virginiaRN

Hi, folks. I have not been on this board for a long time. Today, I had a visit to my bariatric surgeon's physician assistant (PA). I am 16 months out from roux en y surgery and have lost a total of 101 pounds. I went there today because I have been experiencing severe abdominal pain, bloating and flatulence at night, every night x 2-3 weeks. I should add that I am an RN and am one semester away from completing my Family Nurse Practitioner Master's degree. The PA gave me some advice, ordered some meds and labs and I checked out--it was about 4:10pm. She had told me to do the labs today, due to the severity of the symptoms I was having. Their office was closing. I went to my PCP's office--which has a lab tech--and they were closing and the lab tech had left. I went downstairs to the outpatient lab and it was closed. The only lab open was the STAT lab on the 2nd floor. Since I was still in the building, I thought I'd just double check that the PA did not want these labs to be drawn STAT. I went back to the office. It was locked. I knocked on the door. I had already heard the cackling and loud voices from 10 ft away. As I got closer, I heard the PA saying "I know, and every time she moved her arms! I couldn't believe it! And she had her teenage son with her!" Needless to say both me and my teenaged son (almost 17) heard this. He drove me today because I wasn't feeling well and he also needs to rack up his driving hours to complete his driver's permit and get his regular license. Just then, the PA, the receptionist and someone from the billing dept emerged from the door. They turned white as ghosts. Their jaws almost hit the floor. Being the classy person that I am, I didn't reference that I overheard them talking about something on my body just then. Their reaction confirmed what I thought I overheard. I asked the PA if she wanted the labs STAT, she said no, and my son and I walked to the elevator. The women huddled back by the door, somehow frozen. The only way to either the stairs or the elevator was toward the direction my son and I walked. Clearly, the women felt ashamed (?)/shook by being overheard body-shaming a patient, violating HIPAA, and being overall terrible people. As we drove home, I was pretty hurt. Most patients at a bariatric surgeon's office are going to have body image issues. Whether they are pre-op or post-op, they have likely experienced some type of negativity about their bodies (either from within or without, or both.) Also, I should add, I am a breast cancer survivor. December 2018 is my five-year anniversary of having stage 2 invasive breast cancer and having a b/l radical mastectomy and subsequent reconstruction, followed by a hysterectomy. One year after my b/l mastectomy, the reality hit me that my GG breasts were now AAs, mutilated and scarred. I felt unattractive, repulsive and beyond depressed. I was thrilled to be alive and that it was caught in time to prevent spreading to my lymph nodes and that by doing a b/l mastectomy, I didn't have to do chemo or radiation. I failed to be able to tolerate Tamoxifen, and had to be put on a cocktail of other meds that resulted in me gaining about 50 pounds to my already Rubenesque 225 lb body. It was a low time. Then, I got my reconstruction. My breast did not, do not, and will not look like "porn star" boobs, or "stripper boobs," although many people have suggested that was the "up side" of breast cancer. See, when you get a radical mastectomy, they hollow you out like a cantaloupe. Then, either at the same time, or at a later surgery, they insert implants (or, in some cases, spacers). Because I was 220 pounds when I got my reconstruction, they put the biggest implants the FDA allows--800 cc. The reconstruction surgeon repaired a lot of the scarring caused by a severe post-op infection from the initial surgery, during which both of my breast turned black and I had to debride the dead tissue myself at home. I was and am thrilled that I had a good reconstruction surgeon and, after recovering, felt a little bit more whole. While I had no breast tissue before, but now, any extra cushion vanished as I lost over 100 pounds. My breasts are skin and implant. It's definitely not a "hot" look. Well, all this cancer talk comes into play because what the women were talking about was my breasts. You see, when you get a breast reconstruction, your breasts don't look like regular breasts. Again, they are hard, stiff, and look like "robot boobs," as I call them. Today, at the office, I was wearing a bamboo material sundress, that was mostly dark teal, but also had other colors tie-dyed into the design. In the front is a "peekaboo" hole. The rest of the dress is just an A-line dress with a full skirt. It is not particularly "sexy." (Including my flabby/flappy wing-like arms!) But because my breasts don't move, there is a tiny bit of "side boob" seen protruding into my armpits. Not regular side boob--because remember, nothing is "soft" anymore. No, it's part of the round, button shape (just imagine an implant covered with skin, literally.) As I reconstructed what the women were saying, I recalled more and more of the beginning. I guess in the moment, in shock, my brain kind of protected me and I somewhat blanked out. Look, we are all human, I get it. We all make mistakes. But for God's sakes, you would think that the staff--including a provider--would be a little more sensitive about yucking it up about patient's bodies while anywhere near the doors/exit. I am posting here in general for support because it just feels yucky. I know I've never done anything like that as an RN, but one never knows how one's words may affect another person. Also, the HIPAA violation bothers me. I work very hard to whisper, even when I am behind closed office doors, because I know how much sound carries in offices. I often tell my patients "I'm sorry I'm kind of talking softly, but these room walls are paper-thin and I want to protect your privacy." I know I won't have the b*lls to tell the office. I feel like somehow they would turn it around on me, even though 3 of them were there and me *AND* my son heard that. And as a mother of a 16 year old son, a 19 year old son, and a 21 year old daughter--it's creepy. The implication that my son--who has seen me go through hell and high water with cancer and this gastric bypass--would even think about looking at my breasts is disgusting. This can only come from a woman with no children. The PA is probably like 35 (I am 44), no wedding ring. Normally, I wouldn't even mention any of that because I fully believe in living my own life and others live theirs but for f*cks sake, please don't foist your sick thoughts on me. I would like some thoughts on how I might handle this. I feel like I won't have the courage to say anything, for fear of being "gaslighted." But, I also feel like there is a lesson for their staff to learn. It occurred to me to write an anonymous letter to the surgeon/head of practice and give a little vague summary of what happened and advise that his staff might want to not be so catty, mean, and to stop violating HIPAA. I don't know. I just know it hurt. I'm hurt. Thanks in advance for any words of wisdom.

