Help me picture the follow up years...

I am getting ever closer to committing to a DS in with Dr. Ungson at the Mexicali Bariatric Center.  Actually, I think I could make the leap of faith today, but my husband is being all "I'm not going to let you risk yourself without a good plan."  He is right, I know, but there is almost a disconnect in my mind about this because it doesn't seem like it's a big deal.  Well, **doing it** is a big deal.  Planning it is pretty simple. 

1.  Get blood tests every 3 months for a year, then six months for life.   This I drive through my general doctor.

2.  If severe abdominal pain presents go to the ER with the warning that I could be leaking or be blocked but still passing gas etc. 

3.  Otherwise, preventative health as usual.  Annual physical, 5 year colonoscopy, yearly mammograms. 

He says "But what if your blood tests show something."  And I'm all like "Well, we cross that bridge when we get there.  I will do some research (which would probably be internet searches, here in this forum, vitamin lady type people..)"  I think the answer he wants is "We call local Dr. X."   But I guess I feel like I'm not going to trust any surgeon with my nutritional follow ups or general doctor with my bariatric particulars.   Hmm.  "Trust" isn't the right word.  It's more of a "hear but independently verify" kind of thing in my mind. 

Am I wrong?  Is there a local doctor I should set up an appointment with and say "Hey, I'm going to Mexico!!  Will you my base line and follow ups?"  At a minimum I promised to have an appointment with my general doctor to make sure he will do the follow up. Will he know enough to spot weird post-ds things?  Are there any other issues other than blood tests and abdominal pain?   What if he says no?  I feel like I have to be missing something. 

Thanks!!

4) Take vitamins every day - adjust based on labs.

I'm not sure about short term post-op but long term I think you are OK. I'm 15 months post op so keep that in mind while
reading through my thoughts.  

As far as your husbands question it is a good one but the answer is simple. What does anyone do when their blood tests come
back outside normal ranges? You talk to your Doctor, You do research, you adjust your vitamins - in rare cases maybe you get an IV for something or iron infusuion. Having the DS just means you end up watching more things on your blood tests but the followup is still the same.

Yes, if something extraordinary happens you may need a bariatric Doctor but a lot of things that can cause people trouble - obstructions, adhesions, etc
are just a result of stomach surgery and you don't need to be a bariatric surgeon to fix them.  If one is close may be a good resource but a lot of people live too far away from bariatric Docs for it to be an option.

You should talk this through with your regular Doctor and if he doesn't seem willing to help now is the time to start shopping for a new one.
You could then try and find someone who has had DS or even gastric bypass patients in the past.

You can't address deficiencies just through the on-line community. I think your attitude is right about where to find out what would be helpful
but once an issue gets to the deficiency state you also need your Doctor in your corner. So I think the right answer is I make an appointment
with Dr. X, research possible answers on-line, and go with the best information possible in your hand to have that discussion.

Good luck,

Pete

Brandy--You will need a doctor who will follow you as needed once home.  I took my husband with me to see my doctor to sell him on the surgery, gave him written information on the DS, our committment to the process before, during and after and asked him for his involvement once I got home.  That was the easy part.  I'm 4 years out (tomorrow). He writes the lab slips for me when I request them but I really am my own best advocate on finding out if things need adjusting with my blood levels and when I need things done.  Don't get me wrong, he's a wonderful physician but the DS is an unknown for him and we have no one in the state that I am aware of who does the DS so I kind of feel I am mostly on my own. My surgeon is in Brazil so he is not really available except by email (or phone. I suppose).  If your doc doesn't want to support you, you will need to find one who will before your surgery.

Another thing you must know is the heavy committment to take lots and lots of vitamins every day and the not-insignificant $$ to do so.  I also drink protein shakes everyday to maintain my protein intake and they are also expensive.  I am not trying to discourage you from the surgery but you need to be aware that those are life-long responsibilities and the costs continues to rise with everything else in life.

I do not use a nutritionist as those here do not know or understand the DS.  I did see one for several months before my surgery but that ended up just being an opportunity to learn that I did not want a gastric bypass or any othe type of baratric surgery other than the DS.  Your labs will let you know how you are doing and where you need to tweek things.  Hopefully your doc will help you with that. 

Please understand, the DS does not change your head so you will need to address any eating and behavioral issues related to food or you will sabatoge your long-term results.

I love my DS but it is a big committment and not to be entered into lightly.  I wish you much success!

Lisa

Hi Brandy

I did have a surgeon less than an hour away, and for my first two years post op I scheduled annual follow-ups, and realized that I was taking off work, driving 45 min and getting bloodwork, then she would come in, hug me, tell me I look great and ask me if I have any problems.....then go and I paid my bill.  Talk about useless!  

