Question about aftercare

[Vickums 0]

Hi guys,

As y'all know, I'm still in the planning stages of getting the band. It's somewhat complicated by the fact that I'm switching jobs (I landed a sweet job as a labor and delivery nurse) which means new insurance. The good news is that my insurance is BC/BS, which means that as long as I go to a Providence network hospital (which are, like, everywhere), I should be able to get WLS covered. I still refuse to have the lone band doc up here do the surgery because he's only done 15 band surgeries (and I have concerns about him otherwise, too).

But here's the thing. I've been thinking a lot lately about postop complications of late. Like, what do I do if I suspect erosion or slippage? I know I can get fills up here (there's a local family practice doc who does them) but what about diagnosis and treatment of complications??? Those of you who had surgery done out of state, how have you handled it? Do you have to go back to the place you had your surgery? It being Alaska, that would require a plane trip of at least $500 and several hours of travel time. Has anyone had luck getting local GI docs to treat you? Or at least diagnose a potential problem?

I tell you, I'm almost thinking about getting the bypass (I know, I know...) because there is one good WLS doc here who does good, conservative bypasses. Then at least if I had complications I could get treated. My other concern is that because of the Sarcoidosis, I might either a) reject the band (I have a history of sensitivity to metals but so far nothing else) or cough it (or the port, or both) out of place.

Suggestions????

[New Hope 37]

Wow, Vickie, you have a lot of serious things that you need answers for! You are very wise to be thinking about all of those before you do anything. I was banded locally, but I wanted to wish you the Best of Luck and keep researching everything!

[pati-o 6]

Hi Vicky,

I have had so many thoughts similar to yours. I live in Michigan, had to self pay and therefore had to rule out any US doctor based on price alone.

I'm an OPS nurse (R.N.) and work with a TON of surgeons, but wondered if a single one of them would look at me if I had complications from a mexican placed band. Not ONCE did I ever consider a RNY even though they are performed in my own hospitals surgery dept. I've seen and heard of way too many complications from those things. I'm not trying to talk you out of it, just saying that they scared the heck out of ME, so I weighed the pros and cons of having a mexican placed band and decided that it was the right decision to go ahead and travel for it. I KNOW without a doubt that if I had a serious complication and needed immediate treatment that many of my local Drs. would probably treat me (probably with the "WHAT WERE YOU THINKING???" attitude-exactly why I told everyone I was having surgery in San Diego instead of Mexico).

I'm only 6 days post op so it's too early to tell if I'll have complications, but so far, so good. Everything is going great, I'm healing without problems, the diet isn't too tough and I haven't needed to contact the Dr. about a thing.

Anyway, I hope that this may be of some little bit of help to you- from one nurse to another.

best wishes in your journey,

[leatha_g 4]

Big choices.

Having moved from the state I had my surgery in back to Texas. I can tell you that I had a time locating someone who would continue my follow-up. Turns out I had what was diagnosed as slippage so he was able to capitalize on the deal and re-band me. Otherwise, everyone I spoke to besides this one doc absolutely WOULD NOT see me UNLESS it was in the ER. Of course, I had insurance issues also, but those I called who took my insurance refused to touch someone who was banded by another doctor. Whatever you do, have your follow up care decided and established BEFORE you make any decisions to have your surgery anywhere away from home. By this, I mean that you should establish a doctor/patient relationship by seeing this person BEFORE surgery. It has been often said that patients call prospective docs and are TOLD they will see them only to be refused AFTER they've had surgery.

[Vickums 0]

Thanks for the empathy, guys. I think my first step is going to be to talk to the doc here who does fills. As far as I know he's 'only' a Family practice doc, so he wouldn't be able to fix anything (other than an un-fill); but if he could at least diagnose something if something were to go wrong, then that would be a good step. I'm not one to rely on rumors, so I'll definitely make an appointment and talk to him personally -- not go by what other bandsters say. If he can't do it, my options are thus:

1) Get the band and hope for the best. *gulp* Obviously my surgeon would be willing to help me but if he's in Seattle (or Texas), then that's a $600 plane ticket. It's not like I can just pick up and drive, you know?

2) Get the band and see if the doc who does place them here (a doc I do not trust and the reason I'm going out of state to get the band to begin with) could help me. From what I've heard -- rumors again -- not only does he not like the band, but he likes even less even doing fills for other docs' bands. When people have tried to approach him prior to surgery, he charges a $300 consultation fee before he'll even talk to them and then tries to talk him out of it. So I consider him in the "oh HELL no" scenario".

3) Wait until we possibly move to the lower 48 which will bein 2-3 years. My concern about that is that I'm gaining weight as we speak, and because of my Sarcoidosis, I'm having trouble getting around as it is. I wonder what 3 years would do.

4) Get a bypass (obviously not my first choice, and the other choice which has me go "Oh HELL no"). I'd only get a bypass with this one doc who does a pretty conservative bypass (75 cm versus 100 cm or more, and I'd try to talk him down from the 75). My goal is not to lose 100 pounds in six months. I'd be happy to lose 100 pounds at ALL.

My husband is understandably freaked about option number four, as I am. For lots of reasons the bypass is a bad idea for me. But unless I can get proper follow up care, what are my options?

Thanks again for your insight, folks. I suspect it'll be awhile before this is all sorted out; in the meantime I look on in envy at those of you on the "losing" side.

[Staci 2]

Vickie

Love your quote...looks very familiar...like mine?????

Staci

Orlando FL

banded in Mexico 12-14-04

"Well behaved women rarely make history" Laurel Thatcher Ullrich

[Vickums 0]

Heh. GMTA, Staci.

