I have been having trouble getting my doctor to listen to me. Or it least it seems that way to me. Here is the situation I have been dealing with: My first issue was that my doc would not tell me the amount of fluid he was putting into my band (he said he didn't want me to fixate on the number). I didn't like that answer but I dealt with it until I had a fill in Oct and I was too tight. I ended up having to go to my doctors second office but there was a fire in the area that day and they had no power (therefore they could not get the records from my normal office) so my doc is asking me how much fluid is in my band. After that I insisted on knowing the facts.

So I found out that my band was at 3 cc's when it was too tight. Doc took out .4 cc's (down to 2.6 cc's) and it was so loose I could eat anything I wanted. So I go back to see him in the beginning of Dec. and get a fill. We discuss the fact that I was too tight at 3 cc's and too loose at 2.6 cc's, we agree to try for somewhere in the middle. Well it turns out he has trouble hitting my port that day and after poking and prodding around for about 20 min he finally gets the fluid in. As I am leaving I ask him how much fluid he put in and he says I am at 3.2 cc's now. I couldn't believe it. What the heck happened to the conversation we had. Unfortunately I could not stay and get an unfill at that moment because I had kids waiting for me and I was already close to an hour late, plus I was swollen from all the prodding the first time.

It turns out that not getting the immediate unfill was a bad idea because I ended up getting so tight that I couldn't even get my own spit down. I was badly dehydrated by the time I got back to his office. So, again we have a conversation about where the fluid level needs to be and again we agree on around the 2.8cc mark. Again he has trouble finding my port and has to poke and prod forever, then he takes out too much. I'm back to being able to eat everything.

That leads me to the present situation I am in. Should I go back to this quack for another fill? I prepaid for a year of fill and unfills already but this guy doesn't seem to be getting it right. How do I get him to listen to me???

My personal opinion , I would not go back . Your running a HUGE risk of him causing a leak in your band by poking around on you so much for 1.

for 2 he's not listening to you , or at the very least taking into consideration what you say .

I was too tight for a my second fill . I had an unfill, my third fill i was too tight again , however my doc and i discussed if I wanted to try a full CC fill or not . When i went back for the unfill he told me " your very sensitive to fills so we are going to have to go slow from now on , im not going to have you keep getting tight and PB and get sick "

I would have serious conerns about going back to this doc. I would maybe even voice my conerns to him and tell him if he does not start A hitting your port ( Even use flouro ) and listening to your conerns that you would like a refund on your fills and you will go elsewhere.

HTH

Mindy

Is your pre-pay transferable?

I would not go back if I could avoid it. this surgery is too serious for you to have a doctor who you don't feel confidant and comfortable with.

i agree this is too important to not feel 100% confident with your doc and honestly is there anything that he COULD do that would make you feel that way ? I think you should look into possibly transfering care to another MD.

MIndy

Not being able to hit your port on the first or second poke wouldn't be a big concern to me, actually. People who access these ports every day, all the time, have trouble accessing some patients' ports. It might be partially flipped or in a little bit of a funky position. Some ports are harder to access than others. And fluoro won't help them access the port any better, it only shows what's going on in the band itself (i.e. restriction).

I would be more concerned with him not listening to you. Before you give up on him, have a direct conversation about your expectations and make sure you both agree on a plan before he carries it out. You've paid for your fills already, and it's unlikely that you'll be able to transfer that to another doc unless he has another person in his practice. He might have a nurse practitioner or a PA, though, perhaps they could do your fills?

Doctors spend a lot of time in medical school and residency and fellowships before they take care of patients on their own, but they don't necessarily learn how to interact effectively with patients. Plus, all that time spent in school leaves a lot of them a little bit socially impaired, you could say. If his medical expertise seems good (and I wouldn't judge that by whether he can hit your port on the first poke) then I'd try working with him with these things in mind. Most of all, be your own advocate and speak up when you know something's wrong--like when you knew you needed an immediate unfill. It's unfortunate that you aren't in a better position to switch docs, but even if you were, it's often difficult to find a doc to provide aftercare if he/she didn't do the original surgery.

Good luck.

