Why are so many doctors clueless about the RNY surgery?

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On June 9, 2013 at 11:40 AM Pacific Time, Sin Kim wrote:

I don't think that doctors and PA's are clueless about RNY surgery - they cannot be expected to know what every SURGEON believes about his particular patients - anyone who has been here a week sees how as they all have their own protocols.

I have been my own best advocate for 9 years and have no expectation that any professional has more invested in my health than me.

You getting shirty with the professionals who care for you is just going to make your life difficult for you - it is wholly possible to be respectful of their education and knowledge while giving them the benefit of your medical history and politely expressed RNY specific knowledge.    I have never had a PCP not willing to learn what knowledge I have to offer - I introduced myself to my current one as "a patient who will drive you nuts because I will self diagnose and self prescribe" - I don't demand, I don't put her down - I work WITH her to get the best treatment possible for ME under MY cir****tances - it's a strategy that has worked for me with all my specialists too.   I have NEVER had to change doctors because they wouldn't work with me.

 

I am not saying they have to know everything about RNY but it is important to know basic things when treating us.. like no NSAID'S. I just think it's a pain i have to call my surgeons office and re-verify that what my doctor is doing or prescribing is appropriate. Then again this same PA that argued with me yesterday over steroids gave me a shot of Toradol and told me it wouldn't impact my RNY i should have known better because upon looking it up i found out it's a NSAID. non-steroidal but it is an NSAID... it becomes dangerous in certain cir****tances when you are given things your unaware of i was in pain so i didn't pay much attention to the toradol she gave me i just wanted the pain to go away and all i heard is this won't effect your RNY. Had i know it was an NSAID i would have declined. Cir****tances like this are dangerous for us though. IMO all doctors go to school right? They have to have a general knowledge of just about everything.. heart, depression, anxiety, Arthritis, Lupus, Diabetes.. so what makes RNY different i mean shouldn't they have some sort of medical training in this surgery as well? I never get ****ty with any of my health professionals i just kindly correct them. They get paid to treat us right? So if we are diagnosing and telling them what we need why bother seeing a doctor that should have this knowledge besides getting obvious stuff RX, Testing, ETC. Just how i am viewing it. I never realized pre-op how much GP and hospital staff even don't know about this surgery.

I do find it surprising that so many medical professionals are clueless about Toradol being an NSAID, but I think that for you to expect every doctor and PA to get special training in treating RNY patients is unrealistic.  Should they also get special training in treating band patients?  Doctors cannot know everything and there is only so much continuing education they can do (and, quite honestly, I can understand why they might choose other things over worrying about special needs of RNY patients).  That is why GPs/PCPs and ER personnel rely on information from specialists. Yes, the numbers are rising, but as a percentage of the population, there are still not very many of us.  Sadly, there are also going to be medical professionals who don't give a damn about learning much about special treatment considerations of WLS patients because of their personal bias against obese people and those who had surgery to lose the weight.

IMO, it really isn't that onerous for US to know the basics of what THEY need to know or to have some idea of what potential problems we might be running into. Make sure your chart is notated with the fact that you have had RNY, that you cannot take NSAIDs or have a blind NG tube. Make yourself aware of common NSAIDs and ask very specific questions about medications you are not familiar with.  When the nurse said it wouldn't effect your RNY (what an odd phrasing... Of course it won't effect a surgery... it wouldn't effect an appendectomy, either, but it might effect your pouch and stomach), did you pointedly ask if it was an NSAID?  (I understand that with Toradol even if you asked, she might have had the correct answer.  I am just making a point about being very clear with your questions.)  if you have a pharmacy that fills all or most of your prescriptions, have them add a note to your record indicating no NSAIDs so they can help catch them if prescribed.

Like millions of other Americans, I take an anticoagulent (Coumadin).  Unlike most, my body seems to be very sensitive to dosage changes and interactions with other medications and even foods, especially since my RNY. I have had two episodes since my RNY where my blood has been dangerously "thin" and I have had spontaneous bleeding (not only HUGE bruises all over my body (even soles of my feet and palms of my hands), but once into my abdomen and once in my sinus cavity).  If the bleeding had been in my brain, it could easily have been fatal in each case.  MUCH more dangerous than an ulcer. This drug has been around for YEARS and it is prescribed for people with certain heart issues as well as people who have circulatory issues, yet every time a doctor wants to prescribe be a new medication, I either have to know myself whether it interacts with the Coumadin or I have to ask the doctor to double check.  I also always ask the pharmacist to check before (s)he fills it.  It is just part of me being responsible for understanding my medical condition and being able to advocate for my own health.  I don't see the RNY as being any different.

Lora

I should have read your reply first lol. Similar thoughts but yours is much better detailed.

