The Dreaded Follow Up

April 12, 2012 at 3:28 pm (Hospitalizations, Medical) (, , , , , , )

I saw Dr. WLS for my first post-op appointment yesterday. It was just about as bad as I expected. I have witnesses who will tell you it wasn’t horrible, but there were lots of questions and innuendos that I could have happily lived without.

I have many friends who live in disbelief that this guy, who already knows that I was denied WLS by my insurance once, is still pressuring me to get the surgery. As I waited for his assistant in the room, the Jaguar (my trainer/nutritionist) examined the poster with the various surgical options on it – the Roux En Y, the lap band procedure, the the gastric sleeve, and the duodendal switch – and even on the poster it listed the various deficiencies one has to deal with for life if one chooses that surgery. They all thrive on malnutrition. There are no long term studies on the effectiveness, or on how they impact other health factors. Some of the mid-term studies that are coming out now show that over 50% of WLS patients regain some or all of the weight due to restretching the pouch/sleeve. Many patients do not adapt to the lifestyle that comes with having the surgery, because they were so pressured into it that they never considered what life would be like five years down the line. It’s one thing to commit to a lifestyle change in the present, but it’s a whole different animal to learn that there’s no “giving up” if you don’t like it, if you don’t like the new you, if you don’t like how it changes your life.

Now, I know I have many friends for whom this surgery changed their life in a positive way, and I mean them no disrespect. I believe WLS is an incredibly personal decision, like any sort of body modification, and you shouldn’t be bullied, pressured, or otherwise pushed into having it, or even considering it, if that’s not what you want to do to your body. I feel like the treatment I have received from Dr. WLS is as though someone was standing there in front of a trans man telling him, “You won’t truly be a man until you lop your breasts off. You’ll never pass, no one will ever see you as a man, you won’t be able to live a full and meaningful life if you don’t have a masectomy right now.”

I can carve you up like an ice sculpture!

Do I feel that being obese (even morbidly so) is a good thing? I think it’s just a thing. We all have unhealthy things in our lives. Some of these things could be solved by surgery. Many of my friends have hernias that they’ve suffered with for years, but since they aren’t emergent, they haven’t had the operation. At any moment, my appendix could go rogue and explode on me, but I don’t feel the need to have it removed today. I don’t know anyone in perfect health, who couldn’t use some sort of medical intervention. But no one gets hassled about it the way fat people get hassled about WLS.

Anyway, so there I am in the room to talk about my hernia surgery. The nurse asks me a bunch of questions about my diet – and when I give her honest answers about being on a strict plan to help lower blood sugar, rebuild myelin, and the like, she writes nothing down.  She asks if I have been supplementing with protein shakes. I tell her not only no, but if that’s mentioned I might stab someone, because the last time I was on the protein shake diet I got seriously ill. She definitely doesn’t write that down, either.

I took a picture of her intake notes and this is what it said.

Dr. WLS’s assistant, we’ll call her PA Perky, comes in. She claims to remember me from the last time I was there. Before she even asks about the surgery, she asks if “we can get back on the ball with the weight loss.” I tell her I’m not interested, that I am seeing a trainer/nutritionist who is helping me, and that the protein shake diet made me very ill. She gets very fakey-disappointed. As the appointment progresses, she decides to take out my staples. However, she calls Dr. WLS in to look at my scar, and together they decide that maybe they should only take out every other one, since the scar site is under a lot of stress. I tell Dr. WLS that a lot of my post-surgical pain is because the scar is in a very difficult place on my body – right where my belly ends and my mons pubis begins. He claims it’s in the same site as the old scar. This is not true – it is a good three inches lower. The assistant tries to give me the same song and dance about how my scar could “unzip” and I could have organs falling out. My trainer makes a face –  she knows that my organs would have to miraculously make their way through my ab wall and the layer of fat before they’d do that, and that would take something traumatic, not just a little pressure on an external scar. But this is the exact line they used last time to scare me into WLS.

