Question:
I was supposed to have surgery (lap-band) last Wednesday and was being prepped
I was being prepped for lap-band surgery last Wednesday and the anesthesiologist came in with the pre-op test results that had been done on Monday and said that he didn't think we ought to do the surgery - that my glucose was too high and that it could be dangerous to do surgery on an uncontrolled diabetic. I was totally blown away - I didn't know I was diabetic. In fact, I was doing this because there is a very definite history of diabetes in my family. When I went to my surgeon initially he made me write out why I wanted the surgery and that was the crux of my reasoning for it. I have often expressed to him that I was worried about diabetes so I know he knew of my fears. In his defense, my insurance threw me a curve and forced me to wait 6 months from the time I initially saw him until I could really get going and I have taken a long time from start to what I thought was supposed to be surgery. I'm just horribly disappointed that what I had feared the most (diabetes) happened. But I'm also angry that with all the blood tests that he required - and I've had blood work done repeatedly over many months timespan - that he never saw (or mentioned) that my sugar was high. I know that sounds harsh, but I am really questioning his 'care' because of two additional things. 1. He required an EGD - which I did - they scheduled me to come in to the office 10 days later to discuss the results and when I got there (after driving an hour and waiting 2 hours) I finally got in to see him and he asked what I was there for. I told him that he was supposed to review the EGD results with me and he looked through my file and said that they didn't have them yet. He said something to his nurse about it being unacceptable that they didn't have the results yet - and yes, it was, but to me it was unacceptable that they didn't know why I was there and that I had to wait all that time for nothing. And 2, on the day I was supposed to have the surgery, had he said that he would go ahead with the surgery I would have said to go for it, but he insisted that I go back to my GP to get the diabetes under control and in our conversation I asked him if I could just fax the release from my doctor saying that my diabetes was under control rather than driving an hour for another appointment and he told me no - that he couldn't be responsible for remembering where I was 'in the process'. I guess my question is, am I right to be leery of the doctor? I'm not leery of the surgery, I'm just questioning whether I ought to go somewhere else to have it done or am I trying to blame him for sloppy paperwork (for not watching his patients closely enough) when it's something that's my fault. And, I know that God's hand is in this all. I'm just wondering if He's not trying to tell me I need to go somewhere else. — Rev217 (posted on July 8, 2008)
July 8, 2008
RNY surgery has a very high success rate in eliminating diabetes. Many
diabetics have this surgery in order to make this health issue go away. I
know it may take more time, but this may be the better option, now that
you've been told you are a diabetic. DAVE
— Dave Chambers
July 8, 2008
If you ask me, the anesthesiologist saved your life!!! Since the doctor
already had 2 strikes against him (the ones you mentioned), then this (the
blood work) would be the third, especially if he didn't mention the results
with you PRIOR to your surgery!!!!! I think the old saying "3 strikes
and you're out" applies here! Find another surgeon! I know it is
disheartening and frustrating, but you will probably be much better off!!!!
— ALafferty
July 8, 2008
As a Registered Nurse, I want to agree with Dave's advice:
Gastric Bypass RNY will give you the best chance of curing the diabetes
(not the lap-band). It is good that the surgery was postponed because high
sugar levels would compromise wound healing. Quickly get the blood sugar
controlled, and reconsider the larger surgery.
— nancycarle
July 8, 2008
I would immediately speak to your primary physician and explain the
diabetes issue and take copies of all of your lab work to him so that he
can best now how to proceed with your treatment. Then I would use this site
and / or your insurance company and find another surgeon for your
procedure. He is treating you like a dollar sign and not a human being.
Realize that if it is this difficult now, what will happen after the
procedure for follow up exams and questions. Trust your gut and get away
from this guy.
— Tammy M.
July 8, 2008
Your instincts are right 9 1/2 times outta 10!!! Get rid of the guy! He's
just in this for the money...not his patients, obviously. It might just
well be a blessing too, as you think...Maybe you were supposed to have the
RNY...
Here's two good reasons...The first is a 60 Minutes TV documentary on the
reversal of diabetes with RNY and the second link is the Slashing of Cancer
risk de to RNY surgery...