I am sorry but I would be very concerned if my doc had to poke and poke at me to hit my port. Granted I do not expect him to hit it the first time ever time( Although mine is done under flouro and my doc hits it the first time every time under Flouro ) . But she said her doc poked around for 20 mintues. That would be a huge concern for me, you run the risk of him poking the tubing to your port and band and causing a leak .

If he's doing that EVERY TIME , and he's poking her so much he's causing her to be sore ... THAT is a valid concern. Flouro would help them access it better because the doc can see where the port is in reference to the needle .

I can see the needle as soon as my doc puts it in and he knows where to put that needle to hit my port !

Granted this doc might have horrible bed side manners. And a conversation would be the first move. It should not be hard to find a doc to transfer care from one US surgeon to another. UNLESS this doc has a bad reputation , then it might be an issue. But your doc should be able to call up another doc and transfer your care to them . Its done all the time .

Mindy

Granted this doc might have horrible bed side manners. And a conversation would be the first move. It should not be hard to find a doc to transfer care from one US surgeon to another. UNLESS this doc has a bad reputation , then it might be an issue. But your doc should be able to call up another doc and transfer your care to them . Its done all the time .

Mindy

The original poster mentioned 2 times that multiple pokes were needed to access the band. That doesn't signal incompetence to me. Of course there is a risk of puncturing the tubing, agreed. I'm just saying that there is NO practitioner who can hit every port every time on 1 or 2 pokes. And there are lots of people whose ports are difficult to access every time it's attempted. We don't know if she is one of these people or not. If her doc has fluoro available, and she's willing to accept the radiation every time she has a fill, terrific. But I wouldn't assume that this doc is inexperienced or incompetent or whatever based on 2 attempts to access the band. Some people might not see this the same way as me, but as a health care provider (as well as a patient, of course) I can appreciate both sides of this issue, from either end of the needle.

As far as transferring care from one doc to another, just check the complications board here on LBT, or the fills board, or just about anywhere. Bariatric surgeons throughout the US are reluctant to take patients that they didn't perform surgery on themselves for a number of reasons. There are some who will, but lots won't. (One of the surgeons who apparently posts here frequently had an interesting discussion with another LBTer recently about this very topic...it was Dr Brad Watkins, and the thread was orignially about erosion but ended up answering a lot of other questions, if you want to search for it.) Add to that the fact that she prepaid for her follow up care...she would probably have to forfeit that money she paid for her prepaid care, unless she can talk them into refunding it. She might be able to, if she feels the care is incompetent. But what if she does, only to find out that the next person has difficulty accessing her band too? My only point here is that it's always best to try to solve the problem at hand directly before firing your doc and trying all over again with someone new.

These are just my thoughts on the issue, of course, and others may feel differently. To metawnny, I hope you find some satisfactory resolution to this issue.

Gwen

Thank you Mindy and Gwen for your replies. Just to clarify my situation, my doc is being excessive with the poking. The last time he did the unfill I counted 11 needle marks on my tummy, not to mention the rooting around each time the needle was inserted. When I brought this up to him and asked if my port, tubing, or any organs were in danger he said not to worry because there was no way he could hurt anything. I know my port is not flipped because the doc ended up having to send me to the hospital and do the unfill with the help of an ultrasound machine the last time. My port is also very close to the surface so I am not sure why it is suddenly an issue for him to find (he used to find it in one or two sticks).

All that being said, I could deal with that if I could just get him to follow the plan. I sat down with him the last time and we both were clear on the plan before he started sticking me, but somehow when we were all done I only ended up with 2.5 cc's in my band. I was laying on my back with a pillow under my spine so that I could not see the needle in my skin, otherwise I would have asked him how much he took out before he completely pulled the needle out.

I don't know how to get through to him. It seems like we are both on the same page and then wham-o, he changes it midstream. I have an appointment for next week and I think this time I will write in magic marker on my stomach the amount of fill that I need : )

Maybe that will work. If not I will have to recycle cans, have a garage sale, and raid the kids piggy banks for extra cash to switch doctors (providing I can find one of course).

I don't envy your predicament, Metawnny. From what you describe it sounds like your doc isn't "getting it". I hope your next appointment gives you a better experience, and I hope you don't end up having to change docs, just because it can be a pain. But you have to do what is best for you. Good luck and keep us posted!