I talked to my PCP about taking over the details about nutritional health, and she also knew nothing about the DS, but I gave her some literature and links to jump-start her knowledge, and she was enthusiastic to learn more, and just looking at the diagram could see where it was better than RNY.  I got the list of labs my surgeon ran and she kept it in my file to copy the orders for.  When something got low, we would discuss together a plan of action.  It usually was me suggesting what I'd read out here about what other DSers had done and she would say "let's try it and see".  We did really well together.  I only check my labs annually anymore since I got things in order and I've been good for a while now.  We would wrap my labs up in my annual physical (covered completely by insurance) so I got it all paid for without so much as a copay, too.

Back when I got my DS, the sugeons wanted you close by for about two weeks, making sure you went home complication-free.  If anything were to come up, it would during this critical time and could be dealt with, so don't push to come home too early.  The out-of-country surgeons are good about partnering up with a willing PCP as well, so any questions that come up, they will work with them.  

To eliminate quickly common causes of abdominal pain (and need for more surgeries), have them remove the gallbladder and appendix during the DS.  

Seriously, aside from nutritional health, it's like I'm a normal person.  You can totally do this.

Hi,

I live in Maine and had my surgery in MI. I have not seen my surgeon since I left MI two weeks after my surgery. I had to get my PCP on board with my surgery I still stay in touch with my surgeons office after blood tests if they see something not right they do contact me to make sure that its being taken care of with my PCP. I think its all just a matter of getting all your ducks in a row before you start sometimes it does seem overwhelming but it will come together. I am actually headed to Mexico next month for plastic surgery. The biggest thing to keep in mind is like Pete said your vitamins make sure you stay on top of them and your blood test. Best of luck!
Trish

Most of us have all or most of our longterm follow-up through our pcp's. Very few surgeons do longterm follow-up because they are busy with the surgery itself. Imagine if they tried to follow all the ppost-op's they accumulated over the years. There would be no time for new patients after awhile. So it really isn't about your surgeon being in Mexico.

If your pcp isn't on board with your surgery, and refuses to become educated or order labs, it's time to find a new and improved pcp. Some doctors are very negative about bariatric surgery and still recommend "diet and exercise" for their MO patients, despite the fact that the success rate for that, once someone is MO, is less than 5%. If that describes your doctor, it is time to move on. If your doctor is supportive, you should have no problem getting labs. You do need to have an understanding for yourself of the nutritional needs for the DS, but really, it isn't that difficult. The most important thing is to make the committment to do what you need to do to stay healthy, meaning lots of protein, and the necessary vitamins, supplements, and lab work (I only get labs once a year, but then I haven't had any reason to do them more often).

Lastly, regarding your husband's comment. With all due respect to him, and understanding that he spoke out of love and concern for you, it's your decision and no one else's. If you are confident that bariatric surgery, and specifically the DS, is what you need for your health and quality of life, the people who love and care about you need to respect you and accept your decision. They don't need to agree, just to accept.

Larra

I just had my surgery I week ago today by an acknowledged DS surgeon in NJ for same cost as Mexico, however Ungson seems amazing and part of me wishes I went to Mexico just to focus on myself for 10+ days, fear of extra cost if there are complications. I'm too much of a newbie but to me these forums are the GREATEST asset we have - I trust and have more confidence in the veterans on these and other forums then many medical personnel. If your eligible for WLS but not DS through your insurance and will wait - go through their process in regards to getting various testing, etc done to minimize your out of pocket. My surgeon want an upper GI which I had to pay for out of pocket - the test which was suppose to cost $150  o.o.p is more like $400 because everyone beyond the hospital having their charges.  My wife didn't want me to go to Mexico having a very American viewpoint of non-American health care but I can tell you my nursing experience at the hospital was Nurse Ratchet horrible. Good Luck!

Glad to hear you made it through the surgery and are well enough to help others. 

I am having surgery with Dr. Ungson on July 28th.  If you have any questions that I can help once I am going through it, I will be glad to share.

One sentence about your local doctor jumps out at me: "Will he know enough to spot weird post-ds things?"

The short answer is NO---that's your job. Seriously, getting a DS is a life-time commitment to keep educating yourself about the weird post-DS things that can happen. Odds are your PCP will only have 5 or 6 DS patients throughout their entire career, unless you live in a big city with a large DS community. What you need is one that's willing to listen to YOU, one that realizes he or she is not a god, and who is willing to research enough to help you when they don't know what's going on.