Trip to Dr. Keshishian

Jan 30, 2011

Weds 1/26/11 Both my husand and I took the day off work. We got up early, fed and played with our hound, then hopped in the car and hit the freeway by 8:30am to journey toward Glendale for my appointment with Dr. Keshishian.

By 9am we had reached the outskirts of LA and were surprised when we received a call from Dr. Keshishian's office. The receptionist wanted to confirm our appointment for the next day! After some back and forth, she agreed to see what she could do and call us back. When she called back, she said Dr. K had not planned on seeing patients that day but had agreed to come in to meet with us so we would not need to reschedule - Awesome!

We reached Verdugo Hills hospital around 9am. Dr. Keshishian's office is in the adjacent medical building. We checked in at the office, I paid a $15 copay and filled out some paperwork. We had to wait a bit for the Dr since he was off doing errands. He got there around 10:45am.

Dr. Kesihishian told us that he normally has the consultation in a group so patients can bounce questions off of him and the perspectives vary, however he would give me the 1:1 version. (better for me, actually!). He commenced giving me his "speil". By speil, I mean that I could tell he had gone over this information so many times he could repeat it in his sleep. He talked very very quickly, but I was able to match his pace. He was not too interested in my input unless I had questions but I imagine, he hears a lot of long pathetic stories that are irrelevant to the topic at hand so I went with the flow and asked questions afterward. It did not seem overly salesy. If anything, he was cautious in his approach. I liked the drawings of digestive anatomy he drew for me to help me understand different procedures and how things would work with the DS.

I asked a few questions that I will share here since I was unable to find the answers online. I asked what the difference is between Gastric Reduction with Duodenal Switch, Billo-Pancriatic Diversion with Duodenal Switch, and just Duodenal Switch. Dr. Keshishian confirmed they are all the same surgery. I asked Dr. Keshishian if he we could do my surgery Laparoscopically or Open, and what the differences were in healing time. He shared with me that he really likes doing Laparascopically, in fact he thinks it is fun to use the fancy technology. However, he said some insurance plans don't cover it. He said they would submit it to insurance as Laparoscopic and if it is declined, they will try again open. He shared that the healing time is very similar for both operations.

I told the Dr I had heard the length of the common channel is closely tied to the success of this operation, how long does he make the common channel in his operations and how does he decide on this? He said that the length of the intestines vary only relative to the height of the person, so he individually decides on the length based on how long the person's intestines are. Based on this description, it sounds like a percentage approach. Dr. K said he thinks going with a standard length for all surgeries probably makes it easier or faster for other surgeons. He also said that he would rather see me remain 20 lbs overrweight due to a longer common channel than suffer worse gas and other bowel side effects due to a shorter common channel. He gave me the names of several other surgeons in San Francisco to research to help me make my informed decision.

I also asked about recovery time. He said I should plan for 4-6 weeks off work. He encouraged me to take the time to recovery as my body would need it. He said that many patients feel good and think they can return to work after 2 weeks, then after a day back find they cannot handle it. He also said female patients tend to be more resiliant than males. I asked how long my support person should be available to me after surgery (my husband does not have a lot of time to take off). He was very frank with me here... He said this is all about practical considerations... what my house is like... (1 or 2 story?) Do I need to get into a tub or can I step into a shower? I would not be able to wipe my butt so how will this be accomplished? Will my husband literally help me with that, or am I going to shower each time I use the bathroom? Finally, I asked how much time I really need to stay in Glendale since I live in Orange County 1 hr away (website says 10 days for out of town). He considered this for a moment, then told me I should stay there at least one day after I am released from the hospital, then I could go home.

Next, I took a paper True False test about the procedure. I got two questions wrong - one of which was if my apendix and gall blader would be removed during the procedure. The correct answer was true though I don't remember him talking about this. I am rather happy to discover this since I have had past suspected gall blader problems. After that, Diana from the office came in and explained the insurance and pre-operative details. She gave me a check-list to complete before applying for insurance approval and one for afterward, but before surgery. I would need to send the office details of my last 3 visits as well as documentation of prior weight loss attempts and a letter from me on why I want to have this surgery. I would also need a psychological evaluation and a discussion with a nutritionist which they provide.

After getting insurance approval, I would need a number of blood tests, an EKG and a chest x ray.

Finally, the doctor gave me a physical exam listening to my back and chest. He looked at my belly and described the incission. He noticed I have an umbellical hernia which he said he will fix during the surgery Yay! if laparoscopic, I would have 4 incissions across my upper abdomen and a 2-4 inch one near my belly button. If open, it would be 4-6 inches and above my belly button.

I left the visit feeling confident and comfortable in my decision.

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