Dr. B did a Sleeve to Bypass Revision on me due to reflux. I had a consult with another Dr first who said that insurance wouldn’t pay for my revision because of my lower BMI. Dr. B and his staff knew exactly what was needed to get insurance approved!! I can’t say enough positive things about him and his staff. 5 months post-op and no reflux!!
Dr. Bagshahi is a great surgeon. I had a duodenal switch 12/2018 and have had no complications. Things that are important if you are looking for a surgeon: if you want help with your obesity, he’s your guy! He is super knowledgeable about obesity, and obesity related illnesses. During my surgery we discovered I have stage 2 NASH which is a complication of long term obesity. Yes, you are going to wait a little bit. Yes you will see frequent changes in most of the office staff. Yes some visits may feel a bit more rushed than others. BUT you must also advocate for yourself! If you are at your 9 month follow up, as I was, and you have started eating like crap again, SPEAK UP. He was ready to intervene right away. TAKE YOUR VITAMINS. DRINK YOUR WATER. GET IN YOUR PROTEIN. If you do not do these things and expect him to move mountains, you are not at the right office. He is a brilliant surgeon. But he is just that, a surgeon. He works with his hands. His smile is charming. He is a wiz with knowledge. But at times his bedside manner could use some work. He is also human. He is entitled to a bad day here and there. IF you can get down with this, then Dr. B is your guy. He is my guy. He saved my fat life. Now I’m still rebuilding a new one. Thank you Dr. B for your amazing skills!! Thank you to the office manager Rachel who kills herself daily doing the insurance verifications, pre-certifications, assisting with billing, fills in every position in the office when its needed, answers the phones, THAT NEVER STOP RINGING, answering the 10k questions every bariatric patient has through every stage of the process and so much more. Thank you Rachel for taking my calls nearly everyday for the first 2 weeks after surgery and reminding me why I did this when I insisted that there was no way I could drink 100oz of water and 100gms of protein a day. Thank you to the Nurse Practitioner who keeps it real in the room when talking about eating habits and how things are going in my new body. The same nurse practitioner who calls to tell you the results of your post op lab work and what we need to change in our vitamins in between visits. Thank you to the front and back office staff who don’t seem to make it long because you under estimated just how busy his office is. The phones don’t stop ringing. The patients don’t stop coming. Thank you for your kindness even when you are having the worst day and Dr. B just chewed your butt for missing that heart medication or forgetting that copay payment. You guys are the friggin best. And this nurse and patient loves you for saving my life.
Persistent vomiting after any bariatric surgery is not normal and not an easy thing to live with. Upper GI static images versus "cine" films can help identify motility issues in the esophagus, esophageal manometry will also aid in the assessment of the physiology of how you swallow and how food is going down and your doctor can try to see if your symptoms correlate with study findings. A barium meal can also help to see how things are moving through the sleeve after your eat. EGD can look at the shape of your sleeve, etc. However, I will warn you that, it can get confusing correlating symptoms with anatomic findings. Obviously each person is different, at the end of the day you should be able to eat properly and feel good without nausea and vomiting. Often times a revision to RNY is necessary and improve your symptoms, even if you have esophageal dysmotility at least the sleeve will not contribute to your symptoms and the RNY could help over come the symptoms. Best thing to do is talk to your surgeon and work through these studies and come to a solution.
Since the lateral portion of the stomach is removed during sleeve gastrecotmy it can not be reversed. However, depending on what your exact symptoms are and what your eating pattern is there are options. Best thing to do is visit with your surgeon, keep a food journal and visit with the dietician. your surgeon will discuss your issues and review your symptoms, and go from there. Options for work up are: barium swallow with upper GI (x-ray test) and/or endoscopy to look at the esophagus, and stomach itself to gain a better understanding of the anatomy. If you are not able to eat well because of the reflux, or kink, or unacceptable angulation, the option of revision to RNY gastrojejunostomy with address these issues. The key is make sure you are doing your part in regard to "pouch rules," eating patterns, etc (that is the point of keeping the food journal and visiting with the surgeon and dietician first).
Your BMI is 33. By 1992 NIH consensus criteria, which most insurance policies use, your insurance would not cover it. There is plenty of data that shows deterioration of health beyond a BMI of 30, so most bariatric surgeons would consider you a candidate for surgery. However, this would be a self pay procedure.
Obviously pain and nausea after sleeve surgery is a big concern. One of the major benefits of laparoscopic surgery is reduced pain and trauma from the smaller incisions. However, in sleeve gastrecotmy one of the incisions is dilated to remove the stomach that is stapled off. Often times a suture is placed here to prevent a hernia from developing. This can sometimes cause an ache like a bruise or "Charlie-Horse" if you are familiar with the term. The major things to expect immediately after surgery, is nausea, a bit of pain underneath the lower breast bone and a bit of incision pain. Rest assured that most of this, on average, is minor and if well managed post op you will be getting up to walk deep breath (to prevent blot clots in the legs/lungs) and possibly go home the same evening. Steps that can be taken to minimize nausea and pain are: One dose of Emend to manage the post op nausea. Expiril injected at the port sites for post op pain control and obviously oral pain and nausea medicine after surgery. Your surgeon likely has his/her own routine and you should discuss this at your pre-op visit.
This is a very common question at pre-op. Obviously the higher the weight/BMI and the older the age of the patient the more excess skin we see with massive weight loss, as the elasticity in the skin has deteriorated. Good news is the weight loss is life changing and improves health and that should be the primary concern. I always say don't exchange one unhappiness for another. Nonetheless, excess skin is still an issue an typically is addressed 1.5-2 years after surgery and/or when the weight loss has stabilizes for 4-6 months. The surgery for it is called body conturing and can address the apron of skin hanging from the stomach, breast, underneath the arms, occasionally on the inner thighs with often combined liposuction. Younger patient with lower BMI prior to surgery tend to still have a good bit of elasticity and the skin may retract and not require body conturing and the option for non-surgical fat reduction like 3D Tru-scult or CoolScuplt therapy. Regardless, exercise and weight training, good nutrition is always required to maintain weight loss! At your 6 month visit discuss excess skin issues with your surgeon so that you can plan for the surgery 1 or 2 out, so you can be referred to a plastic surgeon and financial planning as these surgeries are often not covered by insurance.
