Considering DS but my PCP is horrified

[Nosh Spice]

Hi all - Joined last week. Appreciate the gold mine of info I'm finding as I continue my research. Thanks to larra for pointing me here.

Age 50, current weight 295, BMI 45. Comorbidities: HBP, sleep apnea. I had a PE in December. Got very lucky. Cause unknown, no genetic factor, no long flights, no hormone therapy.

My dietician - to whom my PCP referred me - is worried about my inability to lose weight on my own. She suggested I investigate DS with Dr. John Rabkin. I had a consult with him July 8. He feels I'm a candidate for DS.

However... my PCP is not on board at all. I met with him today and shared basic info about DS, docs from National Library of Medicine, and Diana Cox's "Conversation with Your PCP." (Which intimidates the heck out of me but I'm not a medical professional.)

He feels the procedure is unsafe given the degree of intestinal bypassing (my words), the risk of malnutrition and other complications that aren't necessarily caused my human error in following the maintenance program, like adhesions. He expressed lots of concern over risk of adhesions.

He did say he would support a gastric bypass (RNY). We've been discussing WLS for at least a year. He's never been a fan esp after my PE. But now he's willing to support RNY. I pointed out that the WL maintenance is less successful with RNY than DS (plus dumping and other RNY cons) but he lectured me a bit on ensuring that safety comes before maintaining weight loss.

So, I think I'm at the point where I need to find another PCP, who is willing to become DS friendly. I'm in the Sacramento, CA area. Any suggestions?

I gotta say he's got me unsure about DS. Like I mentioned, I'm not a medical professional so if I can't find a PCP to partner with, I'm not sure what I will do.

Thanks in advance, Mary

 

[southernlady]

Welcome, @Nosh Spice

Honestly it sounds like your PCP is heavily biased...Any time you have abdominal surgery (and that includes the RNY BTW) you risk adhesions. You can either ignore him or find/educate a new PCP. Maybe ask Dr. Rabkin's office who he suggests.

 

[DSRIGGS]

Your pcp needs to buy a clue... Sorry.

Do not listen to him/her. Do your research and this board is a Great place for that, and you will find the DS is the best thing you can for your health.

 

[Larra]

Your pcp has no understanding of the DS, or probably not of gastric bypass for that matter. Of course both operations carry risk. But there is no reason to believe that you will have more problems with adhesions (of all things to be concerned about from a non-surgeon!) with DS than with gastric bypass. Does he have some actual evidence from the medical literature to back up that assumption? I didn't think so.
Yes there is more malabsorption with the DS. That's why it works! If you are unable to lose weight with diet, and have a bmi in the MO range, and have a serious comorbidity that is most likely to resolve with maximum loss of excess weight (sleep apnea), the DS is far and away your best choice. The rate of resolution of sleep apnea is significantly higher with DS than with gastric bypass.
And if you ever need to take NSAIDs, now or in the future, DS lets you do that, while they are contraindicated for the rest of your life with gastric bypass.
Doctors, and a lot of potential patients, hear the word "malabsorption" and get scared. But almost all the people who get into nutritional trouble with the DS, or with gastric bypass for that matter, do so via noncompliance. So I would say that if someone is not willing, for some reason, to take the necessary supplements and eat the protein needed to stay out of trouble, that person should not have either operation. And unfortunately such people do exist. I don't understand that mindset, but I've seen it, and would never recommend any malabsorptive procedure for these people. But if you are willing to make the lifetime commitment to taking your supplements, you should do just fine with the DS. And while it really is a crucial commitment, it isn't all that difficult.
So if your pcp is willing, however reluctantly, to take care of you and order your labs for you and you like this pcp other than his attitude to bariatric surgery, he may be ok. If not, you need to shop around for a new and improved pcp. Ideally it would be great if your pcp saw your success and the improvement in your health with the DS and changed his attitude, but it's not your responsibility to retrain him. Do what is best for you.

And btw, hi and welcome!! I'm Larra here too.

 

[DianaCox]

Find a new PCP who is willing to learn. The stupidity of using adhesions as the basis for mixing the DS, while ignoring the obvious fact that the RNY is no different in that respect, is a HUGE red flag to me. Brainless!

"What do they call the person who graduates last in the class in medical school? Doctor."

 

[Munchkin]

Get a new PCP. Yours is out of date and it doesn't sound like he/she is willing to be educated.

Yup! A lot is bypassed with the DS. And guess what? It's the only WLS that actually works. And long term, very few ever even come close to losing too much. Most of us who are 10+ years postop are always still trying to lose. Adhesions.... Please. Any abdominal surgery can cause that. RNY included. So let's talk about the RNY. Being a member of the think twice, cut once group, I opted to get the DS as a first surgery. I was one of a group of 10 who had surgery at my workplace. One had a crap band and never lost anything. There were 8 who had the RNY. 10+ years later, I am the only one who still looks 'normal'. The others gained it all back, puking and dumping all the way. I am still fat but I am much better off having had the DS. Honestly if I could have found something more drastic than the DS, I would have done it.

So what's wrong with the RNY? It doesn't bypass enough. It takes about 2 years for the body to adapt to the RNY and that's when they start gaining. And this is just the tip of the iceberg. There's the stoma, dumping, and all the 'rules'. Hopefully in the future the SADI will replace the RNY. The RNY misery factor is too high.

