Significant complications post operatively.

Ok...first and foremost I owe folks an apology for the fallout from my last post.  Particularly, "Lora" I believe is her name.  I have had tremendous pain and multiple complications.  I have lost 100 lbs and only about 5-8 lbs from MY goal.  My problem has been my serious and persistent complications since 6 weeks post op. 

I have some concurrent medical issues that were never discussed pre-operatively that could affect my recovery and long term success.  I just passed my 2 yr anniversary (4/3/12) and just this week had my EIGHTH hospitalization.  My aftercare has been a constant battle to have the problems addressed as a bariatric vs. gastrointestinal issue.  The only recourse this 2nd opinion Bariatric surgeon offered was to refuse a simple cholecystectomy to give me one last hope that this is where the pain is originating from.  I want to caution prospective patients that they need to be pre-emptive in making sure and setting in place and in writing a satisfactory program of aftercare. 

Following my cursory post op visits, any complications that arose were exacerbated by delays due to the Bariatric vs. Gastro argument.  About 6 wks post op I began to have pain.  I have been compliant to a fault (ie-to this day I still journal what goes in n' out - even the wrong foods.)  I journal type of pain, location, pre/post prandial conditions so, I have a thorough accounting of the onset of problems and the length of time to have the problem correctly and effectively addressed.  My last surgery was a battle royale and took 2 ER hospital admissions with NOTHING done, but pain control and discharge home w/persistent pain in the same area EACH TIME.  My hida scans, ejection fractions, US imaging all do not suggest GB involvement or biliary blockage.  At best I have experienced persistent dyskinesia and significant reactive hypoglycemia and dehydration due to the difficult motility and absorption problems that persist. 

I have a particular co-morbidity that can be extremely problematic if not handle quickly and skillfully.  6 weeks post op-I had a stricture.  This is a common problem and out of the doctor's control to avoid.  It was simply the length of time and the exacerbation of pain that frustrated me.  Once the doctor was willing to address this via a lap-the stricture was dilated and all went well.  For two more weeks.  My APS (blood clotting complication) necessitated pre and post op anticoagulant therapy.  Too bad for me again-I had a very serious gastric bleed.  Hospitalization # 3.  BTW...6 weeks prior to my RNY I had back surgery.  So 4 hospitalizations in 2-3 months.  I still remained positive and did experience a relative period of calm.  Definitely the calm before the storm.  *sigh*  I began to experience pain in my right upper abdomen under my ribs w/radiating pain to my back.  Symptoms suggestive of gallbladder disease/gallstones. 

However, my doctor seems mainly to ONLY trust numbers and imaging results and, in my opinion, fails to respond well to what is becoming a patient that may lower a 5 Star Excellence rating.  She began to distance herself from me.  Actually, I was quite distressed at the time of my anastomotic bleed/gastric bleed as she refused to visit, consult or allow her PA to visit me in hospital.  This rubbed me and my husband the wrong way.  However, I REALLY had faith in her surgical expertise and did not wish to alienate her as my bariatric provider.  In late summer of 2013 I began to really tank again.  I could not eat well.  The bolus of food would pass through the esophagus w/increasing belching and bloat even though amounts and chewing were strictly following the rules.  Remember here...I journal and take responsibility for any 'wrong' choices or patterns of behavior.

  But, I became reactively hypoglycemic which is concerning as I was counting and charting amounts of food, proteins, carbs, sugars, fluids, etc frantically trying to meet my daily nutritional goals.  By mid September 2013 I was an emergency admit back into hospital.  Number 5 hospitalization.  She would not visit or consult.  Failed to return any page by me or gastro doc/hospital staff.  I rec'd pain management, rehydration and control of my continued non healing ulcer situation which she insisted was a GASTRO problem not a BARIATRIC one.  I had NEVER had these problems before surgery and felt at the very least she had a responsibility to remain in the loop of my aftercare.  Less than 30 days later I endure ANOTHER ER hospital admit for the SAME symptoms.  Hospitalization #6.  I'm upset now.

