Why do we follow up so much?

I'm wondering.  Why do we follow up so much with our surgeons?  

I saw him at 2 weeks post op.  Then I just saw him again, 6 weeks from the last appointment.  Now he wants to see me in 6 weeks.  

I'm in the after care program, so I see the nurse, NUT, and some trainer woman who likes to talk more than work us out.  That's every week for 3 hours.  We get weighed, BP checked, HR checked during exercise, food journals looked over, questions answered, etc.  

I just don't see a need to see the surgeon so frequently unless there's a problem.  

This last visit he totally shot me down.  He was GREAT when I was in the hospital.  He did a wonderful job on my surgery, saw me every day and was very reassuring, couldn't have been better.  But this last visit, I ended up in tears.  His f'ing scale put me at 6 lbs heavier than mine did.  That's a lot to me.  He said (and he's right) that I'm focusing on the numbers and not on the big picture.  At this point, though, there haven't been enough changes other than with the scale and needing to go down a few sizes in clothing.  When I see a drop... even a half a pound, I'm happy.  As long as it's moving down and not going up, I am fine.

He also doesn't think my goal weight is reasonable.  I'm 5'6", so a healthy weight for me is 120-155.  I want to weigh 140 or less.  He said patients typically lose 70% of their excess weight through RNY.  I don't consider myself a typical patient.   I competed in inline speedskating for 10 years, and coached for 2.  I also enjoy hiking, karate (I'm a blue belt) indoor and outdoor rock climbing, mountain biking, plyometrics, intervals, weight-training, etc. - all high-intensity activities.  He thinks I'll get down to 200 lbs and just that would be really good.  I believe once I get down to that weight, then *I* can push myself to lose more and tone up through the activities I love.  He kind of shot my dreams down.  It sucked.  

I just don't feel like I gained anything positive from the visit and am wondering if it's necessary to see him so often.  What do you guys think?

I think in the first six months or so it's probably good to follow up with the surgeon to make sure you're healing properly, although if your PCP is familiar with RNY and is willing to do that follow up for you, then that would probably be fine too, as long as you aren't having surgery-related problems.  Many of us here on OH do our follow up with our PCP as far as labs go and routine things like that.

I currently don't really have a surgeon.  The doc that did my surgery closed his practice when I was about six months out and I found a new surgeon, who moved out of state when I was about 2.5 years out.  I decided not to bother finding a new one.  My PCP has been ordering my labs since the first surgeon closed his practice.  I did see my new surgeon when it was thought that I had an ulcer but she ended up referring me to a gastroenterologist for that (and it turned out not to be an ulcer) so I could see him again if I had further stomach problems if I wanted to, or my PCP could refer me to someone.

Perhaps you want to look at what your surgeon will be doing for you in your follow up appointments and see if it's something your PCP can do instead or if it's even something you need.  It would probably be good to maintain some sort of relationship with a surgeon for a while, though, in case problems arise.

 i only saw the actual surgeon on my 1 week and 1 month post-op appointment. they have a nurse practitioner in the office that i see for everything else (and one of the RD's every appointment). so i met with them at 1 week, 1 month, 3 months, 6, months, 1 year, and now its yearly until 5 years post-op i think, and then i don't remember what the schedule was after that. maybe every other year?

Every other year after the five year mark is an interesting idea.  Would they still be ordering your labs in between visit?  'Cause you would need labs done more often than every other year.

yup, it's pretty much up to me to call when i want them ordered, which i need to do soon. unfortunately, i'm sure a lot of post-ops don't even go that often...

Oh, I'm sure they don't.  Nutritional deficiencies just scare the crap out of me.  I'm only about 3.5 years out but it seems that I've developed more deficiencies as time goes on.  Because I get labs done regularly, I've managed to catch them before they got serious but I'm just thinking how low my vitamin A or zinc would have been if I'd waiting two years between having labs done.  I think some people assume if they feel OK, their labs must be OK but with many vitamins and minerals you don't usually get symptoms until they are very low. 

 I'm also 5'6", and my surgeon gave me a goal weight of 137 (which coincidentally is exactly half of my highest weight.)   I don't exercise nearly as much as you do (hard to exercise with a )#$W* migraine!), and I told him I wouldn't be able to exercise much.

I'm doing more than I thought I would.  Walking (mostly at dusk when it's not as bright out) or going to the gym (baseball hat on against the fluorescent lights) several days a week.  There are lots of days I don't get out of bed, or only make it as far as my couch.

Today I was out most of the day, but I'll be paying for it for the next few days.

My surgeon generally sees patients at 2-3 weeks post-op, at 3 months, 6 months, and 1 year (then yearly after that).  To me that seems about right...  enough to be sure that the patient is on track and not having problems but not so often that it is excessive.  (If there are issues, of course, more frequent visits are called for.) 

Honestly, sicne I had no problems during the first year, if I had been supposed to go more frequently, I would have just asked her why it was necessary (and then decided whether to keep the next appt or not, LOL).

Lora

Hey Jen!

As much as it is a pain to do so many follow ups with the doc. Its in our best interests.  We did opt to have our guts re-arranged. I know that my hospital requires follow ups at 2 weeks, 1 month, 3 months, 6 months, one  year and every year after that. They keep tabs on us for their statistics.  That's how my hospital got a "high" rating for bariatric surgery.  When I asked my PCP for the surgery he submitted it to the insurance company and they sent me to Cedars Sinai in Los Angeles.  Its 57 miles from my house.  I had planned to have it done at a nearby hospital that already had a good reputation for bariatric surgery and their own bariatric surgery dept.  When insurance companies agree to fork out the money they usually want success stories because they are laying out the money.  I'm sure my insurance company plans on many of my other health problems will go away. 

Sooo how do hospitals and doctors get good ratings?  By having successful patients that theycan document through followups. 

As far as telling you what your goal weight....I don't  think that's the doctor's decision. Its yours and your body. You and your body will be the ultimate deciders on what you will weigh. It will depend if you body will let you be at that weight and how hard you want to work to maintain it.  I don't think that 130 is unreasonable at all!!!!!

My goal of 109 is unreasonable.  I hope to get to that point and then maintain at 120-130lbs.  I don't think I can maintan a weight of 109 without constant hard work to maintain.  But....heck if I get to 150. I'd still be happy because that would be a 100lb loss. 

Its always nice to talk with you Jen because I you are strong young woman!

I'm 5'6".  My highest weight was 340 lbs.  Believe I saw the surgeon at 317 lbs.  He set the goal for 150 lbs.  I would like to get down to 140.  (I'm probably older than you - 59 years old.)  If I weigh a little more, or less, I will still be satisfied.  Whatever weight my body feels the healthiest at.  But Don't feel like it is impossible to weigh less.  Your body will ultimately decide, along with what you're doing now.  He may have shot it down because he didn't want to set you up for failure if you didn't reach your goal.  Won't he be surprised further down the road!!