Every Surgeon is Different

We often see people respond with “every surgeon is different" when people post about being told different things by their surgeons.  And yes, it’s true, every surgeon is different.  They attended different medical schools and did their residencies in different hospitals, so they learned to do things a little bit differently.  For instance, some took a course in nutrition in medical school, while some did not.  They have different personalities.  Some have good bedside manners, some do not.  And they’ve had different experiences as surgeons.  Some may have lost a patient due to complications, while some have not.  Some have performed more surgeries than others.  Some prefer using certain techniques while others may prefer using other techniques.

So when surgeon A performs a leak test while the patient is still in the OR and surgeon B performs a leak test the next day, their training, experience and personal preferences explain the difference.  And either way, the patient receives the leak test that they need.

However, when surgeon A says patients need calcium citrate and surgeon B says Viactiv or Caltrate or Citracal gummies are fine, the differences between those two surgeons might explain why they say different things but surgeon B’s patients will not be receiving the calcium they need.  If I see surgeon A, I need calcium citrate.  If I see surgeon B, I still need calcium citrate, no matter what surgeon B tells me.  And guess what?  If surgeon B tells me I can fly, well, I still cannot fly.  Some things do differ depending on your surgeon, but some things don’t.

Things like:

• We need calcium citrate, not carbonate.
• Carbonated drinks cannot stretch our pouch.
• Drinking with a straw will not stretch our pouch.
• We need protein in order to heal from surgery.
• We cannot absorb B12 from our multi or food we eat.

These things are true regardless of which surgeon we see.  If surgeon A says carbonated drinks will stretch my pouch and surgeon B says they won’t, will switching from surgeon B to surgeon A suddenly make my pouch stretchable by something I drink?  Of course not.

It is important, though, to understand that not only is each surgeon different, each patient is different, too.  If surgeon A tells a patient to do a two week liquid diet before surgery and surgeon B tells a patient no liquid diet is necessary, that might have to do with the surgeons’ personal preferences but also might have to do with the patients’ different needs.  Perhaps patient A has a fattier liver than patient B.  We can ask our docs to explain the reasons behind their recommendations if we’re not sure about them.  But just the fact that two surgeons are “different" doesn’t always explain things.

 

Excellently put - as always - Kelly. thanks for the insight

 Very well put! Same goes for NUT A vs NUT B - just because one tells me mashed potatoes are fine during pureed stage doesn't mean I didn't dump on mashed potatoes, never to try them again!

BTW - did you do phone group last night? I let Kay know that I probably wouldn't be there - was exhausted from traveling all day (planes, trains, AND automobiles!).

No.  I was traveling too, on my way home.  I'm gonna be there next week, I promise!

Every surgery is different.  I am 5 years post op.  Some bypasses are 40 cm and some are 250 cm.  I take no calcium because I don't need it.  My bone scans are normal and I am post menopausal.  My teeth are perfect and my labs are normal to to high normal without supplements.  If you take vitamin C with calcium carbonate you end up with calcium citrate.  Tri harder

Very true post, Kelly!  Where's a "like" button when I need it?? :)

I've been trying to explain the calcium thing to my mom but our primary care doctor (NOT a bariatric surgeon) told her to take Os-Cal...which is calcium carbonate.  She doesn't seem to want to listen to me because we really DO have an amazing primary care doctor, but again, he is NOT a bariatric surgeon so he would likely just not understand the difference for us.  Since my mom had the RNY 22 yrs ago, there are so many things that have been learned since then that she needs to know.  Some of them she listens to me about, some of them she just refuses to believe.  She has so many vitamin deficiencies that you'd think she'd listen to all the new research that's been done since then!

You're right, though...there are some things that are static no matter which surgeon people use.

Jen

Excellent post Kelly. Thanks to you I'm on the correct Vit D supplements now to correct my growing deficency....one that the doctor just ignored telling me to "take calcium with D". Um, yeah, been doing that since surgery and numbers still dropping.....can't wait to see how good my D is in May when I get checked again.

AND I got deficient even while taking all the recommended supplements since surgery...I do not miss my vits...I'm very good about taking them.

Have a a Happy New Year.

Kelly, please don't misunderstand me. I am NOT challenging you or suggesting that you are wrong. What I want to know is how to learn the differences that you speak of.

I'll give a concrete example: Calcium carbonate. How do I know that you are correct and Surgeon B is mistaken. My guess is that you'll tell me that based on everything you've learned, "I still need calcium citrate, no matter what surgeon B tells me."

But if I ask Surgeon B the same question, I presume he'd give me the same answer. And if I went to medical school for umpteen years, isn't it possible that I'd also conclude that citrate is okay?

Again, I'm not criticizing you. I guess I'm just venting, because these questions are NOT as clear-cut as (to use your example) whether or not we can fly.

I'm not offended at being questioned.  I don't think people should just take my word for things.

You're right, it's not always clear cut.

I guess I'd ask surgeon B, "The ASMBS says we should have calcium citrate.  I am wondering why you think calcium carbonate is better?"

If surgeon B said, "Because this study published in JAMA last month showed that patients taking calcium carbonate had better scores on bone density scans than those taking calcium citrate," I'd consider swtiching to calcium carbonate.

If surgeon B said, "I just don't think it matters" or "Huh?" or something like that, I'd stick with the citrate.

Or if surgeon B said what my surgeon said when I asked him that question, "Yeah, I guess we kind of absorb citrate a little better," I would go with citrate.

The only way I know to learn the differences is to ask questions.  Lots of questions.  And evaluate the answers.  To ask for hard data, studies, stuff like that.

Thanks so much. Those questions are very reasonable.

One follow-up: I went to the ASMBS site (http://asmbs.org) and it seems designed exclusively for heathcare pofessionals. Do you know of any other sources of information which are designed for patients, and carry a similar level of authority and reliability?