  I am devastated financially as my husband is unemployed and I, as the sole wage earner, cannot meet all the incredible medical copays/bills on my own.  My husband has a partial disability and we are both well over 50 making employment opportunities considerably more difficult.  Again..these problems are NOT her fault.  But, she is my surgeon and I have felt she has a responsibility to actively participate in an increasingly complicated aftercare situation.  With this in mind...the hospital nurse case manager was called in to help facilitate a consult.  She tried for an entire 24 hour period much of this when we knew Doctor was at the hospital doing procedures so, making time after her surgeries to see me would have been the least difficult for her to handle.  She came the next day and said she WOULD do another lap on me, but I had to discharge home and wait for a spot-she didn't have time for me on her schedule. 

Again, as sole breadwinner, I now have no sick time.  I work in a small urgent care facility w/less than 25 employees so, am not eligible for FMLA support.  I have been unable to meet many after insurance copays which are astronomical.  Didn't matter to her.  Almost a week later I was added to her OUTPATIENT surgery center NOT the hospital bariatric tower where I would have ANY aftercare.  And, low n' behold...she found an internal hernia.  I had a healing ulcer and some adhesional formation  (not her fault again-this is how I heal). I WALKED out of that center 3 hours after surgery!   I have had about 25 surgeries in my life and 6 of them on my belly. 

I fear that as this abdominal pain was not resolving and regardless of imaging and numbers a conservative approach to #8 surgery would be a laproscopic cholecystectomy.  She wouldn't do it.  Said if it bothers me tell her, but she doesn't know if she could convince insurance it's a bariatric problem.  The old "bariatric vs gastro issue" again.  *sigh*  I felt at this time having consulted significantly with gastro and primary care that a 2nd opinion may be in order.  It was agreed that probably would be best. 

As a patient in an HMO status people need to realize as I did having worked in healthcare for 40 yrs-HMO's have associates which communicate regardless of being direct partners in practice.  Though I was authorized to see this doctor-a woman from this forum living in my city and having had similar aftercare battles recommended this surgeon.  I felt a direct patient recommendation would be the best way to go.  He accepted me having had gastro facilitate the auth.  I'm transferred out of one hospital and taken by ambulance 25 miles away with the understanding the long desired chole operation would be done. 

I must add at this time-two days prior to my admit I lost my job because of the ever constant impact my declining health had on the practice.  I lose my insurance on 4/30th.  So, now...the 2nd surgeon decides unbeknownst to me until the evening before surgery his plan is not to do just a simple lap chole...he wants to reverse my RNY!!!!  I'm insane at this stage as I'm doped out of my head on morphine (6-8mg q 4 hours), Zoloft, Benadryl (having skin reaction to morphine) and ambien or Xanax to calm me down.  All this did is exacerbate my state of mind.  Consequently, I would not agree to undoing all I have done and gone through with the lack of assurance that once my body healed I could ever have a modified procedure again. 

It is even harder to get insurance (if you have it) to re-auth a revision of any kind of 2nd operation after RNY.  That's the big surgery typically approved only after banding, sleeve, etc fail.  I am a bull dog and refuse to throw in the towel w/out a fight for retention of my RNY and hard won weight loss achievement.  I explained to the surgeon and even gave permission to my husband should Doctor once inside via lap find it necessary to do the revision if the chole wasn't going to fix the problem of pain and eating difficulties.  Now, it became an issue of MONEY.  Learning I was losing my insurance at month's end he refused to do anything. He worried about money should I have more complications postoperatively.

 His practice partner understood due to our financial situation my reasoning for doing a conservative surgery first.  But, he nixed it and sent her as a frustrated emissary to say "sorry-just don't let anyone but a bariatric surgeon operate on you".  Well, crap...that's why I came to them.  It is now about money and possible future complications.  I get all this as I have worked for years side by side w/physicians of all specialties.  IMO-they forget the Hippocratic Oath...FIRST DO NO HARM.  You have to be a responsible aftercare practitioner to be a successful surgeon.  I am now 12 days away from losing insurance and have yet to find out if the first surgeon will even re-auth me and agree to lap me again.  There's no other choice for me in the area of an alternative and capable bariatric surgeon.