So, as noted much earlier in the postings, I did contact the practice manager and the doctor. I got a written apology via email, and them saying they "hoped I would continue my care with them because after care is so important." I left a very short post on Yelp stating, "The surgeon is excellent but I cannot with good conscience advise anyone with weight issues to go to this practice." A few months later, I get an email from the physician. His PA and the rest of the staff fully admitted the whole thing, never denied it. He claims he had individual meetings with them, forced them through various trainings, etc. Apparently, this "shook up" the whole office culture. He requested that I remove my Yelp review. So, this is a violation of Yelp policy for a business owner to ask for a review to be removed. I complained to Yelp. They never responded. I contacted my local Northern Virginia/DC Yelp "coordinator." She did nothing. I wrote a lengthy email to the physician stating that, in my humble opinion, any problems with business of late is due to the buzz in the area about his practice. EVERY. SINGLE. PERSON. I. KNOW. WHO. HAS. GONE. TO. THIS. PRACTICE. has issues with it, similar to these. In fact, the woman who I go to who waxes my eyebrows (I know, random), told me--without prompting--that the physician ragged on his own wife's body (apparently she had been one of his patients.) His wife is his current practice manager. My waxing lady ended up going to another practice, had the procedure, and has lost 50 pounds, thus far (I think she is like 6 months out.) I work in healthcare in the area, and any time the name of this practice comes up, numerous persons will speak up and tell their horror stories--not with the actual surgery, but how they were treated. So, this is not an isolated incident. I knew SOME of this going into it, but not to this extent. In any event, Yelp removed my review. And then, out of spit toward Yelp--I had been a "Yelp Elite" for 4 years, was about to be "Gold Yelp Elite"--I deleted all 500 of my reviews. This is not the first time an owner has tried to get me to change my review, which I will if the situation grants it, but typically I will not. But I am also very fact-based and don't get into great detail. In this case, I only wrote two sentences, because I didn't want to get sued for slander, but I wanted to be crystal clear. (I also quit being a Yelp reviewer due to their lack of support.) The surgeon was of course, thrilled to hear Yelp removed my review, and now thinks his business will thrive. He overestimates the impact of my one Yelp review. His practice has a very bad rep in the area. As a newly graduated and board-certified Family Nurse Practitioner, I will not be referring patients to him. There are plenty of great practices to refer to.

