Update on my status

[Will2014]

@Will2014 I believe you are generalizing too much. My surgeon did not require a pre-op endoscopy and I didn't have one. He also didn't require a pre-op "liver shrinking" diet. Just clears the day before, and of course nothing after midnight the night before (very important to have an empty stomach to prevent aspiration of stomach contents into the lungs during induction of anesthesia for any surgery, not just bariatric). And while MO people do generally have a fatty, enlarged liver, the amount of variable and there is no special vasculature around the liver. The liver texture is more fragile and more, as you pointed out, harder to get out of the way, so some (not all!) surgeons want it shrunk pre-op.
My surgery went without complication without these measures. I did have a very experienced surgeon who does the DS all the time, and this probably makes a difference. However, if someone's surgeon does request this diet, you are pretty much stuck with it.

I might well have misspoke when I said ALL doctors require an Endoscopy before doing a DS. I should have said MOST do and ALL should. The endoscopy is necessary to rule out pre existing structural abnormalities such as strictures, the presence of pre cancerous cells in the lower esophagus (Barrett's Syndrome), and other possible exclusionary problems. I realize some may not have asked to do it...but I just really see so many reasons to do it and literally none not to. As for there being "no special vasculature around the liver" , I must respectfully disagree. There most certainly is a VERY large network of vessels produced by adipose tissue to sustain itself. In fact, you may be surprised to know that each pound of white adipose tissue contains over 1 mile of vasculature which would not exist if the adipose tissue wasn't present. There is an exciting new research under way to treat obesity by destroying this vascular network, resulting in the obliteration and reabsorption of the adipose tissue. For your reading pleasure : http://www.sciencedaily.com/releases/2004/05/040510012211.htm . This increased vasculature makes hemorrhage almost guaranteed when the liver is handled, the only question will be to what degree. Will it simply muck up the works by reducing visibility, make everything slippery etc. , or will the blood loss result in hypovolemia and actually become a threat to the outcome of the surgery itself. Rare, but it does happen. Anyhoo , I'm a HUGE fan of a pre op low carb diet plan to shrink the liver because there's just no good reason not to do it. I guess some doctors don't believe the surgical candidate can succeed in stemming their caloric intake before their procedures, hence the need for said procedure in the 1st place. I disagree and think almost ALL of we obese folks have been able to lose significant amounts of weight at times, we just couldn't keep it off. I say even if not asked to do it by ones Dr....what harm would a pre op diet to shrink the liver do to anyone? And I've already pointed out the benefits!

 

[Larra]

@Will2014 again you are partially but not completely right. The upper endoscopy routinely done on pre-ops hardly ever finds anything that would contraindicate the surgery. Strictures in people who have not had prior stomach surgery or serious illness are very rare. And Barretts would also be unlikely in someone without serious GERD, which is also usually known pre-op. So the bottom line is that you would have to do a very large number of endoscopies to find anything significant enough to alter the surgical plans. If the surgeon needs this for his comfort level, I guess that's his choice, but to say they are routinely needed is not accurate. Perhaps you have been around long enough to remember when a much larger panel of blood tests was done for even the most routine surgeries. They don't do this anymore because finding anything meaningful hardly ever happened. It makes more sense to order a couple tests that are the most likely to find a serious concern (CBC for example) and order anything else based on the patient's prior medical history.
Your description of the vasculature is also not accurate. Of course if you have more fat, or any other kind of tissue, you need blood vessels to support that tissue. But your description makes it sound as though the fat and a bunch of extra blood vessels are "around" the surface of the liver. In actuality, the fat is spread throughout the liver, not around the outer surface, and likewise the blood vessels that support it are spread through the entire liver. Fat is soft compared to the normal liver texture, so a fatty liver is a softer liver. Think pate (sorry, can't supply the accent mark required for a French word, but I'm sure you understand what I mean). So a big, soft liver makes the surgery harder. But it doesn't mean that there are abnormal, large blood vessels on or near the outside of the liver, or that that is where the fat is.

 

[JenKapNC]

Just wanted to say thank you for all of the advice and encouragement. Just hanging out waiting for that 7/29 consult with the new Doc. FYI I'm having a doozy of a time getting my previous Doc to send the results of my pre-op tests over to Dr. Sudan. Wooooossssaaaa. That's my relax word when I want to wring somebody's neck. Love the "oh we'll send those over to another dr. with no charge" ... yeah you didn't send them... or I can pay a $ a page for copies of my own file.... Grrrrrr...

 

[Larra]

@JenKapNC call them every day if you need to. Be polite but be persistent. Be the squeaky wheel. They will get sick of your calls and get it done.

 

[DBmom23]

totally agree with @Larra and would add that you should ask the name of every person you speak too and be super polite but use their names to add accountability. Such as, "Thank you so much "Michele" for helping me. I have been so frustrated waiting so long for this to happen, but i know you will take care of it for me and i really appreciate it." etc.

 

[JenKapNC]

Great advice ladies! Thanks again! I'll keep you guys posted on how things go at my 7/29 appt.