Gwen

All of this being said, keep in mind that fluro is not going to garuntee a 1 poke hit either. It does show the doc the area he/she needs to shoot for but its not like it has a map with "X" marks the spot on it! Thank goodness I have an exceptional fill doc that hits the port on one poke every time, fluro or not! I am just saying this so you don't think you have to switch to a doc that uses fluro. For me, a self payer, fluro fills are more expensive and if my doc didn't use it, I'd still have no objections. Unfortunately, my doc requires it at the location I go, I guess because she has the machine there and needs to pay for it. I have been to her other location twice for emergency unfills and she didn't have the machine and did a fantastic job. Having fluro is a reassurance though, so I can get an update on how my band is doing and make sure there are no visible problems. I agree with Gwenn, in that, switching docs is no garuntee that it will be any better. But, I'd have a serious conversation with him, and tell him he needs to start listening to you or you will not quit bothering him until he gets it right.

All of this being said, keep in mind that fluro is not going to garuntee a 1 poke hit either. It does show the doc the area he/she needs to shoot for but its not like it has a map with "X" marks the spot on it! Thank goodness I have an exceptional fill doc that hits the port on one poke every time, fluro or not! I am just saying this so you don't think you have to switch to a doc that uses fluro. For me, a self payer, fluro fills are more expensive and if my doc didn't use it, I'd still have no objections. Unfortunately, my doc requires it at the location I go, I guess because she has the machine there and needs to pay for it. I have been to her other location twice for emergency unfills and she didn't have the machine and did a fantastic job. Having fluro is a reassurance though, so I can get an update on how my band is doing and make sure there are no visible problems. I agree with Gwenn, in that, switching docs is no garuntee that it will be any better. But, I'd have a serious conversation with him, and tell him he needs to start listening to you or you will not quit bothering him until he gets it right.

I agree with everything you said . Flouro for me is more of a reassurance espically being self pay . I am lucky as well and have a doc that hits my port the first time every time. And like you said using the flouro is more of a reassurance every time you go in you can see the band as well can the doc and sort of do a check up on every thing .

If switching docs has to be done , i think it MAY be a little easier in this situation because there is no complications ? It may not . The doc in this situation could possibly assist in helping find a new doc. I think the best approach at first is to see if the new doc will listen . Maybe he's just scatterbrained ? And i would stress that concern about being stuck too much as well.

Good luck keep us updated.

Mindy

And fluoro won't help them access the port any better, it only shows what's going on in the band itself (i.e. restriction).

.

Fluoro is the only way they can hit my port because my anotomy has changed so much it faces the floor.

They have to find it, push on me and get it into position to poke it...

I'm just sayin...

You know since you are covered for fill for a year, make an appointment every week, see him every week. you will cost him money and he'll get it right, because you are costing him dollars.

Tell him you need to have the appointments in case he doesn't get it right the first week. His track record proves your point. It's one way to make him listen.

My doc did my surgery and he does my fills and he has a horriable time finding the port opening.

Mine is also pointing to the floor to it is alot of poking and pushing and I am normally black and blue on my stomack when he is done

He said that my port is on eof the hardest he has to find and he also said that my port is part of the way flipped BUT when I loose more weight he is thinking that it may straighten out (I hope so)

I think I may be a little tight right now but I avaid fills and unfills as much as possiable because of the time it takes.

I am normally in teh office with my shirt up and being poked for a good 30-40 min.

(and my office is over one hour away from me)

I would not think to much of the needle pokes and pushing but I would be more pushy to make sure he does the right amount of Fluid.

My doc always talks to me and we decide what he will put in (and if it will be worth the pain) and than he will do it.

He always numbs the area on my stomach but he normally has to numb it at least 2-3 times because it will start to wear off before he is able to finish

Good luck I think if I were you I would just express my concern that he may not be listening fully and the fluid amount is not always correct

Juli has the right idea!! Cost him money, then he'll start listening!

Of course he doesnt have any openings again until the 24th of this month which means I have to be extra careful not to lose the momentum I had going for weight loss. I think I will call today though and make a second appt for the following week and maybe even a third appoint for the week after that. I'll get the appointments all lined up in case he botches it again.

Also I am taking my hubby with me on my next appt. Somehow men seem to listen to other men better then women sometimes. Well see how that goes. I'll keep you posted and thanks for all the support.