Rabkin is a great choice. Are you a great choice? I don't want you to answer, just think! To be a successful long term DSer, you have to know more about your new body than 90% of the doctors in this country. You have to know it, own it, and be willing to advocate for yourself. You have to be able to tell a doctor that he/she is wrong and back up your statements with facts. You need to be willing to learn about nutrition and supplements. WLS in general is not a set it and forget it thing. To be successful you need to be engaged and involved.

In the beginning, the DS does take over your life for a while. Once the big weight loss is done, life becomes more normal and a lot of it is automatic. I don't have to think about it anymore. It's just normal life to me. As I write this, I am drinking coffee and taking my morning vites.

Everything you do is a risk. You can get waxed going out to check the mail or pick up milk. You have to weigh risk VS reward. Surgery is a risk. I knew surgery was the right option for me when it was more frightening to me to stay on my current path and cope with all the comorbs coming my way than it was to go under the knife.

My biggest regret is not having the DS when I was about 10. I made my choice and it was the best choice I could have made at the time. Now it's your turn. I'm glad I had a chance to live as a normal size person and I shudder to think of where I would be right now if I had chosen to do nothing!

 

[k9ophile]

I must agree with what others have posted. I had to have a recommendation letter from my PCP. If you do as well, you need one who will support your decision. I also realize that switching to a new doc could cause problems. You'll have to build that rapport even with the information in your transferred records. I also must say that it will be worth it.

To me, both the DS and the RNY are equally dangerous due to the very nature of any degree of malabsorption. Anyone who is non-compliant is going to be a train wreck. Do not settle for a surgery that you don't want.

 

[Nosh Spice]

I've reached out to Dr Rabkin's office for MDs in Sacto, and will hook up with Rabkin's Sacramento support group to see who they work with. Off I go to find a new PCP. Thanks for the guidance.

 

[Will2014]

Hi all - Joined last week. Appreciate the gold mine of info I'm finding as I continue my research. Thanks to larra for pointing me here.

Age 50, current weight 295, BMI 45. Comorbidities: HBP, sleep apnea. I had a PE in December. Got very lucky. Cause unknown, no genetic factor, no long flights, no hormone therapy.

My dietician - to whom my PCP referred me - is worried about my inability to lose weight on my own. She suggested I investigate DS with Dr. John Rabkin. I had a consult with him July 8. He feels I'm a candidate for DS.

However... my PCP is not on board at all. I met with him today and shared basic info about DS, docs from National Library of Medicine, and Diana Cox's "Conversation with Your PCP." (Which intimidates the heck out of me but I'm not a medical professional.)

He feels the procedure is unsafe given the degree of intestinal bypassing (my words), the risk of malnutrition and other complications that aren't necessarily caused my human error in following the maintenance program, like adhesions. He expressed lots of concern over risk of adhesions.

He did say he would support a gastric bypass (RNY). We've been discussing WLS for at least a year. He's never been a fan esp after my PE. But now he's willing to support RNY. I pointed out that the WL maintenance is less successful with RNY than DS (plus dumping and other RNY cons) but he lectured me a bit on ensuring that safety comes before maintaining weight loss.

So, I think I'm at the point where I need to find another PCP, who is willing to become DS friendly. I'm in the Sacramento, CA area. Any suggestions?

I gotta say he's got me unsure about DS. Like I mentioned, I'm not a medical professional so if I can't find a PCP to partner with, I'm not sure what I will do.

Thanks in advance, Mary

Hi Nosh Spice and welcome! I don't think your PCP is a jerk at all for holding the views he does. But he IS clearly out of his league on this subject, as are 95% of doctors worldwide. Had he been an uncaring ass he'd have simply said nothing, but he risked your anger by speaking up. He actually earns points with me for that. But what Diana and Larra has said also screams it's truth to me that the guy is DANGEROUSLY uninformed and has no business advising you or anyone else on this issue. Adhesions are a risk for any bariatric surgery chosen , and the issue of malabsorption is a problem for the RNY as well as the DS. The REAL danger for me is the risk of dumping syndrome because of the butchering of the pyloric sphincter done by the RNY. Are you (or is your Dr.) aware that dumping syndrome can be a life threatening situation for an aging person in their heart attack years? It's not simply a matter of a little vomiting and not feeling well. It can cause shocking high pulse rates along with violent vomiting, loss of consciousness, etc. It's no laughing matter, and is not an issue at all with the DS. Also, the issue of NSAIDS is of particular import to those of us over 40 yrs of age. Aches and pains are coming for you, if they haven't already. Does your doctor really want you to be unable to take the meds necessary to alleviate them? It's just classic lack of knowledge regarding DS at work here. As more and more folks have it things will change, but not until MANY more have undergone the procedure.

 

[Nosh Spice]

@Will2014, I believe my PCP has my best interests in mind, but he's conservative and (as you say) uninformed in this area, which happens to be a very important area for me.

 

[DianaCox]

There is a cure for uninformed, and that is a willingness to GET informed and LEARN. There is no cure for being unwilling to open one's mind. The key is to be able to discern if your PCP is JUST uninformed, or simply terminally closed-minded. "Ain't nobody got time" for the latter.

 

[Charris]

Its your cash, body, and life The doctor needs to realize he works for you, ultimately you should have the final say about what you get done. If he doesn't like it then he can tell you he doesn't feel comfortable and your partnership with him should end. I never thought about the fact that the doctor works for you until EN mentioned. You call the shots. Its a good thing that he cares about your well being but unless the choices you make are terribly unreasonable or egregious then give you what you ask for...his consent. Good Luck