Hi Folks. Question that you all may or may not have run into. I had roux-en-y GBS 1.5 years ago. Lost almost 100 pounds. That is going well. I have some chronic back issues (degenerative disc dz in lumbar and cervical region) and have done all the injections, radiofrequency ablations, epidural blocks, etc., that I can manage. Pain persists, but ortho has stated it is not appropriate for surgery. To be fair, I wasn't really going around hunting down someone to operate b/c the idea of back surgery is not exactly thrilling to me, having taken care of the post-op back surgery patients in home health and with the back surgery success rate of 50%. Prior to surgery, I was able to take NSAIDs and certainly took my share. My surgeon stated no way on the NSAIDs. After me badgering him, he allowed me to take Celebrex 100mg twice a day along with Nexium 40mg once a day. I did this for 3 weeks. I ended up with a peptic ulcer which had to be treated for a month with a multiple medication cocktail. It was not fun. The ulcer was way more painful that the neck and back pain I originally had. For a while, I managed on regular or arthritis-strength OTC tylenol. Then, my pain management doctor rx'd Vicodin, which is never a good long term solution. So, I took it, with the knowledge that I shouldn't take this long term. I've dc'd this myself and I am still in pain. Also prohibited by my GBS surgeon are oral steroids (prednisone, prednisolone, etc.) FWIW, I have unsuccessfully taken Cymbalta, Neurontin, and a few other neuro-type drugs. I take Lexapro for moderate depression. I can't take a number of meds also because of my epilepsy history from the age of 9. Oh, and I maxed out my chiro benefit this year (20 visits.) Out of pocket, chiro is $70/visit and the chiro wants me there twice a week. I have expressed that I really loved his services but I can't afford $140/week. I used to get 90 minute deep tissue massages about every 10 days, but my therapist moved far, far away and I've struggled to find someone even half as good. Currently doing epsom salt baths, Tylenol, and heat and or cool packs. Normally, I'm good but unusual activity types usually throw me over the edge. (This weekend had a house flood which entails me and my family moving lots and lots of things from one area of the house to another.) I've even done acupuncture, but the cost was prohibitive ($900 for 3 treatments.) I even have my own TENS unit and foam rollers. I do some strengthening and stretching exercises on my own, which helps too. I need to find a better solution for pain management. Anyone find solutions and/or good providers who have a handle on this? I will travel to see someone good. Thanks in advance!

You have REALLY been through it! I totally get where you are coming from about feeling desperate. I live in an adjoining state to 2 states where medical cannabis is legal. Alas, it is not where I live. Absolutely agree with you on the "herbal supplements" and danger. When I am getting a history, and medication list from my patients, typically they leave out the herbals. So I have to ask, sometimes multiple times before they tell me. Sometimes they wait until the end of the appointment. And I'm like, "ahhhh, you are taking gingko biloba. That's why your warfarin isn't working correctly! AHA! Let's talk about this." I appreciate your post and hope you get some relief in the meantime. I'm so sorry you are feeling so bad. I really hope you find some solutions soon. I'm not your provider and wouldn't want to offer medical advice over the internet (illegal for me!) but I reallllllllyyyy hope you find some help that assist in living your life. That just really blows to be in that much pain.

Oh yes, and I forgot, I, too, have that horrible tight and painful feeling around my chest from my b/l mastectomy. Very little has been researched to manage this except for massage and dry needling (and stretching!) Ugh. I know the feeling though!

