Question:
Can any of the types of WLS be done under local instead of general?
Is there any way any type of WLS surgeries be done with a local block and "twilight" sedation rather than general anesthesia that requires entubation? — Amy N. (posted on October 5, 2002)
October 2, 2002
I have never heard of one that could be done that way. This is major
surgery - I wouldn't want anything but general anesthesia.
— Patty_Butler
October 2, 2002
Ouch! Honey, I just don't think so, they do some major cutting up, I don't
think you would want to be half awake for 5 hours with your guts hanging
out...:0)...Why do you ask?? just curious, are you just afraid of general
anethesia?
— Diane B.
October 2, 2002
Amy I too would have rathered do anything but go through General
Anesthesia! Whenever possible I prefer a spinal and stay awake. However
there is no way they could do WLS with a spinal only. Why? Because the area
that would have to be numb (your chest and stomach area) is where your
lungs are! You would'nt be able to breath! Oh I assume they could put you
on a ventulater... but I sure would never want to be on one and conscious!
— Danmark
October 2, 2002
LOL, DB, you made me laugh. Let me add detail to my question. I'm
thinking of having it done laproscopically and thinking of having VGB or
AGB. And, yes, I am afraid of general. I never used to be and actually I
used to be afraid of not being awake during a procedure. But, then a few
years ago my father ended up in a coma from general anesthesia that went
wrong by a resident. He had had the same surgery twice before in his life
and there was never a problem. This third time he was in a coma for 10
days. It was a scary time. Plus, I just had eye surgery with a local
block. I was awake for 3.5 hours having my eyeball reconstructed, and it
wasn't as gross as I imagined it to be. My father just had a deviated
septum worked on with a local with his face hanging out, and he survived.
Now, if it is possible, I kind of like the idea of knowing what the doctors
are doing and hearing their conversations. I am sure their behavior is
slightly different knowing you're awake and listening. Locals are safer
than general. However, if I have to have my ribs spread, then no I don't
want to witness that! But, if it could be done, I would want to know and
would want the option. So,.... nu?... does anyone know IF it can be done
and/or IF it has been done for lap AGB or lap VGB or lap anything?
Thanks!
— Amy N.
October 2, 2002
Thanks Daniel! That was the technical info I was looking for. I guess it
can't be done... oh well. I will just have to push to make sure no
residents do my anesthesia. I was busy writing my long post (just below
this one), when you posted yours. That's why my other long post seems out
of place. Thanks again!
— Amy N.
October 2, 2002
Your are welcome Amy. If you want to stay away from residents... (not sure
you can completely) then stay away from the "teaching hospitals".
I've had several surgeries in two teaching hospitals. The one was Strong
Memorial in Rochester NY and Oregon Health Sciences University in Portland
Oregon. Believe me, I've "done my time" in "helping other
people" by letting them "cut on me". Especially at OHSU! (I
got the butchering of my life from some surgeons there). From now on I
INSIST on experienced people. No experience? My feet will do the walking
(right out the door).
— Danmark
October 2, 2002
Diane, yes in "theory" you can sign up against in. But in
practise it is'nt that easy at all. These people need to learn, I
understand. But NEVER again will someone who is learning be allowed to do a
spinal on "me"! ;) I've learned my lesson on being compassionate
and helpful. They really push these people on you and it's extremely hard
to get out of it. It's best to just stay away from the teaching hospitals.
— Danmark
October 2, 2002
Yes, BJ, having as much confidence in the anesthesilogist is as important
as having confidence in the surgeon. Daniel, you're absolutely right about
theory vs. practice. It can be done at teaching hospitals, but it isn't
easy. My father's recent deviated septum surgery, my mother went with him
ready to do battle. They went to a pre-consultation with the
anesthesiologist of the day. My mother made her cross out and re-write
parts of the contract that mentions residents. The way that that hospital
does it (and many others do too), is you have a consultaion with one
anesthesiologist and then the hospital schedules the anesthesiologists the
day before or the morning of the surgery. The head non-resident doctor
oversees several surgeries at once, and delegates to residents which ones
they will do. The one you meet at the consultation is not always the one
you're going to get. And the day of the surgery the head anesthesiologist
sometimes never steps foot in the operating room with oyur assigned
resident. If the scheduler conveniently doesn't read the changes to the
contract that states residents aren't allowed, then they won't schedule it
as requested. So, you have to fight again the day of the surgery and get
all involved to scramble and rearrange the schedules of the day. And you
have to do it inspite of the comments and attempted intimidation. This
happened to my father. The comments my mother got from the surgeon was
completely arrogant and childishly defensive. She's tough; it didn't sway
her. But, she had to constantly question everybody that came in to speak
to him to make sure she knew what was going on and could catch them when
they tried to do things inspite of her wishes. Unfortunately, most of the
hospitals in Boston that do WLS are teaching hopitals, so wherever I go, I
will have to be prepared to battle. Oh well...
