplement everyday.

Having a fatty liver, I took the preop liquid diet pretty seriously. I wanted to make sure my liver had shrunk some before surgery. Did not want to have an open procedure.
But for most of the lightweights without liver issues, it probably is a mute point.

ps, loved the good morning yesterday!

My surgeon required the 2 week liquid diet or 3 meals of the liquid protein and 1 sensible meal a day.  I did it because I had been diagnosed with a fatty liver and had read on some other boards where people went in for surgery and because of their liver size they woke up and had not had their surgery - so I was pretty compliant with that part.  Not sure if the whole 2 weeks was necessary or not.  It probably depends on the person and if they have the fatty liver or not.  I also did not want to have open if I could avoid it.

I think we all have to find what works for us and our surgery types, as far as our meals/protein drinks.  I'm so glad I listened to everyone here and started doing the protein drinks.  I don't think I would be where I am without them.  My NUT does not want us supplementing with them-maybe 1 per day but that is it.  I drink 3-4 a day and it helps me to not snack on other food, helps me get all my fluids in, plus I like the taste of them.  

We need to keep up with our labs and look for those trends because the doctors normally look back at the last set of labs and the current set and might not notice that downward or upward trend.  Don't depend on the surgeon/NUT/PCP to look out for these - it is really our responsibility.

Linda

 I think Im  the poster child for ridiculous pre op  diets  lol.  My surgeon said  if U dont do  4  shakes a day  and nothing else  Ava  for  6  ENDLESS  weeks I wont DO YOU  LOL    .  Mind U I was 235  lbs, my vision was going blurry from barely controlled  early onset diabetes  ... I FELT  and looked like CHIT  .. so i was  DESPERATE   enough to say   yes  DOC  Ill do WHATEVER  U WANT .  

I should be glad it wasnt WORSE  right ?  LOL

Was it HELL  ?  OH YEAH .   did I lose weight  ?   well  I WALKED  a  lot ( cuz i was STARVING ...  I SHOPPED a lot.. I CHATTED  a lot ...  i did whatever i had to do at the end of the day to knock my starving azz out ... and  what did  I get for my troubles ?   A WHOLE BUNCH OF  SUPPORT STAFF  who said .. YOURE TOO SKINNY  FOR THIS SURGERY  >>>  LOOK  AT ME >> IM FATTER  !!!!!  and the WERE  the PIGLETS !!!   CRAAAAZY    situation 

so i wholeheartedly  agree with Gina  .. preop shake diets  are NOT  for lightweights lol ... 

i went into surgery   maybe  175  lbs soaking wet ..., as a result i got a LARGE pouch and a mini RNY   i  HAVE to revise  .. GRRRRRR 

Thanks so much Gina for this post!

I had my quarterly follow up appt with my surgeon today.......I had to laugh as one of the first things he asked me was: so, how is the weight loss going, are you losing 5 pounds a week?
I was like, no more like 5 pounds a month!  Due to working in the health field I have a pretty bad opinion of the bedside manner of surgeons....I got a good one as far as surgical skills but sometimes I just shake my head at the rest.  He was very nice though when I asked about getting a copy of my labs and printed them for me.   He also said, he was amazed at how much I knew about nutrition and that "you patients are like dieticians, you know more than me" and "look how much you know now".  I wanted so say, look dude I knew this BEFORE surgery (we were talking about what I was eating and I said I hadnt gone above 20 carbs in a meal or above 8 grams of sugar so I have no clue if I dum*****t).  Anyways, thanks for this timely post.  Sometimes I think I am bit cranky about the whole thing but the narcisism bothers me greatly!
It is soooo nice to know that I am not alone in feeling this way.......

~~Jennifer

I love my surgeon. I love my NUT. I love my surgeon's NP, who is a WLS graduate.
My NUT admits she knows only a little, and tries to learn and keep an open mind.  She reads OH, as well as the LW forum, so she's pretty smart (wink!).
 
My surgeon knows surgery, his NP knows what it's like to be on the other side of the knife. I don't ask the surgeon about anything other than surgery. But I ask the NP alot, but I don't ask him WHAT to do.  I ask him WHY he wants me to do it.

Then, I make my own decisions. My best decision has been choose to be an informed consumer of medical advice!  YUP, I was one of those who chose to follow the guidance of the liquid diet because 1) I didn't want to start off in this adventure by breaking the rules before I was willing to follow them and 2) I thought the 2 weeks inconvenience was worth the potential risk reduction of a fatty liver.  Ironically, I'm so glad i did the liquid diet because those two weeks helped prepare me for the first four weeks post-surgery.

So many of the OH LW goddesses have helped me be the informed consumer I am.  But like I take some doctors' "advice" with a grain of salt and adapt it to fit my beliefs, I don't always buy into everything posted on OH either. I listen (or read), but choose my own path and accept the results I get.

tracey