Dr. Rasmussen, Dr. Frech, and a Decision

I go and meet with Dr. Rasmussen. I am glad that he remembers me! I take all the information that I possibly can for him to go over with me. I explain the situation, the diagnosis, and all the medication I have taken for this. I also tell him that Dr. Frech tells me that I need the Roux-en-Y surgery.

We then go over how he would proceed with the surgery. He then tells me he has never done this surgery on a patient with bile reflux so he would like to talk to his partners before proceeding.  I agree. The more opinions we can get on the best way to do this, the better! He is sure that the best of the bypasses will be the gastric bypass which is considered to be the gold standard. We go over all the complications that can happen after gastric bypass which are not limited to; infection, bowel obstruction, hernias at incision sites, hemorrhage, blood clots, leak in the surgical connection, ulcers, dumping syndrome, nutritional deficiencies, and of course death. Dr. Rasmussen tells me this is a drastic surgery and life altering. I will have to eat differently and take supplements for the rest of my life. He also informs me that we could possibly be changing in one set of problems for another. I explain to him that I don’t know what other options I have at this point and he seems to understand. I tell him I meet with Dr. Frech in a week and will have a decision made by then on how we will proceed. I have a week to wrap my head around all the ‘what if’ problems and really think about how different my life will be.

It has been a week and my appointment with Dr. Frech has finally arrived. I am very nervous and so very tired of testing and Dr. appointments and just overall sickness. I want so badly to feel semi-normal and this is what is driving my decision. Dr. Frech comes into the room with such a concerned look on his face. We decide that surgery is the last and only option. We go over a few details and he requests that Dr. Rasmussen take out most of my stomach. In typical gastric bypass patients, the stomach is left intact and still will produce digestive enzymes that aid in digestion. In my case, removing the stomach is the only way to stop the bile from re-fluxing back into the stomach and stopping the pain. If the stomach is left in place, the sphincter will still not function correctly and the bile will continue to back up into the stomach. Dr. Frech reassures me that everything will be OK and I can get through this. His words, at this point, are the only thing keeping me going and giving me some form of comfort. I trust Dr. Frech with my life and not a lot of Dr.s are afforded this privilege. I will see him 3-4 weeks after the surgery.

I go back to see Dr. Rasmussen and let him know that Dr. Frech and I feel that the surgery is the best option and we have decided to go ahead and do it. Dr. Rasmussen has also prepared for this appointment and presents to me 2 different surgery options. I will spare the long details of the 2 different ways and talk about the one that he thinks is best. He decides the hiatal hernia needs to be repaired. However, it doesn't appear to be too big so he is not terribly concerned with it. The next step will be to remove the stomach, how much of it he won’t know until he is actually in my abdomen doing the surgery. He is aiming to leave my stomach the size of a thumb. The next step is to reconnect the newly formed stomach pouch to the intestine and create what is called a limb. The trick to this part of this surgery will be to make sure the limb will be at least 40 cm long. Making the limb this long will hopefully prevent any bile from coming back up into the newly formed stomach. A three part surgery that he is anticipating will take 3-4 hours. This surgery will include a 3-4 day hospital stay, a catheter for 2 days, a barium swallow to check for leaks, and lots of drugs. He also decides that I will see a Nutritionist for a visit to make sure that I will know how to eat after surgery. I am also enrolled in a pre-op class that I will explain later. The medical/technical name of the surgery is called laparoscopic subtotal gastrectomy with roux-en-y gastrojejunostomy and hiatal hernia repair. Due to my work schedule and Dr. Rasmussen’s on-call schedule (plus an assistant surgeon) the surgery is scheduled for 6 weeks out. Holy cow, is this really going to happen?