Dr. Jayaraj Salimath

[DSRIGGS]

This is a rant post about this guy's lack of professionalism, ethics and money grubbing.

BACKGROUND - Cameron has bad gastroparesis, as I have posted in another thread and referenced a few times. We went to see this guy as he is local and Dr K told me (and we had numerous phone conversation and 15 emails) that the procedure Cameron needs that will give him the best shot to have a normal life with the least risk, is not extremely technical and any good general surgeon can do it (we didn't need to fly out to him even though he would gladly do it).

So my issues with this asshat -

1. Upon seeing him we talked to him about Dr K's suggested course which was a pyloroplasty to help the pylorous empty better, a roux-en-y limb off the greater curvature of the stomach (in essence an overflow drain since the stomach won't empty) and hiatal hernia repair (Cameron's stomach has a significant amount in the cavity above the diaphragm). This is not a surgery without risk but it is minimal compared to what this guy wanted to do. He wanted to take down the Nissen (other Dr's have told us this is very risky due to the previous two nissens and that serious esophageal damage could occur), repair the hernia, do a SUBTOTAL GASTRECTOMY (yep take out 95% of his stomach) and a Roux-en-Y. WTF go to that extreme route without trying Dr K's suggested route first.
2. Cameron has had so many issues with this freaking Nissen and subsequent repair thus he wanted something done immediately so he bought into this risky route because Salimath said he would do it as soon as insurance approved. After numerous attempts to change his mind, including another consultation with Salimath where we discussed both procedures again, we reluctantly agreed as Cameron is 21 and in the end it is his decision. Well that was 3.5 weeks ago and insurance granted approval within 4 business days(the following Wednesday). We talked to the nurse scheduler as soon as insurance told us he was approved. She said Salimath needed to do a final review and she would schedule as soon as he did that, but he wouldn't be in the office until Friday. Friday came and he did nothing. The next week came and he was still reviewing and again not in clinic until Friday where he would do final review......nothing again. I asked for him to call me (5 different times over the last two weeks) and the asshat did not (Dr K hasn't recieved a penny from us or seen cameron and he has spent hours emailing and calling me and this fukkstick can't even give me one call?). That was the Friday of the Memorial Day weekend so as I mentioned Cameron ended up having the emergency appendectomy on Memorial day. Again the week goes by and nothing from this asshat. Finally we get a consultation on Friday and the motherfucker tells us that he won't do the surgery because he is independent and doesn't have resident support and since he is going out of the country on the 8th it is too risky (hey fuck head that is why you were supposed to do the surgery 2 weeks ago) and that we need to go to Northwestern where Cameron was diagnosed and they could do surgery. WHAT THE FUCK ASSHAT? You reviewed his history the first consultation and said you were doing the surgery as soon as approved and then you dick us around for 3 weeks and then tell us it is to risky and your wimpy ass is afraid to do the surgery.....thanks a lot dickhead, we could have been going down another path had you been honest with us upfront........on top of all this, Cameron has had a rough recovery from the appendectomy and was out of pain medication on that Friday.....this asshat wouldn't prescribe anything and told him to take motrin...fucking asshole.
3. Because this dickhead dicked us around for 3 weeks (By the way, that is the money grubbing part - he got three office visits that he will bill by dicking us around) we are now in the situation where Dr K is going out of town on the 17th of June and his office person told us that he is reluctant to do surgery and then leave the next week.....so it may be July now before Cameron can get this surgery.

In summary of that long winded explanation, this bastard pushed on to a mentally unstable young man desperate for relief of his suffering an irreversible surgery that could lead to the loss of Cameron's esophagus when a much less risky procedure was available. ...and then he promised this desparate young man that surgery would happen 3 weeks ago and then dicked him around for three weeks before telling Cameron that he was now not going to do the surgery.