Check them
out!http://www.cbsnews.com/stories/2008/04/17/60minutes/main4023451.shtml
http://www.msnbc.msn.com/id/25269713/
— .Anita R.
July 8, 2008
Please get your diabetes under control before surgery. I think you should
follow your instincts on the doctor. I don't think he was looking at just
the money. If that were the case he would have done the surgery anyway. You
need to have confidence in your surgeon. Good luck.
— Paula K.
July 8, 2008
I agree with the other authors for the most part. If after multiple lab
results, no one even noticed abnormal blood glucose levels.... change
docs.
As far as changing surgeries, that is up to you. I am pro- WLS no matter
which surgery a person decides on to save their life... I agree with.
Having said that, I had lapband and was rid of my diabetes in 2 weeks
without having to have the RNY. The same happened with all others in my
support group, NONE have diabetes anymore with the lapband... it may not
have happened as quickly, but it did happen.
Good luck to you,
Dawn Vickers, RN, BLC, CLC
— DawnVic
July 8, 2008
Mary -- first of all, I'm really sorry about what happened to you. I've
had my share of stupid creepy doctors that never addressed real issues, or
at least never told me the "full story", so I feel your pain.
This guy definitely sounds like he's NOT the doctor for you, and, like the
other posters said, go with your instincts. The question I would have,
though, is "did all the bloodwork you had done pre-op INCLUDE glucose
levels?" Labs can only test blood for what the doctor tells them to
test for -- at least in Canada. For example, I'm a type II diabetic and I
have my A1C done every three months --and the lab tests only the A1C, not
for HIV or Hep C or anything else. That might be a question you'd like to
ask this surgeon if/when you ever see him again. And don't be freaked out
by the diabetes -- Type II is a lot easier than Type I (juvenile diabetes)
to get under control, and control can be addressed at least in part by
losing weight. You may have drawn the same crappy genetic card that I did
(both my father and paternal grandmother had Type II diabetes, so guess
what I developed at the age of 49 -- AFTER I lost about 160 pounds from my
VBG?) but even that's not as bad as it seems -- just do everything your GP
says to get your sugar under control and investigate, as others have
suggested, not only a new surgeon but perhaps a different surgery. Best of
luck,
— Cheryl Denomy
July 8, 2008
Mary -- I say RUN away from this dude. Sounds like he's doing surgery on
people and not really going over the ALL important test results. I say get
another surgeon -- Honey, GOD is trying to tell you something -- keep away
from this dude. Ask for any money back that you had to pay prior to
surgery and go someplace else where the surgeon is talking to you about ALL
of your test results.
Peace and Light
— the7thdean
July 8, 2008
I agree with most of above , mostly the part about trusting your surgeon.
It was good that they postponed the surgery for high gloucose levels
becasue they will only go higher after the stress of the surgery and cause
poor wound healing. How high were they? Did they tell you? Make sure you
obtain all copies of all the tests you had done pre op so your GP can use
them to evaluate you. Was this a one time high sugar, or a trend? Did
they do a hemoglobin A1C which checks for how well your sugars are
controlled over about a 3 month time. You want your A1C to be around 6,
but not over 7. THat will tell you how long your sugars may have been
uncontrolled if they indeed are. Did you fast with that pre op blood work,
as that may be a reason for your increased sugar. There are so many
variables to this. Many pieces to the puzzle.
As far as your surgeon, did you research him? Is he part of a bariatric
practice or just a general surgeon? If you are not comfortable with him,
you have the right to find someone who you can trust. If there are any
complications after the surgery or during the surgery you need to know you
can trust that he will take care of you. Make sure he is an accreditied
surgeon who has performed lots of these surgeries.
As far as lapband vs RNY,,, that is a personal decision. I think both will
help you with your diabetes if you indeed have diabetes. RNY just helps
you lose quicker, thus allowing your diabetes to subside quicker. When I
was first diagnosed with Diabetes II, I went on a strict diet and lost
about 50 pounds and was on minimal meds, almost off and all diet
controlled, That proves that weight loss is an important tool in
controlling and hopefully curing your diabetes. ( if in fact you do have
it).
Good luck to you and if you have any more questions, just ask.