The blind NG tube is what caused me to reply to the post your replies to since not only is NSAIDS a concern so is the blind NG tube.

I think it would be nice if doctors knew everything, or at least more things, but the truth is, they don't.  I have PTSD and I was once prescribed a medication to prevent migraines that has a side effect of causing nightmares and hallucinations.  Of course not everyone that takes that drug has nightmares or migraines, but my doctor knew about  my PTSD and it seems to me like it was not the best choice of drug to give someone that already had nightmares several times a week they woke up screaming from.  She didn't warn me about those possible side effects, either.

The first night I took the drug, I had nightmares, then woke up and kept hallucinating.  It was terrifying.  I looked up the  medication after that and learned that was a possible side effect.  After that, I started always looking up the side effects of new prescriptoin drugs before I take them.  I've been known to ask doctors if they could let me see their PDR while I'm there in their office, before I even accept the prescription they offer me.  It would be great if that wasn't necessary, but it isn't possible for a doctor to memorize every single possible side effect of every single medicatipn they might one day prescribe.

I do wish they knew they basics, though, like the fact that Toradol is an NSAID!

I had a similar experience with Ambien.  My PCP -- who knows about my PTSD and prescribes the Ativan for me to use as needed -- warned me that some people did things while on it that they after didn't remember (eating, having conversations, sending emails even), but he never mentioned vivid dreams and hallucinations.  I took one, climbed into bed, got drowsy, but then started "hearing" someone quietly saying my name from downstairs.  I was able to just dismiss it the first time, especially since the dog clearly heard nothing, but it kept happening and with my PTSD it freaked me out.  After the dog and I checked the house and garage thoroughly, I fell asleep but then had a horrible nightmare and was up the rest of the night afterward despite taking an Ativan.

The following day, I looked up the manufacturer's info on Ambien and, sure enough, it mentions hallucinations. 

Lora

Now you understand why I trust no drugs.  I was given Roxicet in the hospital after the morphine pump was pulled and after diludid gave me an allergic reaction.  My roommate asked if she could watch the OC, I said sure I was getting tired anyway.  As I watched the tv I saw these field filled with geese all lifting off to flight together as soon as they did they all caught fire, the camera panned back, now the entire field and water was on fire.  I was horrified, why were they showing this on tv.  They weren't it was a hallucination.  I came home, took one dose and a demon started chasing me, I told him to stop and leave me alone and get out of my head.  I dumped it down the drain the next morning.  All the meds I had to take when I was MO are currently the fodder of late night lawyer lawsuit commercials.  Nearly went into anaphylaxic shock after I broke a toe and was prescribed prescription strength motrin.  Nsaids have been off my table for over 20 years after that.  Mostly everything else is also, I took benedryl once and couldn't open my eyes, could hear everything but could not sleep.  Yeah that was a nightmare also.  

Yep, some of these drugs cause scary **** to happen!  I forget which drug it was for, but it was something for a skin condition, and DEATH was included in the list of side effects/complications shown on the screen at the bottom!  Now I realize that the incidence of death is probably miniscule, but still... risk death to eliminate a skin condition?!?  No thanks... No matter how nasty my skin looks! Back in the 1980s when I  wa only in my 20a but realized how many drugs could alter my Coumadin effects, I bought a Physician's Desk Reference so I could look up any newly prescribed drugs for myself and wouldn't have to trust that a doctor would know about the interaction.  I then bought another one in the late 90's (and now just use the Internet, of course, but get the info from the drug manufacturer not some random web site).

Lora

Actually I know of one drug for cystic acne that death and all sorts of horrible side effects are a consideration, after years of suffering with painful and disfiguring cystic acne my son took Ac****ane and it changed his life, or in this case saved it.  I know most people who are in that same horrible boat of cystic acne will risk just about anything to make it go away.  Now my son has to watch out for Crohn's disease because that is a long term possible side effect.  I know the ravages of Crohn's because my bf's mom has a very severe case and is currently on Humira but I bet my son would still opt to take the Accutane.  His skin is badly scarred now but at least the cysts are finally gone and he has his face back.  Some medicines save, I just happen to have bad luck, not that I wouldn't take something if I thought it was going to save me, I am not nuts.  Just hook me up to morphine, that **** works wonders for pain.

Actually many medical personnel do not know lots about RNY, some no nothing other than its a weight loss surgery. Any new doctor I've gone to I have to tell them no NSAIDS I've also told other medical professionals to note in my records no blind NG tube.

You WILL always want to tell or remind your medical team of certain things. It is out responsibility to manage our health to the best of our ability. PERIOD if you don't then more than likely you will just be a number.....doctors can't remember every little detail of every patient especially if you (general you) are a new patient and are just establishing a relationship with him/her.