Thanks for such a long post! You are too kind to take you time to post this. Actually, I am familiar with many of these points. I am an RN and am graduating in 13 days with my Master's in Nursing and will sit for boards in less than a month to be a Family Nurse Practitioner. In my clinical rotations (Internal Medicine, Family Medicine, Ob/gyn, even Peds), I give my patients talks about eliminating simple sugars out of their diet. In fact, I did my capstone project on the Medical Management of Bariatric Patients, and in addition to the inflammatory processes that simple sugars inflame, you are at high risk for dumping syndrome. I experience extreme dumping syndrome--bother early and late dumping syndrome. Early--from the simple sugars (for example, if I would ever eat like a cookie or half a cupcake) and late (from high fat, like bacon or fast food.) I have had my gall bladder removed so it exacerbates the late dumping syndrome more than someone who has their gall bladder. I'm a stage 2b breast cancer survivor and couldn't tolerate Tamoxifen for a variety of reasons. So, against my doctor's wishes, I had to d/c that med a few years ago. They wanted me to take it for 10 years. I couldn't even tolerate 18 months. I ended up on 13 other meds to ameliorate the s/e caused by the Tamoxifen. Then I had to have a salpingoopherectomy (hysterectomy but left the ovaries so I wouldn't go into premature menopause.) I am quite familiar with the troubles of Femara--my mom took for a while and was MISERABLE. I have the same experience with wine--it causes me pain too. I don't even bother anymore. It's unfortunate but it's just the way it is. I don't know about the actual percentages of for every x y z pounds you lose, your pain is reduced by x percent. I'd love to read the research on that. If you happen to ever get the citation, please post or msg me. That is a powerful statistic that I would love to use with my patients I see in clinic. It would motivate them to get moving on weight loss. Nonetheless, I am continuing to work on my weight loss, having lost 100 pounds so far. Exercising is more sporadic now, especially in the last days of my MSN wherein I'm having to submit so many papers, assignments, take finals, etc. Terrible excuse, but it's my reality nonetheless. I do what I tell my patients to do and get up and march around the house for 10 mins multiple times a day, when I'm not at clinic. And/or walk outside when it's not 29 degrees here! My husband is runner who runs at 7 mins/mile (old guy now who used to run 4min/mile) so when he walks we me especially, he keeps me on a good pace. As you probably know, weight loss and eschewing alcohol are the two major actions you can take as a breast cancer survivor to prevent a recurrence. There are numerous studies on this and I can post if you would like. (I'm in the last few days of coursework and working like a dog to submit assignments, study for finals and boards! So this moment is kinda bad, but soon!) It sounds like you have been through the ringer and I appreciate your post. I'm off all pain meds. I have muscle relaxants that I can use for spasms but I don't use them that much b/c of s/e. The one muscle relaxant that doesn't cause sleepiness is Lorzone, but it's not that effective. I have never had a prednisone shot, although it's sounding mighty enticing. My concern about that is the same as with my patients. It raise blood sugar, puts you at risk for fungal infections, etc. I'm not a big advocate of prednisone injections in general. Thanks again for your post and I will continue my quest to continue to lose weight and very SOON be able to up my exercise even more that my paltry amount. The rebound pain is real with NSAIDs (which I cannot take anyway, as all of us with GBS) and the endorphins released by exercise (and sex, btw!) are inimitable! Keep up all your great work!

Can't remember if I replied. Yes I looove PT. I have gone to about >20 full cycles of PT as an adult. And I'm 45. LOL So that tells you how much I have gone to PT. Specifically, I have been helped by dry needling. I'm actually going to a PT (who does dry needling) today, to see if I can get any relief. I think I have some benes left this year, but may have to pay out of pocket if not. It's worth it.

I love PT. I failed to mention that in my OP. Yes, I have been in PT for my neck or low back over a dozen times in the last 10 years. Dry needling is amazing too. I'm going to a special PT who does dry needling on Friday. I really hope my insurance covers! It was literally a godsend, but I maxed out my PT visits in previous years. I don't think I have this year. Thanks.

I did fail to mention the barrage of muscle relaxants that I have tried. They do help. And tylenol (paracetamol, same drug, different name). I've not familiar with the triple med you mentioned, although I was on celebrex (a COX-2 inhibitor, similar to NSAID, but less ulcer risk) with nexium--and that's when I got the peptic ulcer. I love water exercise. I should get back to that! Thanks.

Yes! I have Lidocaine patches. I've tried so many things, it just slipped my mind. They are okay. Not the best, but better than nothing! Thanks.

Yes ma'am. Scroll up. Reported. Thanks!