— Amy N.
October 2, 2002
Teaching hospitals tend to have the latest technology and techniques.
Properly supervised residents are good docs. My surgeon is a teacher and I
am glad of that. His residents are very nice and I personally admire docs
going into the bariatic field. Just look here at how many lives including
mine and Jen are saved by this procedure. Sorry for the rant but residents
arent bad. They have to gain experience somewhere. Just my 2 cents...
— bob-haller
October 2, 2002
Good reply, Bob. I had my surgery at the Hospital of the University of
Pennsylvania (HUP), which is, of course, a teaching hospital and one of the
top hospitals in the country, period. I don't know about the surgery
itself, but my surgeon's residents and interns were in my room every day
(and sometimes more) checking up on me. I have a few bad memories of an
intern trying to do an arterial stick on me in the middle of the night for
some unknown reason - but I am not sure if those memories were altered
somewhat by the morphine I was getting via the PCA (I had some weird
dreams/nightmares on that stuff too).
<p>
Everyone, please remember that <b>your</b> surgeon was a
resident once upon a time too. And if it wasn't for being able to do
procedures as a resident, he wouldn't be as good as he is right now...JR
(open RNY 07/17 -84 lbs)
— John Rushton
October 2, 2002
You are right Bob in that all residents are not bad. Thankfully most people
on this site have had "more positive than negative" in their
hospital experiences. :) I've had 14 surgeries in my life at 6 hospitals at
Rochester NY (2 hospitals), Canandaigua NY, Norfolk VA, Charlottsville Va,
and Portland Oregon. So along with the good, I've gone through alot of bad.
I sure would'nt wish the bad on anyone here! In OHSU for example (a
teaching hospital BUT A VERY GOOD HOSPITAL!) I had a resident try for 45
excrusiating minutes to get a IV in everyplace in my body he could try
(except my neck). Every vein was fried then along with my nerves. So an
experienced person had to come in and put it in my neck. Then this same
Asian guy (we could'nt understand each other very well anyway) took many
stabs at doing a spinal on me. Finally my left leg jerked violently and
uncontrollable (as if in a seizure) and felt as if it was on fire. I know
these people need to learn somewhere, but I find it very interesting that
while HE was learning (both with the IV and spinal) that NO ONE WHO KNOWS
IS THERE WITH THEM WHILE THEY ARE DOING THEIR THING. Not good! And I would
"NEVER want anyone I love" to have a resident. I'm glad it went
well for you Bob, but my experiences with residents could have left me
paralized. Looking back, I wish to God I had got up, left the hospital and
took the first plane back home. I'll never forgive myself for not doing
that but there were at least three surgeons in the OR waiting for the
resident to get done with the IV and spinal. I did'nt want to let everyone
down... so instead I let myself down. The resident had his training... and
after 9.5 years I'm still suffering from what happened there. I don't want
anyone else to go through some of what happened to me. Stay away from
residents! "If you can't, make damn sure they are doing whatever they
are doing with someone who knows there with them." Health care in our
country has gone way down hill! I've talked to many other people who also
say the same thing. You have to watch every little detail that you can for
yourself and those you love. And ask tons of questions all along the way.
Shoot... I was in a local hospital last year because dangerous low
potassium. I needed a certain amount of bags IVed. The nurse told me how
many, she set the machine to beep when done. She then had other patients.
The machine beeped after the hour or so it had ran. Another nurse came in
and set it to keep running! #^$%&* That would have gave me way to much!
I spoke up. She was'nt going to listen but I insisted! She then inquired
(as I would'nt let it go) and sure enough I was right. It would have been
bad to have too much as well as too little! So much for hospital checks and
balances! What happens to people who are unconscious or have no one there
with them to catch these things! Not good. PLEASE don't go through what I
had to!
Sorry. I've got to quit posting on this subject as I don't want hard
feelings with Bob, John or anyone. ;) I'm an easy going person. I just hate
to think that anyone may get hurt the way I did. :) Be easy going, and
complient and you will more than likely go through some things like I have.
I "think" most of you who feel different, you have not had that
many operations so you have'nt seen the bad along with the good.
— Danmark
October 3, 2002
Dan no hard feelngs. NO ONE should tolerate mutiple needle sticks EVER! I
have a rule, try 3 times then GET SOMEONE ELSE@! We have to be our own
advocate and have the right to say STOP! Yesterday I took jen to our
surgeon, she may have a stricture or ulcer. Gets scoped tomorrow friday.