Well, the saga continues. My new insurance will not cover WLS of any kind. Not evah. Nope. Not gonna do it. SO.... I'm screwed. My current insurance ends the end of March, which isn't near enough time to jump through the hoops of getting the band (including affording a plane ticket to Texas, which is where the nearest non-hackish band doc my insurance covers practices).

I'm currently in negotiations with a local WLS doc who doesn't do the band but who does very conservative bypasses. He does only proximal, only minimal bypass (depending on patient's wishes for weight loss, BMI,, etc) and has an excellent rep with nurses and patients. Obviously this is a HUGE step, and I'm still thinking very seriously about it. I'm going to go to his seminar, have an appointment and ask a million questions. My husband is dead set against me having bypass, so he's not going to let me do this lightly. At this point it's a longshot whether I'd even get it approved and done before my insurance runs out but at least the doc/office people know my insurance and work closely with other nurses at my hospital.

All I know is I have to do SOMETHING. I start my new job in February and I'm losing ground with my mobility. It scares the crap outta me that I paid over $20k for this new career, will have the job of my dreams and be too disabled to enjoy it.

So frustrating.... Believe me, if there were another way, I'd have come up with it. But there is no way I can get financing for the band (I've tried, but my debt ratio is too high) and since all my family is dead (or dead broke) there's nobody to borrow from.

Unless you guys would like to have a car wash for me.

[the best me 6]

Oh my gosh! So, whatever happened? I'm with your husband on the bypass...I hope you can find a way to afford the Band...maybe refinance the house? I am desperate for you! Post a reply and fill us in on what's happening!

[Vickums 0]

Hey Jack,

Thanks for your concern. I'm a nurse, so I'm well aware of what they're talking about, and what's involved in bypass versus the band versus DS; I've talked to several nurses at my work who've had the surgery and have been able to ask really detailed questions that the average WLS consumer might not think of. I have a list of 25 things I plan to ask the doctor during my consult.

Apparently, the smaller the amount bypassed, and the earlier in the digestive process it takes place, the less malabsorption there is. (This "jibes" with everything I learned in nursing school, and has been verified by my husband who has a BS in Biology and who's counseled people on nutritional counseling). Obviously, ANY malabsorption is a problem, especially for someone with an autoimmune disease as I have. I need all the help I can get to keep my inflammatory condition at bay, which is why I take roughly 25 Vitamins, mineral, and other various supplements a day. So that's an enormous concern. OTOH, not having anyone able to follow me after banding is a huge concern as well. Even the one doc up here who does fills is difficult to get in with and is talking about not doing them anymore; and he wont' actually touch the band, just do the odd fill. Yikes. There is literally no one within 2500 miles who would follow me and help me if I had a complication; I'm not sure people who don't live in Alaska quite understand how isolated we are up here, and how limited our health care choices are. It's really quite frustrating how limited we are. The lack of follow up care is scary for me, and why I'm reconsidering banding. The safest operation in the world becomes dangerous without proper follow up care.

The money situation with us is enormously difficult. Without going into details that I'm uncomfortable sharing, there is no way I can have my surgery financed. I have to go through my insurance company or it will not happen. We've figuratively cut the fat out of our budget in order to support a family of FIVE on two health care worker's incomes (we're not doctors, just a nurse and dental assistant) in one of the most expensive states in the US. So it's not as though I'm not motivated; there is literally no way to do it (and I'm a persistent one). I can always wait until we move to Washington or Oregon sometime in the next 5 years, but how much weight will I have gained by then? (I don't wanna know).

So it's frustrating right now. My insurance would cover me going to Texas for the band, but I'd have no follow up care. My new insurance (as of April 1) won't cover WLS at all. So if I'm going to do something, I have to do it now or else possibly wait several years. In the meantime, my mobility is failing, my comorbidities are getting worse, and my Sarcoidosis is getting worse as well, in part because of my inability to exercise and the stress of my weight on my lungs. (I was in the ER the other night because of a flare up, which led to a panic attack).

Sucks to be me, doesn't it?

[Vickums 0]

Kathy, we don't own a house. Not everybody can afford one.

[claraluz 2]

Vicky, you sound like a very thoughtful person in a difficult situation. You are the only one who can ultimately decide what's best for you and I wish you the best of luck, whatever your decision.

Nancy

[Emmy27 1]

I would never tell someone not to have a bypass. For the single reason is that it is such a personal decision, for so many reasons people outside of the situation cannot understand. I would make sure they were educated, as you are and then leave it to them - only you know what is best for you, what will work, what risk you are willing to take.

The one thing that concerns me about you deciding to have a bypass is that your husband is not supportive of it (and you understand why) - I would really try to make sure he was on board with it ahead of time. You will need all the support you can get through this process, the surgery (no matter WHAT kind you have) and post op. I can't imagine doing it with NO support, nevermind with a spouse who thinks I made the wrong decision. But again, that is ME, and MY circumstances.

Good luck with your decision... it's a very difficult one at best. Please let us know what you end up doing.

[Vickums 0]

Emmy and Nancy,

Thanks so much for your support. And you're right, this isn't something I take lightly, or am going into wihtout a LOT of thought. Emmy, I do have good news on the husband front. He and I have talked, and he's now supportive of whatever it is I decide. He's obviously concerned for me, but as he said, "I know you well enough to know that you're not going to jump into something without researching it." He also knows that I hate surgery enough -- I put off having my gall bladder removed for NINE miserable months until I had no choice -- that I'm not going to jump into this with my eyes closed.

Thanks again for your support. I'm still hoping a miracle will happen and I can get the band, but it seems like each possible door to that end is closing. And I won't get the band without after care lined up, just as Leatha suggested.

You guys are the best. No wonder I love it here so much.