Personally, I am over it. I was pretty much over it the next day. Having been heavy most of my life, I've been called much worse, in much more public circumstances, and cried real tears over it. My skin is old leather at this point. As a card-carrying member of the medical profession, I do feel an implicit and explicit duty to protect other patients from this type of behavior. Ironically, as a Family Nurse Practitioner, I will be giving referrals to practices of various specialties. This will not be one of them. Just last spring, in my first Family Nurse Practitioner rotation, I referred all my patients who were interested in learning about bariatric surgery to a different practice because there have been a few other incidents with this practice (that I experienced and some of my co-workers experienced.) I must have referred 20 people to a different practice is 4 months. So, about 5 per month. I graduate in December. If I practice for 20 years (at least), that's 20 x 5 x 12= 1200 potential customers/patients. The surgeon is about my age, so he'll likely be practicing at least that long. I'm sure they'll get along just fine without my referrals, but I'm sure they would have liked them just the same. Just saying... Anyway, thanks for your support. #longgame

That would have been completely dope to say. I will keep that in mind for (god forbid) future episodes. Thanks!

Word. Definitely violated this.

No worries.

Nope. Walking in the hallway & talking abt patient details is the kind of stuff covered in first semester of clinicals, in any part of the medical profession, as you know. No worries. My post was more of a stream of consciousness, a vent. Certainly not organized very well. ✌🏽

Oh, and sorry about not being clear in my OP. They were laughing about my SIDE BOOB coming out of my dress. This only hit me as I replayed the scene in my mind going down on the elevator. I was so stunned, initially I wasn't clear what I heard. But my son confirmed what I heard. I can't update the OP, I don't think or else I would! Thanks.

Oh, and they do NOT deal with "life or death scenarios." As I wrote in earlier posts, their office closes at 4pm, opens at 9am. They see people in the office. The one time I actually came in with blood pressure of 70/50 and dizziness, they left me in the waiting room for 1 hour. They know NOTHING of dealing with real emergencies. In the 14 years this physician has been in practice, never has there been a patient death. I was an ER nurse. I know from "life or death medical and mental health scenarios." Further, even in the ER, if we EVER did joke about a patient--typically never about the body but about a bogus story about how a man got a shampoo bottle stuck up his anus ("I fell in the shower), we did it in the BREAK ROOM, which is located strategically far from patient rooms. Just curious, do you work in healthcare/medicine?

Happy to enlighten you. I teach nursing students of all levels at university, so this is something I am up to speed on. HIPAA specifically states a few things that are of issue here. 1) A member of the care team should not discuss patient information with anyone (in the office, out of the office, or whatever) who is not DIRECTLY involved with the care of the patient. That would include the receptionist and the billing employee. The particulars of the PAs discussion were not need-to-know for the receptionist to check me in or out, nor for billing to submit my bill to my insurance. 2) They were EXITING the office. Even prior to the them exiting (about half of their statements came out as they exited the office--literally walked into the hallway), their words were audible from the hallway. The onus of privacy is on the office. That is why many offices have "white noise machines," to obliterate the private patient information being discussed within the office space. 3) Even within the office, staff is required to use a low tone, and to only talk about information that is relevant to care. Hope that helps.

Part of me would also like to start sending postcards to the office of me in bathing suit with lots of SIDE BOOB showing. But... that'd be super-ornery. LOL

I can't seem to edit the OP, but I wanted to make sure you all knew the update which is that yesterday morning, I wrote a letter to the practice manager & to the surgeon. Love all the comments and they are great. Just wanted to let you know the "reporting" has been done, at least at "level 1." There are more levels to go and I am contemplating my next moves. Thank you!

Yup. Scroll up. Documented. Letters sent. Thanks 4 ur support!

Hi scroll up. I already sent letters! thank 4 ur support

Thanks for your kind words. Letter was written yesterday morning and sent to the surgeon and the practice manager. It was a much shorter and direct version of what I posted here. I also amended my positive Yelp review--kept that general but was very specific about the PA who made body shaming comments. Again, thank you for your support. The responses I got helped me write that letter yesterday morning.