Before you say it, I’ll be clear, here. I am never having surgery with this doctor again. Next time, I *will* go to one of the other hospitals in hopes that they will see how serious I am about not wanting to discuss WLS. I just have to put up with him through the aftercare of this surgery, and then I am never going to see him again. Unfortunately, it’s going to take some time, because my drain is still putting out a fair amount of drainage, which means I will likely have to have it in for a few weeks.

And this time around, Dr. WLS has even more invested; he now sells a line of protein shakes and vitamin supplements in house, where I’m sure he makes a nice percentage. He also has a sleep study doc in house, so maybe this isn’t the first time he’s gone tete-a-tete with my neuro (whom I met when I needed to have a sleep study as part of my pre-WLS examinations). But a friend reminded me of something I’m going to use from here on out when WLS is brought up – since my insurance doesn’t have it as a covered benefit, and we know that for certain now, every time they bring it up I’m going to ask if they’re willing to do it pro-bono. If not, they can stop offering me a procedure that isn’t covered by insurance, please and thank you. (Although I’m almost scared that he’d say yes.)

15 Comments

  1. Kelly MacDougal said,

    My dad and sister are starting the process for WLS. It is almost 3 years since my mom had hers. I’m happy for them and support thier decisions. However they all continue to no understand that I am not interested. They ask every time they see me almost. I wasn’t interested anyway but hearing from you about all the bs that goes along with it reenforces that decision.

  2. Wintersong said,

    The profit-driven incentives for doctors when it comes to weight-loss surgery kinda creep me out. I can’t think of *other* surgeries i see advertised on highway billboards, and when a doctor is saying “you need this (surgery, protein shake, etc) thing, and LOOK, by some coincidence I happen to be selling that exact thing…” I get very nervous. This is something I *do* see happen in other medical areas (ones we don’t agree on).

    • Renee said,

      You’re only “kinda” creeped out by it? I’m not sure I want to see the kind of medical shenanigans that really creep you out!

      To be fair, I do see some other surgeries advertised on highway billboards; perhaps not coincidentally, they’re also targeted at women — laparoscopic hysterectomies. I think I’ll hold off on the commentary there, since I don’t think you, or this audience generally, needs me to spell it out.

    • dying for a diagnosis said,

      Which ones we don’t agree on? I’m confused.

  3. Susan said,

    Wow, glad I could do something to help in even a small way, because I have always felt so angrily helpless over here, knowing that my first/best (as in “what I am best at”) response (“I’M GONNA CHOKE A BITCH!”) would only get everyone thrown in jail & not really help you all that much…

    Have no fears: this jerk will NEVER do it for free, & will only try to lie to you about it, in the hopes that he can put you on his expensive personal diet crap beforehand (mark my words!).But, YES, TOTALLY ask them why they don’t remember that your insurance turned them down!!!

  4. Eric S said,

    Never go to Dallas/Fort Worth. All of the billboards will feel like this surgeon to you. They sell the surgery there like a Geico commercial.

  5. Renee said,

    I suppose I’m not surprised to hear that your follow-up went like this, but I’m still saddened. It amazes me that this kind of pressure is allowed to be put on patients when they’re vulnerable; in fact, part of me wonders whether an intentional infliction of emotional distress suit would stand against PA Perky.

    I was going to say that I can’t imagine a doctor ethically being allowed to push patients this way in any other context, but that’s not true. I’m thinking specifically about OB/GYNs who “encourage” women to have Cesareans. Again, though, I’m going to just stop the potential rant right there.

    • dying for a diagnosis said,

      I think what may have happened behind the scenes at the hospital itself when Dr. WLS told me that either I’d have to listen to his lectures on WLS or GTFO and I complained to the patient advocacy had sometihng to do with that. When Dr. WLS came back the second time, he kept saying, “Well, it’s the weight loss that’s important, not how you do it, although WLS is the fastest, easiest way…but it’s the weight loss that’s important.” It was like he was told he had to separate the medicine (it’s absolutely true that I’d have less problmes with hernias, and would heal faster from hernia surgery, if I didn’t have a belly with an apron) from the procedure.