I am so mad at this little bastard Salimath. BTW, he is a wee little man and even though I am scrawny now I am still 6'2 and would love to whoop the shit out of his sorry ass for dicking around cameron. Cameron has suffered major, major depression over the last year because these gastroparesis symptoms had him feeling like he would never get better and have a life where he wasn't chronically nauseous, bloated and dry heaving. Getting the gastroparesis diagnosis in February and in March finally getting direction from the NW GI who diagnosed him on possible resolution, has dramatically changed Cameron's mood because he now has hope. ....so I know we sound impatient as hell but dicking with Cameron is mentally cruel to him and could have very bad consequences (yes I am talking suicide) so forcing him to live with another 1-2 months of misery after promising resolution is just freaking over the top wrong. I told the little mother fucker he better pray that nothing happens to Cameron as a result of this dicking around because the consequences for him would not be good.

Bottom line, this asshat is a Bariatric surgeon, who BTW doesn't believe in the DS and only does RnY's, is a loser who needs to be avoided at all costs...

Liz feel free to move this to the rants section if you want. I just want to make sure people are aware of this guy's lack of ethics and regard for his patients mental and physical well being.

 

[Larra]

Scott, I am so very, very sorry that you and esp Cameron have been put through all this! I can't say that strongly enough.

However...I am so very, very glad that this doctor will not be doing Cameron's surgery I can't put it into words. It would have been the wrong operation, at least at this point, when there is something so much less drastic and less risky that can be tried. And from the sound of things, it would also have been the wrong surgeon doing the wrong operation. I understand Cameron's disappointment, and yours, at this resultant delay in treatment, but IMHO he has dodged a big bullet.

July must sound very far off to you both right now, but in reality tomorrow will be June, Cameron needs to recover from his emergency for awhile longer anyway, and whether he knows it or not he has far more hope of success with Dr. K than he would have had with your "local" guy.

And I'm glad we provided you with a place where you could rant your heart out and people will understand.

 

[DSRIGGS]

Larra,

Thanks as always...and yes it is great to have a place to rant and such a strong and well educated network.

Regarding the other surgery the emergency appendectomy and talking to the surgical team at UW Madison Hospital, seemed to have convinced Cameron that the subtotal gastrectomy and take down of wrap was not the right thing to do so even if the other guy had done surgery on Cameron it was going to be the Dr K route. This guy had said that he didn't advise that surgery but would do it if that is what we wanted ...well before he reneged on his initial promise.

In the long run yes we did dodge a bullet and if it has to be July that is okay. We are just so anxious to get Cameron back in to a "normal life" and have this behind us (we do realize it may not be a cure all but at a minimum he should see significant symptom relief that should allow him to live a normal life).

Regarding the procedure and his appendectomy which was done lap with 3 incisions, since he will be opened up again and have another healing/recovery process, in your opinion is there benefit to waiting until those after effects heals more or is it actually better to get everything over with now? Additionally since he has had 5 surgeries through his abdominal cavity (1 open, 2 laps, 2 laps with DaVinci Robot) do you think this next one is going to have to be open or do you think it can be done lap (hiatal hernia repair, pyloroplasty and RnY drain anistamosis)?

You are the best

Scott

 

[southernlady]

Oh, good Lord, Scott...that is horrid that he has treated Cameron that way.

After all is said and done, I would be doing a review with the insurance company...they don't want ASSHAT's on their list if they can help it.

Liz feel free to move this to the rants section if you want. I just want to make sure people are aware of this guy's lack of ethics and regard for his patients mental and physical well being.

Scott, not the Rants section but I will move it to the Lounge.

 

[brooklyngirl]

How frustrating, so sorry you're all dealing with such BS.