  I'm scared ppl.  I am sick.  I am in pain.  And, this long diatribe is to vent and apologize for being so stressed and rude on my last post.  I am bleeding at the anastomotic suture line again and I have imaged evidence of a very irregular pouch on one side suggestive of mini unhealing ulcers.   My pain precludes eating well enough to maintain nutritional necessities and even taking ALL my supplements and trying to go on protein shakes and liquids again isn't  easy for me to do.  Something is very wrong in my abdomen.  At great financial sacrifice I will have to cash in my meager $2500 401K and fly several hundred miles away to consult w/legal and alternative surgical docs.  I need help.  I need emotional encouragement and informational support.  Many of you will say based on my last response-I don't deserve a reply.  I get that.  But, please accept my explanation and sincere apology as I have no place else to turn to.  The support group I ALWAYS attended is not regularly scheduled as surgeon #1 has no one to oversee it and she's too busy in the other auditorium recruiting new business.  FOR ALL PROSPECTIVE WLS PATIENTS...it is on you to do due diligence pre-operatively.  I spent over 9 months preparing both physically, financially, medically and mentally for WLS.  Things can and do go wrong.  Be proactive and remember to make sure you have proper aftercare set up in writing beforehand.  Thanks for reading to the end.  Thanks for not turning your back on me.  Celtie

I did attempt to read this, but it is too difficult.  When you post, you need paragraphs after every three sentences.  This big block of text will keep most people from understanding what you are trying to say.

Please edit this and put it into paragraphs to make it readable.

Will do...thanks for the suggestion.  I hate being so verbose.  Guess I was on a rant.  Thanks, Dove 

Celtie

White Dove...if it isn't too much trouble would you mind taking a look and seeing if this is easier to read.  I am trying to be thorough w/info so, I know this is a verbose piece.  Hoping, though, the changes you suggested will help.  I really appreciate your input.  Thanks-Celtie

It is an improvement, but still too many sentences in paragraphs.  Two or three sentences is all a person will read in an internet paragraph.  Your last paragraph has about 20 sentences.  Just go through and put a paragraph after every third sentence.  Some places will be better with two sentences to a paragraph.

I would suggest rewriting this, with a list of surgeries in order and much briefer description of each and just editing out the emotional parts.  The rule for all writing is keep it short and sweet if you want it to be comprehended.

#1

#2

Thank you, Dove.  I'm so sorry.  Asking all to forgive me.  I'm in so much pain.

Worried this is a Petersen Hernia.  Not easily diagnosed.  Original surgeon out of town again until 21st.

Sorry OB forum ppl.  Too hard to keep sitting to fix long post from yesterday.  Forgive me if I ask to

hav you please read thru.

Thank you everyone! 

Celtie

I would also politely recommend that you chuck the thesaurus out the window.

I can't recall the citation off the top of my head, but health-related information is best conveyed online at a 6th grade reading level or below, so sticking to "I had other problems so I went back to the hospital for gallbladder surgery" will make things WAY more readable.

Agent/Sparkle:  I get what you're saying.  Thanks for reminding me.  I've lived in healthcare for too many years.  *smile*  To EVERYONE...thank you ALL for the support and well wishes. 

Spoke to gastro doc this am.  Appt made w/original surgeon.  She's out of country until Monday.  Her surgery schedule may delay appointment until Tuesday. 

Per Gastro-I will go to ER (where bariatric surgeon is on staff) in a life threatening emergency/if worsening pain. 

I hope you all forgive me and I thank EVERYONE (even Lora *wink*)...I don't communicate well or function well heavily medicated.  So sorry.

Blessings to ALL for Easter and Passover (Good Yontif)

Celtie 

Yeah, meds and a healthcare background will do that to a person! I work in healthcare outcomes reporting, so our mantra is "remember your audience" :)

Feel better soon!

Celtie, I know you have a lot to get off your chest and need to unload like I did yesterday. I feel for you. I am sorry you are going through all of this. I will pray for you. Please keep me updated. You can message me if you want to do so.