Eileen, RN
— eyenjeff
July 8, 2008
Two things you are address here. First, you had or have the right
anesthesiologist, but I would find a new surgeon. Second, if your diabites
is that much out of control, you need to get on insulin if you have to to
get it under control. There is a simple test they give you with a little
blood work every 3 months to check you total control. It is call a A1C.
When I first found out I had diabities, it was 7.7 and when it was under
control I was a 6.1-6.2, but now 6 months following RNY surgery I am a 5.5.
Non-Diabitic starts at 5.9. Also I would check out all the options. I
had RNY and I had it because I had freinds that still were on diabitic
drugs after 1 year following their Lab-Band surgery despite the fact they
lost weight. I had Diabities for 25 years and they told me there was a
moderate chance that I might get off diabitic drugs, but no promises. 1
month after surgery I was off 7 Diabitic Drugs and I left the hospital and
never took insulin again. I have a freind that is going for a RNY revision
to his lap-band, and paying this time for the surgery him self, just to try
and cure himself of Diabities Type II. If you have type 1, there is
nothing that is going to cure it available yet. By the way, I no longer
take High Blood Pressure Drugs or Colestrol contring drugs. Best of
Seccuss to you. Listen to the advice you received and attend a support
group meeting to get the facts from others face to face.
— William (Bill) wmil
July 8, 2008
It's me again. Thanks for all your support. I felt like a heel even
thinking that maybe there was a problem with the doctor - after all, we ARE
supposed to be proactive with our health and this process - but I trusted
the doctor to give me the information I needed. My glucose level from the
pre-op testing was 405. I went back to my GP and he did the A1C test which
came in at 14. Yep, that sounds pretty diabetic, even to me. He put me on
an oral medication (that I hate!!!) and insulin shots (that I hate!!!) and
it was down to 156 this morning. I don't know what to do. It's a safe bet
that I'm not going back to the same surgeon (thank you all very much for
your support) but there's a part of me that says that I failed in heading
off the diabetes so just deal with it. It's going to take forever to find
another surgeon and go through the process again.
— Rev217
July 8, 2008
Let me play Devil's Advocate here. I manage a couple medical offices (ENT's
not Bariatric). You are absolutely correct in your anger with the office
visit. The person that put you in the room should have had that report in
the chart or at least called for it, before the Dr came in the room. Dr's
very commonly use the opening line "what are you here for" when
they walk in the room, so don't feel bad about that. Dr's generally do not
review the patient's entire chart in the office setting, there is not
enough time. If he ordered all the sugar level testing, he should have been
responsible for contacting you about it. I would recommend that you request
a complete copy of your medical record, so your PCP can review all the
tests.If you don't want to get another surgeon, I would also recommend
talking to his office manager or nurse and explain everything that happened
and why you are upset. They will normally do what they can to make things
better. Even if you don't go back, your complaint could help. If it is a
matter of lack of competent staff, maybe that would change. Most doctors
don't understand the need for enough staff and the need to pay well, so
they can have quality employees. Especially now that they are getting paid
less and less by insurance companies, they want to keep the costs down in
the office. If you don't have confidence in him as a surgeon, I wouldn't go
back.
When I was overweight before my Lap Band, I was very meek, let people take
advantage of me and treat me poorly, but now....Hell no. Yet another
advantage to WLS.
The diabetes will be gone with your WLS and the diagnosis will actually
help as far as insurance is concerned. (Your sugar was high, especially
since you had been fasting for 8-12 hours prior to surgery.)
I wish you well in you future surgery.
Patty
— pattyann
July 9, 2008
I would say that it was a sign to find another surgeon, you don't want to
have an RNY and then not be followed up with correctly.
— jenks621
July 10, 2008
If it were me in that situation, i too would be extremely leary of that Dr.
I would not only find a different dr but i would consider the DS WLS.
Anyway it stands, the DS would be my second choice for WLS. I hope that you
would research this option. It is being used and researched widely as a
diabetis and not just in the obese. There was an awesome post about a wk
ago on the lapband board with all the research about it. I'm not sure who
posted it, but the post mentions DS in the title. Good luck and God bless.
As i always say, what the Lord brings you too, he will bring you thru.
— Kristi H.
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