 

[Larra]

In general, most surgeons like to wait at least 6 weeks before doing another abdominal surgery to allow the inflammation from the surgery itself (and in Cameron's case from the appendicitis as well) to resolve before going back in. The worst time is about 3-4 weeks post-op. So by July Cameron should be past the bad point.
As to whether this will be lap or open, I have no idea. That will be up to Dr. K, and even he might not know until he gets started (in other words, he might start lap and see that he needs to go open, unless he is certain that it must be done open and goes open from the start). I would suggest in light of Cameron's tolerance for pain meds that you discuss post-op pain medication with him ahead of time and see what alternatives he suggests, or if perhaps there is some kind of pain management specialist who can be part of Cameron's team. Another topic for discussion might be whether or not Dr. K wants to place a feeding tube, as he does with his RNY to DS revisions. I realize this is very different, but given that Cameron already has gastroparesis there is no way to know how long it may take for his stomach to start functioning again even with much improved drainage.

 

[DSRIGGS]

In general, most surgeons like to wait at least 6 weeks before doing another abdominal surgery to allow the inflammation from the surgery itself (and in Cameron's case from the appendicitis as well) to resolve before going back in. The worst time is about 3-4 weeks post-op. So by July Cameron should be past the bad point.
As to whether this will be lap or open, I have no idea. That will be up to Dr. K, and even he might not know until he gets started (in other words, he might start lap and see that he needs to go open, unless he is certain that it must be done open and goes open from the start). I would suggest in light of Cameron's tolerance for pain meds that you discuss post-op pain medication with him ahead of time and see what alternatives he suggests, or if perhaps there is some kind of pain management specialist who can be part of Cameron's team. Another topic for discussion might be whether or not Dr. K wants to place a feeding tube, as he does with his RNY to DS revisions. I realize this is very different, but given that Cameron already has gastroparesis there is no way to know how long it may take for his stomach to start functioning again even with much improved drainage.

Thanks for that insight and good suggestions for discussion. Sounds like it is probably going to be July based on your comments about inflammation and typically wanting to wait around 6 weeks.

The pain management is definitely a concern. The only narcotic that really seems to touch his pain is Dilaudid so one of the things I was wondering with legalized marijuana in California if THC is given orally for pain in hospitals? I have read that some people say it only helps with chronic pain and not acute, but I have read others say that for some it works better than the opiates. In any case I don't like him on narcotics so if THC worked to me that would be a better path.

Regarding a feeding tube I really hope that isn't required because I am not sure how well Cameron will do with one of those, but we shall see.

 

[duh_Mom]

Scott, I know this is as hard on you as it is on him. My daughter had cancer at 18 and anytime there are serious illness for our children - we are as stressed as they are. you may not want to hear this, but now you know 100% sure that this is not the surgeon for you guys - someone or something is trying to take care of you guys. I would think it would be better also, to have more time between abdominal surgeries. During surgery, you are give a paralytic so the bowel is completely still - it needs time to wake up and get over the insult of having the appendix removed. I'll be sending you and Cameron good vibes. Does Cameron have a good counselor to help him thru all this health stuff?

 

[DSRIGGS]

Scott, I know this is as hard on you as it is on him. My daughter had cancer at 18 and anytime there are serious illness for our children - we are as stressed as they are. you may not want to hear this, but now you know 100% sure that this is not the surgeon for you guys - someone or something is trying to take care of you guys. I would think it would be better also, to have more time between abdominal surgeries. During surgery, you are give a paralytic so the bowel is completely still - it needs time to wake up and get over the insult of having the appendix removed. I'll be sending you and Cameron good vibes. Does Cameron have a good counselor to help him thru all this health stuff?

DM,

Cameron had cancer at 16 and has had about 10 surgeries (including several abdominal procedures) and all kinds of neurological garbage since. Chemo as you know sucks and it has wreaked havoc on him.

His bowels have woken up and ileus is always a concern after surgery of the intestines, so we are happy about that.

Strangely enough, his gastroparesis symptoms have been better since surgery. He hasn't really been nauseous and he is eating much more. That is really strange because his GES was back in Februaray and it definitely confirmed moderate to severe gastroparesis with only 34% emptying after 4 hours and a scope was done at the same time so no physical blockage was apparent.