      I also think the “pressure” happens in psychologists and psychiatrists, too. They’re quick to push the pharmeceutical options before recommending other, known therapies that work better over the long term. Again, it’s like WLS; for some people, psych meds are a lifeline that can make life livable; for others, its easier to live life without the drugs and their side effects and pursue things like DBT, talk therapy, hypnosis, and meditation.

  6. Eric S said,

    Oh, and yes, the financial incentives in medicine are definitely out of whack and equivalent to billable hours in the legal and accounting professions.

    • dying for a diagnosis said,

      I have this proto theory about how the specialization explosion has something to do with billable hours and more doctors making money off of one patient. My theory started when I was seeing my PCP and wanted to show him a pressure wound on my back that I was worried about. He refused to even look at it, telling me, “I’m not a wound care specialist!” I replied, “I just want you to look at it and tell me if it needs medical attention or if it’s no big deal.” He’d happily write me a recommendation to a wound doctor, but refused to look at my little cut. I totally didn’t go to the “wound doctor”, but had a friend look at it and tell me it was fine with a little ointment.

      When I was in the hospital, I was seen by the surgeon, the surgeon’s assistant (a PA), a hospitalist, a pain management specialist, an anesthesiologist, a diabetes counselor, a “transitional nurse” (who called me today to make sure I had access to all the medication I was prescribed),

  7. Mer said,

    I… I don’t understand the protein shake thing. Why? What? Why? What’s the point, aside from the fact that they’re expensive and have a high markup?

    • dying for a diagnosis said,

      So here’s my not-so-unbiased-opinion on the whole protein shake thing.

      When you are healing after WLS, for a certain amount of time afterward you must only have a liquid diet. Since protein is one of those things you really can’t live without or get from a pill, you drink protein shakes until your new stomach can handle mushy food, and then you graduate to that. However, you continue to supplement with protein shakes, since it’s hard to come by mushy protein sources that adults will eat and feel happy about.

      Then WLS doctors started making it a requirement that prior to surgery, you start to exchange one or two meals a day with a protein shake, partially to help you lose a little weight pre-operatively, and partially to help you feel what life is going to be like post-operatively. It helps prove that you can handle the restrictive diet that comes with the surgery. This is pretty much standard practice at most WLS surgeon’s offices now.

      What happened with me, was that I was put on a protein-shake-only diet (no real food *at all*) under the auspices that it would help me lose a lot of weight quickly, because WLS is hard on the body and they do encourage you to lose as much weight as you can prior to surgery as possible. Then, as the process turned out to take longer than the surgeon expected (because I wasn’t approved for *emergency* WLS) he just kept me on the diet, despite my protests about losing my hair, feeling nauseous, and not being able to be social in the least, claiming the more weight I lost prior to surgery would give me a better outcome. In the end, I ate nothing but protein shakes for almost eight months (the last two I was allowed to have tofu and eggs as well) until I made the decision to stop. I lost over 150 lbs in that time, and nnow a days many of my doctors point to losing so much weight in such a short amount of time as a contributing factor to my strange undiagnosable condition.

      • Mer said,

        Holy moley. 150 pounds in *8 months*? You cannot account for water retention or… jesus, there is no way to make that ok.

  8. Evil Voodoo Celt said,

    Wow. After you terminate your relationship with Dr. WLS, have you thought of reporting him for questionable ethics? I’m not sure if there’s a BBB equivalent for doctors, but there should be. Also, spreading the word about him on medical review sites (and places like Angie’s List) might not be a bad idea…

  9. Elizabeth said,

    Gods almighty. Dr. WLS sounds like an utter sleazebag. I am sorry that you have to put up with this crapola, on top of everything else *shakes angry elf fist*

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