The staff corraled me wanting blood work for a study. I had it done months
ago and they never got the results. They wanted some blood, I refused. The
last time there 2 each of their floating staff stuck me 3 times each. I
told them I would fax the info as its available. Why get stuck
nnecessaruily and run up extra costs? Besides I had stress eaten:( some
very bad choices./ My nearby hospital vampires.. Blood drawers get me on
one jab 99% of the time. I encourage EVERYONE to be their own advocate and
if your concerned about something be pushy and a pain if necessary to get
it addressed. I might save your life.
— bob-haller
October 3, 2002
In my own experience, I have received the best care since I've gone with my
Primary Care Physician and my WLS surgeon (both teaching
hospital-affiliated). I believe the residents are as good as the doctors
they study under. I have absolute faith in both my PCP and my surgeon. I
have the problem with veins that run and hide. The morning of my surgery, I
was poked 4 times before the anesthesiologist came to my rescue and yelled
at the nurses for not getting him after the 2nd try. But I was so calm and
relaxed, I didn't care (weird, I know). My point is, I've had more problems
with nurses drawing blood and starting IV's than I've ever had with a
resident. We are already experiencing a shortage of doctors, especially
states like Texas. We have to be supportive of training new doctors.
(Although I feel for Daniel and his bad experience.) - Anna LAP RNY 7/3/02
-70lbs.
— Anna L.
October 3, 2002
Boy! I really stirred something up... didn't mean to! Look, I also do
understand the value of residensts and in most cases I'm fine with them
learning on me... as long as my doctor is in charge. And not every trained
doctor is perfect either. The point is, we all need to be comfortable and
confident in who is taking care of us. And if the confidence isn't there,
then one needs to take steps to change their situation so they can have
that confidence. The last thing you want going under the knife is to be
afraid of the people taking care of you. That is why it is so important to
do research and find a surgeon you feel comfortable with. Which brings me
to the next point about anesthesia.
Everyone has their fears and concerns, and we have a choice as to how to
deal with them. I, personally, draw the line at resident
anesthesiologists. Others may draw the line somewhere else. I don't
think everybody should be afraid of anesthesiologists or residents. It
just happens to be MY fear that I have to deal with. You are all welcome
to your own fears; I won't judge them. My own personal reason I draw the
line at anesthesiologists has more to do with some hospital's policies
concerning how they assign anesthesiologists. Most places don't allow you
to choose your own anesthesiologist like you would choose your own surgeon.
I go through the trouble of researching surgeons until I find one i can
trust AND trust his/her judgement enough to pick the resident that will
assist. But, the same thing doesn't always happen for the anesthesilogist.
I can't always pick my own, especially in a teaching hospital. Most times
the surgeons don't even pick the anesthesiologist! And I have to trust the
head anesthesiologist of the day, that I don't know, to make a wise
decision of which resident will learn on me and hope that the experienced
anesthesiologist is actaully in the OR teaching the resident? Hmmmm....
How can I trust that? Especially after my father's experiences? I have
control over who I pick for a surgeon, but the control is out the window
when it comes to anesthesia. Anesthesia doesn't scare everybody, and you
may have the utmost confidence in the anesthesia department of a hospital.
Great, so you don't have to do anything. But, if you're like me and have a
fear, then the choices are either a non-teaching hospital or understanding
your rights and fight to have your requests met. I prefer teaching
hospitals because of the advances in medicine those hospitals have to
offer. But, I don't have to like everything about a teaching hospital.
So, I know what my battles are going to be.
I guess my point is, there isn't one way to go about these issues. It's
not about teaching hospitals vs. non-teaching hospitals or residents vs.
experienced doctors. It is about dealing with fears, finding confidence,
knowing the limitations of the hospital and staff,and knowing your rights
and choices. Everybody should be able to deal with these issues their own
way without judgement.
Wew! I'm done. :)
— Amy N.
October 3, 2002
I know a lot about anesthesia and can tell you that wls will almost always
be performed with general anesthesia or a combination of general and
regional anesthesia. The surgery is considered upper abdominal, which
means more than location. The upper abdominal muscles need to be relaxed
for the surgeon to get visualization and this cannot be done with local
anesthesia. Also, if it could the amount of sedation needed to keep you
comfortable, would be unsafe.
It seems to be that your real problem is legal and is easily
addressed. First, tell your surgeon that you want the best anesthetist
possible, not a trainee and someone who he/she is comfortable with and who
could anesthetize a member of his/her family. Second, when you read the
surgical consent, delete, add or modify it, so you are comfortable with
what you are signing. If this creates problems for the hospital, remember
this is elective surgery and you have the right to go someplace else.
— Addie R.
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