It would be fantastic if by some strange phenomena that the gastroparesis was associated with the appendicitis and went away (yeah, I know that is wishful thinking but I can dream).

His depression has been much better the last 30 days or so and he does not have a therapist right now due to some extenuating circumstances but we are trying to find somebody new.....one thing we are doing is staying away from drug throwing psychiatrists who want to prescribe tons of crap that can (and did) make mental issues worse.

 

[Larra]

Scott, I haven't heard of hospitals allowing use of marijuana, which is legal for medical use in CA but still illegal under Federal law. I kind of doubt that this would be possible, but of course you can ask Dr. K. Assuming that this is not an option, a pain management specialist might still be helpful, and Dilaudid would certainly be available in the hospital.

 

[Jbandmmomma]

I understand the frustration, but also truly think that maybe this happened for a reason. Your son needed a different surgeon and this was maybe the universe's way of getting him out of this guy's hands. Get him to Dr. K and don't look back. And hoping along with you that he finds some physical ease in the meantime.

 

[robs477]

Scott, I have no words of wisdom here my friend as this is way over my "pay grade"...BUT, I do want to send you both my heartfelt best wishes and prayers for success.

 

[DianaCox]

Appendicitis can be chronic. My daughter was ill on and off from 6 mo old to 4.5 when her appendix ruptured. They never diagnosed appendicitis, but her recurring diarrhea disappeared after her appendectomy. Here's hoping that the source of at least some of Cameron's ills has now been removed.

 

[MamaShelia]

Scott! I am literally in tears reading this for your daddy's heart and your precious son! I know, I know, "Monday is the day" now, but I wanted to get some background on what was going on with Cameron, and this post about sent me through the roof! Except, I know as much as you want to kick this doctor's @$$ (and as much as I want to take him down with you!), I know that so much of the anger comes from the desperation of your baby boy and physical and emotional pain that this has caused him !

I am sorry.

I teach in a very urban school where the kids are raised in homes so different from how my sons were raised, yet they love me because they know I care about them and their well-being as they feel I care for my own. I wish every teacher, doctor, professional would just treat people with the respect and care that they would want their family members to be treated with. But, alas, we are living in the dark days of the almighty dollar.

I now know how to pray more specifically for you and your son and the rest of your family--including safe travels, a flawless procedure under the skilled hands of Dr. K, stamina for him as he may find more than he anticipates he will when he gets in there, and a clear head on how to proceed if he does, and a seamless recovery; but most of all a return to some kind of normalcy for Cameron.

Be well and blessings to you and your family!

 

[DSRIGGS]

Scott! I am literally in tears reading this for your daddy's heart and your precious son! I know, I know, "Monday is the day" now, but I wanted to get some background on what was going on with Cameron, and this post about sent me through the roof! Except, I know as much as you want to kick this doctor's @$$ (and as much as I want to take him down with you!), I know that so much of the anger comes from the desperation of your baby boy and physical and emotional pain that this has caused him !

I am sorry.

I teach in a very urban school where the kids are raised in homes so different from how my sons were raised, yet they love me because they know I care about them and their well-being as they feel I care for my own. I wish every teacher, doctor, professional would just treat people with the respect and care that they would want their family members to be treated with. But, alas, we are living in the dark days of the almighty dollar.

I now know how to pray more specifically for you and your son and the rest of your family--including safe travels, a flawless procedure under the skilled hands of Dr. K, stamina for him as he may find more than he anticipates he will when he gets in there, and a clear head on how to proceed if he does, and a seamless recovery; but most of all a return to some kind of normalcy for Cameron.

Be well and blessings to you and your family!

Thanks Shelia and great work you are doing.

Cameron is 21 and has a long history of medical issues. I lost count but I think this is his 11th or 12th surgery since 2010....hopefully the last for a long time.