Where the lack of post op care touches too close to home.

I’m writing this as the wife of a newly post op bariatric patient, and a concerned advocate. My husband is quickly approaching his six month post op mark, at which time the surgeon requests to see his patients. We did a lot of research before deciding upon a surgeon, hospital and center. I say “we”, because I am also a post operative bariatric patient.

Our surgeon runs lab work on his patients 3 months after surgery to see how the patient is doing with their newly altered interior. Most people have a storage of nutrients in their body for some time, and while some numbers may show decline at 3 months, I believe a better view would be seen at six months. Who am I though? Just a patient. However, since my surgeon went to some length to discuss the importance of vitamin B in the gastric sleeve patient, I was alarmed that my husband’s 6 month lab sheet came requesting only 1 test. Vitamin D. You see, his D was low at his 3 month draw, so they decided it should be checked again. Otherwise, he wouldn’t have had ANY labs drawn until 12 months post op.

Concerned about his other labs, I asked my husband to go to the office and talk to somebody there. Surely there was a mistake. When he went, it was after most of the staff had left, and he seemed to have been placated with a “yes, yes. Come back tomorrow for another sheet.”. Since he works unusually long hours, I went to the office on his behalf. When I requested a new lab form, I was stonewalled by the office staff. “No, we don’t do labs at six months.” To which I inquired, but why not? If my beloved surgeon requires seeing my husband, surely he needs labs to tell how he is doing. Yes? NO! No? No. “Dr, wants to see him to see how he is doing, but he doesn’t require any labs, unless he was low at his 3 month draw.

Please excuse my snark here, but seriously? He wants to visually lay eyes upon my husband, but he doesn’t require the labs that could actually tell if he is nutritionally deficient, following a bariatric procedure. Am I understanding this correctly? I asked this, over and over again. I needed clarification. Hell, I wanted somebody to hold my hand and make me understand.

Now, I really LIKE my surgeon. I got a great feeling from him through out all of the pre-op meetings we had, and even during my post op follow ups. But you see, as I had another surgery very shortly after my gastric sleeve, and as a result, my labs fell into the hands of other doctors. My follow up fell into the hands of a great many, and I felt incredibly secure and loved.

Despite the amount of warm feelings I have had for the surgeon, his office staff left me feeling cold and dismayed. They refused to simply fill out a lab form for a patient who was looking to be pro-active with his health, and suggested that if he wanted more labs done, he should see his GP. His GP, who is not a bariatric specialist.

So I go back to the question, why does the surgeon need to lay eyes on my husband at six months, if there will be no labs done to see what is happening internally? Does he have a third eye? A magic wand? A crystal ball?

While we may giggle about the clairvoyance of our doctors, the lack of a standard of care for the post op patient is really starting to hit close to home for me.

We have Bariatric Centers of Excellence, which require statics from the hospitals and the surgeon’s five years out. This means that the surgeons are EXPECTED to follow their patients for at least five years. It shouldn’t fall to the general practitioner to run labs for the bariatric population. If a surgeon’s group, hospital and support center are to yield this honor of excellence, shouldn’t the most pressing part of that fall upon the shoulders of the doctors?

Should the OFFICE staff be the voice of the center of excellence? Shouldn’t labs and appointments go hand in hand? As time goes on and the surgeries performed are understood better and better, why is it falling to us, the patients to have to demand that our health be followed up upon correctly? Why is it that I had to argue, and still leave that office empty handed? Where is the EXCELLENCE in that?

My Super groovy surgeon wasn’t there the day that I went in, requesting a lab form for my husband. He was over at the hospital, rearranging the insides of new bariatric patients. I can’t point my finger quite as snidely at him as I felt initially, simply because I’m sure he is unaware to some extent, of the stonewalling that goes on. However, it IS up to him, to request the labs, and so my question of why do you need to lay eyes upon a patient, with out having their labs drawn first… goes directly to him as well as to the ASMBS.

WHY WHY WHY…. are we having to FIGHT to be PRO-ACTIVE with OUR HEALTH? I do not UNDERSTAND!! I’m angry and I’m sad. How can we change the wrongs with in this system?

4 Comments

  1. Lisa
    May 8, 2012

    After the surgery, I was dropped like a hot potato and had to fight for every call or every appt. I am still running in to all of these problems with trying to get approved for my revision. I have to fight for EVERYTHING. I guess that’s all we can do. :(

  2. Escape Pod
    May 11, 2012

    My bariatric surgeon primarily does RNY, so he doesn’t have many VSG patients. He tends to think that, since we don’t have a malabsorptive component, we aren’t at much risk of nutritional deficiencies. I disagree pretty strongly based on what I read on the boards (besides, my diet is radically different than it was pre-op, and is pretty thin on veggies and fruits at this stage, which seems likely to me to result in nutritional deficiencies, even if I’m absorbing all my consumed nutrients and the bariatric vitamins I take religiously.
    I called my PCP’s office at the 6 month mark and discussed this with the nurse practitioner, and my PCP ordered the labs – no problem. Did she run everything the bariatric program might have? Probably not, but we did catch a pretty substantial decline in Thiamine (which can get pretty serious), and that gave me a good opportunity to press the issue with my surgeon for serious labs at the 12-month mark, and I didn’t get any push-back from him.
    I think there’s a lack of awareness by surgeons of post-op nutritional weak points for VSG patients. Maybe digging around in the medical literature you can bring in a few abstracts to get their attention?

  3. Dagny
    Dec 8, 2012

    I know I’m arriving late here, but Roux en-Y describes the surgical technique that re-routes the small intestine, causing malabsorption.
    Dagny recently posted..Obesogenicity & Broken ThingsMy Profile

    • VSGmom
      Dec 8, 2012

      The VSG (sleeve gastrectomy) is not malabsorptive, but having 80% of one’s stomach removed leaves you very restricted. The first year or more its a struggle to consume enough protein and calories.
      My labs changed drastically post op and continue to change. Being compliant on vitamins is essential, as are lab draws.

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